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Models of Addiction
Evidence-Based diagnostic strategies and tools
We must first use an objective diagnosis or measure:
• What is addiction? – NIH, 2014 “a chronic relapsing brain disease that is
characterized by compulsive drug seeking and use, despite harmful consequences.
• It is considered a brain disease because drugs change the brain’s structure and how it works.
• The changes can be long-lasting and can lead to harmful behaviors
• The definition or label of addiction has evolved over time.
The history of defining alcohol/ drug problems = affects how we treat it
• http://www.williamwhitepapers.com/pr/AddictionTreatment%26RecoveryInAmerica.pdf
• Socrates time were drawn by nose ring by horse around the city
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millions ofgallons of beer/ year
populationgrowth 24%
Since the beginning of civilization, the treatment for people with a mental illness has been bizarre, cruel, and even deadly. These unfortunate souls were often treated as if they were possessed
or even inhuman. Here are some very interesting tactics that physicians have used throughout history
Tx included; spells, potions, opening the skull, electricity
Hx- Schools of thought • Hippocrates, Socrates, Plato
800-300BC • were the first scholars to
challenge the notion that disease was punishment sent from the gods; believing that all illnesses, including mental illnesses, had natural origins.
• Phrenological Chart • Phrenologists believed it was
possible to link psychological traits to specific areas of the brain by measuring the bumps and indentations on a person’s skull. Phrenology enjoyed popularity among the lay public during the late 18th and early 19th centuries, but it was eventually discredited as unscientific. Scientists later proved the more general idea that certain mental activities are linked to specific areas of the brain.
Models of addiction come from political and social influences
how we conceptualize the disease
influences how we treat it (ie: disease vs.
punishment vs. rehabilitation)
our conceptualization or models of
addiction have evolved over time (ie: from
prohibition & incarceration to legalizing marijuana)
Moral Model • 1st model of alcoholism
• Emphasize personal choice as the root cause
• Use is viewed as willful and purposeful breaking of social rules
• Alcoholic viewed as having a personal choice
• 1988 US supreme court decided alcoholism was “willful misconduct”
and not a disease
Temperance Model
• Emphasized the moderate use of alcohol
• The cause of the problem was the substance itself (ie: prohibition- outlawed the substance)
• However, those with the problem continued to find ways to use
•
Characterological Model • Attributes the cause of alcoholism to
personality disturbances
• The assumption is that alcoholics are persons with certain personality traits that requires personality restructuring for a cure
• Treatment is psychotherapy aimed at resolved unconscious conflicts.
• Parts of 12-step program
Conditioning Model
• Based on the belief that problems with drinking are simply learned habits
• People learn to drink for either the rewarding factors (ie: relieve stress, or disinhibit) or the behavior is reinforced (peer pressure)
• Operant or Classic conditioning (negatively or positively reinforced
• Mistake is that behavior can
Be learned or unlearned
Neurobiology Model
• Cause is genetic (heredity) and physiological
• Addiction is a brain disease as a result of neurobiological mechanisms
• Research science documents structural changes in the brain as a result of chemical exposure
• MAT has evolved as a result
Social Learning Model
• Theorists believe addictive behaviors are caused by modeling, expectancies, and lack of coping skills (environment)
• people use drugs from observing parents or peers in the community
• Skill training is a major component of recovery
• Philosophy of 12 step
new learned behaviors
DSM
• Changes from IV to 5:
– Encourages multiple diagnostic categories
– Substance Use Disorder
• Now speaks to a pattern of maladaptive use
• Craving has been added
– Gambling Disorder
• Was previously “pathological gambling” to change the stigma
• First acknowledgement of behavioral addiction
• Substance Use Disorder
– Use results in significant distress or impaired functioning
• Physical, mental, occupational, legal, interpersonal
• Substance Intoxication
– Anyone can become intoxicated
– All drugs but nicotine have ability to intoxicate
• Substance Withdrawal • Collection of symptoms that develops with the
discontinuance of a substance
CNS DEPRESSANTS: -alcohol, -benzodiazepines: minor tranquillizers, valium, Ativan, sleeping meds. -barbiturates; Phenobarbital, seconal
-decreased inhibitions -increased confidence - relaxation -intoxication -poor judgment -slurred speech -impaired memory -decreased motor skill
-Respiratory depression -seizures -liver disease -heart disease -increased risk- cancer -fetal alcohol syndrome -breathing problems -brain damage
OPIATES: -prescription painkillers (dilaldid, oxycontin) -morphine -codeine -heroin -suboxone
-pain relief -drowsiness -intoxication followed by euphoria -constipation -decreased breathing rate -pinpoint pupils
-hepatitis (from needle sharing) -HIV/ AIDS (needle sharing) -increased risk for some cancers -brain damage -pulmonary problems
CNS STIMULANTS: -cocaine / crack -methylphenidate (Ritalin) -Amphetamines -bath salts, khat -betel nuts, ephedra, yohimbe -Nicotine -Caffeine -meth Methlendioxymethamphetamine (MDMA-ecstasy- Molly) stimulant with hallucinogenic properties
-euphoria -increased energy -increased heart rate, blood pressure -decreased appetite -feelings of enhanced sociability, sexuality, confidence
-paranoid psychosis -depression -HIV/ AIDS (needle sharing) -insomnia -sexual disinterest -dilated pupils -seizures -heart attacks/ stroke -extreme anxiety/ panic attacks -hallucinations
HALLUCINOGENS: -Lysergic acid diethylamide (LSD) -Mescaline -Psilocybin (“magic mushrooms”) -Phencydidine (PCP, “angel dust”) -MDMA (Molly/ Ecstasy) - Cannabis
-visual & auditory distortions -hallucinations -altered body image -feelings of enhanced mental capacity -muscle twitches -dizziness, nausea, vomiting -out of touch with reality -distorted body image
-panic attacks -psychosis -flashbacks -poor judgment leading to serious injuries or death -anxiety and depression -memory and thinking problems
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Accidental Science- Phineas Gauge
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Gabrielle Giffords
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Frontal lobes= speech, movement,
commands, and reasoning.
Occipital lobe= sight
Temporal lobe= hearing, understanding
speech, appreciating music
Cerebellum= coordination, balance
Parietal lobes= sensory areas; taste,
temp., touch , movement, reading, math
Brain stem & and hind brain= basic
functions, breathing, heartbeat, digestion,
reflexive actions, sleeping
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The emotional brain
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Young vs. Older brain http://braingames.nationalgeographic.com/episode/4/
• Rapid growth (0-3 and teens)
• Thinking “outside the box”- creative
• Quicker responses
• Take in New knowledge quicker- ie: learn a language
• Less and slower growth/ decline
• Better with a having and using stored knowledge
• Better at language skills
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The Developing Brain
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Drugs and the Body’s circulatory system
• Drugs Body
• Psychoactive drugs are absorbed into the body’s circulatory system and distributed via the blood to other tissues and organs, especially the brain.
• Transported to heart then brain
• Cross the blood brain barrier and act on CNS
• Drugs can cause effect, be ignored, be ignored, absorbed or transformed.
• Drugs= metabolized & excreted
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How drugs get to the brain Drugs are absorbed; distributed; metabolized; eliminated and excreted by the body through these key factors-
• Route of transmission
• Speed of transit to the brain
• Rate of metabolism
• Affinity for nerve cells and neurotransmitters
+ rapidly it targets CNS= + greater reinforcing effect 2.3
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Drugs CNS
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Drugs alter info sent to the brain, they can disrupt messages sent
back to the various parts of the body or disrupt thinking
Old Brain
• Brain stem, cerebellum, mid brain & limbic system
• Regulates basic functions – Breathing, heartbeat,
respiration, temp, hormone
– Basic emotions/ drug cravings- hunger, fear, just reacts (4xs faster than new)
• Imprint SURVIVAL memories
• Moves faster and
Overrides new
brain
New Brain
• Neocortex
• Develops last
• Higher learning – Impulse control, reasoning,
logic, judgment, create, remember THEN act, processes info from old brain, weighs consequences
• Impacted by
drugs 2.10
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How does stimulation of the brain's pleasure circuit teach us to keep taking drugs?
Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way. simplified overview of override:
https://www.youtube.com/watch?v=43SfGbtzyp0&index=2&list=PLiDp5Nr08qmeri0HwCOm4rYhuZYw4j9se
addiction overrides other decisions:
http://channel.nationalgeographic.com/breakthrough-series/videos/the-isolation-of-addiction/
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Memory Comes from positive memory bumps then act as TRIGGERS for continued use.
Stronger the drug= the more rapid the bumps=
the more the imprint
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Memory & Drugs
• Go circuit= old brain
• Comes from positive memory bumps then act as TRIGGERS for continued use.
• Because of the nature and emotional stimuli, drugs continually send the “go” message.
• Stop = new brain
• When a craving has been satisfied, or pain relieved it sends a message to stop sending the “do it more” message.
• Drugs inhibit this stop mechanism in addicts
• P. 2.14- 2.15
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Without Tx the new brain doesn’t get the chance to lead
• Study page 2.17 • Addicted persons are vulnerable to relapse due to 3 key factors:
Overactive “go” signal
“stop” signal impaired
Lack of communication btwn old and new brain
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Neurotransmitters 2.20- 2.23 • Glutamate- learning and memory,
• Dopamine- motivation, pleasure
• Endorphins & Enkephalins- “endogenous opioids”, body’s own natural painkillers. rewards, pain
• Epinephrine, adrenaline- keeps you alert, balanced blood pressure, can increase anxiety and stress when needed
• Serotonin- emotion, body temp, sleep, appetite
• Oxytocin- hormone, love, trust
• GABA- inhibitory chemical, controls Impulses, muscle relaxation, arousal, slows the brain
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• General effects of stimulants- adrenaline rush to the system
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Mild: caffeine, nicotine
Stronger: amphetamines and stronger: methamphetamines
Potent: cocaine, crack
Drugs impact the brain • Hinder dopamine production-
– Stimulants drain the brain’s ability to make the good feeling chemicals; causing depression; and cravings for relapse.
• Short circuit the reward pathways.
– The brain remembers what is pleasurable and seeks to repeat that; leading to repeated use
• Hinder other neurotransmitter production
– Alcohol impacts GABA
– Opiates impact pain messages, increase tolerance
• Brain Damage
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The Amygdala
• http://www.youtube.com/watch?v=6GdALwuYtG8
• Stress is the brain’s/ body’s response to circumstances and events that threaten individual’s coping abilities.
• When we exhibit stress; our body readies itself for a threat/ assault. – primal reaction that has remained unchanged – similar to that of animals
• Amygdala is the brain’s fear-stress barometer
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fear • Amygdala is the low road- fast reaction to things
that go bump in the night. 12 milliseconds to read and react. Emotional center.
• The hippocampus will take 2 or 3 times longer – the high road through thought and reasoning, and then send the message back to the amygdala- ie: only cat at the window.
• The body receives the message later and takes a while to return to a normal state.
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Stress/ chronic stress
• When fear arises; body activates adrenaline; stronger, faster, heart pumps blood flow faster to respond and breath, eyes widen, hair stands on end, become “hypervigilant”
• A trauma is a severe threat to the system.
• Traumas or chronic stress lead to= PTSD
• Mind imprints these episodes and it’s replayed= people use to escape
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Amygdala activates brain stem or “old brain” function
that connects quickly to the central nervous system
For quick responses
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• ? Phases of addiction
