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Latin Verb - Addicio

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Signifies "giving over", could be positive or negative; suggested devotion; intensity that one associated with being passionately involved with some activity

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Addicus

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A person given over as a bond slave to a creditor

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Addiction Definition Ambiguity

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Ambiguity lies in the value attached to the word; it could be tragic or enviable

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1933 Oxford English Dictionary

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A formal giving over or delivery by sentence of court, hence a surrender or dedication of anyone to a master, the state of being self addicted or given to a habit or pursuit, devotion.

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Short Definition of Addiction

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A pathological love and trust relationship with an object or event.

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19th Century Addiction Definition

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Much more restrictive than the traditional meaning; it links addiction to harmful involvement with drugs that produce withdrawal symptoms or tolerance.

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Gabor Mate's Definition

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Any repeated behavior, substance related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others.

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ASAM Definition

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(American Society of Addiction Medicine) Characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant probes with one's behaviors and interpersonal relationships and dysfunctional emotional responses. Chronic disease; involves relapse and remission without treatment or recovery achieves, addiction is progressive and car result in disability or premature death.

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Three General Theories of Addiction

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Moral Model, Disease Model, Maladaptive Behavior Model

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Moral Model - Definition (Addiction as immoral conduct)

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Refusal to abide by some ethical/moral code of conduct. Freely chosen behavior that is irresponsible to evil. Choice to use substances and create suffering for themselves and others.

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Moral Model - Treatment (immoral conduct)

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Punishment. legal sanctions, jail time, fines, loss of privileges. Rectify past deeds and prevent further use.

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Moral Model - Advocates (immoral conduct)

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Conservative groups, law enforcement organizations, zealous religious factors, groups of individuals who have been personally harmed by a substance abuser (mothers against drunk drivers)

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Moral Model - Advantages (immoral conduct)

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Straightforward and clear. Absolute. Simple. Societies inability to address this problem simply reflects widespread moral decay. There is a need to return to "family values"

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Moral Model - Disadvantages (immoral conduct)

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Science suggests addiction is anything but simple. It is not at all clear that addictions are freely chosen. History suggests that punishment is an ineffective way of reducing the prevalence of addictive problems in the population.

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Moral Model - Immoral conduct - outcomes

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law enforcement crackdowns have strengthened organized crime networks. for example- probation; underground trades. police officers don't want the legalization of marijuana.

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Disease Model - Definition

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Underlying disease process. Causes compulsive use, high use is a result of the illness. Addicts are victims of an illness. Use is not freely chosen, they are sick. Not evil, not irresponsible. After one use, addicts experience intense cravings triggered by unknown physiological mechanisms.

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Disease Model - Treatment

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Addicts deserve compassionate care, help, and treatment. Treatment has a wide range of approaches, in terms of intensity, but is supervised by a physician. Treatment focuses on managemeent of medical complications as the patient is educated about the disease model and recovery.

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Disease Model - Advocates

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physicians and other medical professionals, alcohol and tobacco industry, recovery movement; those individuals and families who have been successfully treated and benefited from this model.

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Disease Model and Alcohol/Tobacco Industry

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"it's not the product; it's not our fault!"

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Disease Model and Insurance Agencies

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reluctant opponents of this model. insurance companies like to fix things that can be fixed; "prove what you do works"

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Disease Model - Recovery Movement

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calling addiction a disease makes it more respectable than viewing it as a moral or mental problem. addiction as disease can serve to reduce possible guilt and shame about past behaviors.

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Disease Model - Advantages

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Addiction is taken out of moral realm, victims are helped sooner vs. scorned. society is more willing to allocate resources to help a person with a disease. this model has helped hundreds of thousands return to a healthful living.

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Disease Model - Disadvantages

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several key concepts have not held up to scientific scrutiny...yet! loss of control hypothesis, progressive course of the illness, inability to return to controlled drinking.

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Maladaptive Behavior Model - Definition

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addiction is a behavioral disorder. addiction is learned. addiction is a problem of behavior that is clearly under the control of environmental, famiy, social, and/or event cognitive contingencies. person with addiction is seen as a victim.

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Maladaptive Behavior VS. Misbehavior

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misbehavior - moral perspective. maladaptive refers to a pattern of behavior that has destructive consequences for addicts and/or their families. interventions are based on earning principles; clients are taught skills to prevent relapse. emphasis is paced on changing the environment, teaching clients new skills, experimenting with these two variables to approximate real life. medical aspects are de-emphasized.

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Maladaptive Behavior - Advocates

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Psychologists- Division 50 (the Addictions) of the American Psychological Association Public Health officials

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Maladaptive Behaviors - Advantages

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Practical Data driven; compatible with today's emphasis on efficiency and accountability.

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Maladaptive Behaviors - Disadvantages

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Labor Intensive and evaluation focused Problems with technology transfer...taking what we know in research and putting this knowledge into clinical practice Advocacy groups do not have strong power base

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Attributes of a Good Theory

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1. Theories are clear. They should be able to explain events across a variety of time periods, geographic areas, socio-cultural contexts, and socio-demographic variables. 2. Theories are comprehensive. It can be applied to many individuals in many different situations. 3. Theories are explicit. Concepts must be measurable with a high degree of reliability. 4. Parsimony. Theories explain phenomena in a relatively simple and straightforward manner. 5. Generation of useful research findings. A good theory has a history of generating research findings that support its concepts

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Traditional Models for Understanding Addiction

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Social/Environmental Models Genetic/Physiological Models Personality/Intra-psychic Models Coping/Social Learning Models Conditioning/Reinforcement Models Compulsive/Excessive Behavior Models A Bio-Psycho-Social Model

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Social/Environmental Model - Definition

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Emphasizes the role of societal influences, peer pressure, social policies, availability, and family systems as mechanisms responsible for the adoption and maintenance of addictions. Social influence and support are evident in the social context for use. Cocaine-crackhouse Heroin-shooting galleries Alcohol-bars Inhalants -concentrated use in Hispanic youth

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Social/Environmental Model & Deviance

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Illegal drug use, abuse, and dependence are viewed as deviant behaviors. Deviance becomes an underlying cause while a particular addictive behavior may reflect the response to the social context of peers.

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Evidence for Social/Env. Model

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higher pre-service deviance rate predicted initiation of heroin use in Vietnam veterans.

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Evidence Against Social/Env. Model

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wide spread use of marijuana

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Social/Env. Model - Advantages

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Substantial evidence of the role social and environmental factors play in the adoption of various addictive behaviors.

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Social/Env. Model - Disadvantages

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Drug and alcohol use has changed. Social influences and trends shift over time and cannot account for or predict individual behavior. Not all addicts use for the same reason. addicts use for the same reason.

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Genetic/Physiological Model - Definition

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People are genetically predisposed to addictions. Most convincing data regarding the role of genetics in addictions is in the area of alcohol abuse and dependence. Family studies indicate that increasing risk ratios for individuals as the number of alcoholic relatives rises and as the number and severity of familial alcohol problems rises. Twin studies seem to support the role of genetics. Classic definitions of addiction required that both increase in tolerance and physiologic withdrawal had to be present Not all drugs of abuse produce classic dependence symptoms of tolerance and withdrawal. Alcohol, tobacco, heroin do. Cocaine, amphetamines, and hallucinogens do not appear to do this. And where to other behaviors like gambling fit?

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Genetics and Addiction

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twin studies- Stress in utero? cannot isolate the gene which determines the addiction, is it not there? more environmental. what we may think is genetic may also be learned.

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Genetic/Physiological Model - Advantages

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Clearly some genetic element. Clearly some tolerance and withdrawal for some addictive substances.

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Genetic/Physiological Model - Disadvantages

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Some studies have suggested more emphasis needs to be places on expectations (psychological dependence) or social context

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Personality/Intra-psychic Model - Definition

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Addictive behaviors are a symptom of some historical, intra-psychic conflict ....sometimes labeled as disorders of personality (DSM-Axis II) Evidenced by high correlation of co-occurence of drug abuse and personality challenges. Antisocial traits, low self-esteem, alienation, religiosity, high novelty seeking, activity level, and emotionality have all been identified as precursors or predictors of later addiction.

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Personality/Intra-psychic Model - Advantages

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Some evidence suggests there is a high correlation of individuals with disordered personality and those who engage in addictive behaviors. Personality factors or deep seated intrapersonal conflicts do appear to play some role in explaining addiction.

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Personality/Intra-psychic Model - Disadvantages

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Correlation is not causation. There are many addicts without personality disorder traits and many individuals who struggle with a disordered personality who do not have addictive behaviors.

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Coping/Social Learning Model - Definition

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Unable to cope with life stresses, addicts turn to their addiction for escape or comfort. Individuals use substances or other behaviors as alternative coping mechanisms and rely on their addiction to manage situations, especially when feelings of frustration, anxiety, anger, and/or depression are present. The social learning perspective emphasizes social cognition and just simply coping. Cognitive expectancies, vicarious learning, and self-regulation are all utilized as explanatory mechanisms for addiction. Social learning also acknowledges the role of peers and significant others as models. Influence of expectancies not limited to chemicals. E.G. Winning of lotteries... Think social drinking.

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Coping/Social Learning Model - Advantages

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Quite popular currently among addiction researchers and clinicians. Provides a framework for treatment around development of effective coping skills.

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Coping/Social Learning Model - Disadvantages

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Does not adequately explain how someone with very good coping skills gets addicted. Some people engage in the behavior for positive enjoyment effects and not for relief of problematic emotions. Generalized poor coping skills cannot be the only causal factor.

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Conditioning/Reinforcement Model - Definition

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Substantial body of research from both humans and animals that demonstrates the reinforcing properties of each substance of abuse. Reinforcement models help us to understand the subtle initiation process into addictive behaviors, pairing ingestion with a pleasurable outcome. Reinforcement models help us understand how a variable-ratio reinforcement schedule creates a stable, hard to extinguish pattern of behavior. behavior modification, drinking or getting high triggers release of dopamine, even the expectation/anticipation. first high said to be "so amazing" it's not new anymore, you know what to expect.

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Conditioning/Reinforcement Model - Advantages

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lots of supporting research

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Conditioning/Reinforcement Model - Disadvantages

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addiction cannot be explained by a mode that uses only two basic principles (punishment and reward) even proponents acknowledge that addictive behaviors are complex and multi-determined. even with long periods of abstinence, extinction appears problematic.

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Compulsive/Excessive Behavior Model - Definition

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Addictive behaviors are repetitive. Individuals have extreme difficulty stopping or modifying the behavior which has led to comparisons with other ritualized patterns of behavior such as repeated hand washing or other rituals. The actual behavior is less important than the compulsive mechanism that has become attached to the behavior. Addictive behaviors are really just excessive appetites (for the behavior). This is primarily a psychological process. The individual becomes increasingly attached to his/her behaviors . Changing excessive behaviors would require a personal cost-benefit analysis, a decision making process, and self-reconstitution.

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Compulsive/Excessive Behavior Model - Advantages

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Adds a unique twist in understanding how behaviors are maintained. Is similar to the personality model in that it links the behavior to some psychological function.

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Compulsive/Excessive Behavior Model - Disadvantages

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Cannot explain the unique contribution of the various types of possible addictive behaviors.

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Bio-psycho-social Model - Definition

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This is an integration of previous models. Addiction is best understood as the result of a confluence of factors representing these three broad areas of influence.

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Bio-psycho-social Model - Advantages

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Comprehensive in scope of addressing the multiple causality of acquisition, maintenance, and cessation of addictive behaviors. Supports the complexity of addiction

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Bio-psycho-social Model - Disadvantages

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Does not really explain how the integration of these three factors occurs. Often utilized in treatment but not well integrated so that all three elements are not fully explored.

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What Addictive Behaviors Have in Common

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1. They represent habitual patterns of intentional, appetitive behaviors; 2. They can become excessive and produce serious consequences; 3. There is stability of these problematic behavior patterns over time; 4. There are interrelated psychological and physiological components to the behavior; 5. In every case, individuals who become addicted to these behaviors have difficulty stopping or modifying them. (American Psychiatric Association, 1994, DiClemente, 2003.)

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