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1\] What constitutes psychological theory? - It describes a behaviour. - It makes predictions about the future behaviour. - It must have evidence to support the idea. - It must be testable. 2\] Why are theories important? - Explains why a drug is more/less addictive: - in one...

1\] What constitutes psychological theory? - It describes a behaviour. - It makes predictions about the future behaviour. - It must have evidence to support the idea. - It must be testable. 2\] Why are theories important? - Explains why a drug is more/less addictive: - in one society than another - for one individual and not another - for the same individual at one time and not another - Make sense of similar behaviour (e.g., compulsive) - Explains the cycle of growing problematic drug use. - Must accurately reflect the actual human experience. 3\] Psychological Theories of Substance Use **[1. Moral theory ]** - Originated in the early-mid 1800s with the Temperance movement, viewing addiction as a sin, a fault on one's character and a moral weakness. - Users are characterised as 'misfits', 'no-hopers', or as objects of pity. - dealers are routinely described as 'scum', 'vermin' or 'an evil menace'.  - Punishment - According to the moral model, people who struggle with substance use: - make poor choices - lack willpower - unwilling to change their own lives - Focuses on choice, highlighting the progression from voluntary substance use to loss of control. - Concern: - In most circumstances, a person with problematic drug usage will have no trouble obtaining evidence to support their opinion.\ - Stereotyping\ - reluctance to seek aid\ - Reduced self-esteem - It increases the desire to blame oneself, hate oneself, and feel extremely powerless. - Work against the possibility of meaningful change by decreasing motivation and avoiding taking responsibility. - ["*I believe addiction is a sin.  I know it's a medical and psychological problem, but the Bible tells us that sin is falling short of our potential.  It tells us we should not be mastered by things.  It also tells us to keep the body pure as it is the temple of the Holy Spirit."*] (Major Brian Matters - Salvation Army and the former chair of the Australian National Council on Drugs Drug Advisory Council) **[2.Spiritual model ]** - It is not poor choices or a lack of willpower that causes addiction, but rather a disconnection from God or another Higher Power. - In order to overcome addiction, the individual must first establish a deeper connection with themselves, other people, and the broader world around them. - At the core of the spiritual model is the assumption that people do not overcome addiction on their own. Rather, it is a variety of factors---a Higher Power, a community of other people in recovery, and a spiritual awakening, that allow people to overcome addiction. 4\] Models of Addiction **[1. Disease model ]** - Assumes that addiction originates within the individual. - From a medical standpoint, addiction is a sickness or disease that a person has. - Addiction is an illness caused by a breakdown of healthy neurochemical or behavioural processes. - Addiction is not a continuous state, whether present or not. - Addicts are unable to control their consumption. Once they ingest some of the material (for example, one drink), they are unable to stop themselves and are overcome with almost overpowering urges when they are unable to obtain it. - Addiction is an irreversible disease. It is incurable and can only be treated through lifetime withdrawal. - [12 Step Models] - 12 Step Models are commonly associated with programs like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Al-Anon (a mutual support organization for the families and friends of alcoholics, especially those of members of Alcoholics Anonymous). - These models view dependence as a \'spiritual disease\' and a \'lack of control\'. - [Main Premises of 12 Step Models] - Alcoholism is perceived as an \'all or nothing\' condition, where individuals are either seen as having a problem or not having a problem. - Individuals struggling with alcoholism are believed to be powerless over alcohol and their experiences. - According to the 12 Step Models, alcoholism is not something that can be \'cured\', but rather managed. - The disease of alcoholism is considered progressive, and if drinking continues, deterioration in the individual\'s condition is inevitable. - Support in 12 Step Models is provided through attending groups, peer support, and the concept of submitting to a higher power. - Advantages: - Drug use becomes a health issue, not merely a legal issue. Addicts can better understand their behaviour. - This treatment strategy (to avoid alcohol) may be effective for certain individuals and minimises feelings of shame associated with addiction. - Disadvantages: - Removes user responsibility - Provides only one treatment option (abstinence) that may not be appropriate for many individuals, especially young people - Lacks evidence-based support. - Treatment outcomes from 12 step programmes are related with increased friendship, spiritual connection, and finding meaning in life (Kaskutas, 2009). **[2.Neuroscientific / biological theories]** - Focus is on the effects of drugs on the brain. - Genetic characteristics - Reward systems - Neuro-adaption i. [Genetic characteristics:] Focuses on genetic predispositions to addiction, involving dopamine regulation and cannabinoid system variations. **Inherited Vulnerability to Substance Dependence** - People may inherit an increased likelihood of developing dependence on substances. - No single candidate genes directly related to addiction have been discovered, suggesting involvement of multiple genes or incomplete expression of major genes. **Genetic Factors and Addiction** - Evidence suggests a relationship between tobacco-smoking and genes involved in dopamine regulation. - Variants of the CNR1 gene associated with cannabis, cocaine, and heroin dependence in the brain\'s cannabinoid system. **Family and Twin Studies** - Studies on families and twins have been conducted to understand the genetic influence on substance dependence. **Environmental Factors** - Environmental factors play a role in the development of substance dependence alongside genetic predispositions. **Complex Nature of Genetic Vulnerabilities** - The exact nature of genetic vulnerabilities related to drug abuse is a subject of ongoing research. - Influences may involve multiple genes or incomplete expression of major genes.  ii. [Reward system: ] **Major Pathways of Drug Action** - Different drugs have different primary actions on the brain. - Two major pathways common to most drugs are the dopamine reward system and the endogenous opioid system. **Brain Areas and Addiction** - The brain stem (or base brain) controls basic life functions like heart rate, breathing, and sleeping. - The limbic system (or lower brain) contains the brain\'s reward circuit and is involved in pleasure, emotions, impulses, and memory. - The cerebral cortex (or higher brain) is divided into areas controlling specific functions and is the thinking centre responsible for planning, problem-solving, decision-making, and impulse control. **Effects of Drug Use on the Brain** - Flipping the lid demonstrates how drug use affects the brain, leaving the lower brain in control. - Flipping the lid occurs in response to immediate danger or intense emotions like anger and stress. - Alcohol and drug use weaken the higher brain and strengthen the lower brain, leading to impulsive decision-making based on memory, reward, and pleasure. - The impact of alcohol and drugs on brain function persists even after substance use has ceased, affecting decision-making and recovery. **DEMONSTRATE THE FOLLOWING AREAS OF THE BRAIN USING THE BRAIN HAND MODEL (adapted from DR D SIEGEL).** To help understand why this type of thing happens (the compulsive drive sometimes to use alcohol or other drugs despite a strong desire to say NO), we want to take a few moments to teach you and important yet simple way of understanding the brain. Especially about the areas of the brain that are involved in the development and maintenance of addiction. ***The brain stem (OR BASE BRAIN)*, \[demonstrate by placing finger of one into open palm of other hand\]** which controls basic functions critical to life, such as heart rate, breathing, and sleeping. ***The limbic system (OR LOWER BRAIN)*,** **\[demonstrate by folding thumb of open hand across palm\]** which contains the brain's reward circuit. It links together a number of brain structures that control and regulate our ability to feel pleasure, to feel emotions, to have impulses as well as circuits involved in memory -- especially memory involving emotion. Feeling pleasure motivates us to repeat behaviors that are critical to our existence. The limbic system is activated by healthy, life-sustaining activities such as eating and socializing. ***The cerebral cortex (OR HIGHER BRAIN)***, **\[demonstrate by folding open fingers to form a fist\]** which is divided into areas that control specific functions. Different areas process information from our senses, enabling us to see, feel, hear, and taste. The front part of the cortex, the frontal cortex or forebrain **\[lift index finger & little finger away from palm leaving middle finger & ring finger to demonstrate the higher brain region\]**, is the thinking center of the brain; it powers our ability to think, plan, solve problems, undertake goal-directed action, control impulses and make decisions. **DEMONSTRATE "FLIPPING THE LID" TO HIGHLIGHT HOW DRUG USE AFFECTS THE BRAIN LEAVING THE "LOWER BRAIN" IN THE DRIVERS SEAT....... \[demonstrate by lifting the fingers representing the higher brain away from the palm leaving the folded thumb -- representing the limbic/lower brain -- exposed\]** Explain that there are several things that can cause us to flip our lids -- in helpful ways this occurs when we are in immediate and extreme danger. When this occurs, we bypass the higher brain and go straight to the impulsive and reactive center of the brain (the limbic/lower) brain to take charge -- this can be useful if a Mac truck or a bear are coming at you. Other things that can cause us to flip our lids are things like intense anger (think road rage), and being overwhelmed with stress. Alcohol and other drug use also causes us to flip our lids. When under the influence, the higher brain is often weakened and the lower brain is strengthened (keep using hand model to demonstrate). The lower brain was never meant to be in charge for long periods of time. Why -- because outside of helping us to deal with immediate threats (e.g. trucks & bears), we don't tend to make the best decisions in this part of the brain. Instead of decisions being based on evaluation of choices and consequences, decisions from this part of the brain are more likely to be based on impulse, memory, reward and pleasure. Importantly, the impact of alcohol and other drugs does not only occur when under the influence, from what science has been able to show us, the effect of 'flipping our lid' and decreasing the function of the higher brain goes on for a time after substance use has ceased. A lot about recovery is regaining top-down control over bottom-up thinking. **Tell people we will be using this model as a form of short hand throughout the program to help understanding issues and impacts of addiction.** iii\. [Neuro adaption]: changes in the brain opposing drug effects, leading to tolerance and withdrawal symptoms. - Refers to brain alterations that occur in response to a drug\'s sudden withdrawal following repeated delivery. - When medications are delivered frequently, changes occur in the chemistry of the brain that counteract the drug\'s effects. - When this medicine is stopped, the adaptations are no longer countered, and the brain\'s stability is disturbed (Koob & LeMoal, 1997). - Essentially, this concept contends that neuroadaptation is responsible for both tolerance to drug effects and withdrawal when drug usage is discontinued. - As a result, use continues in an attempt to avoid the symptoms that come with stopping drug use. **[3.Psychoanalytical theories]** - Based on Freudian (Sigmund Freud) psychodynamic theory, which is still widely utilised today. - The basic philosophy is that we can link problems to our childhood and how we cope (or don\'t cope) as adults. - Substance abuse/misuse may be an unconscious response to some of the challenges that people experienced in their childhood. - The foundation of many counselling approaches that seek to acquire insight into an individual\'s unconscious motivations to enhance their self-image. - Nature and Nurture - Psychoanalytic shared assumptions: - Psychoanalytic theory holds that drug use is a sign of underlying psychological disorders. - This indicates severe psychopathology. - Psychological disorders are considered to cause substance misuse, but are not frequently identified as a result of use.\ Addiction is considered a universal disorder. - Example: 1. Unconscious Processes of the Id, Ego, & Superego - The id, ego, and superego are three components of the human psyche according to Freudian psychoanalytic theory. - Fixation at the \'oral\' stage can lead to personality traits associated with this developmental phase. - Id operates based on the pleasure principle and is focused on immediate gratification. - Ego functions based on the reality principle and mediates between the id and superego. - Ego\'s \'self-medication\' refers to its role in managing conflicts between the id\'s desires and superego\'s moral standards. 2. Attachment Theory - Attachment Styles by Bowlby - Secure attachment style is characterized by a healthy balance of independence and intimacy. - Ambivalent-avoidant insecure attachment style involves mixed feelings of closeness and discomfort with intimacy. - Anxious-avoidant insecure attachment style shows a fear of rejection and reluctance to trust others. - Disorganized-insecure attachment style displays inconsistent behaviours in relationships. 3. Personality and Addiction - Distinct Personality Characteristics of Alcoholics/Drug Users - Certain personality traits distinguish alcoholics/drug users from the general population. - Limited evidence supports the concept of an \'addictive personality\' as a predisposing factor. - Personality predictors of drug use (e.g., McGue 1995; Rassool, 2011) include behavioural disinhibition, emotional negativity, sensation seeking, non-conformity, social isolation, and tolerance for deviance. - Psychodynamic Views on Addiction - Current psychodynamic perspectives view addiction as a self-regulation disorder. - Challenges in recognizing and regulating feelings, establishing a coherent sense of self, maintaining relationships, and controlling behaviour are key aspects. - Addictive personality traits are seen as outcomes of addiction rather than predictors. - Treatment Approaches - Therapeutic relationships and specific psychoanalytic techniques are utilized in addiction treatment. - Focus on addressing underlying emotional issues, self-regulation difficulties, and relationship challenges. i. [Social learning model: ] - Russell (1976) introduced the idea that dependence is not only chemical but also behavioural and social in nature. It is based more on the user\'s thoughts about the substance, and what it is like to be \'under the influence\' of the drug itself. - Two central notions that substance use is: \- Is functional. - Focus on the interaction between the environment, the individual and the drug as a way to understand the complexity of the drug experience.  - Key points - Anyone who engages in an activity that they find pleasurable is at risk of developing dependence on that activity. - Dependence is a learned behaviour - results from conditioning, modelling and thinking about the substance. - Dependence exists in degrees. The greater the dependence then the greater the negative feelings experienced in the absence of the activity. - Dependence is a normal facet of human behaviour. It only becomes a problem when the individual experiences a number of negative consequences as a result of their behaviour, but continues to do it anyway. - A sense of compulsion, of wanting to engage in a behaviour (such as drug use), but knowing that one really shouldn\'t, is the hallmark of addictive behaviour. - Behaviours are only terminated when the individual makes the decision that the costs of continued use are vastly greater than the benefits. - Social learning interventions focus on altering the client's relationship with their environment.  - Example: Adolescents who view substance use in a positive light, whose peers use drugs, and whose parents and peers have attitudes that condone substance use are more likely to use substances (Ford, 2008) ii. [Behavioural theory:] - Only considers observable/measurable behaviour - Behaviour is a consequence of learning - Four main types of conditioning: - Classical conditioning - Operant conditioning - Modelling - Tension reduction a. Classical conditioning - Sights, smells and sounds consistently associated with drug use elicit physiological and psychological responses that lead to drug seeking behaviour - Conditioned stimuli (CS) -- cues and triggers - Conditioned response (CR) -- physiological and psychological responses - CS more important than CR **PALVION CONDITIONING EXPERIMENT** - - - - -  b. Operant conditioning model: - Focuses on reinforcing properties of drugs, and the likelihood of people repeating *immediately* pleasurable experiences (and avoiding unpleasurable experiences) - Three main reinforcement types: - Positive reinforcement (e.g., drugs can cause pleasurable sensations) - Negative reinforcement (e.g., use to remove aversive experiences) - Punishment c. Modelling: - Much of what we learn is acquired through observing others. An obvious benefit to this is that it lowers the risk of harm if one does not have to experience negative consequences personally in order to learn that they exist, and it increases the likelihood of pleasant experiences if one can identify them immediately through the experience of others. - Studies have certainly shown that peer and family drinking behaviours are good predictors of drinking. This may explain why first-time drinkers have their first drink even though most people do not find the taste pleasant. At first, and they haven\'t yet experienced any of the pleasant effects of alcohol. They have seen others enjoying it. - Modelling can also provide an alternative explanation to disease accounts of why drinking behaviours seem to \'run in families\'. Modelling, like operant learning, is another way in which people acquire favourable attitudes and expectations about drinking, which are important predictors of high-risk drinking. d. Tension reduction theory: [iii.Cognitive and cognitive behavioural theory ] a. Cognitive model: - Focuses on the thoughts/beliefs, and impact on behaviours and feelings - The way people interpret specific situations influences feelings, motivations and actions. - Layers of beliefs -- core beliefs / schemas  - Cycle of Conflicting Desires - Conflict between the desire to use drugs and the desire to be free of drugs - Leads to a cycle of behavioural, emotional, and thinking patterns - Cognitive-Behavioural Approaches - Thoughts and behaviours can be \'unlearnt\' through Cognitive-Behavioural Therapy (CBT) - Incorporates Third Wave Psychotherapies like Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), and Mindfulness-Based Relapse Prevention - Key Differences to Traditional CBT - Emphasis on mindfulness and acceptance strategies to reduce the impact of internal triggers on substance use behaviour - Broad, functional approach to treatment focusing on motivation and values-based strategies - Transdiagnostic approach targeting psychological problems commonly comorbid with substance use like depression, anxiety, and self-stigma b. Expectancy theory (Bandura): - Addictive behaviours chosen over other behaviours due to our expectancies. - Two specific cognitions: - Outcome expectancy -- beliefs about effects and outcomes of using - Self-efficacy -- belief in one's own ability to effect change iv.[Motivation and Change theories] - Transtheoretical Approach - Increase client\'s awareness of problems, consequences, and risks to initiate behaviour change - Motivational interviewing emphasizes intrinsic motivation for change NEW3.png [V. Family & systems theory; socio-cultural] - Determinants of behaviour are based on an individual's role within a system. - Focuses on society as whole and not just on individuals. - Family and other systems (e.g., peers) have role in initiating and maintaining substance use - The type of society in which people live has an impact on their drug use. In particular, this model makes links between inequality and drug use. It suggests that people who belong to groups who are culturally and socially disadvantaged are more likely to experience substance abuse problems. - Because this model links substance abuse to the conditions of the wider society, importance is placed on interventions on the system rather than the individual. - Many differing theories. Shared common elements: - Boundaries - Reciprocal causality - Homeostasis - Family based interventions e.g. 'Stress coping' perspective (Rosino; Orford) - Importance of placing emphasis on interventions for the system e.g., family therapy/involvement of significant others, addressing stigma, poverty, poor housing, disadvantage etc **[4.Biopsychosocial model]** - Proposes that drug use is influenced by a combination of biological, psychological, and social factors. - Biological factors - genetic predispositions, neurochemistry, and physiological reactions to drugs. - Psychological factors - individual traits, motivations, coping mechanisms, and cognitive processes. - Social factors - cultural norms, peer influences, socioeconomic status, and environmental triggers.