Factors Influencing Addictions Lecture Outline PDF

Factors influencing addictions Lecture 5 Oct 21st PSY 215 (Section 1) Dr. Avideh Gharehgozlou Social Categories: Race/Ethnicity Variations in substance use outcomes are products of social, economic & environmental circumstances as well as biological & psychological characteristics Disparities → i...

Factors influencing addictions Lecture 5 Oct 21st PSY 215 (Section 1) Dr. Avideh Gharehgozlou Social Categories: Race/Ethnicity Variations in substance use outcomes are products of social, economic & environmental circumstances as well as biological & psychological characteristics Disparities → inequitable differences 3 social categories are important in understanding substance use & prevalence, different trajectories & treatment access: Race/Ethnicity, gener, disability status Race → an individual’s physical characteristics Ethnicity → cultural factors (i.e., language) 2 Social categories: Race/Ethnicity There are racial/ethnic differences in substance use, developing SUDs, consequences of substance use & treatment access In the USA: Non-Hispanic whites → highest rates of alcohol consumption Native Americans → highest prevalence of AUD’s Native Hawaiians/Pacific Islanders & American Indians/Alaskan Natives→ highest illicit drug use American Indians/Alaskan Natives → highest lifetime rate of dependence on illicit drugs 3 **don't need to memorize** Social Categories: Gender Gender → a social construct based on societal roles Gender Roles → ideal behaviours for an individual of a specific biological sex In many cultures, social roles for women conflict with alcohol consumption & they experience stronger social sanctions against drinking than men Men have higher rates of substance use & SUD across racial/ethnic categories, but women experience higher rates of problems attributed to alcohol use May be due → social conditions, varian alcohol metabolism, etc. 4 Factors influencing rate of absorption Absorption: movement of drug from site of administration to blood circulation Oral or intranasal administration, inhalation, injection, etc. Factors that determine the rate of absorption: Food in the stomach slows movement of drug into the intestine, delaying absorption Drug concentration → dependent in part by individual differences: Body Size → The larger an individual is, the more diluted the drug will be in the large fluid volume of their body & less drug will reach target sites Sex → the greater fat:water ratio in women results in higher drug concentration at the target site compared to men Age → the smaller fluid volume of a child results in higher concentration & greater drug effect Water helps flush alcohol out Fat keeps alcohol 5 Gender Differences in Alcohol Absorption Why do women have greater blood alcohol content, compared to men, after similar levels of alcohol consumption? Differences in fluid volume (lower water content → decreased ability to dilute alcohol) Different enzyme levels (less Alcohol Dehydrogenase in stomach linings → breaking down less alcohol before reaching the bloodstream) Medication 6 6 Social Categories: Gender Women often drink for less time before developing AUD & other related consequences → telescoping 7 Social Categories: Gender In many countries, women are more likely to be victims of alcohol-related harm perpetuated by someone else In many nations, heavier alcohol use is associated with increased likelihood of intimate partner violence by both genders Alcohol consumption during pregnancy contributes to the risk of Fetal Alcohol Syndrome (FAS) Sex differences in: Reasons for engaging in heavy use → Heavy alcohol use is more likely to be influenced by psychological distress for women Reasons for relapse → Returning to alcohol use is more often related to negative emotions for women, but to social pressure for men Treatment → Women are less likely to use treatment services: Lack of availability of affordable childcare Lack of services for pregnant women More stigma towards a women who abuses substances 8 Sex Differences in Alcohol Use: Reasons for Engaging in Heavy Use: For women, heavy alcohol use is more likely to be influenced by psychological distress. Reasons for Relapse: For women, relapse is more often related to negative emotions. For men, relapse is more often influenced by social pressure. Treatment: Women are less likely to use treatment services due to: Lack of affordable childcare availability. Lack of services for pregnant women. Greater stigma towards women who abuse substances. Social Categories: Disability Status Individuals experiencing disabilities may use substances to cope with pain ,isolation & stigma Prevalence of substance use (other than alcohol) is greater among individuals experiencing disabilities However, the proportion of individuals without disabilities who engage in heavy drinking is much greater Age-related chronic pain & physical illnesses are associated with heavy substance use Heavy substance use often co-occurs with psychological disorders (i.e., depression or anxiety) 9 Social Categories: Disability Status Substance use & SUD can lead to disability in any phase of life Heavy drinking is a well-established cause of disabilities, especially among older adults Heavy drinking can lead to alcohol-induced disorders (i.e., Korsakoff’s syndrome) & cognitive defects later in life Moderate drinking may exacerbate pre-existing health problems 10 Intersectionality Individuals do not belong to one single group (i.e., racial/ethnic minority women) Important to consider the contexts in which individuals are embedded based on social indicators, each of which may, independently or jointly, affect risk for substance use & related problems 11 U.S. NIMHD Research Framework Central tenant: environments influence individual’s health & well-being Environments interact with biological dispositions, making one more/less vulnerable to engage in addictive behaviours NIMHD research framework is a multi-level, multi-domain model which includes both biological & social determinants that contribute to health disparities: Biological determinants → genetic & biological factors that may make one vulnerable to engaging in addictive behaviours & developing SUDs Social determinants → characteristics of different social environments in which one functions, elements of which may affect their exposure to certain risks & protective factors & access to resources Describes cumulative & interactive effects 12 Central Tenet: Environments influence an individual’s health and well-being. Environments interact with biological dispositions, impacting vulnerability to addictive behaviors. NIMHD Research Framework: A multi-level, multi-domain model addressing both biological and social determinants contributing to health disparities. Biological Determinants: Genetic and biological factors that may increase vulnerability to addictive behaviors and the development of substance use disorders (SUDs). Social Determinants: Characteristics of the social environments individuals function in, influencing their exposure to risks, protective factors, and access to resources. Cumulative & Interactive Effects: Emphasizes how different factors interact and accumulate to influence health outcomes NIMHD 4 levels of influenåce interact with 5 domains of influence as determinants of health Levels of influence : individual, interpersonal, community & societal Domains of influence: biological, behavioural, physical environment, sociocultural environment & health care system 13 4 Levels of Influence that interact with the domains of influence as determinants of health: Individual Interpersonal Community Societal 5 Domains of Influence: Biological: Genetic and physiological factors. Behavioral: Individual actions and habits. Physical Environment: The surroundings and conditions in which people live. Sociocultural Environment: Social and cultural factors that influence behavior. Health Care System: Access to and quality of health services. Interaction of Levels and Domains: These levels and domains interact to shape health outcomes and contribute to health disparities. 14 14 Individual Determinants of Substance Use & SUD Biological Domain: Genetic Vulnerability Genetic mechanisms affect the propensity for substance use & developing SUD The ability to metabolize can affect consumption & partially explain racial/ethnic drinking patterns 15 Individual Determinants of Substance Use & SUD Behavioural domain: Coping strategies Individuals may use substances to cope with negative life experiences (i.e, stigmatization, disability status) Heavy substance use can exacerbate risks in adjustment related to employment & educational attainment 16 Individual Determinants of Substance Use & SUD Socio-Cultural environment domain: Cultural Identity Among immigrants: Closeness to one’s culture of origin → a source of resilience Acculturation → a risk factor for alcohol use, heavy use & related problems For immigrants who experience SUD → treatment utilization & retention may be complicated due to linguistic & cultural barriers when acultration is low 17 Individual Determinants of Substance Use & SUD Health care system: Income & insurance coverage Individuals with SES who drink often engage in heavy use & may experience more problems related to their use In countries with limited health care, SES relates to the availability of care & disparities in access to SUD treatment 18 Interpersonal determinants of Substance Use & SUD Behavioural domain: Family functioning Parenting practices & parent-child relationships influence adolescent substance use Among immigrants, parents & children may acculturate at different rates → family conflict → breakdown of family closeness → substance use in children A way to cope with family stressors More access to substances through peers as a result of lower parental involvement & monitoring Childhood trauma is also a risk factor for substance use & development of SUD Some groups (i.e., individuals with disabilities) encounter higher rates of child abuse & neglect 19 Interpersonal Determinants of Substance Use & SUD Socio-Cultural environment: Interpersonal discrimination Individuals who identify with a minority group may experience isolation due to discrimination leading to engagement in substance use High-risk drinking & alcohol use disorders increase as instances of discrimination increase Association between interpersonal discrimination & heavy alcohol use may be due to feelings of anger, PTSD & depression 20 Interpersonal Determinants of Substance Use & SUD Health care system: Patient-clinician relationship Health care providers may unintentionally prevent certain individuals from accessing quality treatment Cultural competence is linked to better communication, greater patient satisfaction & better treatment retention Cultural competence → Compatible behaviours & values allowing effective service delivery in cross-cultural settings In addition to linguistic & cultural barriers in treatment access, discriminatory behaviour through implicit bias may also result in missed opportunities Implicit Bias → Acting on automatic & subconscious assumptions 21 Community Determinants of Substance Use & SUD Behavioural domain: Community functioning Community social infrastructure (i.e., quality schools) sets the foundation for residents’ overall social functioning A lack of community infrastructure → community may lack order, creating greater opportunities for problems (i.e., substance use) Physical environment: Community Resources Communities lacking essential resources inhibit residents from accessing services for addictive behaviours & their consequences i.e., Indigenous populations living in remote locations have higher rates of SUD due to lack of essential community services 22 Community Determinants of Substance Use & SUD Socio Cultural environment: Community Norms Living in areas surrounded by others who share one’s heritage in co-ethnic communities serves as protection against substance use Due to fostering cultural identity Health care system: Availability of services Service availability barriers: In low-income areas, the number of individuals needing treatment may surpass the number of available clinicians & programs Service availability may be lacking due to limited language capabilities & cultural congruence among patients & providers Service accessibility barriers: Low-income households or those with disabilities may face barriers such as work, childcare, etc. Lack of information about available treatment options 23 Societal Determinants of Substance Use & SUD Behavioural domain: Policy and law Americans with Disabilities Act (ADA) defines disability as impairment that substantially limits an individual’s daily function ADA Offers protection from discriminatory practices to individuals who are: Currently experiencing AUD Have previously experiences SUD Are receiving or have received treatment Individuals unaware of this protection may refrain from seeking treatment or certain employment opportunities due to fearing discrimination 24 Societal Determinants of Substance Use & SUD Physical environment: Societal structure Compared to high-income communities, low-income communities: Have more retail alcohol outlets Are less able to offer resistance to criminal drug distribution activities Lack resources to to mobilize against liquor store placements or affect alcohol availability policies Suffer from increased likelihood of substance use due to increased substance avaliability 25 Societal Determinants of Substance Use & SUD Socio-Cultural environment: Social Norms National & local policies play an important role in facilitating norms around substance use i.e., prohibiting a substance in a country facilitates negative public perceptions of its use A community’s degree of societal religiosity also plays a role in establishing norms related to substance use i.e., lowest prevalence rates of substance use & SUD in Muslim countries Religious Norms can help protect against substance use, heavy use & SUD, however, these prohibitions may stigmatized individuals who use substances & are in need of treatment i.e., the hidden subset of the Muslim-led population who engage in substance use despite their country's constraints 26 Societal Determinants of Substance Use & SUD Health care system: Quality of Care SUDs often co-occurs with other psychological disorders, however treatment approaches may not offer integrated services to address both 27 Practitioners must incorporate the NIMHD framework into their practice with diverse populations There are a few strategies at the mico- & macro-levels which can reduce disparities across race/ethnicity, gender & disability status Strategy that applies across levels → ethical standard of cultural awareness and diversity with the recognition & understanding of diverse population groups 28 Micro-level practice implications Practitioners must: Screen all racial/ethnic, gender & ability groups for substance use Use evidence-based screening tools for the appropriate population & administer it in the patient’s prefered language Consider the intersections of multiple identities & how they influence the patient’s circumstances (i.e., racial/ethnic minority women) Parents can employ strategies to prevent substance use through → enhancing family functioning, fostering family closeness & managing conflicts Practitioners should be mindful of intergenerational differences in acculturation 29 Macro-level practice implications Practitioners can advocate for more culturally appropriate programming & treatment opportunities to achieve prevention & treatment equity across diverse groups i.e., treatments should be responsive Early efforts to prevent/delay substance use initiation are necessary to improve disparities, social workers can advocate for policy changes which affect: Alcohol availability & legal age limit for use Availability of disability-accessible, gender and culturally appropriate treatment programs 30