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Lecture 6

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PSYC 3030
Taryn Grieder

Drug Abuse and Addiction Introduction  “Paradox” of addiction: How can a person develop and maintain a pattern of behavior that is so obviously destructive to his or her life?  The modified CAGE test for all addictions: o Have you ever felt you should Cut down your use of drugs or of a behaviour? Have you felt Annoyed when people commented on your use? Have you ever felt Guilty or badly about your use? Have you ever used drugs or performed a behaviour to Ease withdrawal symptoms, or to avoid feeling low after using?  USA: The 2011 National Survey on Drug Use and Health estimated that 8.7% of the US population were current users of illicit drugs (illegal - e.g. marijuana)  Legal drugs (tobacco, alcohol, caffeine) are consumed much more widely  Average age of consumers are 18-20  Canadian Addiction Survey (CAS), March 2005 o A national survey of Canadians’ use of alcohol and other drugs o Done by Canadian Council on Substance Abuse (CCSA)  Looked at use 12 months prior to survey Alcohol  12 months prior to survey: o ~80% over age 15 consumed alcohol o Lowest rate in PEI, highest Quebec  44% drink at least once/week; ~10% 4 or more  ~6% engage in heavy drinking at least once/week (more than 5 drinks a night); 
25% once/month  ~23% exceed low-risk drinking guidelines (14 drinks/ week in men; 9 for women)  Males > Females: o Drank alcohol in the past year o Drank alcohol at least once/week o Drink more than 5 drinks / sitting o More males exceeded low-risk guidelines  Heavy drinking most common 18-24 years of age Cannabis  44.5% used at least once in lifetime o ~14% used in last 12 months  Males > females for lifetime 
(50.1% v 39.2%) and in past year 
(18.2% v 10.2%)  Younger more likely  almost 
70% of lifetime users btw ages 18 
and 24!  Lifetime users significantly higher in BC and Alberta; lower than average in Ontario, Newfoundland and Labrador, PEI  Those who were never married more likely to have smoked cannabis (57.5% vs. 35.2% of married people) Other Illicit Drugs  Excluding cannabis, most commonly reported drugs used: o Hallucinogens (11.4%) o Cocaine (10.6%) o Speed (6.4%) o Ecstasy (4.1%) o Inhalants, heroin, steroids (<1%)  Although1/6 used illicit drug in lifetime, few used during past year (1% or less) - maybe just tried it once and never used it again  Rate is highest among men, 18-19 year olds, residents of Quebec, BC, and Alberta, and single respondents Medicalization of drug addiction in the second half of the twentieth century:  It was now thought that addiction was a disease and that drug addicts should be treated by the medical establishment o If medical professionals say that we need to be treating them, they can get the funding to treat these individuals  Alcoholism was declared a disease by the World Health Organization and the American Medical Association o Disease model has been strongly promoted by community and medical professionals Where are we (they) now?  War on Drugs similar to Prohibition, really ineffective  Existing laws are not consistent with scientific evidence (e.g., nicotine is more addictive than marijuana yet nicotine is legal and weed is illegal)  Money goes toward law enforcement rather than treatment, prevention, or harm reduction  Laws have limited ability to prevent drug abuse What is Addiction?  Many definitions o A.k.a. substance dependence (because of negative connotation of ‘addiction’)  **A chronically relapsing disorder characterized by: 1. Compulsion to seek and take drug - strong urge to take the drug 2. Loss of control in limiting intake - want to stop but you can’t 3. Emergence of a negative emotional state when access to the drug is prevented or you try to stop (aka withdrawal)  Some say taking drug when in withdrawal is negatively reinforcing the drug (drug is taking away something we don’t like  the withdrawal symptoms)  Withdrawal is different for each drug / behaviour  Physical dependence: abstinence leads to highly unpleasant withdrawal symptoms that motivate the person to return to drug use  negative reinforcement o Some drugs (e.g., cocaine) produce only minor physical dependence o Headache is main symptom of caffeine withdrawal  Behavior: addict is driven by craving: a strong urge to take the drug  Individuals remain addicted for long periods of time, and drug-free periods (remissions) are often followed by relapses in which drug use recurs, despite negative consequences The American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) defines substance-related disorders as: Substance Dependence: more severe; corresponds roughly with addiction, when you have the three components stated above VS. Substance Abuse: less severe; may or may not lead to substance dependence, not dependent on drug but you are abusing it DSM-5 replaces those categories with Substance Use Disorder:  The individual has
manifested a maladaptive pattern (causing harm to the user) of substance use for at least 12 months that has led to significant impairment or distress At least two of 11 additional criteria must be met as well: 1. Taking the substance in larger amounts or for longer than they meant to. a. Lack of control / limiting intake 2. Wanting to cut down or stop using the substance but not managing to. 3. Spending a lot of time getting, using, or recovering from use of the substance. 4. Cravings and urges to use the substance. 5. Not managing to do what should be done at work, home or school, because of substance use. 6. Continuing to use, even when it causes problems in relationships. 7. Giving up important social, occupational or recreational activities because of substance use. 8. Using substances again and again, even when it puts them in danger. 9. Continuing to use, even when a physical or psychological problem could have been caused or made worse by the substance. 10.Needing more of the substance to get the effect they want (have tolerance). 11.Development of withdrawal symptoms, which can be relieved by taking more of the substance. Has to maladaptive first, AND two of those 11. If they meet only 2-3 of the criteria they are moderately severe substance use disorder (substance abuse), if 4+ criteria it is a severe substance use disorder (substance dependence). Behavioural Addictions  Many parallels with chemical addictions - failure to resist an impulse, drive or temptation, are chronic, relapsing and can interfere with the person’s life  DSM-V only recognizes gambling as an addiction (has been studied most extensively of the group) Gateway Theory:  Start by taking legal substance and then later progresses to more illicit drugs Impulsivity  Compulsivity (3 Stage Cycle):  Changes in amount, pattern and consequences of drug use as they affect health and functioning  3 components o Periods of preoccupation with drugs and anticipation of upcoming use o Periods of drug intoxication that in some cases are associated with bingeing on the drug o Periods following that drug use that are characterized by withdrawal symptoms and negative affect (e.g. depressed mood)  Take drug in larger amounts, persistent desire, spiraling distress  addiction  Impulsive stage - motivation for drug use is substance’s positive reinforcing effects  Compulsive stage - motivation us the negative reinforcement obtained by relief from drug during withdrawal o Fails to explain relapse in individuals who have gone through drug detoxification  10 heroin addicts over 20 years  A lot of variety in pattern of drug use in 10 people that are ‘heroin addicts’ o Some are impulsive users (drug abusers) and some are compulsive users (drug dependence) Which drugs are the most addictive?  Controlled Substances Act established system by which most substances with abuse potential are classified o Schedule I - no medicinal value, can only be obtained by researchers, have high abuse potential (e.g. heroin, LSD, weed, MDMA) o Schedules II-V - have medicinal value and can get them with prescription (e.g. morphine, codeine, PCP, barbiturates) Factors That Influence the Development and Maintenance of Drug Abuse and Addiction  Addiction potential of a substance is influenced by its route of administration o IV and inhalation administration drugs have high abuse potential vs. something taken orally has low abuse potential o Faster onset - higher abuse potential  Abused drugs act as positive reinforcers (consuming the drug strengthens whatever preceding behavior was performed [taking the drug] and strengthening associations between other stimuli and the drug) o Withdrawal acts as negative reinforcement - drugs are both posi
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