Causes and Treatment of Substance-Related Disorders (Chapter 10)
Familial and Genetic Influences
Alcoholism has been demonstrated to have a genetic component, especially among men.
Seems to be a common genetic influence for abuse of:
Use is influenced by cultural and environmental factors,
abuse and dependence related to genetic factors.
Pos & neg reinforcement. Includes the reinforcers presented by the social situation.
Underlying idea that people abuse or become dependent on drugs to cope with unpleasant
42% of young men in Vietnam War experimented w/heroin, as it was readily available and helped
them deal with the stress of war.
Only 12% were still using heroin 3 years after return to the US.
Survivors of trauma (such as sexual abuse) are more likely to abuse alcohol.
Studies of young adolescents have shown that those who report negative affect are more likely to
use drugs and alcohol.
So addressing life circumstances and anxiety and mood disorders should play a part in treatment.
The negative after-effects of drug/alcohol use (hangovers, crashes) can increase motivation to
take more of the drug. Tolerance increases, requiring more to achieve the same effect, while the
crash intensifies, encouraging continued use. (Motivation shifts from pos reinf to neg reinf.)
Self-medication implies that a person has a disorder that they are attempting to treat through the
use of substances. If these are treated appropriately, it should decrease the need for the drug.
(Cocaine addicts with ADHD treated with Ritalin stopped using cocaine. Neurobiological Influences
Postive reinforcements due to activation of the "pleasure pathways" of the brain. Well
established in animals, still not clear which areas of the brain are involved in the pleasure
response for humans, and how various substances can all cause a similar response.
Negative reinforcement by eliminating aversive experiences--anxiety, pain, boredom.
Anxiolytic effects of alcohol and some other drugs may be due to enhancing the activity of GABA,
which inhibits the brain's normal reaction to anxiety-producing situations.
First reaction to alcohol is euphoria, after several hours sadness and depression. Sons of
alcoholics tend to be more sensitive to alcohol when first ingested, and then less sensitive as the
hours pass. Ten-year follow-up showed that those with that pattern tended to drink more heavily
and more often.
Expectancy effect--behaving consistent with expectations for what the drug will do. This can
happen even when a placebo is ingested.
Beliefs that drugs will have positive effects can influence drug use.
Cravings can develop in response to associated stimuli (sight, smell of alcohol, paraphernalia
associated with drug use, places of friends associated with drug use, mood states, availability of
the drug, etc).
Influence of people we associate with and images of drug use to which we are exposed will have
an effect on drug use and abuse.
Views of drug users:
Moral Weakness--failure of self-control in the face of temptation
Disease Model--a physiological disorder that is no fault of the victim's
Neither does justice to the very complex interrelationship of biological, psychological, and socio-
cultural factors involved. Cultural Dimensions
Preference for psychoactive substance is influenced by one's culture. Cultural norms about
acceptable and unacceptable substance use plays a part. (Heavy alcohol use on certain
occasions--book mentions Korea, and the apparent influence on high rates of alcoholism among
Koreans. But we can also take the example of Purim. Jews are not supposed to get drunk
throughout the year, only on Purim. However, we do have wine at every Shabbos and holiday
throughout the year, which we are expected to drink in moderation and not become drunk. Jews
generally have a low rate of alcoholism.)
Methadone - Heroin
Developed in Germany during WWII, originally called A