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Core Conflict I
- are addicted individuals bad people who need to be punished? (impunitive model)
- or sick people that need to be healed? (healing model)
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Core Conflict II
- social view - addiction is about human connection, helps indiv. reconnect with the world,
- individual view - psychopathology, trauma and self-hatred
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Weil's Theory
human beings have an innate need for altered states of consciousness
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According to NIDA why do people use drugs?
- to feel good
- to feel better
- to do better
- curiosity
- bc others are doing it
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6 Motivations to Use Substances
- self-stimulation - used to feel alive, pleasure, access creative/spiritual self
- self-soothing - treat inner anguish and pain
- somatic I - used to address brain changes, withdrawal symptoms and mood changes
- somatic II - used to cope w medical illness and chronic pain
- social identity - drug addiction as a lifestyle, addict identity
- social justice - social oppression, racism, sexism
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Motivation to Use:
"i felt the prick of the needle, but only for a second bc this great rush of warmth quickly followed, encompassing me from my toes right up to the top hair on my head.. when she was done, i felt i had entered heaven" (beauty queen by linda govach)
self-stimulation: pleasure
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Motivation to Use:
"William sryron (the author) used liquor.. as means.. of letting his mind conceive visions that the unaltered, sober brain ahs no access to"
self-stimulation: creativity
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Motivation to Use:
" after a lifetime of depression and long bouts of self-medicating with alcohol, cocaine, and whatever else was available, heroin was a godsend. in fact I can truly say that junk is one of the best things thats ever happened to me"
self-soothing: self-medication
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Motivation to Use:
"so i stopped smoking meth that christmas eve.. and I went through about 10days of absolute torture and hell before I started to even feel a little bit better, bc as bad as you feel doing meth, the pain of coming off it is much worse. And to most people, this pain is unbearable, and just not worth quitting"
somatic domain I
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Motivation to Use:
"Rush Limbaugh announced on his radio program Friday afternoon that he is addicted to pain medication.. the radio talk show host said he first became addicted to painkillers some years ago following spinal surgery"
somatic domain II
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Motivation to Use:
"Alcohol was the fuel, the catalyst for our artistic ambitions, as well as the social lubricant.. our days of wild drinking were very much tied into a time and place when we were finding ourselves, our circle of friends, our voices as creative people"
Social identity domain
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Motivation to Use:
"Moreover, the vast majority of the addicted poor living on the streets have life histories of severe, cumulative trauma, made worse by the inhuman conditions homeless people face"
Social Justice Domain
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Motivation to Change:
".. I saw my 2 sleeping children in the rearview, teeny tiny, the girls were swallowed by the snowsuits.. If i went inside the house I could get what I needed in 10 min tops...... God had looked after the twins and by proxy me, but I realized at that moment that I was in the midst of a transgression He could not easily forgive"
Family/Relational Threats
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Motivation to Change:
" I had to choose between writing and drinking, I chose writing"
Job Loss/Economic Damage/Prestige Threats
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Motivation to Change:
"You see yourself portrayed in a way that you could never have previously imagined and say no its not possible"
Existential Issues
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Motivation to Change:
" I didn't want to take the chance on dealing, of getting busted.. so I sat down and thought to myself: would I be willing to trade the rest of my life for dope?"
Legal Issues
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Motivation to Change:
"once the decision was made, it was either that or, quite frankly, death"
Heath Concers
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Motivation to Change:
"being sick and tired of being sick and tired" - Dr. Richard Stephens
Role Strain
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Sensation-Seeking Personality
- have a strong need for varied, novel and complex sensation
- willing to take risks for the experience
- group that is more likely to use alcohol or drugs and engage in reckless behavior
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Self-Medication Hypothesis
people use/abuse bc they are trying to relieve emotional and psychological pain
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3 specific types of drugs
- opiates - help feel more calm and mellow, counter aggressive feelings
- stimulants - counter low energy and depression, used for ADHD ppl to calm them
- alcohol - high doses block out unwanted feelings, low doses help connect to other people
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Greaves' Three Core Observations
- Sexuality - addicts have disturbed sex lives, dont get pleasure from sex, replace it with drug use
- Ability to play - dont know how to play without a drug, very few things hold their interest
- Somatic Experience - out of touch with their bodies
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Alcohol Use Disorder (11 criteria)
- 1. alcohol is often taken in larger amounts or over longer period of time than was intended
- 2. persistent desire or unsuccessful effort to cut down on alcohol use
- 3. great deal of time is spent in activities necessary to obtain alcohol or recover from its effects
- 4. craving or strong urge to use alcohol
- 5. recurrent alcohol use resulting in a failure to fulfill major obligations at work, school or home
- 6. continued alcohol use despite having persistent or recurrent social/interpersonal problems
- 7. important social, ocupational, recreational acitivities are given up or reduced bc of alcohol use
- 8. recurrent alcohol use in situations where it is physically hazardous
- 9. alcohol use is continued despite knowing that it causes problems
- 10. tolerance - need for increased amounts of alcohol to get the same effect
- 11. withdrawal - alcohol is taken to relieve or avoid withdrawal symptoms
- 12.
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Peer Cluster Theory
there is a strong association between peer drug associations and self drug use = 0.74
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Positron Emission Tomography (PET)
assesses rates of glucose metabolism to measure brain activity
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Single Photon Emission Computed Tomography (SPECT)
inject isotopes/ligands to measure brain blood flow
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Axon
single long fiber that transmits messages from cell body to other neurons or body tissues
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Dendrites
short fibers that recieve messages from other neurons nad relay them to the cell body
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Neurotransmission
the transfer of a message from an axon of one nerve cell to the dendrites of another nerve
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Synapse
the space between two neurons where chemical signals are released
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Neurotransmitters
chemical signals that stimulate or inhibit the firing of an electrical impulse in the recieving neuron's dendrites
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Dopamine
- originally seen as a pleasure molecule
- now known to be more of a motivating signal
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3 parts of mesolimbic dopamine system
- ventral tegmental area (survival oriented)
- nucleus accumbens (emotion-filled)
- prefrontal cortex (goal-oriented)
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Agonist
drug/medication that binds to receptor and activates the neuron
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Antagonist
drug/medication that binds to receptor and blocks the activation of the neuron
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The Hijacked Brain
- prolonged use/exposure changes brain functioning
- neurotransmitter levels are altered
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Basic Hypothesis of Greaves' Existential theory of drug addiction
alternative states serve an adaptive purpose, it is natural to pursue such states that kids are in touch with
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6 Motivations to Change
- 1. family/relational threat
- 2. job loss/economic damage/prestige threat
- 3. existential issues
- 4. legal issues
- 5. health concerns
- 6. role strain
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Anhedonia
loss of interest in something you used to be interested in because of dopamine depletion
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Hedonic Treadmill
keep seeking substances that will give a brief experience of pleasure even though it continues to shut down the pleasure system
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Which part of these brain can help fix hedonic treadmill?
the prefrontal cortex has to regulate the individual and stop the pursuit of pleasure
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Role of Prefrontal Cortex (PFC) + Executive Cognitive Functions (ECF)
directly involved in self-regulation, volition, purposefully directed behavior, ability of indiv. to resist influence
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Hypofrontality
- increased likelihood of impulsive behavior and greater focus on immediate gratification
- due to impaired PFC/ECF
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4 Routes of Administration (fastest to slowest)
- inhalation
- injection
- snorting
- ingestion
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How does genetics affect addiction?
- affects the degree of reward experienced
- affects the processing of the substance by the body
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DRD2
- dopamine receptor gene
- addicts have lower # of dopamine receptors in their brain
- this leads to increased vulnerability to substances that activate dopamine
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DRD4
- variant of dopamine receptor gene
- association found between this and novelty seeking (personality associated w alcoholism)
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ALDH2*2
- makes it harder to process alcohol
- serves as a protective factor
- mainly seen in Asians
- leads to a flushing sensation when they drink
- reduces the likelihood of developing alcoholism
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Cytochrome P450
- enzyme that metabolizes drugs
- variant of this gene leads to less efficient processing of nicotine
- people are less likely to become smokers
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Naltrexone
- medication used to treat problems with alcohol
- targets the opioid system (which is involved in the pleasure effects of acohol) -- dampens opiate activation -- makes drink less enjoyable
- more effective in patients with certain form of the opiate receptor
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Example of how social dominance is a protective factor
- monkeys were put in a social setting
- subordinate monkeys were in a stressful environment and had higher levels of D2 receptors than dominant monkeys
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6 most dangerous drugs
- alcohol
- heroin
- crack cocaine
- methamphetamine
- cocaine
- tobacco
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Proof that addiction is a chronic disease
- similar to other chronic diseases
- similar relapse rates as well
- treatment is long term, person will always be vulnerable to risk factor for the rest of their lives
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Attribution Theory
if person is held as more responsible for their predicament -- the more they are blamed and the less likely they are the be given pity/help
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Place Preference experiment with rats
- animals put in 2 distinct environments -- given a diff susbtance in each
- wall is removed, allowed to roam
- whichever side the rat favors, indicates the reinforcing properties of that substance
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Why are animals used to test dependence?
bc drugs that animals find reinforcing are likely to have a high abuse potential for humans
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Why do rats press more when given an agonsist?
- bc it blocks dopamine receptors
- since the agonist binds to the receptors and activates the neuron in its place
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Why do rats press less when given an antagonist?
bc it activates dopamine receptors
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Rat Park results
rats that lived in isolation drank high amounts of morphine and lived in a narcotic haze while those in rat park/colony housing barely ever touched the morphine
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What is the breaking point for a drug?
- the last # of times that the mice will press the lever for a drug
- determines the cost/price of the drug
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