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Next - Psychology & Neuroscience of Addiction [Private] > Historical perspectives on drug use and addiction; diagnosing addiction > Flashcards

Historical perspectives on drug use and addiction; diagnosing addiction Flashcards

1
Q

What led to the ‘moral model’ of addiction?

A

Attempts by religious groups to control excess

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2
Q

What was the principle of the ‘moral model’ of addiction?

A

Drunkenness = sin

  • self-directed change demanded of the “sinner”
  • failure resulted in intensified prayer or punishment
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3
Q

What characterised the ‘gin craze’ of the 1730s - 1740s in Great Britain?

A

Fast importation of gin which was becoming the drink of the poor

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4
Q

Which idea did physicians raise in early 19th century?

A

Habit of drunkenness as a disease of the mind

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5
Q

Who first used the term ‘alcoholism’?

What was its meaning?

A

Dr Magnus Huss (1851)

  • alcoholism: disease relating to overconsumption of alcohol
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6
Q

What did the emerging educated middle class in victorian society against intoxication and drunkenness?

A

Moral causes to improve the health of the working poor

  • intoxication / drunkenness not compatible with workers using machinery
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7
Q

What was the Temperance movement (19th century)?

A

Philanthropic lobby group that formed strong alliances with the Church to praise mass abstinence

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8
Q

What was the Society for the Study and Cure of inebriety (19th century)?

A

Provided a place for temperance performers, physicians and public health doctors to discuss the problem of excessive alcohol consumption

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9
Q

How was the ‘medical model’ of addiction born?

A

With the Society for the Study and Cure of inebriety (19th century):

  • temperance performers, physicians and public health doctors discussed the problem of excessive alcohol consumption
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10
Q

What came with the emerging ‘medical model’ of addiction (19th century)?

A

> First attempts at treatment:
- secluded the inebriate in houses in the countryside

> Moral component still present
- worthy vs. unworthy drunk (case vs. non-case)

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11
Q

How was the term ‘alcoholism’ used with the new medical model of addiction?

A

To describe a worthy person suffering from a progressive disease, and who required help

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12
Q

How did the Temperance movement use the term ‘addiction’?

A

Narrow moralised and medicalised meaning

  • limited to drinkers
  • always morally reprehensible
  • referred to progressive disease
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13
Q

What was the leading image of addiction the late 19th and early 20th century in Great Britain?

A

According to Temperance movement:

  • limited to drinkers
  • always morally reprehensible
  • referred to progressive disease
  • “overwhelming involvement”
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14
Q

How did the definition of addiction evolve in the mid-20th century?

A

Large scope, encompassing all socially unacceptable uses of alcohol and other drugs

-> less precise definition

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15
Q

What does the “loss of the soul” refer in addiction?

A

People don’t just change what they do, they change who they are

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16
Q

What are the four descriptions of the term “addiction” described by Bruce Alexander in ‘Globalisation of Addiction’ (2008)?

A
  1. Multitude of habits and pursuits related only to alcohol
    - narrow definition used by Temperance movement
  2. Any use of prohibited substance
    - rising psychoactive drugs in 20s
  3. Gambling and other behaviours
    - emerging scientific evidence
  4. Behaviours that are not considered part of treatable illness
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17
Q

How can we measure problems?

A
  1. Categorical measurement
  2. Ordinal measurement
  3. Dimensional measurement
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18
Q

What does the categorical classification system consist of?

A

> Assessment of presence or absence of an attribute
or
Selection of best category for an individual from a set of options

-> process of diagnosis (= basis of medicine)

19
Q

What does the dimensional classification system consist of?

A

Quantitative assessment of specific attribute along a continuum of intensity, frequency, or severity

  • e.g. blood pressure, symptom level, personality traits
20
Q

What does the ordinal classification system consist of?

A

> Categories that are ordered

  • e.g. low, medium, high
  • > refines the diagnostic system

> “Cut points” can be used to convert scales into ordinals
- indicate thresholds for membership in a category

-> Practical compromise between categorical and dimensional

21
Q

What are the three prominent reasons to make a diagnosis?

A
  1. Better communication between professionals and patients
  2. Helps guide treatment
  3. Informs prognosis
22
Q

What is a syndrome?

A

A clustering of signs and symptoms

23
Q

How does a syndrome permit clinical recognition?

A

Signs and symptoms must be sufficiently regular and coherent

24
Q

What was the consequence of the lack of quantifiable data on diagnosis?

A

Vague and poorly defined relationship between symptoms and diagnosis

25
Q

What was needed to counter the lack of quantifiable data for diagnosis?

A

Standardisation of diagnosis through ‘operational definitions’

26
Q

What did the US-UK Diagnostic Project (Cooper et al., 1972) reveal?

A
  • Psychiatrists in New York and London were given vignettes to diagnose
  • New Yorkers were twice as likely to diagnose schizophrenia
  • because they used a broad psychodynamic concept of diagnosis

-> need of standardisation of diagnosis

27
Q

What are the two major diagnostic standards?

A
  1. Diagnostic and Statistical Manual of Mental Disorders (DSM)
    - APA
  2. International Classification of Disease (ICD)
    - WHO
28
Q

How was substance use characterised in the DSM (1952)?

A

Alcoholism, drug addiction grouped in deep seated personality disturbance

  • no clear symptoms defined
  • “underlying brain or personality disorder”
29
Q

How was substance use characterised in the DSM-II (1968)?

A

> Still characterised as personality disorder

> Addition of:
- physiological signs of dependence (withdrawal/tolerance)

> Based on Jellinek’s ‘The disease concept of Alcoholism’ (1960)

30
Q

How did Jellinek classify alcoholism (alcohol abuse) (1960)?

A

In term of severity:

  • Alpha
  • Beta

> Full syndrome of physiological and psychological dependence

  • Gamma
  • Delta
  • Epsilon
31
Q

Who was Griffith Edwards (1928-2012)?

A

Considered father of addiction psychiatry in the UK

32
Q

How did Griffith Edwards define alcohol dependance in ‘The Description of the Alcohol Dependance Syndrome’ (1976)?

A

Medical definition: Alcohol Dependance Syndrom (ADS)

  • Narrowing of drinking repertoire
  • Salience of drink-seeking behaviour
  • Relief from symptoms when drinking
  • Increased physical tolerance to alcohol
  • Repeated withdrawal symptoms when abstaining
  • Reinstatement (relapse) after abstinence
  • Awareness of compulsion to drink
33
Q

What are the two separate diagnoses defined with the work of Griffith Edwards (1976)?

A

Alcohol abuse vs. Alcohol dependence

34
Q

How were alcohol abuse and alcohol dependence differentiated?

A

With a spectrum:
> Proper use

> Hazardous use
- use of drug other than directed

> Misuse / abuse

  • problematic behaviour
  • use in risky situations
  • use despite adverse consequences

> Dependence
- at least 3 features of alcohol dependence syndrome (ADS) as stated by Griffith Edwards (1976)

35
Q

How was substance use characterised in the DSM-III (1980)?

A

> First category for substance use disorders

> Abuse and dependence considered two separate conditions

36
Q

How was substance use characterised in the DSM-III-R (1987)?

A

Addition of behavioural and physiological aspects given equal weight

37
Q

How was substance use characterised in the DSM-IV (1994)?

A

> 12 classes of drugs

> Problems
- e.g. intoxication, withdrawal, dementia, amnestic syndrome, psychotic/mood disorders

> Clear separation of abuse and dependence

38
Q

How was substance use characterised in the DSM-IV-TR (2000)?

A

> Specific number of criteria required for criteria

> Problem of “diagnostic orphans”

> Abuse = pejorative term

> Dependence = physiological adaptation

39
Q

What characterises the diagnostic criteria of alcohol abuse in the DSM-IV?

A

Abuse is inferior to dependence

- it has no criteria of dependence

40
Q

What characterises the criteria of alcohol dependence in the DSM-IV?

A

Maladaptive pattern of alcohol abuse, leading to clinically significant impairment or distress, manifested by 3 or more occurring during the same 12-month period:

  • Tolerance
  • Withdrawal
  • Impaired control
  • Neglect of activities
  • Time spent drinking
  • Drinking despite problems
41
Q

What was discussed by Hasin et al. (2013) in their review on substance abuse criteria in the DSM-5?

A
  1. Should abuse and dependence be kept as separate diagnoses?
    - Item Response Theory analysis
    - > no
  2. What should the diagnostic threshold be?
    - Categorical system needed because diagnosis is key in medicine
    - > set a number of symptoms as criteria
  3. How should severity be represented?
    - As criteria count increases so does likelihood of SUD risk factors and consequences
    - > use criteria count (2-11) as overall severity indicator
42
Q

What characterises the definition of substance use disorder in the DSM-5 (2013)?

A

> 11 criteria

> term “addiction” is not used at all

> Severity of disorder:

  • 2 to 3 symptoms present in last year = mild
  • 4 to 5 = moderate
  • 6 and more = severe
43
Q

What is addiction?

A

Disorder involving loss of the normal flexibility of human behaviour, leaving a dehumanised state of compulsive behaviour

44
Q

Why was the term “dependence” removed from the latest version of the DSM regarding addiction?

A

Confusion around the terminology:
- dependence used for severe end of spectrum

  • BUT may refer to physiological aspects of addiction

Next - Psychology & Neuroscience of Addiction [Private] (14 decks)

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