Week 7 - Theories Flashcards
1
Q
What constitutes a psychological theory?
A
- describes behaviour
- makes predictions about future behaviours
- must have evidence to support the idea
- must be testable
2
Q
Why are theories important?
A
- Explains why a drug is more/less addictive:
- in one society than another
- for one individual and not another
- for the same individual at one time and not another
- Make sense of similar behaviour (e.g., compulsive)
- Explains cycle of increasing dysfunctional involvement with drugs
- Must be faithful to the lived human experience
3
Q
Moral model
A
- The ‘original’ model of addiction - temperance movement (mid 1800s)
- Addiction was viewed as a sin
- Users are characterised as ‘misfits’, ‘no-hopers’, or as objects of pity; dealers are routinely described as ‘scum’, ‘vermin’ or ‘an evil menace’.
- Punishment
- common theme is choice
4
Q
What do people with substance abuse struggle with according to the moral modal?
A
- make poor choices
- lack will-power
- unwilling to change their own lives
5
Q
Moral model concerns
A
- Stigmatisation
- Reluctance to reach out for help
- Decreased self-esteem
- Reinforces the tendency toward self-blame, self-hatred and a sense of extreme powerlessness.
- Work against the prospect of genuine change - diminishing motivation; avoid taking responsibility.
6
Q
moral model
spiritual model
A
- a disconnection from God or another higher power
- to overcome addiction, the individual must first establish a deeper connection with themselves, other people, and the broader world around them
- a Higher Power, a community of other
people in recovery, and a spiritual awakening, that allow people to overcome addiction
7
Q
Disease model
A
- Assumes that the origins of addiction lie within the individual.
- Medical viewpoint - addiction is a disease or an illness that a person has.
- Addiction - illness that results from an impairment of healthy neurochemical or behavioral processes
8
Q
what does the disease model believe?
A
- Addiction does not exist on a continuum – present or not
- Addicted people cannot control their intake.
- The disease of addiction is irreversible. It cannot be cured and can only be treated by lifelong abstinence.
9
Q
disease model
12 step model
A
- AA, NA, AI-Anon
- Alcoholism is “all or nothing”. Problem or no problem.
- Alcoholics are powerless over alcohol and experiences.
- Alcoholism cannot be “cured”, only managed.
- Disease is progressive and deterioration in condition is inevitable if drinking continues.
- Support through attending groups, peer support, submitting to a higher power.
10
Q
The 12-step program
A
- Admission
- Recognition
- Submission
- Understanding
- Confession
- Readiness
- Humility
- Reparation
- Apology
- Integrity
- Meditation
- Awakening
11
Q
Advantages of 12-step program
A
- drug use becomes a health issue and not just a legal issue
- allows ‘addicted’ people to understand their behaviour
- offers a treatment approach (abstinence) that works for some
- removes some of the shame often felt by people affected by addiction.
12
Q
Disadvantages of 12-step program
A
- removes responsibility from the user
- offers only one course of treatment (abstinence) which is not suitable for all people, particularly young people
- not supported by a large amount of evidence.
13
Q
Treatment outcomes of 12-step program
A
- greater friends
- spiritual connection
- finding meaning in life
14
Q
Neuroscientific/biological model
A
Focus is on the effects of drugs on the brain.
- Genetic characteristics
- Reward systems
- Neuro-adaption
15
Q
Genetic characteristics
A
- People may inherit an increased likelihood (vulnerability) of developing dependence on substances.
- no single candidate genes have been discovered directly related to addiction but may involve multiple genes or incomplete expression of several major genes
16
Q
examples of genetic characteristics
A
- Evidence suggest a relationship between tobacco-smoking and genes involved in dopamine regulation (Sabol et al., 1999).
- Brain’s cannabinoid system - variants of the CNRl gene were associated with cannabis, cocaine, and heroin dependence (Comings et al., 1997)
17
Q
Reward systems
A
- dopamine reward system
- endogenous opioid system
18
Q
neuro-adaptation
A
- Refers to changes in the brain that occur to oppose a drug’s acute actions after repeated drug administration.
- When drugs are repeatedly administered, changes occur in the chemistry of the brain to oppose the drug’s effects.
- When this drug use is discontinued, the adaptations are no longer opposed; the brain’s homeostasis is disrupted
19
Q
Psychoanalytic theories
A
- we can link problems to our childhood and how we cope (or don’t cope) as adults
- Basis of many counselling approaches
which aim to gain insight into an individual’s unconscious motivations and try to enhance their self-image - nature and nurture
20
Q
Psychoanalytic shared assumptions
A
- Drug use is a symptom of an underlying psychological disorder
- Indicates severe psychopathology
- Psychological problems are assumed to cause substance abuse, but not usually recognised as a consequence of use
- Addiction is considered a uniform disorder
21
Q
Unconscious processes that govern the id, ego, & superego (Freudian)
A
- Fixated at the “oral” stage
- Id – drive reduction theory.
- Ego – “self medication”
22
Q
Attachment styles (Bowlby)
A
- Secure
- Ambivalent-avoidant insecure
- Anxious-avoidant insecure
- Disorganised-insecure
23
Q
Personality theory
A
- Group of distinct personality characteristics that distinguish alcoholics/drug users from other individuals
- Predisposing factor (‘addictive personality’)
- Limited evidence of ‘addictive personality’
- Characteristics of personality attributed to addictive personality do not predict addiction, but rather can be the result of addiction
24
Q
personality predictors of drug use
A
- Behavioural disinhibition (impulsivity)
- Emotional negativity (negative mood, depressive PD)
- Sensation seeking
- Non-conformity
- Social isolation and tolerance for deviance
- Avoidance
25
How does psychodynamic theory view addiction?
self-regulation disorder:
* inability to recognise and regulate feelings;
* inability to establish and maintain a coherent, comfortable sense of self and self-esteem
* inability to establish and maintain adequate, comforting, and comfortable relationships;
* inability to establish and maintain adequate control/regulation of behaviour, especially self-care
26
Social learning models
- substance use is : learned and is functional
- based on the user's thoughts about the substance, and what it is like to be 'under the influence' of the drug
- focus on the interaction between the environment, the individual and the drug
27
Key points of social learning theory
* Anyone who engages in an activity that they find pleasurable is at risk of developing dependence on that activity.
* Dependence is a learned behaviour - results from conditioning, modelling and thinking about the substance.
* Dependence exists in degrees. The greater the dependence then the greater the negative feelings experienced in the absence of
the activity.
* Dependence is a normal facet of human behaviour. It only becomes a problem when the individual experiences a number of
negative consequences as a result of their behaviour, but continues to do it anyway.
* A sense of compulsion, of wanting to engage in a behaviour (such as drug use), but knowing that one really shouldn't, is the hallmark of addictive behaviour.
* Behaviours are only terminated when the individual makes the decision that the costs of continued use are vastly greater than the
benefits.
28
Social learning interventions
- focus on altering the client’s
relationship with their environment
personal factors <--> environment <--> behaviour
Example: Adolescents who view substance use in a positive light, whose peers use drugs, and whose parents and peers have attitudes that
condone substance use are more likely to use substances
29
Behavioural theories
- Only considers observable/measurable behaviour
- Behaviour is a consequence of learning
four types of conditioning:
1. Classical conditioning
2. Operant conditioning
3. Modelling
4. Tension reduction
30
Classical conditioning models
Sights, smells and sounds consistently associated with drug use elicit physiological and psychological responses that lead to drug seeking behaviour
- Conditioned stimuli (CS) – cues and triggers
- Conditioned response (CR) – physiological and
psychological responses
CS more important than CR
31
Operant conditioning
reinforcing properties of drugs, and the
likelihood of people repeating immediately pleasurable experiences (and avoiding unpleasurable experiences)
three reinforcement types:
1. Positive reinforcement (e.g., drugs can cause
pleasurable sensations)
2. Negative reinforcement (e.g., use to remove aversive experiences)
3. Punishment
32
Modelling
- People learn favourable attitudes and expectation about drinking based on how the behaviour is modelled.
- Increases the likelihood of pleasant experiences learned from others
- Maintenance associated with past associations with drug-taking environments/situations
33
Tension reduction theory
1. TENSION in society
2. Demands RELIEF
3. PROBLEM of elimination of reduction of conditions that create tension
4. PROBLEM of finding a mode for relief of tension
34
ABC's
Antecedents
- triggers
- situations
- thoughts
- feelings
Behaviour
- something the person does
Consequences
- Reinforcers – outcomes that maintain the
behaviour
- Payoffs
35
Cognitive & Cognitive-behavioural theory
- cognitive model
- expectancy theory
36
Cognitive model
* Focuses on the thoughts/beliefs, and impact on behaviours and feelings
* The way people interpret specific situations influences feelings, motivations and actions.
* Layers of beliefs – core beliefs / schemas
37
Layers of belief
Early experience --> Dysfunctional beliefs about self --> Critical incident --> Automatic negative thoughts
Symptoms:
* behavioural
* motivational
* mood
* thought
* physical
38
cognitive model cont.
- Conflicting beliefs (cognitive dissonance):
Conflict between the desire to use drugs and the desire to be free of drugs e.g. “I should not use alcohol” vs “It’s OK to have a drink just this one time”
- Leads to a cycle of behavioural, emotional and thinking
patterns
- Cognitive-behavioural: thoughts and behaviours are learnt and therefore can be ‘unlearnt’ (CBT)
39
Third wave psychotherapies, contextual CBTs
* Acceptance and Commitment Therapy (ACT)
* Dialectical Behaviour Therapy (DBT)
* Mindfulness-based relapse prevention
40
Key difference to traditional CBT
- emphasis on mindfulness and acceptance strategies to reduce the impact of internal triggers on substance use behaviour (e.g.,
altering the context and function so cravings, distress, or thoughts of using are less likely to lead to substance use).
- Taking a broad, functional approach to treatment, emphasising motivation and values-based strategies
- Transdiagnostic - effectively target key psychological problems commonly comorbid with substance use including depression,
anxiety and self-stigma
41
Expectancy theory
Addictive behaviours chosen over other behaviours due to our expectancies.
Two specific cognitions:
- Outcome expectancy – beliefs about effects and outcomes of using
- Self efficacy – belief in ones own ability to effect change
42
Motivation and change theories
- 'Transtheoretical’
- Increase the client's awareness of the potential problems caused, consequences experienced, and the risks faced as a result of the behaviour in question (AOD Framework 2014)
- Clients do not necessarily enter treatment committed to action and making changes
- Motivational interviewing (Miller) - intrinsic motivation is a necessary and sufficient factor to initiate behaviour change
43
Transtheoretical approach
precontemplation - no intention of changing behaviour
contemplation - aware a problem exists. no commitment to action
preparation - intent upon taking action
action - active modification of behaviour
maintenance - sustained change, new behaviour replaces old
relapse - fall back into old patterns of behaviour
44
family and systems theory; socio-cultural
Determinants of behaviour are based on an individuals role within a system
45
family & systems theory
- Determinants of behaviour are based on an individuals role within a system
- Focuses on society as whole and not just on individuals
- Many differing theories. Shared common elements:
Boundaries
Reciprocal causality
Homeostasis
Family based interventions eg ‘Stress coping’ perspective
Importance of placing emphasis on interventions for the system e.g., family therapy/involvement of significant
others, addressing stigma, poverty, poor housing, disadvantage etc
46
society as a role in drug use
- Family and other systems (e.g., peers) have role in initiating and maintaining substance use
- The type of society in which people live has an impact on their drug use. In particular, this model makes links between inequality
and drug use. It suggests that people who belong to groups who are culturally and socially disadvantaged are more likely to experience substance abuse problems.
- Because this model links substance abuse to the conditions of the wider society, importance is placed on interventions on the system rather than the individual.
47
Bipsychosocial theory
drug use is influenced by a combination of
biological, psychological, and social factors
Biology:
- physical health
- genetic vulnerability
- drug effects
Psychological:
- physical health
- coping skills
- social skills
- family relationships
- self-esteem
- mental health
Social:
- peers
- family circumstances
- family relationships
