Different Views On Substance Dependece, Abuse and Addicition – Essay
Substance addiction, or substance dependence is the compulsive use of drugs, to the point where the user has no effective choice but to continue use. (Wikipedia 2005)Substance abuse refers to the overindulgence in and
dependence on a stimulant, depressant, or other chemical substance, leading to effects that are detrimental to the individual’s physical or mental health, or the welfare of others. (Wikipedia 2005)
Historically the terminology surrounding drug use has been unclear and little concise. It was usual to distinguish between physiological and psychological need.If the drug altered the internal chemistry of the body to the point where the normal state was the dug state, it was called an addiction. However, if it was the abuser that centred his or her life on the procurement and use of the drug, it was called psychological dependence. (Alloy et al 1999)
These definitions have not been embraced by all medical and psychological professions. It was discovered that all psychoactive drugs had both a psychological and a physiological effect. The Diagnostic and Statistical Manual of Mental Disorders (DSM) reserve the term dependence to conditions that specifically involve addiction, and call it psychoactive substance dependence. It also suggests nine criteria that include both physiological and psychological consequences and a person that fulfil any three of these nine come under the diagnosis mentioned. (Alloy et al 1999)
The nine criteria listed by DSM-III-R. (Alloy et al 1999, Wikipedia 2005)
1. Preoccupation with the drug.
2. Unintentional overuse.
3. Tolerance.
4. Withdrawal.
5. Relief substance use.
6. Persistent desire or efforts to control drug use.
7. Pattern of drug-impaired performance in social or occupational circumstances or when dug use is dangerous.
8. The abandonment of important social, occupational or recreational activities for the sake of the drug.
9. Continued drug use despite serious drug-related problems.
The DSM also distinguishes between dependence and abuse, drawing up the parallel diagnosis of psychoactive substance abuse. This is when the use of the drug is at an abnormal level, but not yet a dependency issue. A person that continue to use a drug even if it had a (1) social, occupational, psychological or physical impact, or continued to use it in physically dangerous situations. (Alloy et al 1999, Wikipedia 2005)
The three terms substance dependence, substance addiction and substance abuse, are hence melted down to the two diagnoses of psychoactive substance dependence; including the elements of dependence and addiction, and psychoactive substance abuse. (Alloy et al 1999)
In this essay alcoholism will be used as an example on substance abuse/dependence, as it is a common and easily accessible substance.
The behaviourists view alcoholism as a powerful habit that is maintained by various cues and consequences. What is the primary reinforcer is debated, but suggestions like social acceptance, reduction of psychological tension and avoidance of psychological withdrawal symptoms have been made. (Alloy et al 1999)
The behaviourists believe in two theories for substance abuse and addiction. The first one is the tension-reduction hypothesis, and the other is the opponent process theory.
The tension-reduction hypothesis assumes the dynamics of alcoholism to be rooted in personal troubles faced by all. However some people are inclined to have a drink to alleviate the stress and discomfort, and if successful alcohol has a positive association. However, excessive drinking may cause stress and discomfort, manifested as guilt, and a viscous cycle is started. (Alloy et al 1999)
Behaviourists have identified high risk and low risk persons based on personality scores. A person with outgoing, aggressive, impulsive and antisocial features where considered at higher risk for alcoholism, also the situation is critical to stress- handling. (Alloy et al 1999)
The “opponent process” theory also offers explanations on addiction plus tolerance and withdrawal. It states that the human brain is organised such that any strong emotional state, regardless if it is pleasant or unpleasant, will elicit the opposite state (opponent process) to suppress and counteract the original state and that this mechanism will strengthen over time. (Alloy et al 1999)
The theory states that after a while the relaxation with drinking (state A) will be cancelled out by underlying tension and irritability (state B or opponent process). Then state B will be experienced directly as withdrawal symptoms. (Alloy et al 1999)
The early behavioural programs for alcoholics relied on aversion conditioning. They had initial success, but suffered from heavy relapse rates. Currently programs look into inadequate coping skills, such as unemployment and marital conflicts, and try to remedy these problems. (Alloy et al 1999)
The cognitive theories has been developed by amongst others, Jean Piaget and Albert Ellis. (Wikipedia 2005)
The cognitive theories view alcoholism as motivated and maintained by negative reinforcement, much like the behaviourists. However they focus on cognitive processes such as expectations, self-evaluations and attributions perceived as mediators for alcohol abuse. There are three theories; expectancy theory, self-awareness model and self-handicapping strategy. (Alloy et al 1999)
The expectancy theory focuses on the expectations of the effect of alcohol, as a critical component in whether people will use or abuse alcohol. These alcohol expectations are developed through parents, peers, television and movies and together they from a schema. This schema will determine how that individual will respond to drinking. (Alloy et al 1999)
The use of alcohol is also influenced by positive or negative expectancies, such as enhancement of social/physical pleasure, increase power and aggressiveness, and impairs performance and encourages irresponsibility. Hence if the positive expectancies outweigh the negative people will drink. This theory may be good at describing why people begin to drink, but not why they continue, as the expectations between drink number 1 and 10.000 will change. (Alloy et al 1999)
The self-awareness model proposes that alcohol is used to disrupt information processing, and decrease self-awareness. It can be used in two ways; firstly if self-awareness involves negative feelings, then suppression of self-awareness will be negative reinforcing. Secondly alcohol can disinhibit and enable the person to flirt or be funny, a positive reinforcement. This theory however describes the alcoholic as reflective, self-focused and sensitive to criticism. Empirical findings describe an alcoholic as aggressive, extroverted and undercontrolled. (Alloy et al 1999)
The self-handicapping model reasons that the alcoholic will drink if placed in a situation where he is likely to fail. The drink will be his excuse to fail, shifting the blame form themselves to the alcohol. There is no proof that this model leads to alcoholism, but it ties well in with both the expectancy theory and self-awareness model. (Alloy et al 1999)
Treatments the cognitive way aim to attack the cognitive variables that are faulty. This is done by changing expectancies, increase sense of competence and teach ways of coping with failure. A mixture of cognitive restructuring and behavioural techniques are used. Attention is also given to prevent relapses, correcting how alcoholics handle slips so that it does not lead to a total relapse. (Alloy et al 1999, Wikipedia 2005)
Sigmund Freud came up with the idea and developed psychoanalysis between 1888 and 1939. Psychoanalysis divides the human personality into three entities; the id, the ego and the superego. It is in the focus between the aggressive pleasure-seeking biological impulses and the internal social restraints against them that the human psyche is formed. Freud believed that personality is the result of trying to resolve this conflict, and to bring pleasure without also bringing guilt and punishment. (Meyers 1998, Wikipedia 2005, )
Freud theorised that this conflict is centred on the three systems: id, ego and superego. (Meyers 1998, Wikipedia 2005, Hayes 1994)
The id is always trying to satisfy the basic drives and instincts. It is a reservoir of unconscious energy that constantly drives the human to aggress, survive and reproduce. The id operates on the pleasure principle and has to be restrained by reality so that it will not seek immediate gratification whatever the consequence. (Meyers 1998, Hayes 1994))
The ego is the controller of the id. It operates in the reality principle, and seeks to gratify the id’s impulses. However, the ego will only do this if it is a realistic way of realisation and it will not bring destruction or pain. The ego hence contains the partly conscious perceptions, thoughts, judgements and memories. (Meyers 1998, Hayes 1994))
The superego operates on how things ought to be. It forces the ego to consider not only the real, but also what is ideal. It strives after perfection, and judges any action producing either positive or negative feelings. As the id’s demands are often the opposite of the superego, the ego in the middle struggles to reconcile the two. (Meyers 1998, Hayes 1994))
People with a present rather than a future time perspective is what Freud would have called id dominated persons. This is a personality type that more often use/overuse tobacco, alcohol and other drugs. They are willing to jeopardise future happiness for instant pleasure. (Meyers 1998, Hayes 1994))
The humanistic perspective came as a reaction to the negativity of Freud. They focused on how healthy people live and strive for self-determination and self-realisation, and emphasised on the growth potential of healthy people. The emphasis was on the free will and that people play an active role in determining how they act. The two leading theorists in the humanist movement are Abraham Maslow and Carl Rogers. The humanistic approach has been criticised for promoting an optimistic but often vague view of the mind. (Meyers 1998, Wikipedia 2005, Hayes 1994))
Maslows theory proposed a hierarchy of needs. To move to the next level in the hierarchy a person had to fulfil his or her needs at the level they are. The different levels are seen in figure 1. (Meyers 1998, Hayes 1994))
Figure 1: Maslow’s Pyramid
The ultimate goal for a person is to seek and achieve self-actualisation, fulfilling the person’s whole potential. Another way to view the pyramid is that one can achieve higher levels on the pyramid in some areas, but still try to cover the lower areas in other aspects of life. (Meyers 1998, Hayes 1994))
Alcoholics may find themselves trying to meet their physiological needs, when it comes to alcohol. If the alcoholic in addition lives on the street, safety needs are not met either. However, if the alcoholic is well-educated has a good job and income, then maybe it is the social needs or self-esteem needs that are not covered. (Meyers 1998, Hayes 1994))
Rogers believed that healthy people could satisfy their need for positive regard and self-actualisation, and being in a constant process of self-development and psychological growth. (Meyers 1998, Wikipedia 2005, Hayes 1994))
If people lack this positive regard from others they will be mentally ill, and afraid of what they do may meet disapproval from others. They will constantly feel they have to gain positive regard from others, and their self-concept impossible to live up to. (Meyers 1998, Hayes 1994))
The person will then be torn between true inner self and outer self. This battle Rogers believed could lead to both neurosis and psychosis. It is then up to the therapist to establish this relationship of unconditional positive regard. (Meyers 1998, Hayes 1994))
The different theories and models described, all aim at different aspects of the human psyche and how substance abuse and dependence might be explained. It is such a complex theme that I feel it is unlikely that any single one of these theories have the full answer. Not being a psychologist I would say it is more likely to view a patient bearing all the theories in mind, and using the different theories to explain different areas of the abusers/addicts mind. However, should I pick one I feel is the best model, I would have to go with the behavioural view. I feel it encompass a lot of the issues, and that with this approach the other theories can be used in conjunction when appropriate.
I feel that behaviour is quite essential to how a person end up, and that the environment is a strong influence. To change a habit of abuse and addiction is also to change behaviour.
Word Count: 2010.
Reference:
Myers D.G. (1998), Psychology, 5th edition, Worth Publishers
Alloy, Jacobsen, Acocella (1999), Abnormal Psychology: Current Perspectives, 8th edition, McGraw Hill
Hayes N. (1994), Foundations of Psychology an Introductory Text, 1st edition, Routledge
http://en.wikipedia.org/wiki/Personality_psychology#Humanistic_theories
http://en.wikipedia.org/wiki/Personality_psychology
http://en.wikipedia.org/wiki/Humanistic_psychology