Earleywine Substance Use Problems

2. Auflage 2016
ISBN: 978-1-61334-416-3
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 104 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

The literature on diagnosis and treatment of drug and substance abuse is filled with successful, empirically based approaches, but also with controversy and hearsay. Health professionals in a range of settings are bound to meet clients with troubles related to drugs – and this text helps them separate the myths from the facts. It provides trainees and professionals with a handy, concise guide for helping problem drug users build enjoyable, multifaceted lives using approaches based on decades of research. Readers will improve their intuitions and clinical skills by adding an overarching understanding of drug use and the development of problems that translates into appropriate techniques for encouraging clients to change behavior themselves. This highly readable text explains not only what to do, but when and how to do it. Seasoned experts and those new to the field will welcome the chance to review the latest developments in guiding self-change for this intriguing, prevalent set of problems.

Zielgruppe

For clinical psychologists, psychiatrists, psychotherapists, and counselors, as well as students.

Autoren/Hrsg.

Earleywine, Mitch

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Suchttherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Pharmakologie, Toxikologie

Leseproben

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The Biopsychosocial Model of Drug Problems
Etiological work on substance-related problems can inform treatment in helpful ways. It has generated prevention and intervention efforts that address issues as large as international policy and as small as pharmacotherapies that focus on individual neurotransmitter systems. Theories of drug problems have a long history, beginning with conceptualizations that relied on evil spirits, moral weakness, and complex intrapsychic conditions that proved impossible to measure. Many early theories emphasized a particular domain of contributors to the exclusion of others, making them inadequate in their account of problems. A myopic, restricted focus on any one dimension, whether spiritual, medical, psychological, or societal, led to missing important aspects of problems. Treatments based on these theories invariably neglected aspects of the person and failed to improve associated problems. An alternative approach designed to encompass more of the potential contributors to drug problems developed in an effort to account for the multifaceted nature of human experience – the biopsychosocial model (Mosey, 1974; Skewes & Gonzalez, 2013). The predominant model of drug problems attempts to incorporate findings from disparate literatures ranging from the cellular to the societal. These efforts to explain substance use and related problems have interesting implications for prevention and treatment, and advantages over previous work that focused exclusively on single domains. The heterogeneity of drug-related disorders makes constructing an all-encompassing model quite challenging. The different interacting biological, psychological, and social contributors can be easier to understand in light of different stages of drug use (see Figure 2). Different facets of each contributor can have a different effect on each of these stages and the transition from one stage to the next. One way to view stages of drug use begins with no use and extends to problematic use as well as treatment outcome. The vast majority of people begin life with little exposure to drugs. A subset of those initiate drug use depending upon various factors. A group of those people continues subsequent use of drugs. A subset of this group then develops problems. A handful of these people receive treatment, with a variety of outcomes. The transitions from no use to problematic use to treatment outcome each rest on different kinds and degrees of biological, psychological, and social variables. |22| Figure 2 A biopsychosocial model of substance use. 2.1 Interacting Components
As the name suggests, the biopsychosocial model rests on potentially heritable physiological components. Some research suggests that substance use disorders can run in families, and twin studies support a contribution of genetics (Agrawal & Lynskey, 2008; Hicks et al., 2007). The heritable component might include genes that contribute to out-of-the-ordinary neurotransmitter function, drug metabolism, or sensitivity to stimuli. These qualities alone need not be deficits; in fact, they may provide distinct advantages in certain settings. Inheriting a novel desire for adventure or a tendency to avoid harm might prove adaptive in some environments but lead to drug problems in others (Advokat et al., 2014). Because substance-related disorders are among a handful in the DSM-5 that require something outside of the individual (in this case, drugs) for the diagnosis, the psychological, social, and societal components can prove particularly important. Currently, there is no research to support that a single gene or biological factor predicts the future occurrence of drug problems (Buckland, 2008). In addition, some situations might lead to drug problems regardless of an individual’s biological makeup such as familial and behavioral factors. Repeated exposure to some drugs, particularly the opiates, almost invariably leads to small increases in tolerance and withdrawal regardless of physiological variation among people. Diagnosable symptoms only arise as a result of a combination of these physiological, psychological, and social factors. |23|2.2 Initiation
Separating who will and who will not try a drug depends upon a complex set of biological, societal, and psychological phenomena. The majority of the work on the initiation of drug use looks at school-aged youth. Generally, the availability of the drug, personality, family functioning, socioeconomic stressors, trauma, parental attitudes and use, peer attitudes and use, religiosity, alternative reinforcing activities, and psychopathology contribute. The biological component of initiation may rest on the heritable tendency to seek thrills or fail to control impulses as well as any genetic propensity toward disorders that frequently covary with drug problems. Social policies that create uncontrollable underground markets and various forms of social stressors may put some citizens at particular risk. Modeling from family members, peers, and media alter expectancies and attitudes about drugs. Potential buffers against initiation include religious observance (Salas-Wright, Vaughn, Hodge, & Perron, 2012), academic successes, and participation in extracurricular activities like organized sports and clubs (Pope, Ionescu-Pioggia, & Pope, 2014). These biological, societal, and psychological factors are rarely assigned to people at random, so spurious links between some of these variables and drug problems may exist. In addition, the specificity of these factors to drug problems in particular is probably low. These conditions predict not only the initiation of drug use but a host of other problem behaviors, including aggression, unsafe sex, teen pregnancy, and school dropout (Clayton, Segress, & Caudill, 2008). 2.3 Regular Use
Multiple biological, psychological, social, and societal factors interact to influence the transition from initiation to regular use. A promising candidate for what seems to be inherited is the biological predisposition for a response to the drugs themselves. Several lines of research suggest that individuals vary dramatically in their acute responses to drugs. Even morphine and oxycodone, opiate drugs with legendary reputations for producing euphoria, actually delight some users while nauseating others (Zacny & Lichtor, 2008). Hangover and acute withdrawal from drugs also appear to vary with biological factors. These withdrawal symptoms may motivate subsequent use to alleviate distress in some individuals, but turn others away from the drug completely. These physiological reactions that appear after the first initiation of drug use contribute to repetition of use. A number of opiate users describe their first use in idealized terms. Nevertheless, a minimal or even adverse initial reaction alone might not buffer an individual against becoming a regular user. Social factors may override these biological reactions in interesting ways. A number of Asian drinkers report aversive flushing in response to their first exposure to alcohol, but social pressures led to continued consumption (Nakawatase, Yamamoto, & Sasao, 1993). Comparable fast flushing can appear in Native Americans, some of whom drink problematically despite the aversive experience (see Ehlers, Liang, & Gizer, 2012). Most first-time users of cannabis claim little or no effect but regular users claim they persisted in the absence |24|of a positive experience because other users were so effusive about the plant’s effects. Stories of initial uses of cigarettes usually include queasiness and vomiting. Those who continued to use despite these experience often claim that they did so because friends emphasized that the experience improved. Research suggests that biological factors may contribute not only to the acute effects of drugs but also to the subsequent craving for these drugs (Adinoff, 2004). These factors may also contribute to the transition to regular use. 2.4 Problem Use
The subsequent change from regular use to problem use also depends on various biological, psychological, and social factors. A physiological disposition might separate those who are prone to drug-induced health problems of many types. The tendency to develop symptoms also appears heritable. In addition, psychological aspects of personality, stress reactivity, and expectancies play an important role in the development of troubles. For example, regular use tends to escalate to problems more rapidly in women than in men (Becker & Hu, 2008), potentially for a combination of physiological,...