Explain the Skinner box studies
- by Alexander in 2008
- rats became addicted to drugs made available
- above research used to support medical brain disease definition
Explain Dr. Bruce Alexander and Rat Park (Alexander, 2008)
- in 1970s
- rats in cages consumed much more drugs than those in rat park
- rats in cages put into park resulted in a decrease of intake
- “psychosocial integration” is helpful
- addiction as a response to psychosocial dislocation
- humans can feel psychosocial dislocated
- new definitions of addiction proposed
- definitions and theories have implications for solutions
Explain Dr. Bruce Alexander and Rat Park (Alexander, 2008)
- in 1970s
- rats in cages consumed much more drugs than those in rat park
- rats in cages put into park resulted in a decrease of intake
- “psychosocial integration” is helpful
- addiction as a response to psychosocial dislocation
- humans can feel psychosocial dislocated
- new definitions of addiction proposed
- definitions and theories have implications for solutions
Give stats of the study conducted by Robins et al., 1974 and Robins et al., 2010 (originally published in 1977) among “Army enlisted men”
- 35% of veterans in the sample reported using heroin in Vietnam
- 19% experienced addiction to heroin
- 54% of all veterans in the sample who used heroin in Vietnam became addicted to it in Vietnam
- 75% of all veterans in the sample who used heroin >5 times in Vietnam became addicted in Vietnam
What percentage of the US veterans were found to experience addiction any time within first year of their return to the US?
1%
Of the US veterans who were addicted to heroin in Vietnam, what percentage experienced addiction at any time within the first 3 years after their return to the US?
12%
- transition from war to society
Review Lopez Quintero et al., 2011 Study
- Estimated cumulative probability of dependence remission
- “…defined as the proportion of individuals that achieve remission by a specified time point or interval”
— included: nicotine, alcohol, cannabis, and cocaine dependence - used data from nationally representative sample of US adults (n=43093)
- lifetime cumulative probability of dependence remission:
— nicotine (84%)
— alcohol (91%)
— cannabis (97%)
— cocaine (99%) - Duration of time for approx. 50% of dependence cases to remit:
— nicotine: 26 years; Alcohol: 14 years; Cannabis: 6 years; Cocaine: 5 years
Review philosophical considerations
- longstanding debate among philosophers: Do we have free will?
Viewing addiction as a disease of the will brings up philosophical questions
- is free will truly usurped and destroyed by addiction?
the common understanding (medical view) is as a disease that overrules willpower and the ability to control behaviour
- controversial because of counter-evidence (some people stop and in recoverY)
Review the hisotrical perspective
social science and history can provide a corrective lens
- addiction sometimes viewed as a “modern plague”, without recognition of historical context
- we can see cycles of “drug scares” and moral panics related to different substances (some more real and lasting than others)
- reefer madness, concerns about LSD (1960S), PCP (1970s), crack cocaine (1980s) - even alcohol in the early 1900s (1920s)
What does Virginia Berridge (historian) draw attention to?
- draws attention to context and changes in understanding of addiction over time
— consumption of substances is linked to broader trends in culture, patterns of use that evolve
— sometimes brought on by medicine (like Miltown), fostering use and dependence
What does “Frankenstein narrative” (Mike Jay, 2000) show?
- medicine/doctors promote a substance, then later restrict it
- particularly true for pharmaceutical drugs (like alcohol, cocaine, morphine) which were subsequently demonized
*history helps use see that addiction is not solely an individual-level phenomena, but a societal problem and issue
What does Deaths of despair involve?
- involves increase in deather from drugs, alcohol, and suicide
Who was the Deaths of Despair first coined by?
- first coined by Anne Case and Angus Deaton (economists) to describe increase in deaths related to drugs, alcohol, and suicide among manual workers in the US (Case and Deaton, 2017, as cited in King et al., 2022)
What did the Deaths of Despair argue to be?
- argued to be a consequence of lacking a meaningful life as a result of social/economic changes (ex. deindustrialization -> lower pay/benefits, unemployment, community and family disintegration -> stress)
What are the current treatment options?
Modern approaches use psychotherapy to address the addictive behaviour directly
- Cognitive behavioural therapy (CBT)
- Motivational Enhancement Therapy (MET)
- Social Behavioural Network Therapy (SBNT) and
- further therapy and work may be needed to address underlying psychological problems involving anxiety, depression and prior trauma (as comorbidities, drivers of substance use, or causes)
- history of adverse childhood experiences (ACEs) (particularly physical, emotional, sexual abuse) are demonstrated to increase vulnerability to addiction/substance use
- some genetic factors may play similar role
- medication (may be used to support abstinence, reduce use, or risk)
What does medications used in the treatment of substance use include?
- include opioid agonist treatment (ex. methadone or buprenorphine for the treatment of opiate addiction)
- have also been referred to as opiate replacement therapy or maintenance therapy/treatment
What is the goal of the current treatment options?
- eliminate illicit substance use, increase social stability (ex. housing), reduce overdose and negative health outcomes, including transmission of blood-borne viruses (HCV, HIV)
What is prescription heroin also sometimes used in the treatment of??
What does research indicate about this approach?
- sometimes used in the treatment of opioid dependence
— pharmaceutical grade heroin (or other opioids) prescribed and dispensed for use (usually via injection) in supervised clinical environment
- research indicates this approach reduces health, legal, and social problems stemming from dependency
- not recognized as treatment by abstinence perspective or NA, due to continued substance use (although in medical context)
— now conversation has shifted to “safe supply”
What may the treatment of opioid dependence involve?
- may involve detoxification in conjunction with opioid antagonists (like naltrexone) - may be used together with psychosocial support interventions
What does Naltrexone block?
- blocks the effects of opioids = no high/euphoria
— brand names: ReVia, Vivitrol, and Depaide
— may be used in treatment of alcohol dependence - also, residential rehabilitation for prolonged duration is common (may or may not involve/allow medications) - many of these centres are founded on 12-step priniciples
What are medications to manage alcohol dependence used for?
- used as adjunct to psychotherapy, and relapse management is a key priority
- some support reduced consumption (nalmefene), other abstinence (cessation) including disulfiram, naltrexone, and acamprosate
What things are though to ha ve potential to overcome addiction?
- hallucinations, spiritual experiences, and intense self-reflection
— patients thought to gain considerable perspective into harmful consequences of their drinking - above treatment also included patients being encouraged to join AA or religious services
- success rates reported to be 50-90%
- current research n ow uses LSD and psychedelic mushrooms, and other hallucinogens, in treatment
What have the international governments largely applied?
- largely applied a criminal justice approach to drug use, which may undermine medical or therapeutic approaches by marginalizing, criminalizing, and stigmatizing people who use drugs (PWUD)
What did the War on Drugs attempt to end?
- attempted to end the international trade in drugs by directing military and police resources towards eliminating trade and consumption of drugs
— although this has been a decades-long and expensive endeavor, there is little evidence that it has met its objectives: drug use remains widespread, and drugs are available
— extensive unintended consequences and harm stem from prohibition
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Lecture 247
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Lecture 532
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Lecture 670
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practice questions17
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