Addictions. Assessment

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1 Addictions Assessment

2 What is Addiction?..a degree of involvement in a behaviour that can function both to produce pleasure and to provide relief from discomfort, to the point where the costs appear to outweigh the benefits...may be accompanied by recognition of the physical, social or psychological harm, and an expressed desire to reduce or cease the addictive behaviour, yet despite this change is not easy.

3 Historical perspective Moral model Disease model

4 Disease model of alcoholism Jellinek,, 1960 Progressive, irreversible and incurable disease locates within the individual alcohol precipitates craving with loss of control over drinking irreversible so abstinence is the only possible and necessarily lifelong, therapeutic goal extended to drugs other than alcohol

5 Substance dependence Edwards and Goss,1976 narrowing of drinking repertoire salience of drink seeking behaviour increased tolerance to alcohol repeated withdrawal symptoms relief or avoidance of withdrawal symptoms by further drinking subjective awareness of compulsion to drink reinstatement after abstinence

6 But evidence for loss of control = equivocal assumes cut-off between dependent and non- dependent minimizes situational and interpersonal factors

7 Psychiatric classifications DSM-IV Substance abuse Substance dependence Substances include alcohol, amphetamine, cannabis, cocaine, hallucinogens, inhalants(eg gas, glue, paint thinners), nicotine, opioids,, phencyclidine, and sedative, anxyolytic or hypnotic drugs. ICD alcoholism and drug dependence within category neuroses, personality disorders and other non- psychotic mental disorders

8 Loss of control = key concept of disease model 3 assumptions repeated drug use leads to tolerance when effects of drug wear off, the user will experience withdrawal symptoms, which are alleviated by taking the drug in conjunction with withdrawal is craving, a strong desire or compulsion to have the drug

9 Limitations of disease model the only cure is to abstain, Davies (1962) follow-up of 93 alcoholics who had been in abstinence oriented treatment years later 7 reported drinking in moderation without getting drunk or loosing control. Robins (1975) 470 returnees from Vietnam. 20% judged to be addicted to narcotics while in Vietnam but on return 95% remission rate

10 Limitations of disease model tolerance and withdrawal = situationally psychologically determined Merry 1966 orange + vodka vs orange alcoholics rated strength of craving for alcohol No sig. differences between 2 conditions lack of differences between addicts and non-addicts in personality type personality characteristics and

11 Factors that determine behaviour culture family lifestyle environment behavioural skills thoughts feelings physical factors

12 Psychological Approaches Classical conditioning Operant conditioning Opponent process theory Social learning theory Problem behaviour theory Expectancy theory

13 Classical Conditioning Heather & Robertson 1981 Craving UCS Waning blood alcohol UCR discomfort, irritability Returning home CS CR discomfort, irritability

14 Classical Conditioning in Relapse While Addicted Withdrawal symptoms Situational cues Drug use relieves symptoms Following Detoxification Return to former drug using environment Exposure to CS for withdrawal Conditioned withdrawal symptoms Craving Increased risk of drug use

15 Operant Conditioning Positive Reinforcement Buzz from alcohol Negative Reinforcement Relief of boredom Temporal association Positive immediate Negative delayed Discriminative stimuli Chaining

16 Opponent Process Theory Solomon 1980 a A state Drug use Pleasure b B state Withdrawal experience

17 Social Learning Theory Bandura 1977 Internal cognitive models to guide decision making and future actions Self efficacy Instruction Observation of others Own past performance Emotional arousal Abrams & Niaura 1987

18 Problem Behaviour Theory Jessor & Jessor systems of psychosocial influence Personality Environment Behaviour Proneness

19 Expectancy Theory Tolman 1932 Outcome expectancy Relation drinking with Physical Psychological Behavioural changes

20 Implications of psychological approaches to addiction no single explanation of addiction addicts no different from the rest of us no cut-off point for addiction addiction is not irreversible psychological theories not specific to addictive behaviours

21 Addictive behaviours motivated by short term gains involve diminished control over the behaviour

22 Risk factors for Initiation of Addictive Behaviours legal issues family influences peer influences behavioural factors deviant behaviours psychological factors - expectancies Farrell et al 1992 Correlation number of risk factors and use of drugs in adolescents.

23 Methods of Assessment Direct observation Interview Diaries Analogue assessments Psychometric tests Neuropsychological tests Biological tests

24 Short Opiate Withdrawal Scale

25 Self-monitoring Diary

26

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