Episodic intoxication in traditional societies
•Substance use known throughout time and cultures •Limited access – psychoactive substances are
rather rare and expensive •Heavy societal control for who, when and where can have access to. E.g.:
•heavy drinking during festivals and important social situations
•altered states of mind during religious rituals
•use for medical purposes (e.g. pain relief)

https://s-media-cache-ak0.pinimg.com/originals/5a/24/9f/5a249f35cb3b98db5d1a4b669d1f2bcd.jpg



Epidemic spread of drugs
•16th century
•New discoveries and globalisation of trade
•Cheap and slave labour
•Advancement in agricultural technology
•Intensification of substances – more potent, cheaper, easily transportable, available worldwide
• 1) introduction of tobacco in Europe and Asia, 2) export of cheap alcohol to Europe, 3) export of
opium to far east Asia and Europe
•First attempts to solve the problem: taxation and market limitation

https://upload.wikimedia.org/wikipedia/commons/thumb/b/b6/Opium_imports_into_China_1650-1880_EN.svg
/1280px-Opium_imports_into_China_1650-1880_EN.svg.png


https://s-media-cache-ak0.pinimg.com/564x/81/93/2b/81932bd73d90ea877f014e80fec2bb26.jpg



Addiction as immoral/criminal conduct
•The first model of addiction (appeared in 16th century) and still living today
•Substance use is not seen as a disease but as a personal moral failure, sinful and criminal act
•Excessive substance use is considered as a behaviour of choice and not as loss of control and thus
subject of legal action and punishment
•Understanding still preferred right-wing political ideology. E.g. war on drugs
•It is simple, clear and straightforward
•BUT it is oversimplification and in contradiction to current knowledge (e.g. genetic
predisposition). And leading to even bigger problems  - escalation of violence, organized crime
networks, prisons overload
•

http://s1.ibtimes.com/sites/www.ibtimes.com/files/styles/embed/public/2016/07/13/philippines.jpg



‘They Are Slaughtering Us Like Animals’ - The New York Times - Mozilla Firefox
http://www.nytimes.com/interactive/2016/12/07/world/asia/rodrigo-duterte-philippines-drugs-killings
.html?_r=0

‘They Are Slaughtering Us Like Animals’ - The New York Times - Mozilla Firefox



Russia: The silent HIV epidemic | Focus on Europe - Spotlight on People | DW | 29.11.2018 - Mozilla
Firefox Stigma means Russia risks HIV epidemic as cases rise | World news | The Guardian - Mozilla
Firefox Russia’s HIV/AIDS epidemic is getting worse, not better | Science | AAAS - Mozilla Firefox
Russia’s HIV/AIDS epidemic is getting worse, not better | Science | AAAS - Mozilla Firefox Stigma
means Russia risks HIV epidemic as cases rise | World news | The Guardian - Mozilla Firefox

Addiction as immoral conduct
•Believe in just world (just world hypothesis)
•
•Consequences are result of one's actions (you reap what you sow)
•Often used as blaming of the victims of crimes, poverty etc. (raped woman was too seductive; poor
people are too lazy,…)
•Connected to believe in destiny and higher order - often found in right-wing and religious
ideology
•Guilt reduction, discomfort reduction (discomfort caused by empathy with victims), anxiety
reduction (anxiety caused by uncertainty and unpredictable world)
•
•The poor homosexuals — they have declared war upon nature, and now nature is exacting an awful
retribution (Pat Buchanan, 1983) – summary of why not doing anything with spreading HIV epidemic in
US during Reagan‘s administration
•
•

Temperance model of addiction
•In the most primitive form – preternatural model – the substances are demonic and can take
possession over human mind  (demon alcohol)
•Addict does not have ability to control him/herself
•Addiction is a form of involuntary mental condition
•It is the substance to be blamed
•It is reasonable to abstain from the use completely
•Sympathize with addicts but rejects mild users
•

Temperance model of addiction
https://upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Benjamin_Rush_Painting_by_Peale.jpg/220px
-Benjamin_Rush_Painting_by_Peale.jpg
•Benjamin Rush (1745-1813)
•Founding fathers of the United States
•Founding father of American Psychiatric Association •Alcohol use is behind poverty, health issues,
violence, crime, family disruptions •Addiction is also a disease – addicts should be treated
•Taste not, handle not, and touch not!
•

National Council of IOGT - USA - Mozilla Firefox
International Organization of Good Templars


https://images.vice.com/noisey/content-images/contentimage/23665/straight-edge.jpg
C:\Users\Luke\Desktop\index.jpg
http://pre11.deviantart.net/19d2/th/pre/f/2015/341/e/f/i_m_19_years_old_and_i_m_straight_edge__by_h
adiali-d9jdzz5.png

Illness & personality disorder models of addiction
•Evolved in 1800s in USA – asylums in rural areas that supported people with food and shelter. No
access to the substance
•People in such treatment where in miserable conditions and had to accept themselves as ill. Often
moral semi-religious treatment
•
•
•Addict has a personality disorder – excessive substance user often shows array of antisocial and
maladaptive behaviours.
•The person is untreatable and unrepairable
•Rise of self-help communities

12 step program – Alcoholics Anonymous
•1939 - Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from
Alcoholism
•
•self-help group
•admitting that one cannot control one's alcoholism, addiction or compulsion;
•recognizing a higher power that can give strength;
•examining past errors with the help of a sponsor (experienced member);
•learning to live a new life with a new code of behavior;
•helping others who suffer from the same alcoholism, addictions or compulsions.
•
•newcomers to becoming aware of their lack of ability to control their behaviour (steps 1 through 3
)
•to expand self-examination and incorporate the outcomes of self-reflection into actions (steps 4
through 9 )
•focus on maintaining positive changes in behaviour and the recovery process. The recovery process
includes attending meetings, listening to other members at different recovery stages and working
with a sponsor, who is an experienced member who is encouraged to complete all of the steps (steps
10 through 12 )

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http://www.aceshowbiz.com/images/still/thanks-for-sharing-poster05.jpg

List of twelve-step groups - Wikipedia - Mozilla Firefox (Anonymní prohlížení)



Disease model of addiction
•At first, these processes were not understood. But it was assumed it is 1) brain disease and with
2) genetic susceptibility
•Addicted person is a victim of this disease - it is not chosen and it is not an act of free will
•Loss of control & craving as the common processes in addictions
•Consumption of the substance causes craving for further dozes (through at first unknown
psychological and neurological mechanism)
•

Disease model of addiction
•Since the person is ill and suffering, he/she should be subject of medical treatment
•Treatment was based on management of medical complications (stomach ulcer, liver disease,…) and
raising patient health education – supervision of a physician
•Therapy-like approach heavily influenced by 12 step program and 12-step programs take ideological
support from scientific approach of disease model
•

Disease model of addiction
•Addiction as a primary disease – addiction is not understood a result of another condition (other
psychiatric condition, stress,…) but rather their cause
•Addiction as a progressive disease - addiction is understood as a disease that has its course: 1)
adaptive stage - increasing tolerance 2) dependent stage - withdrawal and maintenance usage 3)
deterioration stage - resulting into major health and social problems
•Addiction as a chronic disease – addiction is understood as a disease that will never disappear
and the person will never be fully cured. Thus complete sobriety is the only way

Disease model of addiction - pros
•Big leap in knowledge, new research
•Removes stigma from suffering people
•The classic disease model is still very simple to be understood by general public •When addiction
became a disease (alcoholism as disease was acknowledged by American Medical Association in 1954)
the help became more accessible
•

Disease model of addiction - cons
•Despite huge advancement in knowledge, it was only poorly incorporated into this model. E.g.
proofed usefulness of light substance taking contradicts chronic disease; natural remission and
maturing out contradicts progressive disease; much stronger environmental factors contradict
primary disease
•Ignoring context - too little emphasis on psychological and social  factors
•The treatment method, although advancement at the beginning, is way behind treatments based on
psychological and social models
•

Physical dependency theory
•By suing the substance, the person can gradually develop a physical dependence
•Physical dependence is a condition in which the person needs the substance otherwise suffers from
various withdrawal symptoms
•This theory assumes that addiction = physical dependence
•NOT proved – many substances do not create physical dependence nor physical withdrawal symptoms.
Many addicts return to addiction after period of treatment in which they were detoxified
•Avoiding negative effects plays a role, however, more crucial proofed to be the pleasure-seeking
•

It is about (anticipated) pleasure
•Positive-incentive theory - all drugs have pleasurable effects. Drug taking is more about getting
the positive effects rather than about removing the negative effect
•Positive-incentive value is usually much higher than hedonic value = anticipated pleasure is much
higher than actual pleasure
•Incentive-sensitization theory – repeated exposure to potentially addictive drugs leads to various
changes in brain. The most important is sensitization = hypersensitivity to the incentive
motivational effects of drugs and drug-associated stimuli that creates pathological wanting.
•Addiction is not about the drug effect, it is about the anticipation of the effect. Addiction is
motivation disorder

Intracranial self-stimulation
http://www.cerebromente.org.br/n18/history/self-stimulation.jpg


(8th Edition) John P.J. Pinel-Biopsychology-Pearson (2010).pdf - Adobe Acrobat Reader DC



(8th Edition) John P.J. Pinel-Biopsychology-Pearson (2010).pdf - Adobe Acrobat Reader DC



Mesolimbic dopamine pathway
•Regulates motivation cognition and behavior and reinforcement learning – e.g. regulates behaviours
related to food, drinks, safety, sex
•
•Primary neurotransmitter – dopamine
•
•The mesolimbic pathway connects the Ventral Tagmental Area near brainstem to the Nucleus Accumbens
and to the Prefrontal Cortex. Important role plays amygdala and hippocampus
•
•

Mesolimbic pathway and addiction
•In animals, drugs self-administered to nucleus accumbens had stronger effect and were preferred.
It correlated with increase on dopamine release
•All drugs affect dopamine functions. Many drugs work as direct dopamine agonists while the rest of
drugs have indirect effect
•Brain imaging technics showed massive dopamine involvement in nucleus accumbens. They also showed
decrease of dopamine D2 receptors availability in addicts leading to increasing tolerance
•Mesolimbic pathway gradually sticks to the addiction object to which it is hypersensitive while
under sensitive to other stimuli – highjacked brain
•
•https://www.youtube.com/watch?v=NxHNxmJv2bQ
•
•

http://www.drugabuse.gov/sites/default/files/images/colorbox/aslide28.gif



Genetics and addiction
•Susceptibility model – tries to explain why some substance users develop addiction while others do
not
•General heritability about 25% in mild drinking and 35% in heavy drinking (heritability estimates
degree of variation of phenotypic trait in population)
•Twin studies – strong genetic factor especially in males (almost no effect in females) and
especially if alcoholism started before age 20 (little effect for later life)
•In other drugs – the strongest influence of genetic factor in heroin (more than 50%), in other
drugs similar to alcoholism (between 25-33%).
•Huge discrepancy in studies, e.g. women are massively under-researched
•
•

Genetics and addiction
•Genes and environment determine addiction together •Inherited characteristic is a
predisposition/risk factor, not a disease itself – addiction is a complex phenomenon with no single
one determining factor •Research on genetics of addiction is not to push people back and feel
miserable of unchangeable. It is for better treatment and prevention

Genetics and addiction
•Candidate gene studies – they try to find the concrete gene that is associated with the disease
•Difficult to find such gene – many possible candidates and often contradicting results
•Uncertainty about how much unique impact these genes have

Reward-deficiency syndrome
•Kenneth Blum
•People with DRD2-A1 allele gene form (older variant) of D2 dopamine receptors are at higher risk
of addictions. •30% of white population – they have up to 40% less dopamine D2 receptors •Feel less
reward from normal activities – need stronger impulse •Feel more negative emotions and anxiety –
take drugs to relief from negative states of mind
•

Reward-deficiency syndrome
The Addictive Brain All Roads Lead to Dopamine.pdf - Adobe Acrobat Reader DC


ADDICTION AS LEARNED BEHAVIOUR
Classical conditioning
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MLRl+GE4nRdS4VNSisU5BmO5D0avmiMllcQ5xLkp6kcLUh52Ioa9GgW9aWMRfJ6XisJppWtSrYtYc7+2OwML4/0pD5d0h9qb55O
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•I. Pavlov & J.B. Watson
•Learning is a result of pairing of a unconditioned stimulus with a neutral stimulus. After
repetition of such paring, original reaction to unconditioned stimulus becomes conditioned to the
originally neutral stimulus.

Addiction and classical conditioning
•Drug effects are strongly influenced by the context in which the drug is administered. The context
usually refers to the physical environment in which the drug is given.
•Drug effect is paired with environmental stimuli – cues and they may trigger craving –
overwhelming desire for the substance/behaviour
•Classical conditioning is behind key factors of addiction – craving, withdrawal symptoms, relapse
•Conditioned drug tolerance: tolerance and sensitization to the behavioural effects of drugs are
expressed in the environment in which the drug is chronically administered but not in an
environment not previously associated with the drug.

•Cue reactivity – learned response that involves psychological and physiological reactions to drug
related cues
•Cues are the most important factors of relapse
•Withdrawal model – cue reactivity should resemble withdrawal-like states (i.e. should produce
opposite to the drug effect)
•Incentive model – cue reactivity should be similar to positive motivational state (i.e. should
produce somewhat similar to the drug effect)
•We usually see mix of these two reactions, however, in alcohol/cocaine/tobacco/behavioral
addictions incentive reaction is stronger while in heroin withdrawal reaction is stronger
•
•
•

ADDICTION AS LEARNED BEHAVIOUR
Classical conditioning
http://blog.questia.com/wp-content/uploads/2015/03/Instrumental-conditioning.png
•B.F. Skinner
•Experience of reinforce or punishment increases or decreases likelihood of certain behaviour
•
•

https://wikispaces.psu.edu/download/attachments/40050309/Operant+Conditioning.png?version=2&modific
ationDate=1275023794000


https://www.simplypsychology.org/skinner%20box.jpg
https://www.youtube.com/watch?v=I_ctJqjlrHA


•Positive reinforcement: drugs and certain behaviours (sex, gambling) are strongly pleasurable and
serve as positive reinforcer
•Negative reinforcement: decreased level of drug in body unbalances physiological system -
withdrawal symptoms
•Occasional reinforcement – somewhat randomized reward produces much stronger reinforcement -
activity to get the reward increases and is more resilient to change. Secondary reinforcement –
cues learned via classical conditioning may be experienced as reinforcers themselves
•
•
•
•

•Drugs and certain behaviours are powerfully rewarding themselves, but addiction arises through
experience and repetition
•Involved processes are automated and are not reflective
•Pre-conscious cue processing - addiction related cues are mentally prioritized without knowing
•Frequently conflict between not conscious/learned motivation and conscious attitude
•Various people vary in their proneness to reward and punishment (e.g. Cloninger‘s typology of
alcoholism)
•
•
•
•

ADDICTION AS LEARNED BEHAVIOUR
Social learning theory
•Albert Bandura
•Learning in social environment through observing and listening to others •Addiction is learned
through imitation of and identification with role-models •Social identity – whom I follow, what is
the group I belong to, what is the group I would like to be part of
•
•

https://s-media-cache-ak0.pinimg.com/236x/bc/09/6c/bc096c2ff992c35abca200057211aea8.jpg
https://s-media-cache-ak0.pinimg.com/564x/e1/1b/23/e11b23d0bf5d281827f4b912cdebd247.jpg
https://www.mydiscountcigarette.net/gallery/original/11514/Demi-Moore-smoke.jpg?1272975824
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https://s-media-cache-ak0.pinimg.com/564x/1f/a2/89/1fa2899aacb2bb8f5f9afb268b7565ad.jpg

https://www.youtube.com/watch?v=EJT0NMYHeGw



SELF-EFFICACY
•Albert Bandura
•Individual believe in own ability to perform certain behaviour
•High self-efficacy – set higher goals, invest more effort and energy. More resistant to stress and
negative experience and able to try various coping strategies.
•Low-self efficacy – lower effort, cease treatment more quickly. Lower stress resistance, often use
substances as the first coping strategy
•Learned hopelessness – opposite to self-efficacy. When the person repeatedly experience aversive
stimuli. Sometimes a product of repeated abuse, trauma. Can lead to enduring negative mood states,
addictive behaviours, cycles of poverty
•

SELF-MEDIACATION MODEL OF ADDICTION
•Taking drugs or involvement in problematic behaviour is a coping strategy with negative and
unpleasant mood states and/or negative life experiences
•People with some mood disorder or problematic affect regulation are more prone to develop
addiction - e.g. higher depressiveness, higher anxiety, personality disorders like antisocial or
borderline
•People with experience of child abuse, trauma or childhood neglect are much more prone to develop
addiction
•

•Psychodynamic psychology – emphasizes feelings and emotions as forces that shape our behaviour,
focus on early child experience •S. Freud – psychoanalysis - use of drugs with oral administration
(alcohol, tobacco,…) are a form of regression to the first year of life (oral stage – when pleasure
is experienced through mouth). Oral stage is about gaining trust in others – addicts usually have
underdeveloped trust and show unhealthy relationship profiles: avoidance and/or overdependency.
•
•
•
•

•M. Klein – object relation theory
•Birth and first months are extremely stressful for the child. Chaos, anger, fear are the dominant
emotions – they must be cultivated in contact with parenting figure. Parenting figure is
internalised as a mental object – parent (mother) within
•Relationship with this internalized object affects social relationships throughout our lives -
what develops in early childhood stays for lifetime
•Good object relation = good affect regulation (positive mood, ability to cope with unpleasant,
more resilient), poor object relation = poor affect regulation.
•
•
•
•
•
•

•H. Harlow, J. Bowlby, M. Ainsworth – attachment theory
•https://www.youtube.com/watch?v=OrNBEhzjg8I
•
•Children internalize cognitive and affective representation of self and others based on their
early attachment experiences.
•Attachment to the parenting figure (significant other) is created especially in the first 6
months.
•Attachment attitudes are persistent and lead our relationship to others and our affective
regulation during our lives
•
•
•
•
•
•
https://latherapyspot.files.wordpress.com/2011/12/picture-5.png

•Insecure attachment is strongly related to lifetime depressiveness and affective disorders, low
self-esteem, lower social support. It creates fertile ground for substance use and other
behavioural addictions •Self-medication model does not explain all cases of addiction – many
addicts do not have affective difficulties, insecure attachment, child trauma or neglect.
•
•
•
•
•
•

DEVELOPMENTAL MODEL OF ADDICTION
•Two main risk periods – early childhood (attachment) and adolescence
•E. Erikson – psychosocial stages of development – adolescence is about identity crisis, time of
storm and stress, and increasing power of peer groups. Substance use may develop as a mean to gain
status in peer groups, it may become part of personal and social identity
•Addiction may be understood as an externalized pathological behaviour. Externalized behaviour
includes conduct problems (verbal and physical aggression, lying, risk taking, vandalism), ADHD,
various addictions
•Any externalized behaviour may be replaced by another externalized behaviour
•Externalized behaviour may occur in childhood as a reflection of internalized disorders (anxiety,
trauma, neglecting parental approach)
•

Addiction as rational choice
•Taken from economic theory – addictive behaviours are consumer behaviour
•We do things because they bring some benefits. We know about the negatives, but benefits
out-weight them
•Cost-benefit analysis
•Weighting benefits (pleasure) and costs (e.g. money, legal consequences, health consequences). In
stressful times, benefits of drugs are getting higher. Why are some substances much more often
used? – their costs are not that high (it is legal, health effects only slowly accumulates over
time,…).
•Assumptions are rather vague. Detailed analysis (e.g. using mathematic formulas) usually wrong.
E.g. theory predicts older people to be more involved in addictions, but it is the opposite

Why do we engage in addictive behaviours?
•Improve social interaction
•Improved physical & sexual appearance
•Improved cognitive performance
•Improved sexual performance
•Improved self-esteem and feelings of self-worth
•Coping with stress
•Pleasure-seeking
•Sensation & novelty seeking
•Overcoming boredom
•Reduce psychiatric symptoms
•And others…
•
•

Societal risk factors
•Families – genetics, parental neglect & abuse, impaired attachment styles, modelling behaviors,
parental approval
•Intimate relationships paradox - addictive behaviors often appear in both but being in a
relationship is one of the main protective factors
•Gender – addiction associated with a traditional gender role in men but also with non-traditional
gender roles in women.
•Environmental factors stronger in women while genetic factor stronger in men. Women have much
lower chance of becoming addicted, their addiction tends to develop later  but has faster
progression and is more frequently associated with affective dysregulation
•Being a parent is a protective factor in women but not in men

Societal risk factors
•Peer influence is very powerful, especially in adolescence but also later in life
•In adolescent the reason is to gain better position within group hierarchy, to socialize, to be
more confident in establishing romantic relationships, to decrease anxiety in general
•In later life stages the peer influence is more associated with mere availability of the substance
and attitudes (norms)
•Normative substance use – each group has some unwritten rules what is considered as normal.
Addicted people often think that the norm is higher that it actually is  - e.g. that others drink
as much as themselves
•Normative feedback (peer disapproaval) can be used for prevention and interventions

Societal risk factors
•Ethnicity – addictions and addictive behaviours are much more common in ethic minorities
•Reasons: cultural background, genetic susceptibility, more frequent poverty, discrimination and
stress
•Critical sociology – addictive behaviours are more frequently and more severely sanctioned when it
is in minorities, youngsters, poor, lower socio-economical status – those that have less power
within the society
•The major society (that in charge) has power to label what is legal and what is illicit, what
should be punished, what should be treated and even what research to support
•Availability of the drug is necessary condition for addiction however many negative effects come
only because the drug is not available. Difficult question – should be substances that are now
considered as illicit available (under certain conditions)?

Social developmental model
•Originated in criminology
•Explains the origins and development of delinquent behavior during childhood and adolescence
•children adopt the beliefs and behavioral patterns within 4 social units - family, community
(neighborhood), school, peer groups. If the social unit has prosocial attitudes, then the child
adopts a prosocial orientation; if the social unit is antisocial, then the child often manifests
problem behavior
•Positive socialization is achieved when youths have the opportunity within each unit to be
involved in conforming activities, when they develop skills necessary to be successfully involved,
and when those with whom they interact consistently reward desired behaviors.
•These conditions should increase attachment to others, commitment to conforming behavior, and
belief in the conventional order. These social bonds to conventional society prevent delinquent
behavior.
•

Social developmental model
•Individual risk and protective factors (e.g. cognitive and emotional regulatory abilities)
out-weights the social factors
•Risk factors out-weights the protective factors
•From social factors, peer influence brings the biggest risks, especially in early initiation. The
biggest protective factor comes from combination of well/functioning family and good individual
predisposition
•Family and community are relatively more important in childhood and early adolescence; school and
peers are relatively more important in mid- and late adolescence
•

Iceland knows how to stop teen substance abuse but the rest of the world isn’t listening | Mosaic -
Mozilla Firefox Iceland knows how to stop teen substance abuse but the rest of the world isn’t
listening | Mosaic - Mozilla Firefox
https://mosaicscience.com/story/iceland-prevent-teen-substance-abuse

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