An NASW Online Webinar Series Presented by: Dr. Joseph Hunter, LCSW, Ph.D.
1. Introduction and Problem Overview 2. Etiology: Genetics, Neurobiology and Psychosocial Factors 3. Co-Occurring Disorders 4. Levels of Care, Addiction Medicines and Therapies
Participants will understand how existing 1. theories seek explain how opiate addiction starts, spreads and sustains its grip in the US population and local communities. 2. Participant will learn the neurological mechanisms of opiate addiction. 3. Participants will learn of the genetic, biological and epigenetic factors associated with opiate addiction.
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Although I am an employee of both Veterans Affairs (VA) and The University of Southern California (USC), this presentation is done independently of those positions. The views expressed in this presentation are those of the author and do not necessarily reflect the opinion, position or policy of the VA, the US Government or USC. In addition, although I am recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers (#324), this training is offered under NASW’s approved provider number.
61.8 million smoked cigarettes 175.8 million people drank alcohol 36.0 million people used marijuana 4.8 million people used cocaine 828,000 people used heroin 1.5 million people used lysergic acid diethylamide (LSD) 2.6 million people used Ecstasy 1.8 million people used inhalants 1.7 million people used methamphetamine [compare to 12.5 million misusers of prescription pain killers]
AGAIN
Drug overdose is the leading cause of accidental death in the US 52,404 lethal drug overdoses in 2015 Opioid addiction is driving this epidemic 20,101 overdose deaths on prescription pain relievers 12,990 overdose deaths on heroin in 2015
Suggests that people take drugs to experience variety self-exploration religious insights altering moods escape from boredom or despair enhancement of creativity, performance, sensory experience, or pleasure Because people enjoy variety, then it can be understood why they repeat actions that they enjoy (positive reinforcement)
Suggest also that the desire to experience pleasure is another explanation Drugs are chemical surrogates of natural reinforcers such as eating and sex. Dependent behavior with respect to the use drugs is maintained by the degree of reinforcement the person perceives as occurring Drugs may be perceived as being more powerful reinforcers than natural reinforcers and set the stage for addiction Individuals who become addicted are unable to control the reward system in their lives and that addiction may be considered a disorder of compulsive behavior very similar to obsessive compulsive disorder.
Learning models are closely related and somewhat overlap the explanations provided by cognitive- behavioral models. Learning theory suggests that drug use results in a decrease in uncomfortable psychological states such as anxiety, stress, or tension, thus providing positive reinforcement to the user. This learned response continues until physical dependence develops The aversion of withdrawal symptoms becomes a reason and motivation for continued use (as suggested too by CB Theory)
Psychodynamic models link addiction to ego deficiencies, inadequate parenting, attachment disorders, hostility, homosexuality, masturbation, and so on. Substance abuse can be viewed as symptomatic of more basic psychopathology. Difficulty with an individual’s regulation of affect can be seen as a core problem or difficulty. Disturbed object relations may be central to the development of substance abuse.
Attachment Theory: Insecurely attached children feel that there is no help during negative affect states, which then creates a feeling of disorganization and overwhelms them. The use of alcohol and drugs can become the always-available attachment figure or object, used for self-soothing/affect regulation. Self Psychology: Lack idealized parent to learning self- soothing so the addictive object (drugs/alcohol) becomes a substitute soothing self object. Object Relations Theory: "Situation-in-person" - what is outside (via object relations) begets the way a person grows, thinks and feels (the inside) The addict has internalized an addicted parent and is repeating the behavior with his/her own family.
A major theme of the behavioral model is, that within the context of the family, there is a member (or members) who reinforces the behavior of the abusing family member. For example, a spouse may make excuses for the family member or even prefer the behavior of the abusing family member when that family member is under the influence of alcohol or another drug. Some family members may not know how to relate to a particular family member when he or she is not “under the influence.”
These focus on the way roles in families interrelate Some family members may feel threatened if the person with the addiction shows signs of wanting to recover Often rigid and enabling roles are formed that enable the family to function to the extent possible – hero, scapegoat, lost child and joker are examples of these. The possibility of adjusting roles could be so anxiety producing that members of the family begin resisting all attempts of the “identified patient” to shift relationships and change familiar patterns of day-to-day living within the family system.
Addiction is viewed as a primary disease rather than being secondary to another condition Offers that there is a progression of the disease of drug addiction across stages: prodromal, middle or crucial, and chronic that are not reversible Consistent with this concept of irreversibility is the belief that addictive disease is chronic and incurable. There is no treatment method that will enable the individual to use again without the high probability that the addict will revert to problematic use. The articulation of addiction as a disease removed the moral stigma attached to addiction and replaced it with an emphasis on treatment of an illness
SPT is concerned with the social evolution of humans and suggests that human identity is inextricably linked to social belongingness Suggests people are innately driven to be active contributors to the wellbeing of their social groups of belonging Suggests that when one is utilizing his/her strengths to contribute to a social group or passion of his her preference, a perception of having life meaning and purpose results
Perceived life meaning and purpose is reinforced when one can see the unique benefits of one’s contribution and receives affirmation for the same Self-Directed violence is highly influenced by one’s perception of lacking mutually beneficial belongingness and a missing sense of social contribution Implication: Adolescents can align life pursuits to establish a sense of life meaning and purpose (habilitation)
Passions Strengths M & P Goal-Directed Action Me Reinforced by visible benefit & Us Benefits positive feedback All of Us Figure I. Self-Preserving Orientation ªM & P refers to life meaning and purpose.
Reinforced by Benefits by success in Me achieving desired benefit. Goal- Directed Actions M & P Passions Strengths Psychological Us Dissonance All of Us Social Dissonance Figure II . Self-Serving Orientation, Example A ªM & P refers to life meaning and purpose.
Addictive substances cause disruptions in the brain that: Enable substance-associated cues to trigger substance seeking (i.e., they increase incentive salience) Reduce sensitivity of brain systems involved in the experience of pleasure or reward, and heighten activation of brain stress systems Reduce functioning of brain executive control systems, impacting the ability to make decisions and regulate one’s actions, emotions, and impulses
All addictive substances produce feelings of pleasure. These “rewarding effects” positively reinforce their use and increase the likelihood of repeated use. The rewarding effects of substances involve activity in the nucleus accumbens, including activation of the brain’s dopamine and opioid signaling system. Studies have shown that neurons that release dopamine are activated, either directly or indirectly, by all addictive substances
Binge/Intoxication: the stage at which an individual consumes an intoxicating substance and experiences its rewarding or pleasurable effects Withdrawal/Negative Affect: the stage at which an individual experiences a negative emotional and physiological state in the absence of the substance Preoccupation/Anticipation: the stage at which one seeks substances again after a period of abstinence
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