Addiction & Rehabilitation Drugs

Drugs and Crime Accounts for a large proportion of present day law violations Contributes to many other types of criminal activity Leads to a huge number of arrests, clogged courtrooms, and overcrowded prisons Places tremendous strain on the criminal justice system

Source: Substance Abuse and Treatment, State and Federal Prisoners, Bureau of Justice Statistics (Washington, D.C.: BJS, January, 2000). © 2003 Prentice Hall, Inc. Percentage Offenders Using Drugs Immediately Prior to Crime Commission, by Type of Drug

Drug Use & Abuse Drug Use Taking a psychoactive substance for non-medical purposes Drug Abuse Drug use that leads to problems (e.g. loss of effectiveness in society; behavioral psychopathology, criminal acts) Drug Dependence A maladaptive pattern of drug use leading to clinically-significant impairment or distress, associated with difficulty in controlling drug-taking behavior, withdrawal, and tolerance The state of needing a drug to function within ‘normal limits’

Pathway to Addiction

Addiction Addiction is: a chronic brain disease expressed as compulsive behavior expressed within a social context prone to relapse treatable

Classic Models of Addiction ModelEmphasized CausesExample Interventions MoralPersonal responsibility; self- control Moral suasion; social/legal sanctions Spiritual Spiritual defect Prayer; 12-step faith-based treatment (e.g. AA) TemperanceDrugsControl of supply; calls for abstinence EducationalIgnoranceEducation ConditioningClassical/operant conditioningCounterconditioning; extinction

Classic Models of Addiction ModelEmphasized CausesExample Interventions BiologicalHeredity; brain physiology; self-medication Risk identification; calls for abstinence; medical treatment Psycho- dynamic Personality; defense mechanisms Psychoanalysis Family Dynamics Family dysfunctionFamily therapy Social LearningModeling; expectanciesPositive role models; rational restructuring of expectancies SocioculturalEnvironmental; cultural; economic Social policy; social services

Positive Incentive (Hedonic) Models (Positive Reinforcement) Drugs produce pleasure - a “high.” Some drugs provide indirect positive incentive - they disinhibit behavior that is normally suppressed (e.g., alcohol and social skills). Most drugs of abuse stimulate the brain’s reward circuits. All known drugs of abuse stimulate release of opioids in the nucleus accumbens Animals will work to micro-inject drugs of abuse and electrically stimulate the same parts of the brain Normal rewards (food, drink, sex) also stimulate release

The Reward Pathway Largely controlled by the limbic system Nucleus Accumbens Ventral tegmental area (VTA) Prefrontal cortex The neurons in the VTA contain dopamine which is released into the nucleus accumbens and prefrontal cortex in response to natural or artificial reward stimuli Stimulation of this pathway produces highly pleasurable sensation Can habituate to stimulation, increasing tolerance

Animal Models of Reinforcement Self-administration Animals work for reinforcing drugs (IV, oral, inhalant) Schedules of reinforcement (fixed, progressive ratio)

Drugs that are self administered by animals Alcohol Amphetamine Barbiturates Caffeine Cocaine Nicotine Opiates PCP THC The Marula Fruit: watch?v=7Le9ufN5uEc watch?v=7Le9ufN5uEc

Drug use and crime Psychoactive drugs: alter conscious awareness or perception Depressants Stimulants Opiates (Narcotics) Hallucinogens

Depressants Central nervous system depressants: remove social inhibitions, relieve anxiety, impair judgment. Include alcohol, barbiturates and minor tranquilizers

Stimulants Central nervous system stimulants: addiction possible, stimulates alertness, wakefulness, euphoria; includes amphetamines, caffeine, nicotine and cocaine and its derivatives

Hallucinogen Hallucinogens: non-addicting; effects include hallucinations, sense of timelessness & mystical insights; LSD, mescaline, psilocybin Cannabis is classified as a hallucinogen legally, but due it it’s effects is considered it’s own category in the DSM Recently, hallucinogens like LSD have been shown to be promising treatments for nervous system disorders such as epilepsy and mental disorders including schizophrenia

Opiates Narcotics: highly addicting, acts as an analgesic, euphoria; includes morphine, heroin, codeine and Demerol

Addiction Psychological dependency: person craves a drug; believes they cannot function without it Physiological addiction: body becomes biochemically dependent on a drug Tolerance: greater doses are necessary to produce the same effect

Drugs & crime Withdrawal: physical and psychological symptoms which develop in an addicted person when he or she abruptly stops or reduces intake of a drug

Legal classification of drugs Drugs classified from Schedule I Drugs to Schedule V, with I the most restricted and V the least restricted Classified based on: (1) medical usage; and (2) potential for abuse Note that alcohol is not included, yet if it were to be classified, it should be a Schedule I drug

Legal classification ScheduleExamples Schedule 1: high abuse potential, lack therapeutic utility and safetyHeroin, LSD, peyote, PCP, mescaline Schedule 2: high abuse potential, but currently accepted for medical practice Opium, cocaine, morphine, benzedrine, methadone, amphetamines Schedule 3: Moderate abuse potential, utilized in medical practiceBarbiturates, amphetamines Schedule 4: low abuse potentialvalium Schedule 5: minimal abuse potential, currently used in medical practice Cough medicines with small amounts of narcotics

Substance abuse and criminality Clear link between drug use and criminality Alcohol Prison inmates 3 times as likely as other males the same age to drink 2+ oz. of liquor per day 25% indicated they had got drunk and hurt someone during last 3 years

Drugs and crime Alcohol involved in 2/3 of homicides in a Philadelphia study, about 40% of rape cases about 75% of arrestees have traces of illegal drugs in their systems In a study of CA inmates, over 40% reported using “heavy drugs” in the last 3 years

Drugs and Crime Hypotheses: Psychopharmacological: drugs contribute to crime by reducing inhibitions (alcohol) or stimulating aggressive behavior (stimulants) Economic Compulsivity hypothesis: Addiction to substances contribute to crime to support a habit. Studies of junkies have indicated that many commit crimes to obtain drugs Lifestyle hypothesis: Offenders both use drugs and commit crimes as part of a lifestyle

Drugs and Crime Studies have found that some individuals commit crimes after becoming addicted (economic) Studies have also found that many abusers were committing crimes before beginning drug usage. During periods of addiction, crimes tended to increase considerably, referred to as “on a run.”

Drugs and Crime Decrease in substance abuse was associated with a decrease, but not stopping, criminal activity For a number of offenders, then, stopping drug use will not stop their criminal behavior, although crimes may decrease

Who needs treatment? 13 to 16 million Americans need treatment for alcohol and/or other drug abuse in any year BUT… Only 3 million receive care

Recovery and Rehabilitation Abstinence Stopping the use of drugs for a period of time Sobriety A lifestyle based on treatment and personal change

Recovery and Rehabilitation  No single treatment is appropriate for all individuals  Effective treatment attends to multiple needs of the individual, not just his or her drug use  Treatment must address medical, psychological, social, vocational, and legal problems = MULTI-SYSTEMIC AND MULTI-MODAL

Coercion Treatment does not need to be voluntary to be effective Court-Ordered Probation Family Pressure Employer Sanctions Medical Consequences

Self Help  Complements and extends treatment efforts, but it is not treatment in- and-of-itself  Most commonly used models include 12-Step (AA, NA) models  Most treatment programs encourage self-help participation during/after treatment

12-Step Groups Facts Available 7 days/week, 24 hrs/day Work well with professionals Primary treatment modality is fellowship (identification) Safety and acceptance predominate over confrontation They offer a safe environment to develop intimacy

Relapse Overall, between 40-60% of people will relapse, or start to use again, after rehabilitation