1. History and Etiological Models of Addiction
Chapter 1
History and Etiological Models of Addiction

2. History and Models of Addiction
A specialized field in counseling
The addiction counseling field evolved like psychology, social work
Early Practice
Limited education, supervision, ethics, and research

3. Prevention in the United States
Historical approaches to prevention
Alcohol’s central role in the colonies
Temperance as moderation
Original goal was moderation
Temperance as abstinence
Women’s Christian Temperance Movement
Volstead Act and Prohibition (1920)
The culmination of the second wave of temperance activity by women was the passage of the 18th Amendment and the Volstead Act, which took effect in 1920.
Carrie Nation
Women got the vote in 1919 with the 19th amendment
The Volstead Act, which reinforced the prohibition of alcohol in the United States of America, was popularly named after Andrew Volstead, Chairman of the House Judiciary Committee, which oversaw its passage. However, Volstead served as the legislation's sponsor and facilitator rather than its author. It was the Anti-Saloon League's Wayne Wheeler who conceived and drafted the bill.
While Prohibition was successful in reducing per capita consumption and some problems related to drinking, its social turmoil resulted in its repeal in 1933.

4. U.S. Drug Laws
Until 1903 cocaine was used in soda drinks (“Coca Cola”)
Pure Food and Drug Act, 1906 (labeling)
The Harrison Act, 1914 (taxation of opium and coca products)
Controlled Substance Act, 1970
Currently, drug laws in the United States are derived from the 1970 Controlled Substance Act ( Center for Substance Abuse Prevention, 1993) under which drugs are classified according to their medical use, potential for abuse, and possibility of creating dependence. (Schedule 1-V)

5. Laws and Agencies
National Institute on Alcohol Abuse and Alcoholism (NIAAA), 1971
National Institute on Drug Abuse (NIDA), 1974
The Anti-Drug Abuse Prevention Act of 1986 created the United States Office for Substance Abuse Prevention (OSAP)
Later became CSAP (part of SAMHSA)
The Anti- Drug Abuse Prevention Act of 1986 created the United States Office for Substance Abuse Prevention ( OSAP); this office consolidated alcohol and other drug prevention initiatives under the Alcohol, Drug Abuse, and Mental Health Administration ( ADAMA). ADAMA mandated that states set aside 20% of their alcohol and drug funds for prevention efforts while the remaining 80% could be used for treatment programs.
CSAP: Center for Substance Abuse Prevention
SAMHSA: Substance Abuse and Mental Health Services Administration

6. Models for Explaining the Etiology of Addiction
The Moral Model
Psychological Models
Family Models
The Disease Model
Biological Models
Sociocultural Models
Multicausal Models

7. The Moral Model Personal Choice Religious Beliefs Legal System
Sinfulness
Legal System
Punishment

8. Psychological Models Cognitive-behavioral models Learning models
Motivations
Reinforcement (positive & negative)
Learning models
Learned response
Use decreases anxiety, stress, etc.
Aversion to withdrawal
Physical dependence
To experience variety
To experience pleasure
To decrease discomfort

9. Biological Models Genetic Models Neurobiological Models
Statistical associations
Genetic factors
Neurobiological Models
Brain chemistry
Limbic system

10. Multicausal Models Syndrome model Integral Model Public Health Model
No single model adequately explains addiction
Syndrome model
Multiple and interacting antecedents
Integral Model
Concepts from integrative medicine and transpersonal psychology
Public Health Model
Agent, Host, Environment

11. Useful Web Sites www.ncadi.samhsa.gov www.drugabuse.gov

12. Substance and Process Addictions Laura Veach and Emeline P. Hollander
Chapter 2
Substance and Process Addictions
Laura Veach and Emeline P. Hollander

13. Neurobiology and Physiology Addiction
Reward Circuit
Neurobiology
Brain research
Reward pathway
Pleasure, which scientists call reward, is a very powerful biological force for our survival. If you do something pleasurable, the brain is wired in such a way that you tend to do it again. Life sustaining activities, such as eating, activate a circuit of specialized nerve cells devoted to producing and regulating pleasure. One important set of these nerve cells, which uses a chemical neurotransmitter called dopamine, sits at the very top of the brainstem in the ventral tegmental area (VTA). These dopamine-containing neurons relay messages about pleasure through their nerve fibers to nerve cells in a limbic system structure called the nucleus accumbens. Still other fibers reach to a related part of the frontal region of the cerebral cortex. So, the pleasure circuit, which is known as the mesolimbic dopamine system, spans the survival- oriented brainstem, the emotional limbic system, and the frontal cerebral cortex.
Source: 13

14. Ventral tegmental area  NA  Prefrontal Cortex
Reward Pathway
Ventral tegmental area  NA  Prefrontal Cortex
Source: 14

15. Nerve Cells and Neurotransmission
Neurons
100 billion nerve cells in the brain
Neurotransmitters
Chemical messengers
Dopamine
Neuroreceptors
Source: 15

16. Cocaine Interfering with Neurons
When cocaine enters the brain, it blocks the dopamine transporter from pumping dopamine back into the transmitting neuron, flooding the synapse with dopamine. This intensifies and prolongs the stimulation of receiving neurons in the brain's pleasure circuits, causing a cocaine "high." ( 16

17. Positron emission tomography (PET) scan
Source:
Cocaine has other actions in the brain in addition to activating the brain's reward circuitry. Using brain imaging technologies, such as PET scans, scientists can see how cocaine actually affects brain function in people. PET allows scientists to see which areas of the brain are more or less active by measuring the amount of glucose that is used by different brain regions. Glucose is the main energy source for the brain. When brain regions are more active, they will use more glucose and when they are less active they will use less. The amount of glucose that is used by the brain can be measured with PET scans. The left scan is taken from a normal, awake person. The red color shows the highest level of glucose utilization (yellow represents less utilization and blue indicated the least). The right scan is taken from someone who is on cocaine. The loss of red areas in the right scan compared to the left (normal) scan indicates that the brain is using less glucose and therefore is less active. This reduction in activity results in disruption of many brain functions. 17

18. Physiological Factors
Tolerance
Neuroadaptation
Metabolic tolerance
Pharmacodynamic tolerance
Withdrawal
metabolic tolerance = When the body becomes more efficient in processing and eliminating a mood- altering substance;
pharmacodynamic tolerance = when the central nervous system is less impaired by the drug. 18

19. Substances of Addiction
Depressants
Stimulants
Cannabinoids
Hallucinogens
Opioids

20. Depressants
Alcohol
Sedative/Hypnotics

21. Alcohol Ethanol Mood altering effects within 20 minutes
Proof
7% alcohol/ethanol = 14 proof
151-proof rum = ___ % ethanol?
Mood altering effects within 20 minutes
Metabolized by the liver as a toxin
Intoxicated
Blood alcohol concentration (BAC)

22. Sedative/Hypnotics Sedative/Hypnotic drugs (CNS) Also depress the CNS
Benzodiazepines (aka “tranquilizers”)
Valium (diazepam), Xanax (alprazolam)
High risk for abuse and addiction
Women at risk
Barbiturates (Tuinal, Nembutal)
Lethal potential
Non-barbiturates (Quaaludes)

23. Stimulants
Tobacco
Nicotine
Ephedrine
Amphetamines
Ritalin
Cocaine

24. Ephedrine, Amphetamines, Amphetamine-like Medications
Legal ban in 2004 (side effects)
Amphetamines (“Speed”)
Methamphetamine
Oral, snorted, smoked, injected
Amphetamine-like medications
Ritalin (for ADHD)
Side effects: weight loss, insomnia, hypertension, anemia

25. Cocaine Epidemics in late 1800’s, early 1900’s “Crack” cocaine
Use has declined since 1990’s
“Crack” cocaine
Smokeable, concentrated form of cocaine
Physical Dependence (tolerance/withdrawal)
Strong potential for abuse

26. Cannabinoids Marijuana Unique properties Tolerance Withdrawal
Dependence
Negative physical effects
Reduced lung capacity
Lowered testosterone levels
Racing pulse
Decreased muscle strength

27. Hallucinogens and Other Psychedelics
Lysergic acid derivatives (LSD)
Phencyclidine (PCP)
MDMA (Ectasy)
The most popular psychedelic of the 1990’s
Perception-altering properties

28. Opioids Parent of all narcotic drugs Opium Morphine Heroin OxyContin
Intravenous injection
HIV Infection risks
OxyContin

29. Process Addictions Ingestive addiction Process addictions
Chemical dependence
Process addictions
Addiction to a behavior, process, or action
Still debated
Examples
Gambling, sexual addiction, work, shopping, food

30. Sexual Addiction Varying definitions Sexaholics Anonymous (SA)
“Addicted to lust”, loss of control
Isolation, Guilt, Depression, Emptiness
Sex Addicts Anonymous (SAA)
Progressive path to increasingly dangerous behaviors
No DSM criteria for sexual addiction

31. Gambling Addiction Pathological gambling Warning signs
Impulse Control Disorder in DSM
Warning signs
Secretiveness
Extravagant expenditures
Increased debt and worry over finances
Increased alcohol, drug consumption

32. Work Addiction “Workaholism” Little data available on prevalence
Socially accepted, encouraged, rewarded
Self-esteem problems, inability to relax, out of control, frenetic, unsatisfied unless doing something
Less productive than non-workaholics
Perfectionistic, inefficient
More research needed

33. Compulsive Buying Shopaholism
Consistent, repetitive purchasing in response to stress
Overspending, Indebtedness, Bankruptcy
Treatment
Teaching how to resist social forces (media, easy credit)

34. Food Addiction and Disordered Eating
Eating Disorders, including:
Anorexia
Compulsive self-starvation
Bulimia
Compulsive cycle – eating and purging
Binge Eating Disorder (no purging)
Overeaters Anonymous
10% of sufferers are male

35. Useful Web Sites Alcoholics Anonymous Al-Anon and Alateen
Al-Anon and Alateen
Narcotics Anonymous
Overeaters Anonymous