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Addiction: Psychological substrates and interventions

Workshop for doctoral trainee clinical psychologists, with Dr Kim Edwards
by

Derek Lee

on 24 November 2014

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Transcript of Addiction: Psychological substrates and interventions

Addiction - An introduction to
the psychological substrates
The Nature of Addiction
The defining feature of addictive behaviour is the extent to which engagement in the behaviour (or in activities associated with the behaviour) assumes more importance for the person than any other behaviour
There is a severe narrowing of the person's
behavioural repetoire such that they may neglect their usual responsibilities, and time away from the activity of choice causes feelings of irritation, frustration and distress
The person continues to engage in behaviours even in the knowledge that they could cause psychological, physical, financial, emotional or interpersonal harm
Conceptualising addiction in these terms is in line with the World Health Organisation's view of addiction and allows us to take a wider perspective in which chemical dependence is a subset alongside other addictive behaviours such as gambling and internet use.
Earlier definitions placed more emphasis on phenomena such as tolerance and withdrawal symptoms
Drug
Brain
Environment
Affect
Behaviour
Cognition
Any substance which when taken into the body
modifies one or more of its functions
"Drugs are exogenous molecules that interact with endogeous molecules and set in train a sequence of events by which a biological process is manipulated" [Graheme-Smith, 1980]
"That is not a drug. It's a leaf."
[Cannabis according to Schwarzenegger]
"I think people need to be educated to the fact that marijuana is not a drug. Marijuana is a herb and a plant."
[Drug education by Willie Nelson]
Theoretical Substrates
Our understanding of substance misuse and how to help people make changes in their use is built upon the following premises
Drug taking is a behaviour
Behaviour does not occur in a vacuum - it unfolds in a social system and is in turn shaped by social factors
Addictions - Psychological substrates and interventions
Dr Derek Lee
February 2012
As such, it is governed by the principles that underlie all behaviour
It is purposeful
It is often the outcome of a decision-making process
It is subject to the laws of learning at all levels
Classical conditioning
Instrumental conditioning
Social learning
Cognitive learning
It is driven by motivation, and underpinned by expectations of achieving a particular outcome.
It has a clear physiological basis
It is understood within a developmental model
Depressants:
alcohol
opiates
benzodiazepines
barbiturates
Stimulants:
Cocaine/crack
Amphetamines
Caffeine
"...perception is where cognition
and reality meet" [Ulric Neisser, 1976]
Hallucinogenics:
Psilocybin
Mescaline
LSD
Nutmeg
"If the doors of perception were
cleansed everything would appear to
man as it is, infinite" [William Blake]
Depressants: alcohol, barbiturates, opiates, benzodiazepines
Stimulants: amphetamines, crack/cocaine, caffeine
NICE
Learning
SM as Behaviour
Allure
Whither CBT?
It can facilitate change at a number of stages and levels:
Early motivation work to move person towards change
Identifying and challenging the thoughts and beliefs that stand in the way of change
Strategies for coping with urges and cravings
Strategies for maintaining changes
Strategies for managing negative mood states
Coping strategies for the challenges of everyday life
Tackling the underlying vulnerability factors
Promoting self-esteem and self-efficacy
CBT
Consids
1805 - Morphine extracted from opium
1898 - Heroin prepared from morphine
1858 - Cocaine extractedfrom cocoa leaf
1884 - Freud heralds cocaine as a miracle drug
1887 - Amphetamines synthesised
1864 - Barbituric acid synthesised
1882 - Paraldehyde
1870 - Chloral hydrate
1843 - Hypodermic syringe
1950 - Chlorpromazine
1954 - Meprobamate
1960 - Chlordiazepoxide
1957 - MAOIs
1957 - Imipramine
1943 - LSD
1961 - Diazepam
Alcohol and Cannabis have been in use for about 6000 years
DSM-IV
Substance Abuse
"A maladaptive pattern of substance use leading to clinically significant impairment or distress..."
One or more of the following in any 12 months:
Failure to fulfill major obligations because of recurrent use
Recurrent use in situations that are physically hazardous
Recurrent substance-related legal problems
Continued use despite recurrent social or interpersonal problems caused by or exacerbated by the substance.

Symptoms have never met criteria for substance dependence for this class of drug
DSM-IV
Substance Dependence
"A maladaptive pattern of substance use, leading to clinically significant impairment or distress..."
3 or more of following in any 12 months:
Tolerance
Withdrawal
Consumption greater or for longer than intended
Desire to reduce or control use, or failed attempts to control use
Large amounts of time dedicated to acquiring substance
Narrowed behavioural repetoire
Continued use despite knowledge of harmful effects
DSM-IV
Substance Dependence
"A maladaptive pattern of substance use, leading to clinically significant impairment or distress..."
3 or more of following in any 12 months:
Tolerance
Withdrawal
Consumption greater or for longer than intended
Desire to reduce or control use, or failed attempts to control use
Large amounts of time dedicated to acquiring substance
Narrowed behavioural repetoire
Continued use despite knowledge of harmful effects
DSM-IV
Substance Abuse
"A maladaptive pattern of substance use leading to clinically significant impairment or distress..."
One or more of the following in any 12 months:
Failure to fulfill major obligations because of recurrent use
Recurrent use in situations that are physically hazardous
Recurrent substance-related legal problems
Continued use despite recurrent social or interpersonal problems caused by or exacerbated by the substance.

Symptoms have never met criteria for substance dependence for this class of drug
Dr Kim Edwards
&
A workshop for doctoral trainees in clinical psychology
Anything that impinges upon the natural development of a complex system is likely to leave at least a temporary fingerprint and at most a permanent scar.
Scoline, curare
Conditioning
Full transcript