SubstanceRelated Disorders: Theories

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Substance-Related DisordersTheories Treatment
03-28-05
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Gender Ethnic Differences

• Women are generally less likely to abuse drugs or
  alcohol
• In U.S., Whites have higher lifetime rates for
  drug problems than Blacks or Latinos
• Asian and Asian Americans have relatively lower
  rates of substance use disorders
• American Indians/Alaska Natives have relatively
  higher rates of substance use disorders
• At older ages, Blacks and Latinos have higher
  rates of alcohol dependence than Whites

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Acculturation Substance Abuse

• Length of time living in U.S. is positively
  associated with increased risk for substance use
  disorders (and other mental disorders) among
  Mexican Americans
• Spanish language use is associated with lower
  risk for substance use disorders
• Possible protective factors religion and
  familismo

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Etiology

• Biological explanations
• Psychodynamic explanations
• Behavioral explanations
• Sociocultural/Social Cognitive explanations

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Biological Explanations

• Alcoholism is four times higher among male
  biological offspring of alcoholic fathers vs.
  offspring of non-alcoholic dads
• Adoption studies and twin studies (MZ vs. DZ
  twins) support heredity of ETOH abuse
• Genes studies may be able to identify traits such
  as preference for alcohol in rats
• Risk factors may include biological sensitivity
  or responsiveness to alcohol

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Psychodynamic Explanations

• Childhood trauma results in repression of painful
  conflicts involving dependency needs
• Alcohol releases inhibition and allows repressed
  conflicts to be expressed
• Alcohol enables oral gratification and to satisfy
  dependency needs
• Lack of empirical support for theory

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Sociocultural/Social Cognitive Explanations

• Cross-national and religious differences in
  alcohol consumption and alcohol abuse
• Parents model heavy consumption, antisocial
  behaviors, rejection of children
• Reduced monitoring of childrens behavior
• Adolescent peer groups

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Behavioral Cognitive Explanations

• Anxiety reduction (e.g., drinking cat study
  approach-avoidance conflict)
• Learned expectations (e.g., tasting experiment,
  Marlatt et al., 1973)
• Expectations include feelings of confidence,
  tension reduction
• Effects of alcohol use moderated by type of
  tension, coping style, social support
• Classical conditioning and overdose of drugs

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Relapse

• Marlatts model
• High-risk situation -gt coping response -gt
  feeling of self efficacy -gt probability of
  drinking -gt abstinence violation effect -gt
  probability of full relapse (see p. 289)

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Theories of Addiction Process

• Solomons Opponent Process Theory
• Wises Two Factor Theory
• Tiffanys Theory of Automatic Processes
• Stages of Change Model (Prochaska DiClemente)

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Stages of Change(Transtheoretical Model)

• Precontemplation
• Contemplation
• Preparation (Determination)
• Action
• Maintenance
• Relapse

Prochaska DiClemente (1984, 1986)
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Interventions for Substance Abuse

• Self-help support groups (e.g., AA, NA)
• Pharmacological approach (e.g., Antabuse for
  alcohol, methadone for heroin, nicotine patch)
• Cognitive-behavioral approaches
• 1) aversion therapy
• 2) covert sensitization
• 3) skills training
• 4) reinforcing abstinence
• 5) relaxation and systematic desensitization