3.13. Additional Modules
Session 2: Basic models of drug dependence
Total time required: 20 minutes
Lecture: Models of drug dependence 20 minutes
¾ PowerPoint: Slides 10-18
A variety of different factors can predispose a person to becoming drug dependent. These factors can be:
x biological, x psychological, x social.
Drug dependence has biological, psychological and social roots and biological, psychological, and social/environmental factors are all important for understanding and adequately treating drug depend-ence.
Drug problems can have multiple causes. The most widely used explanation models of drug depend-ence are outlined below.
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Before starting to explain the different models of drug dependence, explain to the participants that there is no right or wrong model of underlying factors of drug dependence but that drug dependence is a complex phenomenon including a wide range of different aspects.Models underlying drug dependence
Medical/disease model
In this model drug dependence is seen as a lifelong disease involving biologic and environmental sources of origin. Disease is defined as a severely harmful, potentially fatal condition that manifests itself in an irreversible loss of control over the use of psychoactive substances. Although the disease may go into remission, there is no known cure for it.
Social learning model
This model links drug use to social learning. According to this model, social reinforcement causes individuals to model the drug use behaviours of their parents, older siblings, and peers. Social learning theorist Albert Bandura (1977, 1986) indicates four stages of social learning:
x Attention: the individual makes a conscious cognitive choice to observe the desired behaviour (in our case drug use).
TRAINING CONCEPTS AND MODELS OF DRUG DEPENDENCE
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3.1
x Memory: the individual recalls what s/he has observed from the modelling.
x Imitation: the individual repeats the actions (the drug use) that s/he has observed.
x Motivation: the individual must have some internal motivation for wanting to carry out the modelled behaviour, i.e. drug use.
Genetic model
Research over the past 20 years has identified a genetic predisposition in some individuals to alcohol, tobacco, and other substances. Epidemiological studies indicate that 40 to 60% of an individual’s risk for dependence to alcohol, opiates, or cocaine is genetic. A growing number of genetic researchers now believe different classes of substances may be connected to unique genetic structures explaining why some people get dependent on certain drugs.
Bio-psychosocial model of dependence
The bio-psychosocial model shifts our focus from the drug itself to understanding drug use as a dis-ease whose course depends on the interactions of the drug or compulsive behaviour, the biogenetic and psychological susceptibilities of the individual, and the social context in which drug use occurs.
Biological factors/brain chemistry
Psychoactive drugs influence the body in such a way as to stimulate the pleasure centre of the brain.
In this way, drug problems are biologically based. The powerful favourable effects of drugs, especially the euphoria they produce, involve several chemical messengers (=neurotransmitter) in the brain. The prolonged drug use results in long-lasting changes in the brain structure.
Therapists and researchers have found that a family history of drug dependence may be a particularly potent risk factor for drug problems, and the risk seems even higher if a member of the nuclear family has a history of drug dependence.
Psychological factors
Psychological factors may include personal variables such as the way a person behaves, thinks, and feels. Specific psychological factors might predispose a person to become drug dependent, amongst these:
x Emotional problems: depression, anxiety, etc.
x Mental disorders: bipolar disorders, attention deficit/hyperactivity disorder, psychosis x Psychological stress
Social (environmental) factors
“We influence the environment but it also influences us.”
A variety of social factors can predispose someone to become dependent. Social factors often are related to personal interactions but also can be related to environmental factors:
x Peer pressure x Poverty
x Social relationships x Life changes and crises x Traumatic events x Cultural isolation
Social and psychological factors are very important to understand the development and persistence of drug dependence and related problems because these are the areas that we will most likely be able to intervene upon and possibly change. We have not determined how to change biology yet, although some progress has been made in pharmacotherapy.
Conclusion (questions and comments)
Total time required: 10 minutes
x Group members should learn as much as they can about drug dependence in order to under-stand and advise prisoners, their children and other family members and help them as soon as possible if they start to show early signs of becoming dependent on alcohol or other drugs.
x It is important to be sensitized to the different stages of dependence. If a person is still at an early stage of drug dependence, someone who knows about the stages and the process of drug dependence could initiate help from drug counselling services and other services at this early stage and prevent further harm.
x Drug dependence is a chronic relapsing disease and has biological, psychological and social roots and biology, psychology, and social/environmental factors are all important for under-standing and treating a drug problem. There is no right or wrong model of underlying factors of drug dependence but drug dependence is a complex phenomenon including a wide range of different aspects.
Evaluation
Total time required: 10 minutes
INFECTIOUS DISEASES
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