ETIOLOGY OF SUBESTANCE DEPENDENCY

DR MOTAHARE MIRDAMADI

psychiatrist

Substance abuse

the excessive and compulsive use of substance

for their effect on the mind. tolerance to the drug, an increasingly higher

dose of the drug is needed. withdrawal : it will cause physical problems.

How Drugs & Alcohol Work

They interact with nerve circuits, centers, and chemical messengers Results;

I Feel Good – Euphoria & Reward I Feel “Better” – Reduce negative feelings This Feels “Normal” I’m craving it, tolerating its effects,

withdrawing and feeling sick

Common Characteristics of People Who are Addicted

Unemployed or employed Multiple or no criminal justice contacts Difficulty coping with stress or anger Highly influenced by social peer group or a

loner Difficulty handling high-risk relapse situations

or craves excitement

conscious decision or a chronic, relapsing illness

changes that occur in the brain can turn drug abuse into a chronic, relapsing illness.

More specifically, genetic factors contribute 40% to 60% to the risk for alcoholism

addicts who become dependent early in life are the most genetically predisposed to the disease

First, there is an activation of the brain's "pleasure pathway.

MULTI FACTORIAL

major questions concern the etiology of addiction, including the relative roles of genetic and environmental factors, neurochemical and neuroanatomic changes, and the course of the illness

initial drug use

Environmental factors: family's beliefs and attitudes exposure to a peer group that

encourages drug use

Risk factors:

Biologic factorEnviromentpsychologic

Environmental correlates

influences of family, peers, and availability children and adolescents. favorable attitudes or

actual use of drugs by parents absence of parental support, chaotic living

conditions, divorce or separation, and inconsistent parenting styles

coherent and consistent parenting styles are "protective" against substance abuse

Have easy access to drugs

Peer group :modeling and social reinforcement Availability: For example, living in college

dormitories versus living with parents gender :male; Although males and females self-

report similar reasons for using drugs 18 and 44 years of age unmarried lower socioeconomic status.

environmental factors

environmental factors

woman's risks for problem drinking include: the influence of her partner's drinking, her degree of depression, her sexual history (including sexual

orientation and sexual dysfunction), a history of violent victimization (physical

and sexual)

alcohol

Genes may influence traits such as impulsivity, which can make a person more likely to become alcoholic.

Genes may also influence the level of dopamine in the brain

COMMUNITY INDIVIDUAL / PEER

Availability of Drugs Alienation and Rebelliousness

Community Laws and Norms Favorable Toward Drug Use

Friends Who Engage in the Problem Behavior

Transitions and Mobility Favorable Attitudes Toward the Problem Behavior

Low Neighborhood Attachment and Community Disorganization

Early Initiation of the Problem Behavior

Extreme Economic Deprivation Constitutional Factors

FAMILY SCHOOL

Family History of the Problem Behavior

Early and Persistent Antisocial Behavior

Family Management Problems Academic Failure Beginning in Late Elementary School

Family Conflict Lack of Commitment to School

Favorable Parental Attitudes and Involvement in the Problem Behavior  

Peer group

PSYCHOLOGIC FACTORS:

Have depression, bipolar disorder, anxiety disorders, and schizophrenia,PTSD

Have low self-esteem, or problems with relationships

Live a stressful lifestyle, economic or emotional

Live in a culture where there is a high social acceptance of drug use

Risk factor

Family history of addiction. the effects of many genes

Being male. twice

Having another psychological problem. depression, attention-deficit/hyperactivity disorder or post-traumatic stress disorder

Peer pressure. young people ;strong factor in starting to abuse drugs.

Lack of family involvement. A lack of attachment and lack of parental supervision.

Anxiety, depression and loneliness. coping with painful psychological feelings.

Taking a highly addictive drug heroin and cocaine

More Common Characteristics

Emotional and psychological immaturity

Difficulty relating to familyDifficulty sustaining long-term

relationshipsEducational and vocational deficits

Co-Occurring Disorders

Mood Disorder+: 24-40% have a co-occurring substance abuse disorder

Alcoholism+: 65% of females and 44% of male alcoholics have co-occurring mental health disorder(s)

THE MAJOR ONE = DEPRESSION19% of female alcoholics, 4x the rate for men

antisocial personality

nature of the substance

crack, heroin or cocaine can bring about addiction more rapidly

if a group of people were to take crack every day for six months, versus another take alcohol, the number of crack addicts would be a lot higher than the number of alcoholics.

For some people trying a substance even once can be enough to spark an addiction. Crack, also known as crack cocaine or rock, is a freebase form of cocaine that can be smoked.

start consuming a drug earlier in life have a higher risk of addiction

How the body metabolizes (processes) the substance - in cases of alcohol

Classical conditioning

physiological positive reinforcement (euphoria) social positive reinforcement (enhanced peer

status) Physiological negative reinforcement :in warding off

a withdrawal reaction Social negative reinforcement :escaping from a

noxious home, school, or vocational life. peer cluster theory

• conditioned stimuli

environmental cues are present during drug use-> drug’s behavioral and

physiological effects. With repetition the cues

become conditioned stimuli, experiences as drug

craving.

Sensitization

Withdrawal creates a craving

or desire for the drug and plays a very strong role in recurrent patterns of relapse

Sensitization occurs when the effects of a given dose of a drug increase after repeated administration.

repeated presentation of the environmental cues, absent the drug, should extinguish the conditioned association.

he emergence of withdrawal symptoms as a result of exposure to conditioned

cues can contribute to drug use relapse

cognitive It has been argued, that substance

abusers differ from others:beliefs about potential benefits of the

drug ability to cope with the stress of

everyday life

Cognitive

self-reported motivations reasons for which type of substance use: motivations for alcohol and marijuana abuse include

"getting away from problems,“ cocaine and amphetamines involve "staying alert

and awake.“ "self-medicating" motives increase with

consumption ,pain relive

Cognitive Deficits

Memory problems – short-term loss Impaired abstraction failed problem-solving strategies Loss of impulse control These deficits are similar to those with brain

damage

pleasure pathway

The mesocorticolimbic pathway from the ventral tegmental area to the nucleus accumbens and the frontal cortex is a key component of the brain reward system for drug reinforcement

Nature Video Cocaine Video

Front of Brain

Back of Brain

Amygdalais not lit up

Amygdalais activated

Personality

no evidence for "addictive personality“ distinct personality syndrome: interpersonal alienation, poor impulse control, manifest emotional distress childhood and the quality of parenting received Sensation seeking Depressed mood Low self steem

RF versus protective

Risk Factors Domain Protective Factors

Early Aggressive Behavior Individual Self-Control

Lack of Parental Supervision Family Parental Monitoring

Substance Abuse Peer Academic Competence

Drug Availability School Anti-drug Use Policies

Poverty Community Strong Neighborhood Attachment

prevention efforts

Family Management ProblemsFavorable Attitudes Toward the

Problem BehaviorSocial Skills (protective)Bonding (protective)

Persons Risk Factors Protective factors

Individual Behavioral disengagement copingNegative emotionalityConduct disorderFavorable attitudes toward drugsRebelliousnessEarly substance useAntisocial behavior

Positive physical developmentEmotional self-regulationHigh self-esteemGood coping skills and problem-solving skillsEngagement and connections in two or more of the following contexts: at school, with peers, in athletics, employment, religion, culture

Adolescence

 Persons  Risk Factors Protective factors

Individual Difficult temperament Self-regulationSecure attachmentMastery of communication and language skillsAbility to make friends and get along with others

Family Cold and unresponsive mother behavior Parental modeling of drug/alcohol use

Reliable support and discipline from caregiversResponsivenessProtection from harm and fearOpportunities to resolve conflictAdequate socioeconomic resources for the family

School, Peers, Community

  Support for early learningAccess to supplemental services such as feeding, and screening for vision and hearingStable, secure attachment to childcare providerLow ratio of caregivers to childrenRegulatory systems that support high quality of care

Infancy/Early Childhood

Family Substance use among parentsLack of adult supervisionPoor attachment with parents

Family provides structure, limits, rules, monitoring, and predictabilitySupportive relationships with family membersClear expectations for behavior and values

School, Peers, Community

School failureLow commitment to schoolAssociating with drug-using peersNot college boundAggression toward peersNorms (e.g., advertising) favorable toward alcohol useAccessibility/ availability

Presence of mentors and support for development of skills and interestsOpportunities for engagement within school and communityPositive normsClear expectations for behaviorPhysical and psychological safety

Age of onset

Alcohol and drug use tends to begin in mid-to-late adolescence, though it is greater among individuals who experience early puberty .. A delay in drinking until 20- to 21-years-old reduces the risk of developing alcohol-related problems Youth perception that parents approve of their alcohol or drug use

One of the most consistent risk factors for adolescent drinking is perceived parental approval (Donovan, 2004). Reported maternal care perception has been shown to be significantly lower among alcohol and those who use multiple drugs (Gerra et al, 2004).

Peers engaging in problem behavior

Associating with drug- or alcohol-using peers, or being rejected by peers, can create problem behaviors and influence attitudes and norms related to substance use (O'Connell et al, 2009). Exposure to peer problem behavior is correlated with increased alcohol and other substance use in the same month (Dishion et al, 2000). Those who drink in a social setting, or who have peers who do so, are more likely to abuse alcohol later in life (Beck et al, 1996).

Early and persistent problem behaviors, risk-taking, and high sensation-seeking

Early aggressiveness or antisocial behavior persisting into early adolescence predicts later adolescent aggressiveness, drug abuse, and alcohol problems (Hawkins et al, 1995).

Parental monitoring (or perception of monitoring)

Adolescents who report low parental monitoring are significantly more likely to use a variety of substances (Shillington et al, 2005). Positive parental style and close monitoring by parents are proven protective factors for adolescent’s use of alcohol and other drugs (Stewart, 2002).

Parent or older sibling drug use (or perception of use)

Familial alcohol-using behaviors are strong predictors of adolescent alcohol use (Birckmayer et al, 2004). In a 2003 study, alcohol initiation most often occurred during family gatherings. Moreover, a family history of alcoholism was a significant risk factor for the development of adolescent problem drinking (Warner et al, 2003).

Low perception of harm

Low perception of harm towards alcohol and drug use is a risk factor for use (Henry et al, 2005). Individuals with attitudes or values favorable to alcohol or drugs are more likely to initiate substance use

Strong parent and adolescent relationship and family cohesion

Adolescents who have a close relationship with their parents are less likely to become alcohol involved (Birckmayer et al, 2004).

Youth access and availability

The majority of alcohol consumed by youth is obtained through social sources, such as parents and friends, at underage parties and at home (Birckmayer et al, 2004). Availability of alcohol or illegal drugs leads to increased use (Hawkins et al, 1995).

Poor school achievement and low school bonding

Adolescents who have a low commitment to school or do poorly are more likely to become alcohol involved