Essay: Intervention &amp Addiction Therapy Theory &amp Practice

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Intervention & Addiction Therapy

Theory & Practice, Intervention and Addiction Therapy

The study of psychology is a complex science integrating environmental, social, and biological factors to develop a successful understanding of the continuously changing structure of an individual's psychopathology. Implicit in that study is the assessment and evaluation of foreign substances within the body. A growing body of work has discovered several relevant biochemical and psychosocial mechanisms related to the phenomenon of addiction which must be accounted for in any discussion or practice of substance abuse counseling. Though there is a significant social component in the decision to use and abuse controlled substances, existing therapeutic practices are fairly effective in combating those relatively superficial desires often rising from deeper self-concept dissonance. However, for any therapeutic technique to be successful a thorough understanding of the biological imperatives associated with the addiction is essential.

In the course of an undergraduate degree in Biopsychology at ____, courses in genetics, chemistry, biochemistry, and biology were requisite as well as standard psychology courses. This ensured that students had a full understanding of psychopathology from a mechanical, chemical, and social perspective. At times though it was difficult integrating chemistry and genetics with classes such as "Theory of Mind." The vastly different approach to scientific observation and experimentation required by each field forced students to expand their understanding of therapeutic technique as one which encompasses the whole body of an individual not simply their subjective emotional experience of life.

The emphasis though, in the program at ____ was hard science, a great deal of time was spent teaching the various methods utilized in the collection and analysis of data. A failing of the program consequently was a lack of humanization of what is a very personal and emotional human experience. In the first days of actual clinical experience, I was struck by the significant disadvantage resulting from this educational approach. While I had learned what physical and psychological symptoms to expect with addiction to controlled substances, I was not prepared for the nature of the emotional story and experience which accompanied that addiction.

Before treatment or intervention can be considered a thorough understanding of addiction itself must be gained. One of the most significant features of addiction is that it is not the "normal" result of experimentation (Koob & Le Moal 1997). Though addiction is a serious problem, not every person who drinks becomes an alcoholic, every person who smokes does not become addicted to nicotine, and every person who tries controlled substances does not become immediately and irrevocably addicted to them. What then causes some people to become addicts where others do not?

There are two primary schools of thought regarding the actual mechanism of addiction. One, the disease model, suggests that addiction is the presentation of an existing underlying biological susceptibility. The behavioral model though suggests that addiction is the result of modeling or conforming behavior (Botvin et al. 1990). Recently though there has been research into the mechanism of addiction as a biological and social cycle which is the result of a catastrophic failure in self-regulation. Self-regulation being defined as the ability to mediate the desire and decision to take the substance in question (Koob & Le Moal 1997). Ultimately substance seeking behavior becomes compulsive as opposed to controlled and recreational. Also, the number and severity of activities an individual is willing to endure in order to procure those substances. This compulsive lack of self-regulation though is not necessarily restricted to intoxicating substances in the traditional sense, so too can gambling eating even intercourse can become so compulsive that they too are classified as addictions (Robinson & Berridge 2001).

A significant aspect of the reason these substances are so effective, and do easily lend themselves to addictive behavior is their disruption of naturally evolved behavioral and chemical responses to a variety of stimuli (Nesse, 1994). Be it euphoria, pain relief, dissociative states, these substances remove individuals from the totality of an experience which their body was equipped through evolution to handle in a controlled and safe manner. This interference in chemically charged life events can easily result in a maladaptive behavioral cycle where an individual begins to substitute the artificial high for the natural effects of various bodily response systems. An evolutionary approach to addiction accounts for both the behavioral response to exposure as well as the various underlying chemical responses which mediate the continued behavior. A strong factor in the decision to try a drug is the expected impact on some emotional state. Emotion is either pleasurable or painful, though the breadth of emotional responses encompasses a wide range of intermediate states between pleasure and pain, inherently emotion must evoke one or the other (Nesse, 1994). Emotions necessarily are not hedonically neutral. From an evolutionary perspective, the human body and brain has been programmed to seek opportunity and success which are linked strongly with pleasure. Negative emotions associated with threat or loss are generally associated with pain. In these instances pleasure and pain are not to be understood simply as physical experiences, rather individuals are capable of experiencing emotional pain as well as psychological pain. Those same things are true of pleasure. Emotion therefore is a highly complex set of stimulus and response designed to promote success and success seeking behaviors.

In years past these traits were essential to the survival and continuation of the species. Now though they present a stark vulnerability to addictive substances. As is seen in animal models of addiction, there is a driving and overwhelming desire to seek out pleasurable stimulation and avoid painful stimulation (Nesse, 1994). While animals exhibit these behaviors in much simpler constructs than their human counterparts, the driving force behind the action is quite similar. Even in the context of recreational substance use where there is no dependence component present, an individual continues to use because of the pleasurable or pain alleviating properties of the substance. A primary and significant difference between use and addiction though is the ability to self-regulate (Robinson & Berridge 2001). When an individual uses a drug, they are making a decision to participate in an activity which they are aware of as being high risk. However, when the desire to use that drug becomes compulsive as a result of a lapse in self-regulation the recreational use becomes abuse and dependence.

One prominent theory regarding the shift from substance user to addict is a lapse activated causal pattern. That is, a pattern of behavior which develops as a result of an initial lapse which triggers organism wide lapses in self-regulation and control. This pattern of behavior is accompanied by numerous negative emotional features, such as depression, which serve to exacerbate and perpetuate the cycle of dysregulation. Ultimately, this addiction cycle disrupts the reward system existing within the brain which makes exiting the addiction cycle virtually impossible. One existing addiction cycle in conjunction with the associated lapsed self-regulation behaviors and emotional features will also make an individual more vulnerable to additional addiction behaviors (Koob & Le Moal 1997).

The neurochemical seat of addiction is the mesocorticolimbic dopamine system. Dopamine being a strong excitatory neurotransmitter associated with pleasurable activities and experiences. Many addictive substances also affect this neurotransmitter triggering the cascade of its release throughout the brain. It is through this mechanism that drugs such as cocaine induce euphoria in users. Though not all intoxicating substances work on dopamine, there is evidence of strong neurochemical correlates in the brain which signal behavior rewards. The cycle of addiction described by this mode is complex accounting for the behavioral, psychological, and chemical facets of addiction (Brown & Miller 1993).

The process of addiction begins with a lapse in some self-regulating behavior. This lapse may occur for any number of reasons. During this lapse an individual consumes some intoxicating substance or engages in other high risk behavior resulting in the increased release of neurotransmitters associated with the positive reward cycle. This chemical relief temporarily mediates the distress of the first lapse. Once the effects of the intoxicating substance have worn off however, the individual is confronted not only by the initial distress which resulted in the lapse but the added distress of having consumed some intoxicating substance compounded by the withdrawal effects of that substance. It is this confluence of factors generally associated with the difference between recreational substance use and clinical substance abuse.

The spiraling distress experienced after that first lapse is possible the most significant motivational force compelling an individual to not only use again, but to use in a larger quantity (Koob & Le Moal 1997). This secondary use produces the same results as the first, possibly intensified by the greater degree of comedown resulting from the greater intake of the substance. A mediating factor in the cycle is the neurochemical result of introducing intoxicating substances into the body which trigger the release of neurotransmitters inappropriately. This cycle continues becoming more extreme as the lows between uses become more intense. Ultimately, the individual is unable to break the cycle of addiction which… [END OF PREVIEW]

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