Assignment 11
2 pages for this one, don’t copy , and follow all the instructions
Addictions
The traditional model of addictions has been one called the disease model. It focuses on genetics and
biological causes for addiction. Its basic premise is twofold: First that some individuals are more
susceptible to addictions due to their biological make-up, and second that some substances are highly
addictive to everyone and should be avoided at all costs. This second premise has been used to validate
The War on Drugs. However, as we begin to understand more about the addictive process, some things
come to light that give us pause for thought.
But let’s start at the beginning…
Imagine you are a rat. And no, I’m not
trying to get existentialist on you, you’ll
see where I’m heading in a moment.
You are an intelligent, social animal
who thrives on living in a community of
like-minded rats. Almost from birth,
your “home” has been a small, stainless
steel cage, with solid sides and a mesh
front. You have a small dish for food
and a water source, but no other
stimulation except what you can see
out of the front of your mesh cage.
Your only interaction is with the
researchers, who give you food and
water, but nothing else; otherwise,
they may confound the variables in
their research. You live like this, day after day, an intelligent creature with no stimulation, no friends, no
joy. Then, one day, you are hooked up to an IV that delivers a substance each time you press a
lever…you press the lever and your brain feels joyful and stimulated. Every time you have some of this
stuff, life seems good for a while. So you start to have more and more of this stuff, eventually choosing
it over the offer of water and food. Some of you may prefer this substance so much that you eventually
die of starvation. The researchers conclude that obviously this drug is highly addictive and dangerous
and laws should be created to limit its availability.
But, the researchers are also aware that rats and humans might be different, so they interview
individuals who are either highly addicted to substances, or are slowly recovering from their addictions
in prison or in rehab facilities. This strengthens their disease model theory – some individuals are more
biologically susceptible to addictions and some substances are dangerously addictive no matter who you
are, because of the effect they have on the brain.
I’m hoping that some red flags are popping up for you. When we critically think about this
methodology, how sound is it, really? What factors are missing from this research?
In 2010, researchers from Simon Fraser University, in BC, asked those questions. They wanted to find
out what would happen if rats weren’t confined to a small, metal box, but something that more closely
approximated a good life for a rat. They created “Rat Park.”
Rat Park was a big space, where rats had access to varied food sources, water, toys, opportunities to
exercise and most importantly, other rats. There were spaces to sleep comfortably, mate, raise young
and play – a rat Utopia, if you will.
So, their first question was: will rats still choose the drug, when living in this more stimulating and social
environment?
The answer? No. The rats in Rat Park were 20 times less likely to choose the drug than their caged
controls, even when the experimenters laced the drug water with sugar to entice them to use it.
Their second question was: What if we create a drug addiction in the rat and release it into Rat
Park…will it continue to use?
The answer? No. The majority of the rats chose to struggle with withdrawal effects, in favour of playing
with other rats in rat park.
Okay, so the research from the rats has seemingly offered up an alternative explanation, but what about
for humans?
When looking at substance abuse in humans, there are some patterns that emerge that might offer an
alternative explanation for the source of addictions. Here is a summary of the findings:
1. A primary need for humans is to have connection to other humans
Attachment issues to primary caregiver: insecure attachments linked to higher rates of addictive behaviours.
Social isolation for any number of reasons: new to town, recent death of partner, mental health issues can cause isolation from others and these are all linked to higher rates of addictive behaviours
Incarceration: again, isolation from supportive systems, intimacy – linked to higher rates of addictive behaviours.
General Loneliness: predictive risk factor for development of addictive behavior
2. Not all substances are naturally addictive; for many, context and intent provide a critical back-drop. For example:
Morphine in hospital for chronic pain vs. on the street
Those taking morphine in hospital do not become “addicted”
Once released from the hospital, pain sufferers were able to wean onto other painkillers or eventually no painkillers at all without a strong desire for more
morphine – the key factor appears to be level of social support network,
thriving in natural environment
Another key point, here, is that the disease model doesn’t offer an explanation for behavioural
addictions, which follow the exact same cycle as addictions to substances. Food addictions, exercise
addictions, shopping addictions, gambling addictions, work addictions…the disease model can’t extend
itself to explain why these behaviours become addictive to the point of causing an individual stress and
dysfunction – if so, we’d have to have a War on pretty much everything in our society. In addition,
we’ve further complicated the problem by collectively deciding as a society what constitutes a “bad”
addiction vs. a “good addiction”, even though they are equally damaging to the individual engaging in
the behaviour. Some examples of socially approved of addictions are work addictions and exercise
addictions. Food addictions, while not social approved of, are certainly not considered as problematic as
drug addictions, even though binge eating activates many of the same reward pathways as opiates or
amphetamine. This practice means that we can easily separate ourselves from the “addicts” who are
different from us because they are helplessly under the control of a “bad substance.”
In reality, behavioural and substance addictions are exactly the same. In fact, the definition of addiction
has been revised over time to include behaviours and activities. The definition is:
Persistent, compulsive use of a substance/activity known by the user to be physically, psychologically, or socially harmful. May include substance dependence or behavioural addiction.
The cycle of addiction includes:
Have obsessive thoughts that create a need Engage in compulsive behaviour that alleviates need/withdrawal Temporarily satisfied or satiated
Start to experience withdrawal symptoms
This is the same, regardless of whether your addiction is to opiates, cocaine, eating or shopping.
From a behavioural point of view, addictions begin due to positive reinforcement, and continue due to
negative reinforcement
So, what is happening at the brain level?
Most drugs activate either the dopaminergic system (reward centers) or opiate systems (well-being)
These create feelings of euphoria, joy, pleasure and peace
Social isolation, social conflict, low quality of life is associated with activation of pain centers in the
brain.
***Makes sense we’d want to alleviate that, doesn’t it?
So…if addictions are a socially created phenomena due to lack of key attachments, isolation, poor
quality of life, lack of social support, etc. How do we combat it? Prevent it?
Harm Reduction
One movement is harm reduction. Its purpose is to accept the individual where he/she is at and to provide information and supplies that will render that addiction less harmful to the individual and those around that individual. A really key feature of this model is acceptance of the individual and compassion, offering social support and a sense of connection with another human being. This has allowed some individuals to eventually drop their addictions.
Examples: Seaton House in Toronto: first legalized “wet shelter” (serve measured glasses
of alcohol under supervision) Methadone Treatment Needle Exchanges Safe Injection Sites Free Condoms, HIV information and HIV testing
What do we do to prevent addictions from occurring in the first place?
Time and money could be put into researching early identification of those at risk for developing addictions
Those with insecure attachments Those in new environments without a support network Those in stressful environments Those struggling with social skills and loneliness
Money to do this could be found in the “war on drugs” movement – which has not been
effective and, in light of current research, potentially even more harmful. The war on drugs isolates drug users further, creating more of a disconnect from
others, a shaming stigma and no alternative to drug use.
As this is an introductory course, and this just one of the modules, I will end
our discussion of social alternative theories to addictions. However, if you
are interested in learning more about this approach to addictions, I’d invite
you to read Dr. Gabor Mate’s book called “In the Realm of Hungry Ghosts:
Close Encounters with Addiction”. He is a well-known doctor who did a lot of
work with people living with addictions in East Vancouver. It’s an interesting
read. In the power point that follows, there are some questions you can ask
yourself if you feel that you are at risk for addictions or may currently be
caught up in a cycle.
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