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Because learning changes everything.® Models and Contributing Factors of Substance Use and
Abuse

• No one theory or reason to explain the causes of addiction and

alcoholism.
• Early models: Labeled alcoholics as inherently weak or unable to
control their consumption of alcohol.
• Other models: Argued that alcoholics used alcohol in a pathological
manner to block out memories of unpleasant personal experiences.
• Physiological model: Scientists searched for a biochemical link to
Chapter 2 alcoholism.
Why People Use and Abuse
Drugs and Alcohol • Matrix of genetic, social, psychological, and environmental factors can
cause an individual to develop problems with alcohol and drugs.

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Learning Objectives
Models and Contributing Factors of Substance Use and
Abuse
• Explain the relationship between the drive to alter consciousness and
alcohol/drug abuse.
• Explain alcoholism as a disease. No single model explains all substance abuse behaviors and underlying
• Describe the key elements of the models and theories of substance reasons.
abuse disorders. The reality includes many confounding variables.
Clients are all different, with different coping skills, family histories,
physical traits, affective temperaments, personality traits, and
developmental histories.

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Drugs Why Do You Drink/ Use/Smoke? (From TRT Perspective)

• Have always been used to alter consciousness. It's stress....

• Open avenues to unconscious issues, conflicts, and perception new to I just drink to calm down....
the user’s life. I need to relax....
• Become traps that keep people from using their minds in positive I'm so tense....
ways.
It lets me worry less....
• Drug use becomes unrealistic and neurotic when it becomes an
I can avoid the conflicts....
addiction.
It makes decisions easier....
I can do the tedious work easier....
I can summon energy....
It reduces the tension....
It allows me not to think so much....
It makes me feel better....
It is pleasurable.
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Tension-Reduction Theory (TRT) 1

Trauma and Substance Use Disorders (SUDs)
Early research focused on tension reduction and relief from stress as a
primary reason for alcohol and drug use.
The American Psychological Association defines "trauma" as:
Directly experiencing or witnessing an event that "involves actual or threatened death,
Considered as one aspect of drug use today.
or serious injury,
or other threat to physical integrity,
Involves the concept of homeostasis. or learning that a family member or close associate has experienced such events,
• Individuals use alcohol/drugs to balance out (counteract) stress, and has a response that involves intense fear, helplessness, or horror."
anxiety, emotional tension, and conflict.

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Tension-Reduction Theory (TRT) 2 Trauma and Substance Use Disorders (SUDs)

Two Major assumptions. Two Major hypotheses :

• Alcohol reduces tension.

• 1 The Self-Medication Theory : Using/ Abusing is an attempt by the
• Individuals drink alcohol for its tension-reducing properties. individual to assuage feelings related to traumatic experiences.
• 2 High-Risk Hypothesis: Using/ Abusing contributes to the
development of post traumatic stress disorder (PTSD).
Genetically predisposed individuals find that alcohol or other drugs have
effects that buffer stress for them.
Lifestyle of substance abuse puts the individual in situations that are
traumatic.

Risk behaviors put the individual in situations that have traumatic

negative consequences.

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TRT 3 Etiological Model

Trauma and Substance Use Disorders (SUDs)
Focuses on discomfort and tolerance to stress as a major factor in using
alcohol/drugs.
• Individuals who have both trauma and substance use disorders often
do better in inpatient/residential treatment programs that specialize in
Individuals have biological variations in their levels of tolerance to stress the treatment of both trauma and substance use disorders.
and stimulation.
• Programs that do not have this sensitivity or expertise will often
Alcohol is used to shut down the stimulation overload from the result in the client having multiple relapses and further shame.
environment.

Alcoholism as a biochemical defect.

• Individuals are easily agitated by stimuli, become uneasy, and use
alcohol for its sedating effect.

Stress/tension causes "reactive" overreactions and behaviors that

contribute to relapse.

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The Twelve Steps of Alcoholics Anonymous 2

Case Study
• Made direct amends to such people wherever possible, except when
to do so would injure them or others.
• Continued to take personal inventory and, when we were wrong,
• Case 2.1 on page 28
promptly admitted to it.
• Case 2.2. on page 29
• Sought through prayer and meditation to improve our conscious
contact with God as we understand Him, praying only for knowledge of
His will for us and the power to carry that out.
• Having had a spiritual awakening as the result of these steps, we tried
to carry this message to alcoholics and practice these principles in all
our affairs.
SOURCE: The Twelve Steps are reprinted with permission of Alcoholics Anonymous World Services, Inc.

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Disease Model of Alcoholism Genetic Model of Alcoholism

The American Medical Association declared alcoholism a disease based on: Alcoholism: Group of illnesses in which the influences of genes and the
environment ebb and flow over the course of the at-risk lifetime.
• Known etiology.
• Symptoms get worse over time. Adoption studies.
• Known outcomes. • Adopted sons of alcoholic biological parents are four times more likely
to become alcoholics.
12-step program (an informal biopsychosocial spiritual model) based on the • Sons of alcoholic biological parents are more likely to be classified as
disease model. alcoholics at an earlier age than their peers.
• Assumes alcoholic/addict is predisposed to addiction by genetically
transmitted at-risk factors. • Daughters of alcoholic fathers exhibit a high incidence of somatic
anxiety and frequent physical complaints.

Genetic influence disease model does not emphasize genes or specific

disorders but instead assumes that multiple biological risk factors interact Twin studies.
with psychosocial environmental factors. • Higher rate of alcoholism in identical twins than in fraternal twins.

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The Twelve Steps of Alcoholics Anonymous 1 Personality Traits and Personality Disorders 1

• We admitted we were powerless over alcohol—that our lives had Addictive personality: Over simplistic and labels all alcoholics and other
become unmanageable. addicts as possessing a particular personality that:
• Came to believe that a Power greater than ourselves could restore us
to sanity. • Leads to addictive and compulsive behavior.
• Made a decision to turn our will and our lives over to the care of God It is better to say:
as we understood Him. Individuals have psychological vulnerability due to many different
• Made a searching and fearless moral inventory of ourselves. personality traits
• Admitted to God, to ourselves, and to another human being the exact • Psychological vulnerability: Personality traits that make a pattern of
nature of our wrongs. substance dependence more likely to develop.
• Were entirely ready to have God remove all these defects of character.
• Humbly asked Him to remove our shortcomings.
• Made a list of all persons we had harmed and became willing to make
amends to them.

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Personality Traits and Personality Disorders 2 Self-Medication Motive

Three-dimensional model of personality. Drug use is a purposeful attempt by the user to:
• Harm avoidant: Cautious, apprehensive, fatigable, and inhibited.
• Reward dependent: Ambitious, sympathetic, warm, industrious, • Assuage painful affective states.
sentimental, persistent, and moody. • Manage psychological problems and disorders.
• Novelty seeking: Impulsive, excitable, exploratory, quick-tempered,
fickle, and extravagant.
Explored to help users:

• Identify why they are taking drugs.

• Learn how to better cope with the affective states and psychological
problems.

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Mood and Affect Disorders

Alcohol/drugs are used to alleviate and self-medicate feelings of negative

emotional states.
Personality Traits and Personality Disorders 3
Primary affective disorders associated with self-medicating with
alcohol/drugs.
• Major depression, dysthymic disorder, cyclothymic disorder, atypical
I'm angry and drugs quiet me.... depression, bipolar disorder, and seasonal affective disorder (S A D).
It's hard for me to get close to others without drugs....
I feel anxious and fearful, so drugs relax me....
Increased incidence of mania—tenfold and threefold in female and male
I am bored and isolated, so drugs soothe that....
alcoholics, respectively.
Of all the personality disorders, the one with the strongest relationship to substance
abuse is narcissism. The personality disorder with the second highest correlation to
substance abuse is borderline personality disorder.

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Attachment and Substance Abuse Factors Contributing to Alcohol/Drug Use in the Family

• Disruptions in attachment create problems in connection. • Imbalance in parenting. • Significant trauma and stress in
• Difficulty in interpersonal bonds disrupts self-compassion and • Marital discord. the family.
compassion for others. • Alcoholic/addict behavior. • Physical, emotional, sexual,
• Alcohol and drugs are used to compensate for disconnection, and psychological violation.
• Imbalanced and dysfunctional
dissatisfaction in relationships, and to alleviate pain and suffering. family interaction. • Inappropriate boundaries.
• The result is disconnection from spouses/partners, family members, • Shame, abandonment, and
and friends, as alcohol/drugs become the primary relationship. rejection.

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Family Model Developing and Enhancing a Sense of Self

Includes all aspects of family life. • Control their destructive impulses.

• Understand their values, needs, and desires.
States that alcohol and drug addiction and dependence are family • Make wise decisions.
diseases. • Resist peer pressure when it endangers their welfare or inhibits their
• Genetic predisposition to alcoholism. growth.
• Find nonchemical means of fulfillment and satisfaction.
Children from alcoholic, dysfunctional, and shame-based family systems • Think intelligently and rationally.
are at greater risk of developing problems with alcohol/drugs.
• The modeling of family members who use alcohol/drugs also greatly
influences the development of alcohol/drug dependence.
• Parents with substance-abuse problems have extreme difficulty in
being effective parents.

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Factors in Adolescent Abuse of Drugs (PEACE) Other Factors That Contribute to Substance Abuse

• P (Pressure from peers). Boredom.

• E (Escape). • Existential boredom: Lack of purpose in life.
• A (Availability of drugs).
• Interpersonal boredom: Being bored with small talk versus having
• C (Curiosity). feelings of happiness with people.
• E (Emptiness).

Impulsivity/disinhibition.
• Personality traits such as sensation seeking and aggressiveness.

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Poor Self-Concept Social Learning Theory

• Generalized risk factor for problems with alcohol/drugs.
• Focusing on programs that teach children and adults to develop and It's fun to use and be with friends.... It's peer pressure....
enhance a sense of self, thereby making them less at risk of alcohol It's cool to use and chill out....
and drug problems.
I can use drugs and belong....
I can connect with others when we are together....
Sex is better....

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Social Learning Theory Psychoanalytic Models

Alcohol use. Fixation at the oral stage of development resulting in a narcissistic

personality.
• Socially acquired.
• Learned behavior pattern. Strategy for allaying anxiety over masculine inadequacy.

• Maintained by Abusers use alcohol/drugs to suppress latent homosexuality and ego-

dystonic feelings of homosexuality.
• antecedent cues.
• Consequent reinforcements. Alcohol/drug use is caused by a structural deficit in object relations.

• Cognitive factors. • Individuals have a hard time establishing effective interpersonal

relationships due to their difficulty in managing their affect and impulse
• Modeling influences. controls.
• Interaction of behavioral and genetic mechanisms.
Drugs used to cope with overwhelming feelings of rage and loneliness.

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Social Learning and Cognitive Behavioral Patterns about Alcohol/Drugs

Addiction
Frequently denote power or feeling powerful to users.
Addictive behaviors.
• Are learned maladaptive behaviors.
Have a powerful meaning as weapons of self-destruction and ultimately
• Occur on a continuum of use.
death.
• Determined by social, situational and environmental factors, beliefs
and expectations, family history and prior learning experiences.
Have important symbolic seduction and sexuality meanings.
• Exhibited under perceived stressful conditions.
• Strongly affected by the individual’s expectations. • Exploited in advertisements for tobacco and alcohol products.
• Can be changed by acquisition of new skills and cognitive strategies.

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Sociocultural Models Existential Issues

Influence of a culture on rates of alcoholism. Deal with the limitations of existence.

• Degree to which a culture causes acute needs for adjustment of inner • Limitations of life itself or how long we live, the unknowns related to
tension. death and dying.
• Attitudes toward drinking.
• Extent to which the culture provides substitute means of satisfaction. Drugs are a way to escape existential issues and to gain a temporary
relief and change in focus.

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Poor Future Orientation and Hope

Individuals who see their future as negative might abuse drugs.

Many addicts/alcoholics report that they don’t expect to live very long.
• Thinking that their life span is limited, they are not concerned about
having good physical health.

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Table 2.4: Optimism and Pessimism

• Dr. Seligman describes pessimists as thinking that a "negative event

or interaction" is permanent, pervasive (in all parts of one's life), and
personalized (caused by your own inadequacy).
• Whereas an optimist's reaction to a negative event or interaction is
very temporary, specific (related to this one event), and external
(does not reflect the internal self).

Pessimism Optimism
Permanent Very temporary
Pervasive Specific
Personalized External
SOURCE: Learned Optimism by Martin Seligman, Pocket Press, 1991.

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