Substance use and abuse

Friday, September 01, 2006

Evaluation Points You Should Know For Substance Use and Abuse

1) Nature – Nurture Debate. This issue occurs within this topic because of the contrast between the medical approach to addiction and the psychological. Essentially the medical model assumes that addiction is primarily and sometimes only a biological condition in which the individual is physiologically dependent on a drug. Whereas the psychological approach assumes that drug addiction is similar to other forms of addiction which are behaviourally and cognitively shaped. This is important because how we view addiction will lead to the development and implementation of certain forms of treatment. For example, the medical approach will argue that the use of other drugs and biological forms of intervention are the most effective ways of ‘curing’ addiction. Whereas the psychological approach will want combine these with psychological interventions that may include psychotherapy, behaviour modification, cognitive restructuring and even hypnosis.

2) Methodological problems evaluating clinical and public health interventions to prevent smoking addiction.

Who has become a non-smoker? Someone who hasn't smoked in the last month/week/day? Someone who regards themselves as a non-smoker? (Smokers are notorious for under-reporting their smoking.) Does a puff of a cigarette count as smoking? Do cigars count as smoking? These questions need to be answered to assess success rates.

Who is still counted as a smoker? Someone who has attended all clinic sessions and still smokes? Someone who dropped out of the sessions half-way through and hasn't been seen since? Someone who was asked to attend but never turned up? These questions need to be answered to derive a baseline number for the success rate.

Should non-smokers be believed when they say they don't smoke? Methods other than self-report exist to assess smoking behaviour, such as carbon monoxide in the breath and cotinine in the saliva. These are more accurate but are time-consuming and expensive.

How should smokers be assigned to different interventions? For success rates to be calculated, comparisons need to be made between different types of intervention (e.g. aversion therapy vs cue exposure). These groups should obviously be matched for age, gender, ethnicity and smoking behaviour. Ps could be matched on what stage of change (contemplation vs precontemptation vs preparation) they are at, or on health beliefs such as self-efficacy, or costs and benefits of smoking. The list of items to match on is endless, but it is difficult to find Ps that match if many variables to match on are used.

3) The social dimension is missing from many of the popular explanations of addiction. This is obviously important because of the significant positive correlation between lower socioeconomic groups and addiction to illegal and health damaging substances. Thus many current explanations would seem to reduce addiction to either biological or psychological levels and ignore the complexity of the issues when an interactionist approach is adopted which would look at how biology, psychology and social factors interact to create addiction.

4) Problems with the Disease Model. There are some problems with the disease model, the main one being that the nature of the disease has never been identified. What sort of disease is it, and how can a disease make people take drugs? There have been a number of attempts to explain the abuse of specific drugs in terms of a disease process; for example, it has been suggested that alcoholism is a result of a type of food allergy to the grain from which alcohol is manufactured, but such attempts have been limited to a specific drug and have never been particularly convincing.

There has never been a comprehensive disease theory that suggests a mechanism that can account for all types of addictions as a single disease, Perhaps this is not necessary, but considering the similarity of different addictions, it would be scientifically pleasing, and much more useful, if one theory could explain many different addictions. The continued absence of any disease mechanism that can account for the compulsive use of specific drugs or addictive behavior in general makes it increasingly difficult to accept the belief that addiction is a pathological condition.

There are those who argue that the fact that we do not understand the origins or the mechanism of the disease does not mean it is not a disease (Maltzman, 1994). In fact, we recognized many conditions such as diabetes and polio long before science could explain them in terms of biochemical deficiencies or viruses. Nevertheless, one might expect after all this time that some sort of disease process would have been discovered that would explain the compulsive use of at least one drug.


At 3:52 PM, Blogger Aaron Grey said...

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Aaron Grey
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