Understanding psychology: key concepts and applications

¶ … Psychology: Alcohol & Drug Abuse

The over-all focus of this paper is to show how alcohol, drug addictions and abuse is fundamentally a disease of the brain. It will focus on various psychological aspects of addiction, such as some theories as to why people get addicted to drugs or alcohol in the first place, and some theories for treatments of those addictions; some psychological processes of how certain drugs work; how those drugs shape addiction through their processes; and finally analyzing the understanding of addiction within the brain.

Some major theories for why people begin to use substance such as drugs (legal or not), and alcohol are the reward and reinforcement theory, recreational use, and the stress-reduction theory. Some theories for treatments include using combinations of cognitive/social support rehabilitation, or using some form of rehabilitation with medications as well. The types of drugs and their effects that will be discussed consist of stimulants, depressants (including alcohol), and narcotics. Finally, this paper will analyze the mechanisms in the brain that allow the disease of addiction to grab hold of a person, and what medication treatments are being used to treat addiction as a brain-based disease.

Psychological Theories

Many people may wonder (this author included), why a person decides to use drugs or alcohol in a manner that is not considered "normal," or "social." Some reasons may be that a younger population of users find drugs being glamorized in careers like modeling or professional sports; some may give in to peer pressures in order to socialize with certain groups at school, some may just be curious and find the experience more than they bargained for; and still some may have stress related incidents in their history that they just rather forget (Feldman, 2009). More often than not it boils down to two reasons how addicts get their start: the first is they were just curious which activates the reward and reinforcement pathways within their brain (more on this later), or they are highly susceptible to stress and start self-medicating to cope (Anton, 2010). The theory of reward and reinforcement will be fully explained the in the Brain Pathways section later in this paper, but to basically lay out the premise of the theory we can begin with a cigarette example. Let's say a person may smoke a cigarette for the first time and notice that after their first inhalation they feel a great sense of relaxation and stress-reduction, mostly because nicotine has activated the brain's "pleasure center," (the reward) and because of that they seek out cigarette's again in order to feel relaxed and stress-free once more (reinforcement) (Drummond, 2001; Oltmanns, & Emery, 2010). This type of addiction is also known as a "biologically based" based addiction, because the body is literally craving the same feeling/substance repeatedly and cannot perform normally without it (Feldman, 2009).

Stress-reduction theories are equated to layman's term such as "self-medicating," and "using drugs to escape one's problems." (Anton, 2010). Indeed, in Raymond Anton's article on substance abuse he states that there is an increasing amount of research done on genetic and developmentally at risk persons for lower levels of stress tolerance, which may induce certain people to turn to drugs or alcohol at any time during their lives. Some events in a person's history may be too much for them to take, such as past sexual abuse, war (especially for soldiers in Iraq), and childhood trauma (Anton, 2010). What usually happens for a person who is self-medicating is that there is some stress, either from the above mentioned reasons, or just daily life in general, and a person will turn to alcohol to help them relax, or to help them forget (Feldman, 2009). Of course, after several drinks the stress is gone, the person feels happier, looser and continues this nightly ritual until the person can no longer feel relaxed or forget the haunting memories normally and now needs alcohol to do this for them, in ever increasing quantities. This is also known as the "psychologically based addiction," where the person feels that they need the substance of choice in order to cope with the stress because they feel they cannot cope with it normally (Feldman, 2009). Substance used for stress coping can be something legal, such as cigarettes, alcohol, or prescription drugs; to something illegal like cocaine or marijuana.

The two main types of therapy that can be provided for an addicted person is rehabilitation, either inpatient or outpatient, and medication coupled with rehabilitation; recently treatment is leaning towards the latter due to the more accepted notion that addiction should be classified as a disease (Anton, 2010). Inpatient rehabilitation treatment usually occurs when a patient with a substance addiction is sent to a residential-type home outfitted with doctors and therapists specializing in substance abuse, where the patient usually goes through detoxification, attends counseling sessions, group sessions, and receives medication for a certain period of time (Anton, 2009; Oltmanns, & Emery, 2010).

Outpatient rehabilitation treatment is when a patient does not stay at a residential center, but goes through programs like Alcoholics-Anonymous, seeks out a cognitive-behavioral therapist specializing in addiction, or may go to some other type of group support therapy (Anton, 2009; Oltmanns, & Emery, 2010). Alcoholics-Anonymous, and other similar support-based self-help groups, are thought to help addicts based on the "personal growth process," coping strategies, and the social support and motivation that is offered by those who attend and have remained sober for a long time (Oltmanns, & Emery, 2010). Cognitive-Behavior therapy helps addicts recognize thoughts, feelings, situations, or behaviors that bring on substance abuse; and teaches them coping skills to deal with those issues in a healthy way (Oltmanns, & Emery, 2010).

Processes & Effects of Substances

This section will illustrate process of effects, withdrawal symptoms, and adverse reactions caused by certain substances that are abused. First, let us start off with substances that are considered legal, but are nonetheless abused and have high rates of addictiveness. Caffeine is one of the most common legal stimulant substances used by most people in America, and its effects are feeling alert, increased mood elevation, and decreased reaction time (Feldman, 2009). Withdrawal symptoms may include headaches, irritability, and even depression; adverse effects can most likely manifest in "nervousness and insomnia." (Feldman, 2009).

The next two most used legal substances are alcohol and cigarettes, or nicotine. Alcohol is a depressant, and its effects, adverse or not, relies on the number of drinks a person has had within a certain period of time; usually between two or three drinks the person will feel less anxious, more relaxed, and their inhibitions weakened (Feldman, 2009). However, four or more drinks can induce slurred speech, clumsy gait, emotional mood swings, and impulsiveness; which can quickly give way to trouble breathing, coma or even death, depending on the amount consumed at one time (Feldman, 2009; Oltmanns, & Emery, 2010). Withdrawal symptoms can include, depending on how severe the addiction, vomiting, headaches, hallucinations, tremors, seizures, and death (Feldman, 2009). Nicotine is a stimulant, but its effects mimic that of antidepressants, in that the user feels instantly relaxed and stress-free (Oltmanns, & Emery, 2010). Withdrawal symptoms consist of tremors, headaches, irritability, nausea, trouble sleeping, and severe mood swings; adverse effects of nicotine abuse are attributed to many serious diseases such as lung cancer and heart disease (Oltmanns, & Emery, 2010).

Two major illegal drugs that are of major concern for those working with youth in America are methamphetamine and cocaine (Feldman, 2009). Both are considered stimulants, and are abused with the same intentions of caffeine, usually with students or those working long hours looking to stay alert and productive to get more done throughout the day (Feldman, 2009; Oltmanns, & Emery, 2010). Methamphetamine is a synthetic drug that is easy to make, easy to find, and inexpensive compared to some drugs, which produces increased mood elevation, alertness, energy, and "heightened confidence." (Feldman, 2009) However, withdrawal can be characterized as a crash, with the user feeling very tired, lethargic, irritated, and with prolonged use suicidal (Feldman, 2009). Adverse reactions with repeated use consists of a range of physical symptoms like high blood pressure, and high body temperatures; with a range of bizarre symptoms like self-mutilation, paranoia, hallucinations, seizures, psychosis, and death (Feldman, 2009). Though cocaine has similar processes as methamphetamine, if not the same, and its adverse reactions when abused can be twice as likely to cause overdose and death (Feldman, 2009; Oltmanns, & Emery, 2010).

The widespread use of heroin is increasingly alarming due to its rapid deterioration of a person's normal life functions; it is considered a narcotic or an opiate due to its synthetic derivation from morphine, which is made from the poppy seed pod (Feldman, 2009; Oltmanns, & Emery, 2010). The effects of heroin are pain relief, comfort, happiness, and a kind of euphoria when injected into the blood stream that lasts for a short period of time (Feldman, 2009). Heroin is considered the most dangerous drug to be addicted to because it activates both types of addictions, biological and psychological, in that once the drug has worn off the main withdrawal symptoms are a great need to "repeat the experience" and "larger amounts of heroin are needed to produce the same pleasurable effect." (Feldman, 2009). Adverse reactions to abusing heroin include depression, convulsions, coma, financial difficulties due to the cost of obtaining the drug, homelessness, high risk for AIDS/HIV, violence, suicide, and death (by overdose) (Feldman, 2009; Oltmanns, & Emery, 2010).

Analyzing Physiological Effects & Treatments

Addiction begins when a person feels a craving for a substance, which has activated the "pleasure center" of their brain, which are the dopamine reward pathways and endorphins located in the limbic system (Oltmanns, & Emery, 2010). In chronic abusers of substances like alcohol, heroin, or cocaine, these pleasure centers have been so artificially high, repeatedly, that according to Raymond Anton, the brain has been literally "hijacked" by the floods of dopamine, that when the user is not high the limbic system does not have normal responses to pleasurable things like food or sex anymore. Therefore, according to Anton, the drug is increasingly needed for users to feel any sense of well-being, and explains why users have an escalating feeling of depression when coming down from a high, and lends to the rising popularity of the theory that addiction is a brain-based disease. These pathways are so addicted to the drug that when a substance abuser just looks at pictures of alcohol or drugs, or the paraphernalia such as needles, or even pictures of the environment where they may use, these pathways are abnormally activated vs. participants who did not have a substance abuse problem (Anton, 2010).

Thankfully, because the idea that addiction is indeed a physiological disease of the brain that users suffer from for the rest of the lives even after being sober for many years there have been tremendous strides in using medication as treatment for addictions (Oltmanns, & Emery, 2010). According to Anton, there has been an increase in research for a cocaine vaccine, where clinical trials are being performed, and there have also been some new developments for other medication treatments for methamphetamines, opiates, and nicotine. Additionally, Colin Drummond, in his article solely concerning cravings, strongly recommends more research on the effects of using medications to treat alcoholism, as well as more investigations of the limbic systems neurotransmitters and their influence on cravings and addiction.

As it stands today there are many medications being used to help facilitate detoxification, and to help substance abusers of illegal drugs "maintain a state of remission." (Oltmanns, & Emery, 2010). A drug called Antabuse is a fairly common medication treatment for those wishing to abstain from alcohol, and its main function is to make the patient violently ill when they drink even the smallest amounts of alcohol (Oltmanns, & Emery, 2010). Of course, the only problem with this form of medication is that the patient can simply stop taking it if they want to drink again, however, they can take a different drug called Revia, which helps to block the reward pathways that alcohol would normally activate, thus dampening the affects of alcohol and curbing the rewarding aspects (Oltmanns, & Emery, 2010). Another drug for alcoholism called Campral, which has the highest success rate, is used for those seeking relief from withdrawal symptoms and is meant to be used in conjunction with psychological therapies like cognitive-behavioral, group therapy or inpatient rehabilitation (Oltmanns, & Emery, 2010).