One thing that determines use is the balance between perceived risks and
benefits associated with a substance.  The rank-ordering exercise that was included in your text on pages 120-121 was intended to illustrate one set of risk/benefit examples.

Looking at the qualities of many benefits and risks associated with drug use, 

• The BENEFITS tend to be more *immediate* and *certain* 
  • For smoking, benefits can include positive feelings (relaxation AND stimulation), clear-headedness, taste, and social benefits.   For the addicted smoker, smoking will also lead to the elimination of withdrawal symptoms. 

   

• The RISKS tend to be more *distal* (far) and *uncertain*.
  • Risks or negative effects for smoking include risk of cancer and heart disease, other lung diseases, putting loved ones at greater risk for the same, bad breath, and a reduction in taste and smell sensitivity.  

Clearly, the risks outweigh the benefits in severity.  Based only on that, we should assume that no one would ever smoke.  However, the benefits are certain to happen and happen immediately upon using the drug (notably, elimination of withdrawal symptoms.)  The negative effects may or may NOT happen and the more important ones (e.g., health risks) have less control over current behavior because of the delays in their occurrence (many years in case of heart disease or cancer).  

Principles of learning theories based on consequences note that sure and immediate consequences have significantly greater behavioral control than those that are uncertain and removed by time (ex.: would you more likely work hard on a job today if you expected payment today or if you expected payment 20 years from now?)

Self-tests of concepts:

Use of drugs, the pattern of that use, and addiction (if it occurs) are all examples of complex behaviors controlled by a variety of factors-- both within the person and outside.  The theoretical perspectives discussed in the notes provide different areas of focus.  Although no one perspective can explain addiction alone, each has something to contribute to our total understanding.

The approaches to treatment, then, derive directly from these assumptions.  Take a look again at the table from page 300:

Table 5-3: Major Treatment Perspectives
Perspective	Major Assumptions	Example Goals and Methods of Treatment
Biomedical	·     Addiction has biological cause ·     Drugs alter the functioning of the nervous system ·     Some people are more vulnerable for substance disorders from genetics or other physiological causes	·     Disease model: Need to permanently remove “pathogen” (drug) from person’s life. ·     Use pharmaceuticals to block or alter drug’s effects; treat related brain disorders
Behavioral-Cognitive
Behavioral	·     Addiction is a learned behavior because of consequences ·     Automatic bodily responses to drug stimuli can be learned that further motivate use	·     Modify behaviors by shifting consequences ·     Modify learned responses to stimuli ·     Can include controlled use as outcome
Cognitive	·     Beliefs about self and actions affect decisions about use and change ·     Cognitions and situational demands interact	·     Modify beliefs and perceptions about self, use, and quitting use ·     Inoculate against triggers for relapse
Psychodynamic	·     Addictions are symptoms of underlying problems ·     Unconscious conflicts and weak ego defenses make someone vulnerable	·     Insight into underlying issues is key for recovery ·     Strengthen ego
12-Step and Other Self-help Groups	·     Perspectives vary, but most typically view addiction as a disease	·     Gain strength from group to fight addiction ·     Complete abstinence is typical goal

Intervention and Treatment:

Be aware of Williams' stated goals for intervention (see page 293), but also the CRAFT approach discussed in the Addiction film clip.  As people potentially working in education or human services, intervention is probably the most likely role you'll play in relation to someone else's drug use. 

TERTIARY PREVENTION-- takes place at later (advanced) stages of drug abuse-- GOAL is to avoid relapse and maintain health status after therapy.  This is essentially the extended aspect of drug treatment.

TREATMENT ---------
Goals of treatment:  1)   To intervene in the progression of the chemical dependency  2) To educate and assist the (client) in changing self-destructive behaviors  3) To develop within the client the commitment to carry out a plan of abstaining from drug use.

Be sure to look again at the different approaches to therapy and the Addiction movie clip on Cognitive-Behavioral Therapy for a clear look at an integrative approach.

Relevant film clips:

It was noted that therapies using multiple approaches, tailored to the needs of the individual will be most effective.  In the sum-up to the therapy lesson, an integration of the important aspects of the differing approaches was noted:

• Enhancement of clients' self-efficacy (through skill building);
• Use of incentives (to create and maintain motivation);
• Holistic treatment packages (to address clients' lifestyles);
• Patient-treatment matching (to individualize treatment strategies)
• These all would need to follow medical detoxification.

Lastly, the psychology of ALCOHOL'S EFFECTS were covered in class and Chapter 6.  Be aware of research and theories related to why alcohol can have such varied emotional and behavioral effects (after all, it's a simple drug, right?), noting the balanced-placebo design and the alcohol myopia theory and implications for aggression, sexual behaviors and tension reduction (pages 165-173).  Further, be familiar with the material on Fetal Alcohol Syndrome (pages 175-177);  Alcohol addiction and problem drinking (pages 177-181).  Again, you will not be specifically tested on the beginning of the chapter, but you should familiarize yourself with that material (especially alcohol pharmacology) in order for the covered areas to make sense.

O.K.--  Check your studying with these questions from previous exams.  

Click here to go to practice exam.

Remember, too, that last fall's exam appears on the Web Vista page.

In sum, drug abuse is generally seen by treatment professionals as a disease-- something that affects the individual; that the individual's actions can potentiate, but it is certainly something more than just a behavioral problem.  Alternatively, the view politically during the later '70's, and full-fledged in the '80's, and continuing today, is that drug abuse is primarily a behavioral problem that needs to be punished rather than treated.  Any comprehensive attempt to deal with the nation's "drug problem" has to also deal with this gap between views.

Hey there!  Here are a couple of web sites that offer information about substance use and other psychological disorders and therapy:

Internet Resources for Psychological Disorders and Approaches for Treatment and Therapy Internet Mental Health (www.mentalhealth.com)-- An excellent resource for information on psychological disorders.  If you go to the Index and go to "Substance-related disorders", you'll find articles, booklets, and web-links. A comprehensive list of "self-help" resources: http://PSYWWW.COM/resource/selfhelp.htm#substance See also the links provided at the Addiction series' page: http://www.hbo.com/addiction/