Addiction and pain
Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of time.
Mark Twain
- Hedonism refers to the pursuit of pleasure and avoidance of pain. Herbert Spence (1881) argued that the function of pleasure was to support behaviors that benefited life: eating, drinking, sex.
- But pleasure can be sought for its own sake, opening the possibility of behavior we would see as abusive:
- Addiction: compulsive use which exposes the individual to long-term negative consequences.
- Tolerance
- Withdrawal
- Negative health or life consequences
- DSM-V Substance use disorder (APA 2013):
- impaired control (carving so strong they lead to intense effort to secure despite intentions not to do so), social impairment (withdraws or compromises other areas of life), risky use (use despite physical danger or adverse physiological consequences), pharmacological criteria (tolerance and withdrawal).
- Psychoactive drugs:
- Caffeine
- Alcohol
- Nicotine
- Marijuana
- Psychotherapeutics
- Cocaine
- Hallucinogens
- Opioids
- Controlled substances: manufacture, possession, and distribution are regulated by the federal and/or state governments of the United States
- Can criteria of substance use disorder apply to exercise, gambling, Internet use, eating? Fuzzy boundaries again
- Motivations can shift: initial use may be to achieve pleasureable effects, late use may be to prevent or end withdrawal effects
- Tolerance: habituation—need for greater amount
Withdrawal: characteristic pattern of symptoms produced by absence of substance after a period of use - Risk factors:
- Genetic: what exactly is it that “runs in families”?
- North American first peoples and the metabolism of ethanol
- alcohol-metabolizing enzymes alcohol dehydrogenase and aldehyde dehydrogenase
- “Conclusions
- Substance dependence has a substantial genetic component in Native Americans, similar in magnitude to that reported for other populations. The high rates of substance dependence seen in some tribes is likely a combination of a lack of genetic protective factors (metabolizing enzyme variants) combined with genetically mediated risk factors (externalizing traits, consumption drive, drug sensitivity/tolerance) that combine with key environmental factors (trauma exposure, early age of onset of use, environmental hardship/contingencies) to produce increased risk for the disorder.”
- Cindy L. Ehlers, PhD and Ian R. Gizer, Ph.D. Evidence for a Genetic Component for Substance Dependence in Native Americans. Am J Psychiatry. 2013 Feb 1; 170(2): 154–164.
doi: 10.1176/appi.ajp.2012.12010113 - Again (and again and again): human behavior and motivation are complicated: beware of simple explanations
- North American first peoples and the metabolism of ethanol
- Personality traits: sensation-seeking, impulsivity
- Barratt Impulsiveness Scale is available: www.impulsivity.org/measurement/bis11
- Family and society
- modeling, expectations, availability
- laws, Prohibition
- Culture
- Genetic: what exactly is it that “runs in families”?
- Common neurological path ways: dopamine and the “reward system”
- Treatment
- Factors associated with successful treatment of substance abuse: family, job, motivation for change
- Antibuse: a punishment paradigm
- Naltrexone: heroin, cocaine, alcohol, gambling
- Behavioral Addictions
- Gambling (only behavioral addiction officially in DSM-5)
- Parkinson disease, L-dopa, gambling problems
- Internet addiction? (under study in DSM-5)
- Internet Addiction Test (IAT) created by Dr. Kimberly Young is available at:
- www.globaladdiction.org/dldocs/GLOBALADDICTION-Scales-InternetAddictionTest.pdf
- Sexual addictions?
- Gambling (only behavioral addiction officially in DSM-5)
- So, what do addictions teach us about human motivation?