Understanding substance abuse as a disease скачать в хорошем качестве

Understanding substance abuse as a disease

41 Chapter 2 Why People Use and Abuse Drugs and Alcohol morphine) are used to kill pain, numb, shut down, or shut out the world. In con- trast, stimulants (e.g., cocaine, amphetamines) are used to increase stimulation, activ- ity, and action. Unfortunately, continued drug use creates a negative cycle of abuse, dependence, and addiction. Other Factors that Contribute to Substance Abuse Boredom and Altered States Boredom is often cited as a major factor in alcohol/drug abuse by adolescents as well as adults. As previously described, the drive to alter one’s consciousness is directly related to using alcohol/drugs to counter uncomfortable feelings of boredom. Surprisingly there has been very little research to date into the nature of the rela- tionship between boredom and alcohol/drug problems, alcoholism/addiction. Nor have there been concerted efforts to help addicts/alcoholics deal with boredom as a relapse dynamic. McWelling Todman, Ph.D., an expert on the topic of boredom and psychiatric disorders, states: Despite its prominence in studies of human performance in industrial settings . . . the construct of boredom continues to be ignored by most clinicians. Even in the field of substance abuse, a field for which there has been no shortage of anecdotal and speculative commentary on boredom’s motivational role in the addictive cycle, there has been surprisingly little in the way of empirical scrutiny. (Todman 2003) The recent emphasis in the alcohol/drug recovery field of using meditation practices and mindfulness training is directly related to teaching people how to be more present and aware and to be able to deal more effectively with boredom by “showing up and being present” (see Chapters 12 and 13 on treatment and relapse prevention). Boredom can involve many different issues. (See Chart 2.1.) Early research on boredom and alcohol use (Orcutt 1984) identified two different types of boredom. Existential boredom, which is defined as a lack of purpose in life, was found to have a strong, positive relationship to frequency of alcohol use among males. Another kind of boredom, interpersonal boredom, is defined as being bored with “small talk” ver- sus having feelings of “happiness with people.” Orcutt found that the more they felt interpersonally bored, the more alcohol both males and females consumed. Impulsivity and Disinhibition It seemed like a good idea at the time. Impulsivity/disinhibition includes personality traits such as sensation seeking and aggressiveness. I refer to some substance abusers as “edgewalkers”—people who are living on the edge of danger or risk. Impulsive/ disinhibited individuals are at increased risk for alcohol-related problems (Caspi et al. 1997; Schukit 1998), and the traits of impulsivity/disinhibition are elevated in the children of alcoholics (Alterman et al. 1998; Scher 1991). fie40673_ch02_025-055.indd 41 2/8/20 5:42 PM Section I Understanding Substance Abuse 42 Social Learning Theory It’s fun to use and be with friends. . . . It’s peer pressure. . . . It’s cool to use and chill out. . . . I can use drugs and belong. . . . I can connect with others when we are together. . . . Sex is better. . . . A variety of models can be considered psychosocial or social learning models. The key element of these models is the social learning aspect of alcohol/drug use. Social learning theory also incorporates other models, such as the tension-reduction model. For exam - ple, the young child who sees Dad drink his martini at the end of the day and witnesses the relief of tension may come to see drinking alcohol as an extremely positive expe - rience. Nathan (1983) describes alcohol use as a socially acquired, learned behavior pattern, maintained by antecedent cues (classical conditioning and expectancies), con - sequent reinforcements (operant conditioning and tension reduction), cognitive factors, modeling influences, and the interaction of behavioral and genetic mechanisms. Marlatt and Gordon (1985) emphasize certain social learning and cognitive- behavioral points about addiction: • Addictive behaviors are a category of “bad habits” (or learned maladaptive behaviors). Biological factors may contribute to predisposing an individual to alcohol problems, but specific patterns of use are learned. C H A R T 2 . 1 Kinds of Boredom Interpersonal Boredom Being bored with “small talk” versus having feelings of “happiness with people” Existential Boredom Having difficulty with meaning or purpose in life An inability to know what will make you happy leading to a pervasive sense of meaninglessness Abandoning important life goals and dreams because of practical concerns or other pressures Leisure Time Boredom Not being able to find rewarding things to do during leisure time Life Boredom Neglect of life goals leading to a state of emotional