Addiction
Week 1
Lecture 1: Introduction
What is addiction?
The psychology behind addiction has more similarities that differences
- Example: smoking cigarettes and taking heroin have similar mechanisms
Why is it important to study addiction?
- 4 of the main reasons for death worldwide are addiction (smoking, alcohol, drugs)
- Opioid crisis in USA: average 115 opioid deaths each day → largest cause of death in
men under 30
- Over 3 million annual deaths due to alcohol and drug use (majorly men)
- Americans lose 119 billion through gambling each year
- Addiction is one of the 3 most common mental disorders in Europe
Lifetime prevalence Netherlands (DSM-V):
- Any mood disorders - 20.2
- Any anxiety disorders - 19.6
- Any SUD - 19.1% (1 in 5)
- Not all in treatment
Gender differences in prevalence: 80% of the population in treatment are men
Societal relevance of SU:
- Impact on health: health care, morbidity, mortality
- Relationships with crime: 50% of crimes are substance related
- Impact on public safety: driving, chemical waste
- Impact on work-related productivity
Is it a real disorder?
Some believe people with substance abuse disorders just have weak will, researchers say it is a
brain disease
- Medical approach (brain scans) advances the research
It is regarded by most psychologists and psychiatrists as one of the most prevalent disorders
(DSM-V)
DSM-V: must display at least 2 of the 11 symptoms within 12 months:
1. Taking the substance in large amounts or for longer than meant to
2. Wanting to cut down or stop, but not managing to
3. Spending a lot of time getting, using or recovering from use
1
, 4. Craving to use the substance
5. Not managing to do what you should at work, home or school, because of the SU
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational or recreational activities because of SU
8. Using substances again and again, even when it puts you in danger (drunk
driving)
9. Continuing to use, even when you have a physical or psychological problem that
could have been caused or made worse by the substance
10.Needing more of the substance to get the effect you want (tolerance)
11.Development of withdrawal symptoms, which can be relieved by taking more
Not everyone will get addicted: most people don’t develop SU disorder
Ever used SU disorder
Cigarettes 76% 32%
Heroin 2% 23%
Cocaine 16% 17%
Alcohol 92% 15%
Amphetamines 15% 11%
Cannabis 46% 9%
Of the people who used it at least once
Addiction and SU cannot be understood apart from the social and historical context
- Prohibition of alcohol
- Legalization of cannabis
- Cocaine and amphetamine stocks in the Netherlands
Types of substances:
- Tobacco (cigarettes)
- Stimulants (cocaine, amphetamines, ecstasy)
- Depressants (alcohol, benzodiazepines)
- Opioids (heroin, prescription drugs)
- Hallucinogens (LSD, cannabis, ketamine)
Neurotransmitters: about 80 chemical substances that provide communication between cells
Synapses
- Drugs release more dopamine in the synapse and release more dopamine in the brain
- The neurotransmitters are “cleaned”
- Drugs inhibit the reuptake (more signal)
2
,Agonist: drugs that mimic the same response as the endogenous system
- Cocaine is a dopamine agonist because is stimulates the release of dopamine
- MDMA is a serotonin agonist because it increases its release and inhibits its
reuptake
Antagonists: bind to the same receptor sites as the neurotransmitter but they block the
response instead of initiating it
Alcohol is really complex in the brain (many neurotransmitters involved):
- GABA agonist
- NMDA antagonist
- Opioid agonist
- Serotonin agonist
Drugs and reputation
Risks: law vs public view
- Alcohol associated with good times
3
,Chapter 1: The History of Addiction
Helps to set current issues in context by exposing both continuity and change
Addiction was first associated with substances (alcohol, psychoactive drugs, nicotine)
Recently also with behaviours (gambling, gaming, certain kinds of food)
→ ‘age of addiction' surrounded by the products of ‘limbic capitalism”
Learn the history to better understand the persistence of addiction as a way of explaining
behaviour
Pre-history (-1800): “Humans have probably always used substances now described as
‘addictive', but they have not always understood them in these terms”
- Pre-historic use of opium and cannabis in Asia
- Alcohol
The precise dating of the emergence of the concept of addiction is unclear
- 17th century drunk Englishmen?
Late 1700s - early 1800s physicians began to publish works which characterised the harmful
effects of long-term alcohol over-use as a disease
- Disease of the mind
- Disease of the will
- No clear distinction between medical and moral understandings of addiction
- Authorities disagreed about the roots of addiction: traced to the characteristics of the
individual or to the properties of the substance?
Rapidly developing system of international trade in a growing range of psychoactive
substances
- ‘Intoxicants’: tea, coffee, tobacco, cannabis and opium (Portugal and Britain from 17th
century onwards)
The drug trade was an integral part of imperial expansion and domination
- Example: Britain's export of opium from India to China → lead to wars and widespread
opium use in China
20th century psychoactive substances were freely traded
- It became obvious that they cause problems → new ways of defining was needed
The Rise of Addiction (1800-1940s): SU appeared more problematic in Europe and North
America
Industrialisation created a need for skilled workers - ability to work could be impaired
Sobriety became more economically valuable
Christian saw alcohol as sinful and dangerous to moral and medical health
4
, - Transnational temperance movement: reduces alcohol consumption and shaped
attitudes towards alcohol use, tobacco and other drugs
Medicine and pharmacy became more professionalized → more regulation
- Opium derivatives: morphine and heroin + hypodermic syringe
Changing terminology: inebriety (1830-1860s) → morphinomania, narcomania, habit,
addiction (1870s) → alcoholism and drug addiction (1880s)
Alcoholism was understood to be an inherited characteristic that parents would pass on to their
children, thereby weakening the ‘race'
- Thought that this could be combatted through eugenics (preventing alcoholics from
having children and encouraging breeding)
SU was often associated with racialised minorities:
- Opium associated with Chinese (England)
- Cocaine associated with African Americans (USA)
Rooted in racism, but lead to a push for regulation
- Meetings at The Hague in 1912 restricted narcotic trade to ‘legitimate medical purposes
only’
- USA 1914: prohibited use of opium, cocaine and derivatives
- UK during WW1: banned opium and cocaine sale to troops
- The Dangerous Drugs Act: extended to the rest in 1920
Increased regulation → growing use of the concept of addiction
- Addiction replaced the other terms (end of 19th century)
- 1910-1920: term ‘addiction’ used much more often by medical practitioners
The Standardisation of Addiction Concept (1950s-1980s): concepts of addiction became
somewhat more universal
- International regulation + growing global concern with impact of drug and alcohol use
- The Single Convention on Narcotic Drugs (1961): prohibited production, use and
trade in narcotic drugs throughout the world
- Drugs and alcohol treated differently
Alcoholism was first listed in the DSM in 1952 - primarily understood as a personality disorder
- 1960s: alcoholism was described as a behavioural disorder
- 1970s: ‘dependance’ (compulsive drinking)
- Shift to dependence represented a psychiatrisation or psychologisation
(greater attention being paid to nature and impact)
Dependence: applied to alcohol, drugs and later, to tobacco
- Homogeneity in the response to different substances (still dealt with differently)
5
Week 1
Lecture 1: Introduction
What is addiction?
The psychology behind addiction has more similarities that differences
- Example: smoking cigarettes and taking heroin have similar mechanisms
Why is it important to study addiction?
- 4 of the main reasons for death worldwide are addiction (smoking, alcohol, drugs)
- Opioid crisis in USA: average 115 opioid deaths each day → largest cause of death in
men under 30
- Over 3 million annual deaths due to alcohol and drug use (majorly men)
- Americans lose 119 billion through gambling each year
- Addiction is one of the 3 most common mental disorders in Europe
Lifetime prevalence Netherlands (DSM-V):
- Any mood disorders - 20.2
- Any anxiety disorders - 19.6
- Any SUD - 19.1% (1 in 5)
- Not all in treatment
Gender differences in prevalence: 80% of the population in treatment are men
Societal relevance of SU:
- Impact on health: health care, morbidity, mortality
- Relationships with crime: 50% of crimes are substance related
- Impact on public safety: driving, chemical waste
- Impact on work-related productivity
Is it a real disorder?
Some believe people with substance abuse disorders just have weak will, researchers say it is a
brain disease
- Medical approach (brain scans) advances the research
It is regarded by most psychologists and psychiatrists as one of the most prevalent disorders
(DSM-V)
DSM-V: must display at least 2 of the 11 symptoms within 12 months:
1. Taking the substance in large amounts or for longer than meant to
2. Wanting to cut down or stop, but not managing to
3. Spending a lot of time getting, using or recovering from use
1
, 4. Craving to use the substance
5. Not managing to do what you should at work, home or school, because of the SU
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational or recreational activities because of SU
8. Using substances again and again, even when it puts you in danger (drunk
driving)
9. Continuing to use, even when you have a physical or psychological problem that
could have been caused or made worse by the substance
10.Needing more of the substance to get the effect you want (tolerance)
11.Development of withdrawal symptoms, which can be relieved by taking more
Not everyone will get addicted: most people don’t develop SU disorder
Ever used SU disorder
Cigarettes 76% 32%
Heroin 2% 23%
Cocaine 16% 17%
Alcohol 92% 15%
Amphetamines 15% 11%
Cannabis 46% 9%
Of the people who used it at least once
Addiction and SU cannot be understood apart from the social and historical context
- Prohibition of alcohol
- Legalization of cannabis
- Cocaine and amphetamine stocks in the Netherlands
Types of substances:
- Tobacco (cigarettes)
- Stimulants (cocaine, amphetamines, ecstasy)
- Depressants (alcohol, benzodiazepines)
- Opioids (heroin, prescription drugs)
- Hallucinogens (LSD, cannabis, ketamine)
Neurotransmitters: about 80 chemical substances that provide communication between cells
Synapses
- Drugs release more dopamine in the synapse and release more dopamine in the brain
- The neurotransmitters are “cleaned”
- Drugs inhibit the reuptake (more signal)
2
,Agonist: drugs that mimic the same response as the endogenous system
- Cocaine is a dopamine agonist because is stimulates the release of dopamine
- MDMA is a serotonin agonist because it increases its release and inhibits its
reuptake
Antagonists: bind to the same receptor sites as the neurotransmitter but they block the
response instead of initiating it
Alcohol is really complex in the brain (many neurotransmitters involved):
- GABA agonist
- NMDA antagonist
- Opioid agonist
- Serotonin agonist
Drugs and reputation
Risks: law vs public view
- Alcohol associated with good times
3
,Chapter 1: The History of Addiction
Helps to set current issues in context by exposing both continuity and change
Addiction was first associated with substances (alcohol, psychoactive drugs, nicotine)
Recently also with behaviours (gambling, gaming, certain kinds of food)
→ ‘age of addiction' surrounded by the products of ‘limbic capitalism”
Learn the history to better understand the persistence of addiction as a way of explaining
behaviour
Pre-history (-1800): “Humans have probably always used substances now described as
‘addictive', but they have not always understood them in these terms”
- Pre-historic use of opium and cannabis in Asia
- Alcohol
The precise dating of the emergence of the concept of addiction is unclear
- 17th century drunk Englishmen?
Late 1700s - early 1800s physicians began to publish works which characterised the harmful
effects of long-term alcohol over-use as a disease
- Disease of the mind
- Disease of the will
- No clear distinction between medical and moral understandings of addiction
- Authorities disagreed about the roots of addiction: traced to the characteristics of the
individual or to the properties of the substance?
Rapidly developing system of international trade in a growing range of psychoactive
substances
- ‘Intoxicants’: tea, coffee, tobacco, cannabis and opium (Portugal and Britain from 17th
century onwards)
The drug trade was an integral part of imperial expansion and domination
- Example: Britain's export of opium from India to China → lead to wars and widespread
opium use in China
20th century psychoactive substances were freely traded
- It became obvious that they cause problems → new ways of defining was needed
The Rise of Addiction (1800-1940s): SU appeared more problematic in Europe and North
America
Industrialisation created a need for skilled workers - ability to work could be impaired
Sobriety became more economically valuable
Christian saw alcohol as sinful and dangerous to moral and medical health
4
, - Transnational temperance movement: reduces alcohol consumption and shaped
attitudes towards alcohol use, tobacco and other drugs
Medicine and pharmacy became more professionalized → more regulation
- Opium derivatives: morphine and heroin + hypodermic syringe
Changing terminology: inebriety (1830-1860s) → morphinomania, narcomania, habit,
addiction (1870s) → alcoholism and drug addiction (1880s)
Alcoholism was understood to be an inherited characteristic that parents would pass on to their
children, thereby weakening the ‘race'
- Thought that this could be combatted through eugenics (preventing alcoholics from
having children and encouraging breeding)
SU was often associated with racialised minorities:
- Opium associated with Chinese (England)
- Cocaine associated with African Americans (USA)
Rooted in racism, but lead to a push for regulation
- Meetings at The Hague in 1912 restricted narcotic trade to ‘legitimate medical purposes
only’
- USA 1914: prohibited use of opium, cocaine and derivatives
- UK during WW1: banned opium and cocaine sale to troops
- The Dangerous Drugs Act: extended to the rest in 1920
Increased regulation → growing use of the concept of addiction
- Addiction replaced the other terms (end of 19th century)
- 1910-1920: term ‘addiction’ used much more often by medical practitioners
The Standardisation of Addiction Concept (1950s-1980s): concepts of addiction became
somewhat more universal
- International regulation + growing global concern with impact of drug and alcohol use
- The Single Convention on Narcotic Drugs (1961): prohibited production, use and
trade in narcotic drugs throughout the world
- Drugs and alcohol treated differently
Alcoholism was first listed in the DSM in 1952 - primarily understood as a personality disorder
- 1960s: alcoholism was described as a behavioural disorder
- 1970s: ‘dependance’ (compulsive drinking)
- Shift to dependence represented a psychiatrisation or psychologisation
(greater attention being paid to nature and impact)
Dependence: applied to alcohol, drugs and later, to tobacco
- Homogeneity in the response to different substances (still dealt with differently)
5
