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Week 7 - Coggle Diagram

- - - - Rockefeller Plan advocated for a shift in policy, emphasising that social issues should be addressed through proper inteverntion rather than prohibition
      - Government began to tackle underlying issues like poverty and crime, moving away from blaming alcohol for societal problems
      - By late 1930s, a few major companies emerged as dominant players in alcohol market
      - Alcohol control became a sig aspect of public policy, reflecting a more nuanced understanding of alcohols role in society
      - Following repeal, government established regulations for alcohol production and sales
    - - Emphasises personal responsibility and community support in overcomming alcohol addiction
      - Contrasts with earlier views that blamed alcohol itself for addiction, focusing instead on individual expreiences & recovery
      - Views alcoholism as a progressive disease, suggesting some individuals have a predisposition that makes them susceptible
      - Lasting impact on how society views and addresses alcohol dependecy
      - Founded in late 1930s, shortly after prohibition, as a self-help network for individuals strugglign with alcohol dependency
  - - - His personal experience with problem drinking adds credibility to his arguments
      - Suggest a binary view of addiction can stigmatise individuals and hinder their willingness to seek assistance
      - Research involves randomising ppts to diff narratives about alcohol use, demonstrating impact on problem recognition & help-seeking behaviour
      - Promotes a more inclusive understanding of alcohol-related problems, encouraging broader public health discussions
      - Advocates for continuum narrative regarding alcohol use, arguing it helps individuals recognise their own problems & seek help
      - Highlights need for narratives that resonate with individual experiences to foster recognition and intervention
    - - Adrian Chalres effect demonstrates potential for media figures to ingluence public behaviour
      - Emphasies that many individuals may not identify as alcoholics but still benefit from reducing their intake
      - TV program and writings have sparked public interest in reducign alcohol consumption, laeding to mroe downloads of alcohol reduction apps
      - Highlight importance of public figures to shape societal attitudes and encourage healtheri behaviours
      - Raised awarenss about alcohol consumption through his media work, illustrating prevalence of problem drinking
      - Impact of media on public health initiatives underscores role of communication in addressing substance use issues
  - - - Difficulty in producing and transporting beer and wine led to rise in illegal alcohol production, bootlegging
      - Organised crime flourised with criminal networks profiting from illegal alcohol trade, leading to increased violence and crime rate
      - Despite law, alcohol consumption initiually decreased, with fewer cases of liver cirrhosis reported
      - Speakeasiers emerged as underground bars where people could consumer alcohol, contributing to cultural shift during 20s
      - Volstead Act marked official start of prohibition, making alcohol illegal in US and leading to sig cultural shift
    - - Business owners began to shift their prohibition stance as they lost tax revenue and sought to reinstate legal alcohol for profit
      - Great Depression further pressured government to reconsider prohibition, seeking tax revenue and to uplift public morale
      - Valentine's Day Massacre of 1929 in Chicago exemplified the violent outcomes of organised crime during this era
      - Officially ended in 1933 after 13 years, leading to a new era of alcohol regulation
      - Resulted in notable increase in organised crime, with gangs solidifying their power and influence in American society
    - - Anti-Saloon League was formed by business owners adovcating for prohibition ensure a sober workforce & reduce accidents
      - Government used alcohol as a scapegoat for social issues, avoiding deeper problems like poverty and education
      - Industrial revolution impact on society led to increased concerns about worker productivity & safety, leading businesses to support prohibitions
      - Propaganda, such as Drunkard's Progress, illustrated perceived dangers of alcohol consumption, influencing public opinions
      - Late 1800s and early 1900s saw numerous failed attempts at prohibition, culminating in the Volstead Act of 1920, which prohibited alcohol production and consumption in the US
  - - - In young adults, alcohol is attributed to 13.5% of deaths, indicating a critical public health concern
      - Global burden of isease caused by alcohol is quantified at 5.1%
      - Causal factors in over 200 diseases and injuries, contributing sig to global burden of disease
      - Leads to social and economic losses, including violence, criminality and absenteeism from work
      - Responsible for approx 3 million deaths annually, accounting for 4% of all global deaths
      - Also provides ejoyment and social benefits for many
    - - Policymakers face challenges in creating effective policies that consider both
      - Cultural context inlfuenced conomic impact; with diff countries exhibiting vaying levels of acceptance and regulation
      - Economic benefit must be balanced against health and social costs associated with alcohol misuse
      - Understanding economic implications can inform strategies for harm reduction and public health initiatives
      - Generates substantial tax revenue, contributing at least £10.5 billion annually to UK economy, 2% of total tax revenue
      - Dual nature as both a source of revenue and public health concern necessitates caregul consideration
  - - - Concept of will and agency was central to Rush's understanding, viewing habitual consumption as a psychological pathology
      - Emergence of temperance movements in the 19th century advocated for complete abstinence from alcohol
      - Rush;s medicalised approach aimed to treat addiction as a disease, focusing on compulsive nature of drinking
      - These movements were oten led by women, highlighting impact of alcohol on family structures and social morality
      - Late 19th century saw establishment of inebriate asylums for individuals with severe alcohol problems
      - Temperance movement demonised alcohol, assocating it with antisocial behaviour and moral decay
    - - Ongoing debates exist regarding disease model with some advocating for alternative perspectives
      - Temperance movement's legacy persists in certain conservative areas of America
      - Late 20th century saw formalisation of brain disease models of addiction, which continue to influence contemporary discussions
      - Historical context of addiction treatment reflects evolving socieal attitudes
      - Freud's psychoanalytical thought contributed to the understanding of addiction, although he himself used cocaine
      - Establishment of addiction-related societies in late 19th century laid groundwork for modern addiction research & treatment
  - - - Viewed positively, often considered healthy, and was even given to children for medicinal purposes
      - Puritanical ministers regarded alcohol as a good creature of God reflecting its acceptance in society
      - Many individuals in UK consumed beer throughout the day, both at work and home
      - Drunkenness was normalised, although certain aspects of excessive drinking were still judged negatively
      - In the late 18th and mid 19th centuries, consumption was sig higher averaging nearly 20 units per person per week
      - Societal perception of alcohol varied with some viewing excessive consumption as a moral failing
    - - Rush was pivotal in framing addiction as a medical issue in his early 19th century work
      - Rush identified addiction as an uncontrollable urge to drink, marking a shift towards understanding addiction in medical terms
      - Drugs like opioids and cannabis were not widely recognised or consumed, with tobacco having a diff societal perception due to its non-intoxicating nature
      - Enlightenment period influenced perception of addiction, leading to a more scientific appraoch to understanding alcohols' effects
      - Concept of addiction as a disease primarily related to alcohol in Western world until later 19th century
  - - - Peer support model fosters community & reduces stigma assoc with addiction by framing it as a disease
      - Some studies suggest that the social networks formed in AA contibute sig to its effectiveness
      - Free and widely available, providing a safe space for individuals seeking support for alcohol-related issues
    - - Outdated and does not adequaely address complexities of modern alcohol use and addiction
      - Resistance to academic research limits ability to evaluate its effectiveness through rigorous scientific methods
      - Strong Christian undertones may alienate non-religious individuals or those from different faiths
  - - - Has been used in religous rituals, social gatherings and as a form of trade throughout history
      - Relationship between alcohol and capitalism has shaped its production and consumption patterns globally
      - Reveals it deep-rooted presence in human socity, influenced by cultural practices and social norms
      - Understanding these cultural influences is essential for addressing contemporary issues related to alcohol use & addiction
    - - Portrayal of alcohol in advertising often emphasises social enjoyment and success, potentially downplaying risks
      - Public figures and celebs can influence drinking behaviours through their endorsements and personal stories
      - Media representations of consumption can shape public perceptions and attitudes towards drinking
      - Critical analysis of media mesages about alcohol is important for understanding societal norms and expectations
    - - Impact of social media and technology on drinking behaviours & addiction is an emerging area of study
      - Future studies may explore intersection of alcohol use with mental health, particularly in vulnerable populations
      - Ongoing research into genetic & environmental factors contributin to AUD is crucial for developing effective interventions
      - Collaborative efforts between researchers, healthcare providers & policymakers are essential for addressing alcohol-relateed issues
  - - - Terms and classifications have changed, reflecting societal atttudes and scietnific understanding of addiction
      - DSM-5 categorises AUD as a SUD with specific criteria for diagnosis
      - Evolved sig since first publication in 1961, where alcoholism was categorised with personality disorders
    - - Individuals are diagnosed based on number of symptoms present, with thresholds for mild, moderate and severe
      - Reflects a growing recognition of complexity of addiction and need for tailored treatment approaches
      - Introduces a spectrum approach, allowing for a more nuanced understanding of SUDs
  - - - Societal harms include increased healthcare costs, crime and family disruption related to alcohol misuse
      - Alcohol industry sig impacts economies, particuarlyl in regions where alcohol consumption is legally permitted
      - Alcohol consumption is assoc with various long-term health effects, including liver disease, addiction & mental health issues
      - Public health campaigns aim to raise awreness of the risks associated with alcohol consumption & promote responsible drinking
    - - Contrasting views exist, particularly among public health advocates, who believe in potential for moderation and reduction in problem drinking
      - Dichotomy in perspectives highlights the debate between trad recovery models like AA and modern approaches
      - Viewed as a progressive disease by some, necessitating lifelong abstinence as the only remedy
    - - Concept of continuum of AUD suggests that individuals may fall anywhere from non-consumption to severe addiction
      - Understanding criterai is crucial for effective treatment and support for individuals struggling
      - Diagnosed based on criteria that assess severirty of alcohol consumption and its impact on daily life
      - Role of healthcare professionals in diagnosing and treating AUD is essential for recovery
    - - Evolution of understanding of addiction has been influenced by cultural, social and scientific developments
      - Lechner (1997) marked a pivotal moment in recognising addiction as a brain disease
      - Alcoholism was first introduced in early 20th century, with sig contributions from Gileni, who categorised it as a hetergeneous disease
    - - Likens addiction to other chronic diseases, emphasising need for medical treatment
      - Brain disease model posits that addiction is caused by pathologies in brain strucutre or function
      - Model has evolved over time, reflecting changes in societal attitudes towards addiction and recovery
    - - Origins in 1930s reflect a Christian framework, which has become less relevant
      - Remains popular due to its accesibility and the suppor it provides to millions globally
      - Emphasises spirtual growth and submission to a higher power, which may not resonate with all individuals
  - - - DSM-5 cateogrises substance-related issues under SUD, emphasising spectrum approach
      - Transition from DSM-IV and DSM-5 marked a shift from cateogrical definitions of abuse & dependence to a continuum
      - Early editions included categories like excessive drinking & substance use which ahve been redfined in DSM-5
      - Outlines 11 symptoms for SUD, with severity classified based on number of present symptoms; 6 or more indicates severe, 2-5 indicates mild
      - Evolved over time, reflecting changing societal attitudes towards substance use
      - Illustrates historical prejudices and changing perceptions of addiction and substance use
    - - Moderate drinking still poses risks, including physical health issues and antisocial behaviour
      - Allows for a more nuanced understanding, encouraging individuals to recognise their patterns & seek help
      - Public health perspectives advocate for addressing problem drinking across entire pop, not just severe cases
      - Contrats with trad views that stigmatise those who do not fit the alcoholic label, preventing them from seeking help
      - Acknowledges that addiction is not a binary condtion but exists on a continuum, affecting people differently
      - Promotes harm reduction strategies, which can be more effective in addressing alcohol-related issues
  - - - Temperance movement aimed to reduce consumption, leading to 18th amendment, which prohibition manufacture, sale and transport of alcoholl
      - Prohibition resulted in unintended consequences, including rise of illegal speakeasies and organised crime
      - Early 20th century saw sig changes in alcohol laws, particulrly during the temperance movement & prohibition era
      - Alcoholics Anonymous movement emerged as a peer support group for individuals struggling with AUD, emphasisng shared experiences and recovery
    - - Hogarths; painting illustrate societal views on gin and beer consumption
      - Gin Lane depicts neg consequences of gin consumption among women, while Beer Street portrays men consuming beer in a pos light
      - Perception of consumption has historically been gendered, with different attitudes towards men and women drinking
      - This gendered perspective continues to influence contemporary discussions about alcohol use and addiction
    - - Fermentation process involves converting sugars from fruits or grains into alcohol with help of yeast
      - Approx 1/3 of global population currently consume alcohol
      - Alcohol has been consumed for at least 9000 yrs with wine originating in Georgia and beer dating back to around 4000BC
      - Historical context of production and consumption has been influenced by various factors incl culture, religion and trade
- - - - Brain disease model posits that addiction is a chronic relapsing brain disease characterised by compromised voluntary action
      - Disease concept has roots in early medical theories such as those proposed by Rush
      - Theories generally agree that initial drug use is voluntary but chronic use leads to neuroadaptations that impair control
      - Modern drug treatmetn services are based on understanding of addiction as a disease, utilising medications that target CNS
      - Aim to explain psychological and neural mechanisms underlying addiction, focusing on chronic drug use and brain effects
      - Particularly influential in the US, supported by organisations like the National Institute of Drug Use
    - - Volkow's research has been pivotal in demonstrating neurobiological changes associated with addiction, particularly in dopamine receptor availability
      - Impaired response inhibition & salience attribution (ISA) theory (Volkow & Goldstein) explains how addiction alters brain function
      - Leshner's article in later 90s framed addiction as a brain disease, contrasting stigma of moral failure
      - Studies comparing meth users to healthy controls reveal lower dopamine D2 receptor availability in the striatum, indacting altered reward processing
      - Suggests that addiction is akin to other chronic diseases, where willpower is compromised
      - Emphasises need for compassionate treatment approaches that recognise addiction as a medical condition not a moral failing
  - - - MZ twins may sunbathe together, increasing skin cancer rates due to shared behaviour rather than genetics
      - Environmental factors can sig alter heritability estimates; egalitarian socities may show higher heritability for certain traits due to reduced environmental variance
      - MZ twins share more similar environments than DZ twins, potentially leading to overestimation of heritability
      - Many heritability studies are based on European samples, limiting generalisability to other populations
      - Reflect proportion of variation in a trait attributable to genetics, but can be misleading due to environmental influences
      - Interplay between genes and environments is complex, with gene-environment interactions influencing outcomes like addiction
    - - Errors in HEs from twin studies can also contribute to missing heritability phenomenon
      - Plomin's work highlights importance of understanding limits of current genetic research in explaining behavioural traits
      - Rare SNPs may contribute sig to heritability but are often overlookedin studies
      - Implications of missing heritability challenge deterministic views of behaviour, emphasising role of environment & agency
      - Refers to gap between estimated heritability and cumulative effect of known genetic variants
      - Understanding genetic basis can lead to potential therapeutic advancements, though practical applications remain limited
  - - - Increase in dopamine correlates strongly with subjective craving, indicating a direct link between dopamine levels and drug desire
      - Concept of salience attribution suggests that drug-related stimuli capture attention due to altered brain systems, leading to compulsive behaviour
      - Volkow (2006) study demonstrated that cocaine use leads to increased synaptic dopamine levels, observable through PET
      - Implications highlight challenges in abstaining from drug use when faced with drug-related cues
      - Surge of dopamine to cocaine cues compromises ability to make sensible decisions of abstaining
    - - Kaufman (2003) found that cocaine users exhibited hypoactivation in prefrontal brain areas crucial for EFs, particularly inhibition
      - Go/No-Go task results indicated that cocaine users struggled to stop their responses, demonstrating impaired DM capabilities
      - People who used cocaine showed more behavioural errors in response inhibition tasks
      - Suggests that addiction not only affects craving but also the cog processes necessary for self-control and DM
  - - - Distinguishes between craving and pleasure, suggesting that addiction is more about the former
      - Highlights role of environmental cues in triggering drug-seeking behaviour, even in absence of the drug itself
      - Developed by Robinson & Berridge, explains how reward system becomes hyper-responsive to drug cues, leading to heightened cravings & compulsive behaviours
    - - Suggests that as drug use continues, shifts from goal-directed to habitual, occurring automatically w/o conscious thought
      - Emphasises importance of context & environmental cues in maintaining addictive behaviours, suggesting that interventions should target these cues
      - Modernised by Everitt & Robbins posit that addiction can be viewed as a learned behaviour that become habitual over time
    - - Emphasises role of dopamine in reinforcing drug-seeking behaviour and development of compulsive drug use
      - Repeated exposure to drugs alters the brain's reward pathways leading to more craving & less response to natural rewards
      - Incentive Sensitisation and Reinforcement model, developed by Volkow, posits that addiction is driven by the reward system becoming sensitised to drug-related cues
  - - - Developed by Robinson & Berridge in eraly 90s, posits that drugs increase mesolimbic dopamine neurotransmission, enhancing salience of drug-related stimuli
      - Distinguishes between incentive salience and pleasure suggesting that addiction is characterised by heightened wanting without increased pleasure
      - Drugs cause neuro adaptations that lead to excessive wanting for drug-related stimuli
    - - Everitt & Robbins proposed that with prolonged drug use, DM shifts from PFC to dorsal striatum, leading to compulsive behav
      - Rodent studies demonstrated that lesions in specific areas affected drug-seeking behavious
      - Chronic drug use leads to a transition from goal-directed behaviour to habitual behaviour
      - Emphasises that addicted individuals may act without considering the consequences leading to habitual drug use
  - - - Certain genes encode enzymes that metabolise acetaldehyde, with poor metabolism linked to recued alcohol use & dependence
      - Many genetic associations have low replicability, indicting complexity of genetic contributions to addiction
      - Variosu genetic polymorphisms have been identigied that may confer risk for SUDs, including those affecting metabolism of substances like alcohol
    - - Complicates identification of specific genetic factors and their interactions with environmental influences
      - Majority of variants assoc with addiction have been shown to have small effect sizes, necessitating larger sample sizes
      - SUDs are characterised as highly polygenic, meaning multiple genes contributes to risk, each with small effects
  - - - Criticised for being dogmatic and not fully supported by evidence, particularly in context of recovery and treatment
      - Many individuals with SUDs recover naturally, suggesting addiction is not solely a brain disease but influenced by environmental and social factors
      - Critics argue that the brain disease model is reductionist and overlooks social factors
      - Contingency management, which incentivises abstinence, has shown effectiveness indicating that behav interventions can complement biological understanding
    - - Twin studies indicate a sig genetic component to addiction but the replicability of specific genetic variants remains low
      - Addiction is polygenic, rather than a single gene being responsible
      - Heritability estiamates for SUDs range from 30-70%
      - Complexity underscores need for multifaceted approach to understanding and treating addiction
  - - - Ranges from 30-70%, indicating sig genetic influence on risk of developing SUDs
      - Population-specific and can change over time
      - Refers to the proportion of observable variation in a population that can be attributed to genetic differences
      - Does not apply to individuals; for example, a trait being 55% genetic does not mean that any one's trait is 55%
    - - Assumption is that both type share the same environment, allowing researchers to isolate genetic influences on traits
      - Calculating use the formula Vg/Vp
      - Essentail for estimating heritability, comparing MZ and DZ twins
      - High estimates for addiction suggest that genetic factors play a substantial role compared to environmental influences
- - - - Large sample size enhance generalisability of findings, making it a valuable contribution to addiction research
      - Certain demographic and behavioural factors could predict dependence, importance of comprehensive data collection
      - Conducted with 10,000s of ppts, cross-sectional, assessed exposure variables predictive cannabis depend. after initial use
    - - Suggest that reliance on these criteria can lead to oversimplified conclusions about causal relationships, especially in addiction
      - Evolving nature of research methods necessitates re-evaluation of traditional criteria for establishing causation
      - Critiques (Ionnadis, 2015) argue that BH criteria may not address complexities of causation in observation studies
    - - Allowed researchers to establish a temporal relationship, ruling out reverse causation, a common issue in cross-sectional study
      - Findings suggest that adverse childhood can sig influence alter substance use behaviours
      - Examined impact of early life experiences on cannabis dependence, focusing on parental death before 5 as predictive
  - - - Regular Use - following initial, individuals may begin to use substances regularly, can lead to more tolerance & dependence
      - Problematic use - as use escalates, individuals may experience neg consequences, yet continue using, shift towards addiction
      - Initial Exposure - begins with the opportunity to try a substance, influenced by social, environmental and psychological factors
    - - Genetic predisposition - certain genetic markers, such as OPRD1 polymorphism, may increase vulnerability, seen in case-control
      - Psychological factors - mental health issues such as depression and anxiety can influence and be infleucned by substance use
      - Environmental influences such as peer pressure, family dynamics and SES can sig impact likelihood of developing an addiction
  - - - Limitations - inability to establish causation due to confounding variables; parental death may correlate with cannabis dependence but other factors could influence this relationship
      - Researchers can use statistical methods to control for confounding variables but does not eliminate possibility of non-causal relationships
      - Strengths - can provide insights into real-world scenarios and are often easier to conduct than RCTs, allow researchers to identify potential associations between variables over time
    - - Reproducible findings across different studies strengthens causation; if multiple show similar results, likelihood of causal increases
      - The cause must precede the effect; bullying at 12 leading to cannabis use at 15 supports temporal relationship
      - A strong correlation between exposure and outcomes suggests a potential causal relationship; sig effect size in cannabis use and Sz indicaates possible link
    - - Case-control studies are retrospective and compare individuals with a condition to those without, examining past exposure; help identify potential risk factors but are limited by retrospective nature
      - Cross-sectional studies assess data at a single point in time, comparing groups based on exposure to identify associations with outcomes like depression
      - Cohort studies follow a group over time to observe outcomes based on exposure
  - - - Peer influence and gender also play a role in development, with males being more likely to develop issues related to alcohol
      - Cultural norms and laws surrounding alcohol use can influence rates of problem use, as seen in countries with lenient regulations
      - SES, early conduct problems and parental alcohol consumptions are significant predictors of early alcohol use onset
      - Economic deprivation & family adversity are linked to higher risks of druge use, alignign with self-medication theories
      - Risk factors can be categorised into social, environmental, family, individual and policy-related factors
      - Confounding variables must be considered when analysing observational data to avoid misattributing causes of addiction
    - - Offer valuable insights, may not always translate directly human behaviour due to complexity of addiction
      - Longitudinal studies (Ferguson, 1995) provide insights into progression of alcohol use and its predictors over time
      - Daly et al demonstrated that high impulsive rats, with lower dopamine D2 receport density, were more likely to seek cocaine
      - Cross-sectional studies, like National Comorbity Survey, assess addiction preavlence and risk factors in a representaitve pop
      - Animal studies provide a controlled environment to investigate addiction mechanisms that would be unethical in humans
      - Understanding strengths and limits of diff reserach methods is crucial for interpreting findings in addiction studies
    - - Majority of individuals who develop SUDs will eventually recover, highlighting importance of understanding risk and resilience
      - Identifying these factors can aid in prevention and treatment strategies for addiction
      - Not all individuals who try a substance become addicted, 15-25% of heroin & cocaine users become addicted, tobacco over 30%
      - Journey of addiction is heterogenous, with each individual's experience being unique, influenced by variety of factors
      - A sequential process that begins with first opportunity to use a drug and can process to problem use and full addiction
      - Effect sizes of predictors for addiction are often small, that multiple factors contribute to likelihood of developing addiction
  - - - Economic factors, such as poverty & family instability, are assoc with increased risk of SU and addiction
      - Role of peer groups in influencing drug use behaviours is crucial, particularly during adolescence
      - Legalisation of cannabis raises questions about its potential effects on usage patterns and addiction rates
      - Understanding socio-demographic context can help tailor prevention and intervention strategies for at-risk populations
      - Societal nroms and laws regarding SU sig impact addiction rates with more permissive cultures showing higher levels of problem use
      - Multifactorial nature necessitates a comprehensive approach to address the various influences on SU
    - - Interaction between biological predispositions and environmental factors create a complex landscape for understanding addiction
      - Long-term substance use can have detrimental effects of mental health & cog function, creating a feedback loop
      - Psych factors, incl mental health conditions, can predispose individuals to SU as a form of self-medication
      - Individual resilience factors, such as coping strategies and support systems, can mitigate risk of developing addiction
      - Personality traits and cognitive biases can influence the likelihood of developing addiction
      - Tailoring interventions to address individual differences may enhance treatment effectiveness
  - - - Observational studies - used when RCTs are unethical, such as cause of addiction; include cohort and case-control studies
      - Case reports - provide weakest form of evidence, focusing on single patients or events without generalisability
      - Randomised Controlled Trials - considered gold standard for testing drug efficacy; ppts are randomly assigned to treatment or placebo groups, allowing for unbiased results
      - Triangulation of evidence - combining data from multiple study designs to mitigate biases and enhance validity of findings
      - Different study designs provide varying strengths of evidence for inferring causality
    - - RCTs have demonstrated the effectivenes of Naltrexone in treating alcohol dependence
      - Ethical considerations prevent use of RCTs to study causes of addiction directly, but they can be used to test treatment methods
      - Ppts are randomly assigned to either an active treatmetn or a placebo, ensuring that differences can be attributed to treatment
      - Can also be adapted to study effects of quitting vs continuing drug use, using incentives for abstinence
      - Crucial for establishing efficacy of treatments in addiction
- - - - Khantzian's self-medication hypothesis suggests that individuals may use drugs to cope with adverse life experiences, framing it as a rational response to pain
      - Evidence supports that trauma and MH issues can predict future drug problems
      - Trad economic theory of addiction posits that individuals amke rational choices based on cost-benefit analysis, yet many addicted individuals express desire to quit but struggle to do so
      - Opioid crisis exemplifies how addiction can stem from attempts to manage chronic pain through prescribed meds
    - - Recreational drug use often fails to address root cause of problems, raising questions about rationality of self-medication
      - Not all psych patients resort to recreational drugs, indicating that addiction can occur independently of MH issues
      - Critics argue that many individuals become addicted without underlying psych issues, challenging self-med hypothesis
      - Qualitative reports suggest that many users consume for pleasure rather than to alleviate pain
    - - Future feelings and preferences are unpredictable, complicating the notion of rational DM
      - Cog biases and lack of insight can sig affect DM processes, especially in high-stakes situations like addiction
      - Arises whether we should always respect these choices or consider the broader impact on family, friends and clinicians who may have a diff perspective on what constitutes a good decision
      - Interplay of personal desires and external influences can lead to decisions that may not align with long term wellbeing
      - Individuals often believe they are making the best decisiosn for themselves, even when they lead to neg consequences
  - - - West & Brown propose that self-destructive preferences can be rational if they are based on individual's current desires & context
      - The interpretation of rationality is contentious, especially when considering external pressures & coercion that may influence DM
      - Debate continues on whether addiction-related choices can be considered rational, given rapid changes in prefrences
    - - Concept of 'affect heuristic' suggest that emotional responses can skew perceptions of risk, leading to potentially irrational decisions
      - Understanding heuristics is crucial for dev effective interventions and support systems for individuals struggling with addiction
      - Slovic's research highlights how emotions and feelings sig impact risk judgement in substance use and addiction
    - - Argues that addiction is not merely a lack of choice but rather a complex interplay of conflicting motives and desires
      - Suggests that preferences can change rapidly, influenced by situational factors, such as being in environment where it is normalised
      - Emphasises that addiction involves unstable preferences and strong appetites, leading to fluctuating desires for substance use
      - West & Brown support idea that preferences are dynaic and can shift based on context, challenging notion of fixed preferences
  - - - Treatment involves identifying high risk situations and making conscious decisions to abstain from substance use
      - Effectiveness of CBT supports notion that individuals can exert control over their addictive behaviours
      - CBT for relapse prevention emphasises the role of choice in recovery, helping individuals develop strategies to avoid drug use
    - - Policies may need to balance the recognition of individual choice with the understanding of addiction as a complex disorder
      - Debate over addiction as a rational choice vs a medical condition has sig implications for how society addresses SU issues
      - Understanding addiction through a rational choice lens can inform public health policies and treatment approaches
  - - - West & Brown summarise by stating that feelings often take precedence over analytical thought in risk perception
      - Smokers may overlook risks due to pleasure and social status it brings, leading to a skewed risk assessment
      - Positive feelings associated with an activity can lead to reduced perception of risk, while neg emotions can exaggerate perceived risk
      - Emotional influence persists even after regular smoking, as positive affects continue to overshadow the risks
      - Slovic's work emphasises that our judgements of risk are sig influenced by our emotions and feelings
      - Distinction between analytic and intuitive systems in DM is crucial, with intuitive system often dominating in emotional situations
    - - Aligns with Kahneman's Type 1 (intuitive) and Type 2 (analytic) DM framework
      - In addiction contexts, the intuitive system often leads to decisions that favour immediate gratification over long term consequences
      - Analytic system is associated with rational DM, while the intuitive system reacts quickly based on feelings
      - Smokers may ignore long term risk of lung cancer due to immediate pleasure derived from smoking
      - Slovic identifies 2 cognitive systems; the analytic system (formal logic) and the intuitive system (emotion-driven)
      - Emotional power of distant risks is often diminished, leading to a lack of fear regarding future circumstances
  - - - Perspective suggests that addiction can be a means of managing distress rather than a purely compulsive behaviour
      - Implications of self-medication theories highlight the need for understanding the underlying reasons for substance
      - Self-medication is viewed as a rational choice where individuals use substances to cope w/ psychological or physical pain
    - - Real-life behaviours often contradict the rational model, as individuals may not reduce usage in anticipation of drug shortages, despite knowing the consequences
      - Theory's reliance on precise economic models may overlook the nuanced realities of addiction and human behaviour
      - Critics argue that rational choice theories oversimplify the complexities of addiction and do not account for emotional and psychological factors
  - - - Unpleasant context of war may have driven drug use as a coping mechanism but returning to a different environment facilitated rational DM to abstain
      - Suggests that addiction can be context-dependent, with environmental factors playing a crucial role in recovery
      - Robins' study showed that 1% of soldiers remained addicted after returning home, highlighting role of environment
      - Availability of drugs also influences decisions; less access can lead to reduced consumption
      - During Vietnam War, many soldiers became addicted to opium and heroin
      - Underscores importance of considering situational factors in addiction treatment and prevention
    - - In experiments, ppts preferred money over cocaine, as the monetary value increased, demonstrating sensitivty to alternative reinforcers
      - Suggests that even those with addiction can adapt their choices based on situational factors
      - Higgins indicates that individuals with cocaine use disorder can make rational choices when presented with alternatives
      - Heyman's work argues for a reevaluation of addiction, suggestign that life changes can lead to rational decisions to reduce drug use
      - Implication is that addiction is not solely a disease but can involve rational DM processes
      - Challenges notion that addiction is purely compulsive and highlights the potential for recovery through rational choices
  - - - Historical perspectives on addiction suggest that it was once seen as a moral failing rather than a medical disorder
      - Importance of understanding addiction as a spectrum between rational choice and compulsive behaviour is emphasised
      - Addiction is often viewed through lens of rational choice, where individuals make conscious decisions regarding substance use
    - - Addictive behaviours are framed as conscious choices, where individuals weight benefits of drug use vs potential consequences
      - Challenges notion that addiction is purely irrational, suggesting that user are aware of their choices and their implications
      - Becker and Murphy (1988) posit that individuals make rational decisiosn to maximise utility, even in addiction
      - Argue that there are no inherent abnormalities in DM for those with SUDs
  - - - Implications affect policy and treatment approach, with choice advocating for punitive, while disease promote treatment access
      - West and Brown classify these theories, emphasising need for a nuanced understanding of addiction
      - Automatic unconscious theories propose that addiction is driven by habitual DM and impaired self-control mechanisms
      - Highlights importance of intergrating both perspectives for effective addiction policy and treatment
      - Choice theories suggest that individuals make rational decisions regarding drug use, while disease models argue that addiction leads to compulsive behaviour without proper DM ability
    - - The choice between rational choice and disease models has sig implications for public policy regarding drug use
      - Rational choice may support strict legal consequences while disease advocates for compassionate treatment options
      - Dichotomy is seen as a false choice; both perspectives can exist and inform policy
      - Effective public health strategies may require a blend of punitive and supportive measures to address addiction comprehensively
      - Understanding emotional and contextual factors can lead to more effective prevention and treatment strategies
- - - - Roman physician Celsus recognised alcohol dependence as a disease 2000yrs ago, marking early acknowlefgement of medical
      - 18th century saw sig societal changes, incl Opium wars, which illustrate global impact of addiction and drug trade
      - Alexander the Great's death attributed to heavy drinking in 322BC highlights long standing issue of alcohol consumption
      - Rush, a founding father, described alcohol addiction as physically toxic and morally destructive
    - - Raises questions about individuals who use drugs excessively but do not wish to stop; to Heather, they are not addicted
      - Emphasises behavioural patterns over psych or physical consequences, which can be a limiting understanding
      - Heather defins addiction as repeated failure to refrain from behaviour despite intentions to stop
      - Complexity highlighted by need for a broader definition that incl psychological and social factors
      - Evolution of addiction definitions reflect changing societal attitudes
    - - Society of Study of Addiction was originally named Society of Inebriety
      - Historical terms include sin, illness and disease, showing evolving perception from moral failing to medical condition
      - Inebriety was commonly used in the 1800s, reflecting societal views on addiction at the time
      - In 17th century, often described in terms of physical symptoms like fever or compulsion compared to 20th cent psych and social
    - - Opioids - effective painkillers that provide euphoria (morphine, heroin, fentanyl), opioid crisis is a sig public health issue
      - Psychedelics - alter perception and mood (LSD & psilocybin) which act on serotonin receptors
      - Depressant - slow brain function (alcohol and benzos), which act as GABA agonists, inhibiting neuron firing
      - Cannabis - contains THC, provides relaxation and can lead to anxiety or paranoia
      - Stimulants - increase physical and mental activity (caffeine, cocaine, meth), elevate catecholamine levels, enhancing dopamine and serotonin
    - - DSM provides criteria for diagnosing SUD, emphasising behavioural patterns rather than biological markers
      - Terms like SUD are preferred over addict to reduce stigma and promote a person-centred approach
      - Chronic condition characterised by repeated powerful motivation to engage in rewarding behav, that leads to sig unintended harm
      - Severity of addiction can be assessed throguh subjective urges, frequency of harmful behav and attempts to limit or cease activity
    - - Opioid crisis in US has led to surge in deaths, particularly from synthetics like fentanyl, worsened by overprescription of painkiller
      - Smoking is leading cause of drug related death globally, over 7 million annually, compare to 600,000 alcohol and other drugs
      - Geogrpahic distribution of SUD shows sig variation; Russia has high mortality rates due to SUD
      - Government interventions, such as advertising bans and high tobacco taxes, have reduced smoking rates in many countries
  - - - Rush's writing in 18th century laid groundwork for understanding addiction as a disease
      - Trotter's essay on drunkenness in 1804 contributed to the discourse on addiction as a mental health issue
      - The Opium Wars (1839-1842) example of addiction;s impact on soceity and interanational relations, priority of profit over health
      - Kerr's advocacy for recognising inebriety as a disease reflects evolving understanding of addiction in 19th century
    - - Shift from stigmatising language to person-centred terms reflect a growing awareness of complexities of addiction
      - Current research explores bio, psych and social factors contributing to addiction, aiming to improve treatment outcomes
      - West and Brown definition emphasises chronic nature of condition and importance of understanding it as a spectrum
      - Role of societal attitudes and policies in shaping discourse around addiction remains a critical area of study
  - - - WHO provides data on global substance use trends, highlighting public health concerns
      - Understanding prevalence is crucial for developing effective prevention and treatment strategies
      - Legal substances like alcohol and tobaccoo have high prevalence rates, while illegal drugs show varying patterns of use
      - Case studies from different countreis illustrate impact of cultural attitudes on substance use and addiction rates
      - Substance use varies sig across diff regions and cultures, influenced by social, economic and legal factors
    - - Public health initatives aim to reduce harms of substance use through education, prevention and treatment programs
      - Economic impact is susbtantial, affecitng healthcare systems and productivity
      - Addiction, overdose and social consequences such as crime and family disruption
      - Successful harm reduction strategies include needle exchange programs and supervised consumption sites
      - Contributes to a sig global burden of disease, affecting physical and mental health
  - - - Include physical (withdrawal, tolerance), psychological (cravings) and social impacts (interpersonal relationships, work performance)
      - Inclusion of craving in DSM-5 reflects shift towards recognising psych aspects, while legal problems were removed due to low predictive power
      - DSM-5 outlines 11 symptoms with severity categorised as mild, moderate or severe based on number of symptoms present
      - Transition from DSM-IV to DSM-5 represents a sig change in understanding addiction
    - - Term addiction added to DSM-5 for first time in decades
      - Also intrdouced concept of behavioural addictions, such as gambling, expanding undersatnding of addiction
      - Historical evolution of definitions illustrates changing landscape of mental health and societal attitudes towards drug use
  - - - A socially defined concept, lacking a universal biomarker or blood test for diagnosis, making it complex and controversial
      - Definition varies across cultures & contexts, influenced by societal norms and values
      - 16th century, term evolved to imply devotion or being bound to something, reflecting a duality in its meaning
      - Understanidng addiction requires a multidisciplinary approach, incorporating psychology, sociology and medicine
      - The term addiction origins from Latin 'addicto', which referred to a debtor being enslaved to a creditor, indiciating loss of freedom
    - - Evolution of diagnostic criteria reflects changing understandings of addiction and substance use disorders over time
      - Importance of recognising addiction as a spectrum rather than a binary condition allows for more nuanced treatment approaches
      - Key criteria include impaired control, social impairment, risky use and pharmacological criteria
      - Case studies illustrate the application of these diagnostic criteria in clinical settings, highlighting the complexities
      - DSM and ICD provide frameworks for diagnosing substance use disorders
  - - - Complexity refelcted in interplay between positive reinforcement and negative reinforcement
      - Cravings can be powerful and difficult to resits, often leading to relapse even after periods of abstinence
      - Not merely a physical dependence; encompasses psych craving and social consequences
      - Treatment approaches may vary, some individuals successfully overcoming without formal treatment, others require structure
    - - DSM-5 provides crtieria to assess severity of SUDs, allowing for a nuanced understandings of addiction
      - Subjective urges and cravings are critical indicators of addiction severity, influencing the likelihood of drug use
      - Should be viewed on a spectrum rather than binary condition; individuals experience varying degrees of problematic use
      - Effective interventions, such as nicotine replacement therapy, can help manage cravings and support recovery efforts
  - - - Coffee - introduced to human consumption around 6th century AD, its popularity surged after colonialism
      - Alcohol - fermentation of fruits for alcohol dates back to 5000BC, with distillation processes emerging in the 11th century
      - Cannabis - evidence of use dates back to ancient civilisations, with sig cultural and medicinal roles
      - LSD and MDMA - synthesised in 20th century, gained popularity in 60s and 80s, respectively, reflecting changing societal attitudes towards psychoactive substances
      - Opium - used in Mesopotamia around 3400BC, it is one of the oldest known drugs, derived from the poppy plant
    - - Development of faster routes of administration has contributed to the rise in addiction rates
      - Societal implications of drug refinement include increased accessibility and normalisation of drug use in various contexts
      - Historical advancements in chemistry have allowed for synthesis of drugs like morphine and heroin, altering their use & societal impact
      - Historical context of drug use highlights complex relationship between humans and psychoactive substances
      - Process of refining drugs has led to more potent and concentrated forms, increasing potential for abuse
    - - Notable drugs include opium, cannabis and coffee, each with unique cultural significance and hisotrical timelines
      - Interaction between drug use and human evolution suggests that psychoactive substances may have influenced societal development and cultural practices
      - Evolution of drug use reflect changes in society, culture and technology, including refinement of drugs & consumption methods
      - The role of marketing and industrial processes in promoting drug use has shpaed modern consumption patterns
      - Humans have utilised psychoactive substances for thousands of years, with evidence of plant-based drugs dating to 8000BC