Neural Sensitization

Like in my last blog entry I decided to revisit my entry titled What Causes Addiction?. The third cause that article mentioned is outlined below.

The article states that "neural sensitization… [causes] pathological “wanting” to take drugs". Through repeated use addicts alter their neural pathways causing them to be extra sensitive to drugs and drug triggers. The article goes on to suggest that when these sensitive systems are triggered the response may be completely implicit. This means that an addict may take actions without being conscious of their motivations. Unlike these implicit "wanting" signals, there are also explicit "wanting" reactions that manifest as drug cravings. These are often in the forefront of the addicts mind. The article states that the implicit reactions lead to the conscious experience of craving. The article makes an important distinction between "liking" and "wanting". Although an addict may want to be sober, once their brain is triggered the implicit and explicit systems kick in and the pathological "wanting" to use begins.

"Susceptibility to sensitization is determined by a host of factors, including genes, sex hormones, stress hormones, past trauma, etc., in addition to individualized patterns of drug exposure." This statement perhaps explains why some people can use highly addictive substances like heroin and meth without becoming addicted and others claim to be addicted after their first use. Everybody is different and a plethora of factors influence how are bodies and minds will react to use. Another very interesting thing is that once sensitization occurs for one substance, it is very easily transferred to other substances. The 12-step fellowships seems to have grasped this concept and encourage all members to be entirely sober even if they only had a problem with a specific substance. Often people will switch addictions and this offers a solid explanation as to why that might occur. People who become highly sensitized to drugs may also become highly sensitized to non-chemical stress, the article states that this may be why the risk for relapse is so high during periods of high stress.

This sensitization seems to permanently affect the addict and can perhaps explain why relapse is so common even after years of sobriety. An addict will remain hyper-sensitive to drugs and drug cues as well as stress. This is why "the addict might suddenly “want” to take drugs again regardless of cognitive expectancies about “liking,” declarative goals, absence of withdrawal, etc.".

Reward Learning

In my blog entry, What Are The Causes of Addiction?, there are four causes listed. The second cause is the one I will be writing about here. 

According to the article, "drugs produce abnormally strong or aberrant associations involved in reward learning, more powerful than natural reward associations". There are two ways that this extremely strong learning system can really impact an addicts decision making. The first is that memories of the drugged experience may be extremely vivid and intrusive. The second is that drug use can alter an addicts memories, causing them to view drug use in a more positive light than is appropriate. If these two statements are true, it seems clear that this would fuel addiction. Basically, an addict does drugs and then can not stop thinking about doing the drugs. In addition, they remember the incidence in an exaggeratedly positive light, perhaps ignoring the consequences. This information seems to fit cohesively with addicts' descriptions of their use, except in the fact that they are able to logically understand and predict the consequences yet use anyways. The author suggests that perhaps the habits are so reinforced by learning that they become compulsive. It seems there must be some other piece that motivates the addict to behave in these compulsive and automatic behaviors though. Addicts put drugs ahead of everything in their lives including basic survival necessities. This suggests that the reward from drug use is superior even to the natural reward associations we need to survive. This clearly seems to be an important factor in what causes addicts to use, but there are other factors to examine.

Pleasure-Pain Hypothesis

In my blog entry, What Are The Causes of Addiction?, I wrote about an article that discussed four different theories. I decided to write about the first cause and my interpretation of that since I found the information to be so pertinent.

The first cause this article identifies is "the traditional view that drugs are taken first because they are pleasant, but with repeated drug use homeostatic neuroadaptations lead to tolerance and dependence, such that unpleasant withdrawal symptoms ensue upon the cessation of use". This statement seems aligned with what I discussed in my most recent blog about addicts initially choosing to use, but eventually their brains are damaged in such a way that it is no longer a choice. The withdrawal symptoms that occur following prolonged use can be both physical and mental torture, causing the addict to want or need to use again. Once a person becomes an addict, they are no longer using to feel good, they are using to stop feeling bad. There is an old adage that comes to mind to describe this phenomenon: "the person takes the drug and then the drug takes the person."

While this theory makes sense, there is a major flaw with it. If addicts are using primarily to escape withdrawal symptoms, then why would an addict relapse after they were already through the withdrawals. Relapse amongst addicts is common, even for those who have many years of sobriety. 

The article does not offer an explanation for this shortcoming in the theory, but I think there are likely multiple causes. While this cause affects a person who is in active addiction, there are clearly other factors that would cause a person with substantial time sober to relapse. In addition, there might be other factors related to why an individual would take addictive substances to begin with.  

Addiction and Free Choice Revisted

I revisited my blog entry, Addiction and Free Choice, and decided to break it down based on what I have learned since then.

The article states that addiction is a disease and that those who die from their addictions are sick people, rather than morally deficient. The author states that "an addicted person’s failures in the realm of choice are the product of a brain that has become greatly compromised". This statement makes a lot of sense to me after reading about brain scans and other studies that show differences in the brains of addicts and non-addicts. It is also an interesting paradox of sorts, because while the addict is choosing to use, their brains are not really capable of making any other choice. Although free-will may be present initially when the addict begins using, the article claims that is still not a reason to judge them later on. When compared to diabetes or cancer, both of which can be caused by a persons' decision to partake in unhealthy behaviors, it is apparent to me that we are dealing with a similar phenomenon. Just because an addict makes poor decisions by using potentially addictive substances, does not discount the fact that they develop a disease. When viewing addiction from this disease model, it is clear that despite whatever led to the addiction, some type of treatment or intervention is necessary for recovery. This is not just a moral, emotional, or spiritual issue- it is also biological. 

Sick or Sinning?

I found the following source during our in-class scavenger hunt. This article is extremely balanced and offers arguments on both sides of the biological vs. moral debate. I copied and pasted the parts of the article that apply to this issue, however left out big chunks of the article that discussed insurance and government policy issues. While that was all very interesting to read, I believe my paper is going in a different direction. 

Clemmitt, M. (2007, February 9). Combating addiction. CQ Researcher, 17, 121-144. Retrieved from http://0-library.cqpress.com.skyline.ucdenver.edu/cqresearcher/

Addiction is a compulsion — not only to use an addictive substance like tobacco or cocaine but also to gamble or even shop — despite serious negative consequences. Addicts generally feel a loss of control over their behavior, and many give in to their compulsions after quitting.

The brain rewards certain behaviors — such as eating sweet food or having sex — with an evolution-ensuring payoff: pleasure. Many scientists believe drugs like cocaine hijack that reward system, skewing the brain to prefer a drug to other experiences. But skeptics say it's not surprising that some people habitually seek a predictable, intense drug reward. Others point out that psychological problems or a stressful environment may predispose some people to develop addictions.

Nevertheless, “most people who try any drug, even heroin, use it only experimentally or continue use moderately and without ill effect,” according to analysts from the Drug Policy Research Center at the Rand Corporation think tank.  Only about 9 percent of marijuana users become clinically dependent on the drug, as do 15 percent of alcohol users, 17 percent of cocaine users and 23 percent of heroin users. But 32 percent of those who use tobacco — considered the most addictive substance — become addicted. 

Not all substance abusers remain addicted, however. In a long-term study of heroin addicts, for example, after 33 years just under half of the surviving participants said they'd been off heroin for five years or longer. At the same time, 11 percent of the original participants had died from a drug overdose; 10 percent from homicides, suicides and accidents — many probably related to drugs — and 7 percent from a chronic liver disease that afflicts injection-drug users. 

No one knows why only a small percentage of people become addicts or how best to help addicts kick their habits for good. “We basically know how to get people off drugs for a month,” says Alexandre B. Laudet, director of the Center for the Study of Addictions and Recovery at the New York City-based National Development and Research Institutes. “But we know there are people in recovery for 35 years.”

Finding out how to help kick addictions permanently is vital, not just for addicts but also for society, says David C. Lewis, a professor of medicine at Brown University. “When people get into treatment, crime costs and accident costs both dive,” he says. “A family's health-care costs also go right down within the first year or two, along with absenteeism” from work. A Brandeis University study found that addiction costs the American economy $400 billion a year. 

New neuroimaging techniques are enabling scientists to learn more about how addictive substances affect the brain, possibly eventually leading to new drugs or other treatments foraddiction. Recent studies have found, for instance, that:

• Stroke patients with damage to a particular brain area were able to quit smoking without experiencing cravings or relapse;
• Socially dominant monkeys are less likely to overuse cocaine than more passive monkeys;
• Drug addicts show impaired function in several brain regions that are important for distinguishing the relative value of different rewards and behaviors.

Researchers also have learned that social and personal environments can influence people in unexpected ways to either seek or avoid treatment, Laudet says. In a study of women addicts, for example, researchers initially thought husbands and boyfriends might reinforce women's efforts to kick drugs and encourage them to stay in treatment. Not so, one study participant said of her partner: “Actually, he likes me better when I'm high.” 

Americans have long debated whether addiction should be viewed as a disease or a moral choice. “We're really torn as a society on whether we want to help addicted people or punish them,” says Scott Kellogg, a psychotherapist and clinical assistant professor of psychology at New York University.

Advocates of the “disease” point of view note that current science shows high levels of drug use change brain function. They also cite the value of removing addiction's moral stigma so substance abusers will come forward and seek help. Opponents of the disease label argue thataddiction science remains fuzzy and that calling addiction an incurable disease robs abusers of hope that they can change.

Addiction is more serious than substance abuse and indeed qualifies as a disease, according to John T. Schwarzlose, president of the Betty Ford Center. “There is a well-defined criterion that distinguishes between the abuse of alcohol and alcoholism,” he said. “Once someone is addicted . . . there is a change, an alteration, of the neurochemistry of the brain. And you cannot go back once you've become addicted.” 

Actress Mariette Hartley, a long-time spokesperson for alcoholism recovery who wrote a book about her own struggle with alcoholism and depression, calls alcoholism “a self-diagnosed disease” in which sufferers realize they are powerless over their own desire to drink. For an addict, “it's very, very hard to try to drink like a normal drinker. I find it impossible,” she said. “A lot of people who've tried . . . desperately to control their drinking, can't physically control their drinking.” 

Most who see addiction as a disease view it as a “primary” disease — not a symptom of another medical or psychological condition — and believe it afflicts those who are “biologically susceptible,” according to William L. White, a senior research consultant for Illinois-based Chestnut Health Systems, a mental-health and substance-abuse treatment organization. “One either has or does not have the biological risk for addiction.” 

Laudet, of the Center for the Study of Addictions and Recovery, contends that addiction is not just a disease but a chronic disease — similar to diabetes and high blood pressure — characterized by a tendency to relapse if the sufferers go off their treatment.

“There is a behavioral component” to developing addictions, as with other chronic diseases, says Laudet. Addicts who relapse are like someone who has had a heart attack and goes back to eating unhealthy foods, she says. “But we don't blame people” with chronic disease for their relapses the way we do addicts who fall off the wagon, she notes. “As long as society — at least in the back of its mind — thinks addiction is a moral failing, it's very difficult to sell enhanced treatment.”

In fact, brain scientists are finding, among other things, that drugs change the brain and that different brain structures may give people different predispositions to begin or relapse into drug abuse.

Michael A. Nader, a professor at North Carolina's Wake Forest University School of Medicine, studies the relationship between brain function and behavior. Among his findings: Cocaine use changes the brains of laboratory monkeys, and socially dominant monkeys have fewer of certain neuroreceptors in their brains and are less prone to use large amounts of cocaine. This research and a series of other studies are showing that drug addiction “is at main a disease,” Nader says. “It's clear as day” that addiction is not the result of “some moral weakness.” 

The new science is “guilt-relieving,” says Brown University's Lewis, and may give people hope to continue or re-enter substance-abuse treatment instead of giving up because they think they are doomed to failure. The new findings allow people to see that a drug relapse, for example, “isn't 100 percent within their control, that people relapse despite their best efforts,” Lewis says.

He is quick to point out, however, that by calling addiction a disease scientists are helping people to better understand the condition — not trying to justify substance abuse or abuse-related bad behavior.

Furthermore, treating addiction as a “disease” may imply that it can be treated with drugs — such as methadone for heroin addicts — and “this creates controversy,” Lewis says. “Using a drug to treat a drug-related problem seems like a moral issue to some people.” In its “wishful, utopian view of itself, the United States is an abstinence-based society,” he says. “There can be almost religious overtones to abstinence only.”

Some critics of the disease model say that neurological research shows such wide variations in the way different substances affect brain structure and function that the science can't possibly lead to the conclusion that addiction is an actual disease.

In fact, “recent research on the effects of drugs points us toward the conclusion that . . . addictionhas little to do with what drugs contain, although it has a lot to do with what we think drugs can do to us,” according to New Jersey psychologist Stanton Peele, the author of several books on substance abuse.  This means that addiction is not a disease in which drugs alter brain structure in a way that forces addicts to seek more drugs, as some argue, Peele says.

Peele argues that brain research actually provides evidence that addiction is not a disease, because brain studies find different drugs acting differently in many different regions of the brain. Many neuroscientists “try to unify all drugs of abuse around their impact on dopamine,” which they “regard as the mediator of pleasure in the brain,” he says. But since other behaviors, like eating, having sex, winning a competition or being praised, also affect the brain's dopamine system, just as drugs do, “drug use cannot be distinguished from a hundred other activities.” 

Instead, Peele says the variety of responses to drug and alcohol use — some people growing addicted, some not, some breaking away from addiction on their own or with treatment — shows that “addiction is caused by environmental factors” that lead people to feel insecure or unhappy. Increasingly in modern society, people don't have a personal sense of “joy and competence,” according to Peele. Developing a regular, ritualized habit of using pleasure-producing substances like drugs and alcohol, often in a social situation, or engaging in activities like gambling, shopping, or overeating, provides “a soothing sensation that everything is all right,” Peele said. As such, it is experienced as a difficult-to-end addiction by people plagued with “uncertainty, self-doubt and anxiety.” 

Twelve-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous rely on two vital tools for recovery: mutual support and the acknowledgment that addicts are “powerless” to combat their addiction alone. But critics argue that most people who beat addictions do so without such groups and that the idea of being “powerless” over drugs or alcohol may make some people more rather than less likely to go on using.

Twelve-step programs insist that abusers keep up their participation in a program and help other recovering addicts, says former addict McDaid, the Washington lobbyist. “In treatment, they tell you, 'When you're not using, your addiction is doing pushups,' ” she says, so staying involved in a recovery group is a crucial source of ongoing support — even for addicts who are not currently using.

And helping other addicts keeps recovering abusers conscious of their own vulnerability toaddiction's dangers, says McDaid. “If I'm not working with new people, I'm much less likely to stay tuned in” to that fact, she says.

Most of the low-income addicts she knows who are kicking their habit say their success is due to mutual support and reliance on some higher power, says Laudet, of the Center for the Study of Addictions and Recovery, and “most go to 12-step” programs. Ex-addicts continually talk about the need for support from family and friends, and many are involved in churches. “People draw enormously on religion,” she adds.

Twelve-step groups also subscribe to the addiction-is-a-disease theory, says Brown University's Lewis. “They've always gravitated toward the medical explanation, in part because it's guilt-relieving.”

Addicts go to 12-step programs because they identify with the model of addiction presented by such programs, says psychotherapist Kellogg, at New York University. According to AA, addicts cannot control their response to the addictive substance, he says. “Some addicts respond to this idea very deeply, and others are troubled by it.”

Current science may be leaving some AA doctrine behind, Kellogg says. For example, 12-step groups have long stressed the “mysterious” nature of alcohol and its hold on addicts. “But scientists are finding now that relapses are very predictable.”

Some 12-step critics say that by emphasizing quitting “one day at a time,” 12-step groups let addicts off too easily. “American society at large is now the carrier of AA doctrines,” says Trimpey, always assuming there is a hidden reason for misconduct. This theory has contributed to a creeping national philosophy of powerlessness that makes addicts less likely to end their addictive behavior, he says.

By suggesting that an addict commit only to staying substance-free one day at a time, 12-step programs “inexplicably reserve the privilege of relapse,” says Trimpey, making it more likely that they will do so. That approach robs people of their belief that “they have free will, that humans have a choice in the matter.”

Saying “no” one day at a time gives the abuser an excuse for any future failures, so it doesn't have the good effect of saying “never,” Trimpey continues.

Mutual-help groups aren't needed to beat the most physically addicting substance, nicotine, which suggests that they aren't the answer for other addictions either, according to psychologist Peele.

Surveys indicate that nicotine is the most hard-to-quit addictive substance — harder than crack or alcohol, he wrote. “Yet . . . a large percentage (half or more) of people ever addicted to smoking have quit,” says Peele, most without any group work or treatment.

Historically, the debate has been characterized by ambivalence. For example, in an 1825 sermon, the Rev. Lyman Beecher, a Presbyterian clergyman and temperance leader, simultaneously dubbed uncontrolled drinking “a disease as well as a crime.” Were “any other disease as contagious . . . and as mortal, to pervade the land, it would create consternation,” Beecher said. Despite calling addiction a disease, however, he condemned intemperate drinkers as being “addicted to the sin,” and enmeshed in “an evil habit.”

In 1829, Boston-born physician William Sweetser wrote of alcoholism as both a medical and a moral problem. Chronic drunkenness has bad physical effects, creating a “morbid alteration” in most bodily structures and functions, and some alcoholics have inherited vulnerability to the problem, he wrote.

But he worried about the implications of the “disease” label. It's clear that chronic drunkenness “becomes a disease,” he wrote, but a “disease produced and maintained by voluntary acts.” Thus, he wrote, “should the opinion ever prevail that intemperance is a disease like fever, mania, etc., and no moral turpitude be afflicted to it, drunkenness . . . will spread itself even to a more alarming extent than at present.”

Similar ambivalence attended public views of other drugs. For example, women and higher-income Americans widely used opium-based drugs like morphine in the late 19th and early 20th century, and most had been introduced to the drugs by their physicians. In fact, most “opium eaters” were women, partly because doctors widely prescribed opiates for menstrual pain and menopausal symptoms. An 1885 survey in Iowa, for example, revealed that 63.8 percent of opiate users were female. Many opium users became addicted. A 19th-century adage attested to opium's power: “It is not the man who eats opium. It is opium that eats the man.”

But others fought the notion that addicts were powerless over drugs. “That the responsibility of taking the opium or whiskey . . . is to be excused and called a disease, I am not willing for one moment to admit,” wrote Chicago physician C. W. Earle, in the 1880s. “I propose to fight this pernicious doctrine as long as it is necessary.”

Today, brain imaging and other neuroscience research have revealed much about how some drugs operate, and decades of experience offer clues about what treatment techniques work. But the question of what addiction is and how best to deal with it remains cloudy.

“Addiction is a mystery, and it continues to be a mystery,” says New York University psychotherapist Kellogg, even though addiction knowledge has advanced substantially. “We're like the blind men and the elephant,” taking on an issue too complex for simple conclusions.

For instance, drug use may be different for different people, and “some drugs may have more biological issues involved,” he continues. “Because of genetics, perhaps, some substances may be more reinforcing for some people.”

Many different models exist, all with different consequences for how addicts and addiction are viewed, he says. For example, he says, there is a significant difference between the traditional “disease” model promoted by 12-step programs and the “medical” model pursued by neuroscientists.

Calling addiction a “disease” has been interpreted as saying, “once you're an alcoholic, you can never change, and it's impossible to control your alcoholism,” says Kellogg. “Many people experience that as true. They talk about their disease as a metaphor for the part of themselves that wants to keep drinking. It could be the brain, or a spiritual part of the self.”

Brain scientists may or may not buy that idea, but they have their own “medical” — or “pharmacological” model — whose key goal is to develop addiction treatments, especially anti-addiction drugs, Kellogg says. So far, studies show that chronic substance abusers are especially vulnerable, because there are changes in the brain that could increase the strength of drug cravings.

“Ten years ago, people believed everything was genetic,” says Brown University's Lewis. With time has come a different understanding. While everyone is born with certain inherited brain structures, “ 'genetic' is not a fixed entity,” he says. Increasingly, scientists believe vulnerability toaddiction is due to an interaction between genetic and environmental factors. Rather than being a disease that's biologically determined, “a 50-50 equation looks closer to the mark,” Lewis says.

Substance-abuse researchers hope neuroscience and behavioral research will yield new medications to treat substance abuse and a better understanding of what treatments help which people. But most agree that addiction's complexities will not be easy to crack.

Independent researcher Peele believes addictions arise mostly from social conditions that leave people feeling powerless and directionless and that addiction may be more prevalent in the coming decades. During speeches to parents around the country, he often asks if they think there will be more addicted kids in the future. “About 90 percent raise their hands,” he says.

Americans increasingly have been “medicalizing” more and more conditions, such as childhood hyperactivity, Peele explains. “In college, kids swap pharmaceuticals.” That all adds up to more future addiction, he predicts.

Others say it is more likely there will be a future boom in addiction treatments rather than a jump in addiction rates. Over the next decade more and better anti-craving medications will be on the market, says Brown University's Lewis. “The big pharmaceutical companies have figured it out, especially with alcohol. There are a lot of people out there who want these treatments.”

Meanwhile, the addiction-as-disease theory may extend to more behaviors, says Lewis. “I suspect that when the science is in, most similar things — like gambling — will show some of the same neuroceptor changes as drug addiction.”

“Gambling, sex and shopping will probably get in,” says New York University's Kellogg.

When it comes to treatment, today “we're stuck with the reality that everything works with somebody, and nothing works for everybody,” he says. While many who recover do so entirely on their own, many different kinds of help — from 12-step programs to medication — also seem to work for some people.

“We're seeing greater flexibility” in how treatment professionals and researchers view theaddiction and recovery landscape, he says. For instance, while it was once unthinkable, he predicts that the U.S. substance-abuse paradigm may slowly shift toward “an increased emphasis on moderation” in substance use, rather than immediate total abstinence. “It's kind of moving that way now,” he says.

Researchers will continue their quest to “tailor treatments” to the right people, says Laudet, at the Center for the Study of Addictions and Recovery. In the complex landscape of addiction, that's a top goal, but it will be difficult to reach, she says.

Ending social stigma so addicts are more willing to get treatment may be even more important, but that depends on the public — not on medical researchers, says Laudet. “If all of these people in respected roles in society could come forward and show a positive face of recovery, it would probably do more to change things than all the research we can do in our lifetimes.”

Early Maladaptive Schemas Influence on Addiction

http://0-www.ncbi.nlm.nih.gov.skyline.ucdenver.edu/pmc/articles/PMC3905522/
At the above website I found a very interesting study discussing the relationship between addiction and early maladaptive schemas. This study indicates that the cognitive make-up of individuals influences how their biology and environment will affect them.
I especially think the graph is useful in seeing visual representation of the differences between addicts and non-addicts.

Shaghaghy, PhD, Farhad, Majid Saffarinia, PhD, Mohadeseh Iranpoor, and Ali Soltanynejad. "The Relationship of Early Maladaptive Schemas, Attributional Styles and Learned Helplessness among Addicted and Non-Addicted Men."Millennium Web Catalog. Kerman University of Medical Sciences, 18 Mar. 2011. Web. 28 Mar. 2014.

Addiction is considered as one of the major problems in family and community in the world. According to the World Heart Organization (WHO) and the United Nations Office on Drug and Crime (UNODC) drug abuse is on the upswing.1

Social science and psychology researchers believe that studying the causes of people’s tendency to drug abuse is one of the requirements to reduce addiction. They assume that addiction is a multifactorial phenomenon divided into three categories including sociocultural, biological, and psychological factors.

Among these, psychological factors are very important. Psychologists believe that the effects of biological and sociocultural factors are affected by psychological trends.

According to cognitive view, organizing the experiences determines how to behave. Organizing the experiences is based on cognitive processes and any disruption in these processes can create behavioral, emotional and communicational problems.3

Cognitive theorists developed a new approach to treat a variety of mental health problems, including personality disorders and addictive behaviors, by focusing specifically on the development of dysfunctional schema that emerge during childhood.4

Early maladaptive schemas (EMSs) are chronically self-defecting emotional and cognitive patterns that develop early in life. They are the causes of many psychological disorders. Maladaptive schemas and inefficient ways the patient learns to adapt with others often lead to chronic symptoms of anxiety, depression and substance abuse.5

Based on the revised model of learned helplessness theory, another factor that increases a person's vulnerability is attributional style which means how individuals explain different events. It means that when individuals encounter an unpleasant and uncontrollable event, they are interested in recognizing the cause. Abramson states three indexes for this issue namely internal/external, stable/unstable, and specific/global. Therefore, if a person attributes a bad event to a stable, internal, and global cause, it can result in learned helplessness (LH)

Comparing means of attributional styles of addicts and non-addicts showed significant differences between optimistic and pessimistic attributional styles, i.e. addicts were more pessimistic and developed LH more. Although these findings are consistent with studies conducted by Haj Hosseini, and also Garcia et al.,20,21 Fletcher did not find a significant difference between addicts and non-addicts in terms of attributional styles.6 and his findings indicate that LH is related to relapse to addiction after treatment. He stated that pessimistic addicts were more likely to return to substance abuse.6 We also found a direct relationship between LH and successful addiction treatment. Therefore, addicts who suffered more from LH were less successful in treatment and more likely to relapse to substance abuse.

Pearson correlation between EMS and pessimistic attributional style in addicts revealed positive relationships between pessimism and defect/shame, dependence/incompetence, and emotional inhibition schemas. Therefore, more pessimistic addicts had more sever schemas. In addition, Pearson correlation between LH and EMS in addicts indicated direct relationships between LH and entitlement, emotional inhibition, dependence/incompetence, failure, defect/shame, social isolation, abandonment, and emotional deprivation. These findings are consistent with Aimee’s research which found dependence/incompetence schema related to LH.4 Similarly, Hoffart and Sexton, and Tarquinio also suggested that since emotional deprivation, mistrust/abuse, social isolation vulnerability to harm and compliance were related to pessimism, schema therapy would lead to increased optimistic attribution.22,23 Likewise, Tilden and Dattilio, and Hoffart et al. found a positive relationship between pessimistic attributional style and EMS in depressed individuals and many couples with marital problems.24,25

At the end, according to what was mentioned in this study, addicts have more cognitive problems in comparison with non-addicts. Therefore, it is necessary to pay more attention to cognitive factors in addiction treatment to increase the success rate of the treatment.

Conclusion

Our study showed that addicts suffer from high levels of early maladaptive schemas. They had a more pessimistic attributional style. Moreover, addicts who developed higher levels of learned helplessness were less successful in addiction treatment and more likely to use drugs again after treatment. These issues show that addiction institutions and therapists have to pay attention to cognitive factors for addiction prevention.

Causes and Risk Factors Associated With Addiction

This article, which I found on the same site as the article in my previous blog, provides support for the biological disease model of addiction. It discusses how brain chemistry is literally changed due to repeated drug use.

Nordqvist, Christian. "What Are The Causes of Addiction?" Medical News Today. MediLexicon International, Mar. 2009. Web. 27 Mar. 2014. <http://www.medicalnewstoday.com/info/addiction/what-causes-addiction.php>.

Doctors say there is a link between the repeated use of an addictive substance and how the human brain experiences pleasure - its use has a nice reward, leading to further and more frequent use. The addictive substance, be it nicotine, alcohol or some drug actually causes physical changes in some nerve cells in the brain. Another name for a nerve cell is a neuron. Neurons release neurotransmitters into the synapses (empty spaces) between nerve cells, which are received by receptors in other neurons.

What is a neurotransmitter - it is a chemical that a nerve cell releases, which thereby transmits an (electric) impulse from one nerve cell to another nerve cell, organ, muscle, or other tissue. Put simply, a neurotransmitter is a messenger of neurologic data from one cell to another cell.

Tolerance increases

After a while, the user of the potentially addictive substance does not get the same pleasure and has to increase the dose - his/her body’s tolerance to it increases.

Eventually, the user no longer experiences pleasure from the substance and takes it simply to prevent withdrawal symptoms - taking the substance just makes them feel normal.

Experts say that when tolerance increases, the risk of addiction is much greater.

_________________________________________________________________________________

The following article, also from the same webpage, lists several risk factors to addiction:

Nordqvist, Christian. "What Are The Risk Factors for Addiction?" Medical News Today. MediLexicon International, Mar. 2009. Web. 27 Mar. 2014. <http://www.medicalnewstoday.com/info/addiction/risks-of-addiction.php>.

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

Although anybody, regardless of age, sex or social status can potentially become addicted to some substances, there are certain factors which may increase the risk:

• Genetics (family history) - anybody who has a close relative with an addiction problem has a higher risk of eventually having one themselves. It may be argued that environmental and circumstantial factors that close family members share are the prominent causes.
• Alcoholics are six times more likely than non-alcoholics to have blood relatives who are alcohol dependent. Researchers from the Universidad de Granada, Spain, in a study revealed that "the lack of endorphin is hereditary, and thus that there is a genetic predisposition to become addicted to alcohol".
• Geneticists believe that the reason some people try cigarettes and do not become smokers, while others do so very quickly is probably linked to the type of genes we inherit from our parents. Some people can smoke once in a while, throughout their lives, and never seem to become addicted, while others are unable to stop smoking without experiencing the unpleasant withdrawal symptoms. It is most likely that the way the receptors on the surface of our brain nerve cells respond to nicotine is influenced by our genes.
• Gender - a significantly higher percentage of people addicted to a substance are male. According to the Mayo Clinic, USA, males are twice as likely as females to have problems with drugs.
• Having a mental illness/condition - people with depression, ADHD (attention-deficit hyperactivity disorder) and several other mental conditions/illnesses have a higher risk of eventually becoming addicted to drugs, alcohol or nicotine.
• Peer pressure - trying to conform with other members of a group and gain acceptance can encourage people to take up the use of potentially addictive substances, and eventually become addicted to them. Peer pressure is an especially strong factor for young people.
• Family behavior - young people who do not have a strong attachment to their parents and siblings have a higher risk of becoming addicted to something one day, compared to people with deep family attachments.
• Loneliness - being alone and feeling lonely can lead to the consumption of substances as a way of copying; resulting in a higher risk of addiction.
• The nature of the substance - some substances, such as crack, heroin or cocaine can bring about addiction more rapidly than others. For example, if a group of people were to take crack every day for six months, and another identical group of people were to drink alcohol every day for the same period, the number of crack addicts at the end of the six months would be a lot higher than the number of alcoholics. For some people trying a substance even once can be enough to spark an addiction. Crack, also known as crack cocaine or rock, is a freebase form of cocaine that can be smoked.
• Age when substance was first consumed - studies of alcoholism have shown that people who start consuming a drug earlier in life have a higher risk of eventually becoming addicted, than those who started later. Many experts say this also applies to nicotine and drugs.
• Stress - if a person’s stress levels are high there is a greater chance a substance, such as alcohol may be used in an attempt to blank out the upheaval. Some stress hormones are linked to alcoholism.
• How the body metabolizes (processes) the substance - in cases of alcohol, for example, individuals who need a higher dose to achieve an effect have a higher risk of eventually becoming addicted.