Drugs as instruments: a new framework for non-addictive psychoactive drug use

Most people who are regular consumers of psychoactive drugs are not drug addicts, nor will they ever become addicts. In neurobiological theories, non-addictive drug consumption is acknowledged only as a "necessary" prerequisite for addiction, but not as a stable and widespread behavior in its own right. This target article proposes a new neurobiological framework theory for non-addictive psychoactive drug consumption, introducing the concept of "drug instrumentalization." Psychoactive drugs are consumed for their effects on mental states. Humans are able to learn that mental states can be changed on purpose by drugs, in order to facilitate other, non-drug-related behaviors. We discuss specific "instrumentalization goals" and outline neurobiological mechanisms of how major classes of psychoactive drugs change mental states and serve non-drug-related behaviors. We argue that drug instrumentalization behavior may provide a functional adaptation to modern environments based on a historical selection for learning mechanisms that allow the dynamic modification of consummatory behavior. It is assumed that in order to effectively instrumentalize psychoactive drugs, the establishment of and retrieval from a drug memory is required. Here, we propose a new classification of different drug memory subtypes and discuss how they interact during drug instrumentalization learning and retrieval. Understanding the everyday utility and the learning mechanisms of non-addictive psychotropic drug use may help to prevent abuse and the transition to drug addiction in the future.     

Flaws of drug instrumentalization

The adaptive use of drugs, or "drug instrumentalization," is presented as a reality that the scientific literature has largely ignored. In this commentary, we demonstrate why this concept has limited value from the standpoint of nosology, why it should not be viewed as "adaptive," and why it has dangerous implications for policy and public health efforts.     

Psychoactive drug use: Expand the scope of outcome assessment

The "hijacking" and "drug instrumentalization" models of psychoactive drug use predict opposite outcomes in terms of adaptive behavior and fitness benefits. Which is the range of applicability of each model? To answer this question, we need more data than those reported by studies focusing on medical, psychiatric, and legal problems in addicted users. An evolutionary analysis requires a much wider focus.     

Sacramental and spiritual use of hallucinogenic drugs

Arguably, the religious use of hallucinogenic drugs stems from a human search of metaphysical insight rather than from a direct need for cognitive, emotional, social, physical, or sexual improvement. Therefore, the sacramental and spiritual intake of hallucinogenic drugs goes so far beyond other biopsychosocial functions that it deserves its own category in the drug instrumentalization list.     

The psychosocial etiology of adolescent drug use: a family interactional approach

The purpose of this monograph was to propose a framework, family interactional theory, for explaining the psychosocial aspects of adolescent drug use. Three themes are stressed: (a) the extension of developmental perspectives on drug use, (b) the elucidation of family (especially parental) influences leading to drug use, and (c) the exploration of factors that increase or mitigate adolescents' vulnerability to drug use. We present a developmental model with two components; the first deals with adolescent pathways to drug use, and the second incorporates childhood factors. The model was tested in two studies: one cross-sectional study of 649 college students and their fathers, and one longitudinal study of 429 children and their mothers. The subjects were given self-administered questionnaires containing scales measuring the personality, family, and peer variables outlined in the model. The results of each study supported the hypothesized model, with some differences between parental influences. We also found that individual protective factors (e.g., adolescent conventionality, parent-child attachment) could offset risk factors (e.g., peer drug use) and enhance other protective factors, resulting in less adolescent marijuana use. Implications of the findings for prevention and treatment, future research, and public policy are discussed.     

累积生态风险与青少年网络成瘾:心理需要满足和积极结果预期的中介作用

青少年网络成瘾与个体所处的生态背景密切相关。目前已有不少研究探讨家庭、学校、同伴背景中单个或少数风险因素对青少年网络成瘾的影响,但少有研究关注多个背景中生态风险因素的累积对青少年网络成瘾的影响及其心理机制。本研究基于累积风险模型和动机心理学理论,考察累积生态风险对青少年网络成瘾的影响及基本心理需要满足(个体在现实生活中需要被满足的情况)和积极结果预期(个体对网络使用诱因大小的判断)在其中的并行和/或链式中介作用。被试为5所中学的998名青少年。结构方程模型分析表明:(1)在控制了人口学变量后,累积生态风险对青少年网络成瘾具有显著的正向预测作用(呈"负加速模式")。(2)累积生态风险通过显著降低基本心理需要满足(表现出"梯度效应"),进而促进青少年网络成瘾。(3)累积生态风险通过显著提升积极结果预期(呈"负加速模式"),进而促进青少年网络成瘾。(4)累积生态风险对青少年网络成瘾的影响被基本心理需要满足和积极结果预期两条并行路径完全中介。上述结果表明,累积生态风险对青少年网络成瘾具有重要影响,且这种影响是通过需要和诱因两种动机力量一"推"一"拉"的合力来实现。     

Helping behaviour among people who use drugs: Altruism and mutual aid in a harm reduction program

People who use drugs, and particularly people experiencing addiction, are rarely afforded the opportunity to have their voices heard when it comes to drug treatment or drug policy or even when attempting to define themselves and their life experiences. Of course, there is much more to a person than one area of their behaviour. The current study seeks to capture and understand the lived experiences of people who use drugs, with a focus on their relationships and helping behaviour. We interviewed 32 participants in a harm reduction program seeking to provide understanding beyond stigmatizing and criminalizing drug narratives, by exploring their motivation and context for helping behaviours. Grounded theory methodology was used to understand the patterns of helping behaviour, along with the contexts in which help is or is not given. We particularly focus on participants' distribution of syringes and carrying medicine to reverse overdose (naloxone). Participants shared stories of altruism and mutual aid, along with barriers and disincentives to helping others. We situate these behaviours within contrasting environments of a free harm reduction program and the competitive market system of the U.S. society. Implications for practice and public policy are discussed.     

Cocaine addiction and personality: A mathematical model

The existence of a close relation between personality and drug consumption is recognized, but the corresponding causal connection is not well known. Neither is it well known whether personality exercises an influence predominantly at the beginning and development of addiction, nor whether drug consumption produces changes in personality. This paper presents a dynamic mathematical model of personality and addiction based on the unique personality trait theory (UPTT) and the general modelling methodology. This model attempts to integrate personality, the acute effect of drugs, and addiction. The UPTT states the existence of a unique trait of personality called extraversion, understood as a dimension that ranges from impulsive behaviour and sensation‐seeking (extravert pole) to fearful and anxious behaviour (introvert pole). As a consequence of drug consumption, the model provides the main patterns of extraversion dynamics through a system of five coupled differential equations. It combines genetic extraversion, as a steady state, and dynamic extraversion in a unique variable measured on the hedonic scale. The dynamics of this variable describes the effects of stimulant drugs on a short‐term time scale (typical of the acute effect); while its mean time value describes the effects of stimulant drugs on a long‐term time scale (typical of the addiction effect). This understanding may help to develop programmes of prevention and intervention in drug misuse.     

Drug addiction. Is it a disease or is it based on choice? A review of Gene Heyman's Addiction: A disorder of choice.

In Addiction: A disorder of choice, Gene Heyman surveys a broad array of evidence—historical, anthropological, survey, clinical, and laboratory‐based to build an argument about the role of basic choice processes in the phenomena that comprise drug addiction. He makes a compelling, multifaceted argument that conceptualizing drug addiction as a chronic disease (like schizophrenia or diabetes) is both misleading and erroneous. In developing his argument, he points out that the best survey data available indicate that most drug addicts quit their addiction, a fact inconsistent with a chronic‐disease model. He illustrates how basic, normal choice processes can lead to addiction, arguing that people do not choose to be addicts, but that normal choice dynamics can lead them to that condition. He points to a variety of factors that keep most from becoming addicted, with a focus on the role of choice governed by choice‐by‐choice contingencies versus choice governed by the outcome of sequences of choices, a difference in an under‐described activity called framing. His view is consistent with the most effective treatments currently available, and provides a basis for continued basic research on choice as well as research on treatment and prevention.     

基于“相关线索-自动化用药行为”联结的成瘾记忆消退

成瘾记忆消退致力于消除成瘾者相关线索与药物奖赏效应的联结,以达到消除心理渴求、戒断成瘾行为的目的,但其效果还十分有限。最近,大量的动物和人类实验研究发现:在相关线索下,成瘾者的激活脑区不仅包括中脑边缘皮层-背内侧纹状体,还延伸到感觉运动脑区-背外侧纹状体。这意味着成瘾记忆中存在相关线索与自动化(习惯性)用药行为的联结。所以,与成瘾相关的记忆可能包含两种不同的成分:一是与药物奖赏效应相关的情绪记忆,另一种是与用药动作、技能有关的动作记忆(程序记忆)。由于在成瘾阶段,药物奖赏效应对药物使用和复发的作用已经相对减少,因此,针对成瘾记忆的消退训练,以相关线索与自动化用药行为的联结为标靶,可能可以取得更好的效果,值得做进一步的深入探索。     

Addiction: An Emergent Consequence of Elementary Choice Principles

ABSTRACT

Clinicians, researchers and the informed public have come to view addiction as a brain disease. However, in nature even extreme events often reflect normal processes, for instance the principles of plate tectonics explain earthquakes as well as the gradual changes in the face of the earth. In the same way, excessive drug use is predicted by general principles of choice. One of the implications of this result is that drugs do not turn addicts into compulsive drug users; they retain the capacity to say ‘no’. In support of the logical implications of the choice theory approach to addiction, research reveals that most addicts quit using drugs by about age 30, that most quit without professional help, that the correlates of quitting are the correlates of decision making, and, according to the most recent epidemiological evidence, the probability of quitting remains constant over time and independent of the onset of dependence. This last result implies that, after an initial period of heavy drug use, remission is independent of any further exposure to drugs. In short, there is much empirical support for the claim that addiction emerges as a function of the rules of everyday choice.     

Chinese Internet addiction inventory: developing a measure of problematic Internet use for Chinese college students.

The current study developed a psychometrically sound multidimensional measure of Internet addiction: the Chinese Internet Addiction Inventory (CIAI). Data were collected from 1,029 Chinese undergraduate students from 14 universities and colleges. The initial sample was split randomly into two samples (N1=516; N2=513). An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were conducted on the two samples respectively. Findings from the EFA suggest that this measure assesses three dimensions of Internet addiction: conflicts, mood modification, and dependence. Items in each dimension showed high internal consistency and acceptable test-retest reliability. Findings from the CFA further confirmed the three-factor measurement structure of CIAI. Test of criterion-related validity also showed good abilities for all three CIAI subscales to discriminate between an Internet addictive group and non-Internet addictive group. The theoretical and clinical implications of CIAI and its limitations are discussed.     

A SIKH PERSPECTIVE ON ALCOHOL AND DRUGS: IMPLICATIONS FOR THE TREATMENT OF PUNJABI-SIKH PATIENTS

This paper presents a Sikh perspective on the use of alcohol and drugs. In doing so, it takes into account the dichotomy that exists between Sikh ethical values and the Punjabi cultural attitude toward alcohol and drugs. It further discusses the Sikh perspective on treating substance-related disorders in the light of contemporary approaches to addiction, such as the bio-psychosocial model and the Alcoholics Anonymous twelve-step program. The paper concludes by highlighting the treatment issues that need to be taken into consideration when helping Punjabi-Sikh patients recover from alcohol or drug related addiction.     

Pavlovian conditioning of drug reactions: Some implications for problems of drug addiction

This paper reviews the classical conditioning of drug reactions, with special emphasis on the relationship of this phenomenon to drug addiction. Several aspects of drug addiction such as drug craving, high relapse tendencies, and the recurrence of withdrawal symptoms are reviewed and interpreted in light of classical conditioning theory and data. A theory is proposed that attempts to account for various aspects of the addictive process. The implications and empirical methods for testing this theory are outlined.     

药物成瘾过程的心理-神经理论模型

药物成瘾一般被界定为强迫性药物寻求和药物摄入的行为模式,是一个由偶尔用药逐渐过渡到强迫性用药模式的过程。成瘾过程伴随着一系列脑机能和心理机能的改变,但对药物滥用如何导致这些改变以及这些改变如何诱发成瘾却存在着不同的解释。本文在简要评述拮抗过程模型和异常学习模型的基础上,重点讨论了诱因一易感化模型的主要观点及其行为实验和神经心理学证据,并提出成瘾理论研究进一步整合的可能性。     

Substance use and abuse among children and teenagers

During the past several years, there has been a renewed national concern about drug abuse, culminating in the current "war on drugs." In this review, we emphasize that even though child or teenage drug use is an individual behavior, it is embedded in a sociocultural context that strongly determines its character and manifestations. Our focus is on psychoactive substances both licit (cigarettes and alcohol) and illicit (e.g., cannabis and cocaine). We feel that it is critical to draw a distinction between use and abuse of drugs and to do so from a multidimensional perspective that includes aspects of the stimulus (drug), organism (individual), response, and consequences. Our selective review of substance use and abuse among children and adolescents covers epidemiology (patterns and extent of drug use), etiology (what generates substance use), prevention (how to limit drug use), treatment (interventions with drug users), and consequences (effects and outcomes of youthful drug use).     

American Indian methamphetamine and other drug use in the Southwestern United States

To investigate the extent of methamphetamine and other drug use among American Indians (AIs) in the Four Corners region, we developed collaborations with Southwestern tribal entities and treatment programs in and around New Mexico. We held nine focus groups, mostly with Southwestern AI participants (N = 81) from three diverse New Mexico communities to understand community members, treatment providers, and clients/relatives views on methamphetamine. We conducted a telephone survey of staff (N = 100) from agencies across New Mexico to assess perceptions of methamphetamine use among people working with AI populations. We collected and analyzed self-reported drug use data from 300 AI clients/relatives who completed the Addiction Severity Index (ASI) in the context of treatment at three diverse addiction treatment programs. Each focus group offered a unique perspective about the effect of drugs and alcohol on each respective community. Though data from the phone surveys and ASIs suggested concerning rates of methamphetamine use, with women more adversely affected by substance use in general, alcohol was identified as the biggest substance use problem for AI populations in the Southwest. There appears to be agreement that methamphetamine use is a significant problem in these communities, but that alcohol is much more prevalent and problematic. There was less agreement about what should be done to prevent and treat methamphetamine use. Future research should attend to regional and tribal differences due to variability in drug use patterns, and should focus on identifying and improving dissemination of effective substance use interventions.     

Shyness,Loneliness Avoidance,and Internet Addiction: What are the Relationships?

Given that shyness has been consistently linked to Internet addiction in youth, an examination into the mediating effect of a desire to avoid loneliness on the shyness–Internet addiction link could offer potential insights into a possible explanatory mechanism as well as directions for Internet addiction prevention and intervention in young adulthood. Thus, the aim of this study is to investigate the mediating role of loneliness avoidance in the relationship between shyness and Internet addiction among 286 youth Internet users. Shyness was significantly and positively correlated with loneliness avoidance and Internet addiction. In addition, loneliness avoidance was significantly and positively correlated with Internet addiction. Most importantly, loneliness avoidance may predispose shy youth to become addicted to the Internet. Theoretical and practical implications of the research findings for youth wellness are addressed in this study.     

亲子间科技干扰与青少年网络人际关系成瘾：有调节的中介模型

对1353名高中生进行问卷调查,探究亲子间科技干扰与青少年网络人际关系成瘾之间的关系,相对剥夺感的中介作用及内在觉知的调节作用,结果表明：（1）亲子间科技干扰正向预测青少年网络人际关系成瘾;（2）相对剥夺感是亲子间科技干扰与网络人际关系成瘾之间的中介变量;（3）亲子间科技干扰与网络人际关系成瘾的间接效应前半段受到内在觉知的调节。因此,亲子间科技干扰和网络人际关系成瘾之间存在有调节的中介效应。     

The whys and the hows of psychosocial approaches to addiction

The field of addiction psychology attempts to addresses a major social problem. Yet, discourse within the discipline suggests a biological focus, driven by disease‐model of addiction, has caused our understanding to be too narrow. In contrast, psychosocial approaches conceptualize the phenomena from various perspectives. We here bring together papers utilizing a variety of methods in the context of substance use and mis‐use. These explore the effects that alcohol primes have on attentional control, how procrastination may predict hazardous drinking, the typology of “pre‐drinking” motivations and the effects of dyadic membership. It also looks at prevention in terms of public health messaging and also heroin use uptake. We hope showcasing these studies will encourage addiction researchers to widen the scope and method of their enquiries.