MECHANISMS OF

ADDICTION
DR JAMES OTIENO AYUGI
MB,CHB,M.MED MBS
UB
DEPARTMENT OFPSYCHIATRY
 What to Expect in This Lecture
 A THEORY
 Nature Theories
 Biological Theories
• Neurochemical explanations
• Genetic explanations
• REWARD PATHWAYS IN ADDICTION
• ADDICTION
• TOLERANCE AND DEPEDENCE

 Psychological Theories
• Psychoanalytic explanations
• Personality theories
• Behavioral theories
 What is Theory?
 A theory is an explanation for the
occurrence of something
 WE SHALL attempt to explain here :
• HOW
• Drug addiction may occur
 Nature Theory
 Suggest that predisposition to
drug use and addiction are
intrinsic to human nature
 Early theories explained
addiction in terms of being Timothy Leary

weak-willed, etc.
 Andrew Weil suggests that use
and addiction is rooted in a
universal desire to alter
consciousness
Andrew Weil
 Evaluation of Nature Theory
 Strength
• Intuitively appealing
 Weaknesses
• Cannot be empirically verified or
falsified
• Cannot explain why individuals opt for a
particular type of conscience-altering
behavior
 Biological Theories
 Emerged in 19th century in response to the
moralistic “nature” theories
 Used a “disease” model to explain
addiction
• As a disease, addiction was seen as something
that was readily spread
• Drugs were seen as “toxins” that destroyed the
body
 More recent biological theories have
focused on the following two areas:
• Neurochemical bases for addiction
• Biogenetic bases for addiction
 Biological Theories:
Neurochemical Explanations
 Neurochemical explanations identify the
source of addiction in neurotransmission,
which can be defined as,
• “the mechanism by which signals or impulses are sent
from one nerve cell (neuron) to another” (Sunderwith,
1985)
 The specific neurotransmitter varies
across drug types:
• Opiates – endorphins
• Cocaine – dopamine
• Antidepressants – serotonin
The Neurochemisty of Addiction
 REWARD PATHWAY OF
ADDICTION
 HUMANS AS WELL AS OTHER
ORGANISMS ENGAGE IN BEHAVIOURS
THAT ARE REWARDING(PLEASURABLE)
 THERE ARE NATURAL REWARDS AS
WELL AS ARTIFICIAL REWARDS
 THE PLEASURABLE FEELINGS
ASSOCIATED WITH THE REWARDS
PROVIDE A + REINFORCEMENT SO
THAT THE BEHAVIOUR IS REPEATED
 NATURAL REWARDS
 FOOD

 WATER

 SEX

 NURTURING
 ARTIFICIAL REWARDS
 DRUGS
 ALCOHOL
 PSYCHOSTIMULANTS(COCAINE ,AMPHET
AMINES)
 OPIATES(HEROIN,MORPHINE,)
 MARIJUANA
 OTHERS(NICOTINE,CAFFEINE,INHALANT
S,HALLUCINOGENS,OTHER PRESCRIBED
DRUGS)
THE REWARD PATHWAY
 REWARD PATHWAY
 THE PLEASURABLE FEELING
POSITIVELY RE INFORCES THE
BEHAVIOUR WHICH CAUSED IT( e.g.
eating, drug taking)

 REPEATATION OF THE BEHAVIOUR

 ADDICTION
 A COMPULSIVE OUT OF CONTROL
DRUG USE DESPITE ADVERSE
CONSEQUENCES
 VOLUNTARY INTAKE(REVERSABLE)
 EUPHORIA
 TOLERANCE
 PHYSICAL DEPENDENCE
 INVOLUNTARY INTAKE(COMPULSIVE
INTAKE,CRAVINGS,OBSESSION,SELF
DESTRUCTIVE
BEHAVIOUR(ADDICTION)=RELAPSE
 DEPENDENCE AND
TOLERANCE
 TOLERANCE= A STATE IN WHICH AN
ORGANISM NO LONGER RESPONDS TO
A DRUG
 A HIGHER AMOUNT/DOSE IS
REQUIRED TO ACHIEVE THE SAME
EFFECT
 DEPENDENCE= A STATE IN WHICH AN
ORGANISM FUNCTIONS NORMALLY
ONLY IN THE PRESENCE OF A DRUG
 TOLERANCE AND
DEPENDENCE
 DEPENDENCE IS MANIFESTED AS A
PHYSICAL DISTURBANCE WHEN THE
DRUG IS
REMOVED( WITHDRAWN)=WITHDRA
WAL SYMPTOMS WHICH MAY BE
MILD e.g. in CAFFEINE OR
SEVERE/LIFE THREATENING AS IN
ALCOHOL
 DEPENDENCE AND
ADDICTION
 DEPENDENCE MEDIATED VIA THE
BRAIN STEM AND THE THALAMUS
 WHILE ADDICTION IS MEDIATED VIA
THE REWARD PATHWAY IN THE
VENTRAL TEGMENTAL AREA, THE
NUCLEUS ACCUMBENS, AND THE
PREFRONTAL CORTEX
 IT IS THERE FORE POSSIBLE TO BE
DEPENDENT ON A DRUG WITHOUT
BEING ADDICTED TO IT
 DEPENDENCE
 DSMIV DEFINITION
 A MAL ADAPTIVE PATTERN OF
SUBSTANVCE USE LEADING TO
CLINICAL IMPAIRMENT OR
DISTRESS, AS MANIFESTED BY AT
LEAST 3 OF THE FOLLOWING
OCCURRING AT A ANY TIME IN THE
SAME 12 MONTH PERIOD
 MANIFESTATIONS OF
DEPENDENCE
 TOLERANCE
 WITHDRAWAL
 LOSS OF INTAKE CONTROL,CRAVING
 DRUG ACQUISITION,USE AND
RECOVERY CONSUMES A MAJOR
PROPORTION OF THE AFFECTED
PERSON’S TIME
 REDUCTION IN ALTERNATIVE
ACTIVITIES
 DRUG USE IS CONTINUED DESPITE
 Biological Theories
Biogenetic Explanations
 Genetic explanations suggest that some
individuals are born with a genetically
determined predisposition toward drug use
and addiction
 Genetic explanations rely primarily on
epidemiological data to demonstrate this
linkage
 Much of the research in this area focuses
on alcoholism
 Four broad types of research
• Animal studies
• Family pattern studies
• Twin studies
• Adoption studies
 Evaluation of Biological Theories
 Neurochemical explanations have, to
date, been applied to a small number
of drugs
 Biogenetic explanations:
• Offer very strong epidemiological
evidence for a genetic basis
• There remain some critical questions,
however:
 Can we generalize from studies of
alcoholism to other types of drugs?
 Researchers have not identified the
biogenetic mechanism that causes this
genetic link
 Psychological Theories
 Grounded in more general theories of
psychology that began to emerge in the
19th century
 Focus primarily on the nature of individual
experiences which might make one more
susceptible to drug use and/or addiction
 Four broad types:
• Psychoanalytic explanations
• Personality theories
• Behavioral theories
 Psychological Theories:
Psychoanalytic Explanations
 Based primarily on the work of
Sigmund Freud
 Identifies cause of drug
addiction as abnormal
personality development
 Addiction the result of a search
Sigmund Freud
for compensatory gratification
emanating from an unhealthy
“fixation” at a certain point of
personality development
 Psychological Theories:
Personality Theories
 Based on the notion that addiction is a
manifestation of a unique type of
personality
• Lawrence Kolb suggested that addicted suffered
from a sociopathic personality
• More commonly, psychologists have pointed to
an addictive personality
 More recently, psychologists identify
“personality characteristics” that tend to be
associated with drug addiction
 Jerome Jaffe suggested 3 personality
features characteristic of marijuana users:
• Non-conventionality
• Open to new experiences
Jerome Jaffe
• Lower rates of conventional achievement value
 Psychological Theories
Behavioral Explanations
 Modeling – Albert Bandura
• Draws upon Skinner’s idea of operant
conditioning
• Suggests that individuals model behavior
after significant others
 Reinforcing factors in drug use
• Euphoria
• Cessation of withdrawal Albert Bandura
• Analgesic effects
• Primary reinforcement vs. secondary
reinforcement
• Negative reinforcement
 Sociological Theories
 Come from sociological theories
explaining crime and deviance
generally
 Fall into 3 broad categories
• Social Process Theories
• Social Structure Theories
• Societal Reaction Theores
 MECHANISMS OF
ADDICTIONS

 I THANK YOU!
 Social Process Theories:
Control Theories
 Assumption: Human beings are
predisposed toward maximizing
self-interest; hence, everyone
has the capacity to commit crime
 Task: Must answer, “Why do
most people not engage in drug
use or crime?”
 Social Structure Theories
 Focus is on why certain categories of
people tend to be more involved in
drug use or addiction
 Three types of structural theories
• Strain Theories
• Cultural Deviance Theories
• Integrated Structural Theory
Strain Theories: Cloward and Ohlin
 Theory of differential opportunity
suggests that there are 2 opportunity
structures: a legitimate and an
illegitimate one
 Drug users are double failures: they
have failed to succeed in both
 Such failure results in retreating
from society altogether
 Evaluation of Strain Theories
 Has not stood up well under
empirical scrutiny
 Many street drug addicts are not
even interested in achieving in the
legitimate opportunity structure
 Moreover, to sustain an expensive
drug habit, usually requires success
in the illegitimate opportunity
structure
 Cultural Deviance Theories
 Tradition has its beginning at the
University of Chicago in the 1920’s
 Application to subcultures of drug use in
1960’s by John O’Donnell at the University
of Kentucky
• Explained the emergence drug subcultures that
arose in transitional neighborhoods
• Suggested that criminalization of drugs posed
a common problem to users of drugs in these
neighborhoods: how to obtain regular supplies
of the drug
• Users learned to commit crimes and other
creative ways to get these drugs
 Societal Reaction Theories
 Represent a “paradigm shift” in
sociological theorizing
 Rather focusing on why people engage in
deviant (e.g., drug using) behavior, focus
is on explaining why society reacts the
way it does
 Two theories identified with societal
reaction framework
• Labeling Theory
• Conflict Theory
 Labeling Theory
 Three primary questions:
• Why are certain behaviors defined as
deviant?
• Why are particular individuals labeled as
deviant?
• What is the effect of the label?
 Conflict Theory
 Based broadly on the classic work of
Karl Marx
 Elliot Currie suggests that heroin
and crack use are concentrated in
economically deprived inner cities:
• Because economic opportunities are
scarce Elliot Currie
• Resulting in perceived powerlessness
and alienation
• With the consequence of destroying
individual and family life
 According to conflict theorists, drug
policy must address economic and
political conditions which polarize
social classes