Literature – Risk behavior and addiction in adolescence
Lecture 1 – required reading
1) Understanding the etiology of adolescent substance use through
developmental perspectives
- E. Trucco, S. Hartmann
Individual factors
Adolescent substance use is a result of sequential cascade of biological predispositions and
symptomatology that emerge during early childhood. Childhood temperamental traits affect the
emergence of externalizing and internalizing symptoms
- Biological factors
A key vulnerability factor for adolescent substance use is a family history of substance use disorder
(FH+) with a heritability of approximately 50%
- Cascading effects via behavior problems
The dual systems model of risk posits that increased risk taking results from the temporally dissimilar
development of two neurobiological systems: the socioemotional system, which develops rapidly
during early adolescence, and the cognitive control system, which develops through early adulthood.
This imbalance increases vulnerability to substance use
Social factors
- Parent socialization context
Within the domain of parental control, monitoring and knowledge may be the most widely supported
protective practices against adolescent substance use, parental monitoring and knowledge may
protect against adolescent substance use by minimizing exposure to substance-using peers
- Peer socialization context
Similarities between peers and adolescents result from two processes: selection refers to an
adolescent’s decision to join certain peer groups based on similarity in attitudes or behaviors related
to substance use, whereas socialization reflects an adolescent’s change in attitudes or behaviors
related to substance use to assimilate to peers
The relative influence of selection versus socialization varies across substances and development.
Modeling and socialization influences had a strong effect on adolescents’ use of soft drugs, but only a
moderate to average effect on their use of hard drugs
Social norms theory posits two processes through which peers affect substance use:
- Descriptive norms (belief about the prevalence of substance use)
- Injunctive norms (belief about approval of substance use)
, 2) Substance and behavioral addictions
- Sussman, Chapter 1 – introduction to the concept of addiction and
addictive effects
- Substance addiction: repetitive intake of a drug (such as alcohol) or of food.
- Behavioral addiction: engaging in types of behaviors repetitively which are not directly taken
into the body such as gambling or sex.
Physiological withdrawal symptoms (the appearance of both physical and psychological symptoms
which are caused by physiological adaptations in the central nervous system and the brain due to
chronic exposure to a substance) were until recently only seen as an ‘addiction’. Behavioral addictions
alter endogenous ligand functions.
Drug misuse may lead to a variety of negative life consequences. Drug misuse can result in overdoses
or seizures during withdrawal leading to visits to emergency rooms, sickness, decreased function (e.g.
paralysis), or even death.
Behavioral addictions (e.g. gambling, internet, love, sex, exercise, work, shopping) were discussed
informally for a long time among AA and other 12-step group participants, subsequently resulting in
new 12-step organizations targeting these dysfunctional behaviors.
A variety of behaviors very recently have come to be considered addictions by researchers and
practitioners, delineated by common features (e.g. appetitive effects (impact on mood, arousal, or
thinking), preoccupation, subjective sense of loss of control, negative consequences).
- Tobacco addiction
Deep inhalation of tobacco did not occur until after flue-curing (four to eight week air curing, which
results in tobacco low in sugar, and which gives tobacco smoke a light, sweet flavor, and a high
nicotine content). The public consensus that nicotine was addictive, and the driving force behind
regular tobacco use, occurred with publication of the Surgeon General’s report on nicotine addiction
in 1988.
- Alcohol addiction
Alcohol misuse has been noted throughout written history. Also, Abraham Lincoln attributed much
vise, misery, and crime to the abuse of alcohol but also supported kind treatment of those who had
fallen victim to alcohol addiction.
- Opium-related addiction
Initial use of opium was described as “divine enjoyment”. After the opium wars, the opium trade was
legalized in China and production increased, maintaining relatively high prevalence of opium
addiction and related social and economic problems in China.
- Cocaine addiction
Replacement medications that did not contain opiate derivatives to treat opiate addictions led to new
problematic drug use.
- Marijuana addiction
Marijuana was viewed as a hilarious herb that was purchased regularly and without good sense.
, - Food addiction
No history.
- Gambling and sex addictions
Were always viewed as behavioral addictions in history. Gambling shorter than sex addictions,
because there were no electric devices back then.
Intensional definition of addiction:
Causal or process model type statements of addiction. Intensional models attempt to describe at
minimum an addictive behavioral process (i.e. this happens, that leads to this, and then to that), and
at maximum an etiology (a causal story). These type models have relatively good explanatory power
though they often are more distant from observables than descriptive (extensional) models.
Extensional definition of addiction:
a taxonomy of addiction elements, which subsequently might be organized into a (more) intensional
theory-based perspective.
Intensional definition of addiction
1. Physiological/psychological dependence
A behavior that results in its continued performance being necessary for physiologic and
psychological equilibrium. The addict is trapped into a pattern of increasing involvement with the
behavior.
- Tolerance: refers to the need to engage in the behavior at a relatively greater level than in the
past to achieve previous levels of appetitive effects (or achieving diminished effects at
previous levels of behavior).
- Withdrawal: abrupt termination of the addictive behavior, an abstinence syndrome. This will
lead to intense physical disturbances in case of some types of drug abuse.
- Craving: is now one of the criteria of substance use disorder in the DSM-V. This is an intense
desire for engagement reoccurs, is compelling, and one often gives in to this desire.
2. Impulsive-obsessive/compulsive behavior
Engagement in the addictive behavior leading to pleasure or relief rather than on a notion focusing
on ‘maintaining an equilibrium’. There are two variants:
- Positive reinforcement: engaging in the behavior due to a ‘building up of tension’. Resulting in
pleasure and perhaps later leading to self-reproach.
- Negative reinforcement: building up of tension, anxiety and stress which is released, resulting
in relief of anxiety but no particular pleasure. Then leading to obsessions which produce
anxiety and stress leading to a craving for relief again.
