Negotiating the Relationship Between Addiction, Ethics, and Brain Science PMC

Just as Polanyi and Schön maintain that professional competence is based in tacit, rather than explicit, knowledge,61,62 expertise often is manifest in insights that are difficult to track on a strictly cognitive level. Because these observations often are manifest only when cases are reviewed after the fact does not diminish the ethical obligation that the clinician use all of his or her capabilities, not only those which can be readily explained. Because it is entirely possible to advocate for shared decision making without challenging the notion of the cold technician, we propose to move the emphasis to an approach that emphasizes human warmth, understanding, generosity, and caring. When we look at the psychological dimension, it also allows us to understand and work more effectively in helping individuals, families and communities thrive and flourish in a positive way. When we understand the impact of our perception, purpose of rewards, motivation, expectancy, and maturation, it helps us to find solutions to the addictive behaviours that may not have been an option previously. It allows for the development of more positive behaviours by understanding alternatives, and more possibilities and gives opportunities for making positive decisions with those options.

The Biopsychosocial Model and Its Limitations

In this paper we use the term “substance use disorder” or “addiction” to refer to both the complex nature of severe substance dependence and substance abuse. Heroin is lipid soluble, which leads to fast penetration of the blood-brain barrier and high abuse potential (Julien 2001). The reinforcing and euphoric properties of opiates arise from increased amounts of extracellular dopamine in the ventral https://kochmeister.ru/sozdanie-dachnogo-landshafta-svoimi-rukami-vazhnye/ tegmental area and nucleus accumbens. Individuals experiencing withdrawal may suffer severe symptoms that include sweating, nausea, vomiting, abdominal pain and irritability (Koob and Le Moal 2005). The risk of mortality is increased due to overdoses; there is an increased risk of acquiring bacterial infections, and other blood-borne pathogens such as HIV and HCV, as described earlier.

Comparing public perceptions of substance addictions and behavioural addictions

• The degrees in which self-control is exerted, free choice is realized and desired outcomes achieved are dependent on these complex interacting biopsychosocial systems.
• “HAT is not simply a pharmacotherapy; it is a treatment approach that is situated within a context involving neighborhood factors, the local drug scene, housing, policing, medical care, and other treatment services.
• In modern neuroscience, it refers to the position that the dynamic complexity of the brain, given the probabilistic threshold-gated nature of its biology (e.g., action potential depolarization, ion channel gating), means that behavior cannot be definitively predicted in any individual instance [85, 86].

Despite significant efforts, excessive patterns of alcohol, tobacco and other drugs have been estimated to cost the United States alone over $400 billion annually [4]. Worldwide, addictions are prevalent and low- and middle-income countries may not have the resources to adequately address these disorders [5, 6]. The impact of addictions typically is widespread, with some estimates indicating seven people being affected for each identified addicted individual, and there often exist substantial social consequences [7]. Addictions may influence employers as well as families, and the impact may be felt trans-generationally as parents with addictions may neglect children or model unhealthy behaviors [8].

The Biopsychosocial Model

The substantial task for the BPSM is to explicate a unified theoretical perspective and integration across the three relevant sciences. It turns out, I will propose in what follows, that the required shared theoretical perspectives is systems theoretic, as Engel anticipated, in which concepts such as regulation and control, information and communication, function and dysfunction, play critical roles across the whole biopsychosocial domain. When neurogenetic attributions are presented in the clinic, pharmacological treatments are often believed to be a more effective option over psychotherapy (Phelan, Yang, and Cruz-Rojas 2006). This attribution could sway those who assign the cause of their addiction to be exclusively neurological or genetically based, and not necessarily evaluate the risks and benefits of pharmacotherapy, psychotherapy, or receiving both as combination.

• Attachment theory may present a unique opportunity to bring together these lines of enquiry, enabling an integrative developmental model of addiction with early experiences laying the foundation for psychological as well as neurobiological trajectories to substance use, abuse, and dependence.
• For example, effective tax strategies that have helped curtail tobacco use particularly amongst adolescents and young adults may be used to model similar efforts with respect to food taxation [31, 206].
• Factors such as availability and peer modeling account for the inter- and intra-group disparities (Thomas 2007).
• Moreover, substance use leads to changes in group affiliation as the person exits native groups and enters groups that are more open to drug use by their members (McCabe et al., 2005; Poulin et al., 2011; Scalco et al., 2015).
• They all expressed love and care for their children and emphasised the importance of their children as a motivational factor for staying sober.
• The model need not necessarily be confined to addictive behavior; indeed, Bandura would argue that it applies to the totality of human experience.

A brain disease? Then show me the brain lesion!

With respect to adolescents, limiting fast food and sugared sodas (e.g., in school cafeterias and vending machines) warrant consideration. Similarly, policy efforts could restrict the availability of substances with addictive potential that might lead to greater adolescent initiation or use (“bidis” or flavored cigarettes and alcohol-containing caffeinated beverages). Using information related to individual differences in biologies may help to optimize such policies, and the resulting policies may have substantial impact on reducing the societal burdens of addictions. From a global perspective, having resources and policies that would help increase the currently scarce mental health and addiction efforts in low- and middle-income countries could have a major impact on world health [ ]. The prevention strategies with the most empirical support involve targeting important risk factors and bolstering important protective factors at individual, familial and community levels [189].

Collectively, the data show that the course of SUD, as defined by current diagnostic criteria, is highly heterogeneous. When present in a patient, however, such as course is of clinical significance, because it identifies a need for long-term disease management [2], rather than expectations of a recovery that may not https://esenin.ru/o-esenine/gibel-poeta/lagunovskii-a-prichina-samoubiistva-sergeia-esenina be within the individual’s reach [39]. From a conceptual standpoint, however, a chronic relapsing course is neither necessary nor implied in a view that addiction is a brain disease. Human neuroscience documents restoration of functioning after abstinence [40, 41] and reveals predictors of clinical success [42].

Biological Models of Addiction

Perhaps most significantly, once these substances made their appearance in the archeological record, they did not vanish, but remained a permanent fixture of society. The informants who had periods of severe use of substances all talked about demanding situations relating to work, troubled relationships, mental health problems, or loneliness. These struggles concerned being caught up by adverse childhood experiences, situations that arose during severe substance use, or life challenges during the years after they left treatment. The domain of psychological influences may best be described as the psychological characteristics, both strengths and weaknesses, as well as vulnerabilities that make up the youngster’s emotional and mental health competence. In Figure 1 a number of individual characteristics are listed to provide a general description of this domain.

Multiple behavioral approaches, including contingency management, motivational interviewing, and cognitive behavioral and family therapies, have empirical support, with varying levels of data to support each approach in specific populations [183, 190, 191]. Comparatively few medications have been tested for their efficacy and tolerability amongst adolescents with substance abuse or dependence [192], and even less research has examined the extent to which pharmacotherapies might be https://agrimonia.info/what-has-changed-recently-with-16/ helpful amongst non-substance addictions [193]. As in adults, other considerations (e.g., co-occurring disorders and after-care) are important in the treatment of adolescent addictions [194, 195]. Given the relative immaturity in adolescents of brain regions like the prefrontal cortex involved in emotional and motivational processing including in the regulation of craving for drugs and food [66, 67], adolescents may be biologically vulnerable to engagement in addictive behaviors.

Substances such as alcohol and legal or illegal drugs have been used for recreation, celebration, and coping with difficult life situations and health problems [37]. Several theories and models have been developed to understand the concept of substance use disorder (SUD), focusing on, for example, self-medication, behaviour, self-regulation, neurobiology or social living conditions [25, 33, 47]. The World Health Organization (WHO) and Norwegian health authority use a comprehensive, multi-disciplinary understanding of SUD based on a biopsychosocial approach. This approach assumes that psychological and biological factors are in constant interplay with relational, social, economic, cultural and political elements in the development and maintenance of SUD and that each person’s pathway to developing SUD is unique [10, 11, 37]. Using substances to cope, feel better, and belong may reduce anxiety, restlessness, disturbing emotions, and feelings of hopelessness and loneliness [14, 19]. The substances affect the brain’s central functions, including dopamine production and executive functions, with a consequent craving for substances and impaired impulse control [47, 49].