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Kolas J, von Mühlenen A. Addicted to socialising and still lonely: A comparative, corpus-driven analysis of problematic social networking site use. J Behav Addict 2024; 13:163-176. [PMID: 38353729 PMCID: PMC10988419 DOI: 10.1556/2006.2023.00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 03/28/2024] Open
Abstract
Background and Aims Problematic Social Networking Site Use (PSNSU) is not a formally recognised addiction, but it is increasingly discussed as such in academic research and online. Taking a quantitative, exploratory approach, this study aims to (1) determine whether PSNSU is presented like clinically defined addictions by the affected community and (2) address how well measurements of PSNSU fit with the thematic content found within the associated discourse. Methods Four corpora were created for this study: a corpus concerning PSNSU and three control corpora concerning established addictions, including Alcohol Use Disorder, Tobacco Use Disorder and Gaming Disorder. Keywords were identified, collocates and concordances were explored, and shared themes were compared. Results Findings show broad thematic similarities between PSNSU and the three control addictions as well as prominent interdiscursive references, which indicate possible confirmation bias among speakers. Conclusions Scales based upon the components model of addiction are suggested as the most appropriate measure of this emerging disorder.
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Affiliation(s)
- Janelle Kolas
- Department of Psychology, University of Warwick, Coventry, CV 7AL, United Kingdom
| | - Adrian von Mühlenen
- Department of Psychology, University of Warwick, Coventry, CV 7AL, United Kingdom
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2
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Pisupati S, Langdon A, Konova AB, Niv Y. The utility of a latent-cause framework for understanding addiction phenomena. ADDICTION NEUROSCIENCE 2024; 10:100143. [PMID: 38524664 PMCID: PMC10959497 DOI: 10.1016/j.addicn.2024.100143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Computational models of addiction often rely on a model-free reinforcement learning (RL) formulation, owing to the close associations between model-free RL, habitual behavior and the dopaminergic system. However, such formulations typically do not capture key recurrent features of addiction phenomena such as craving and relapse. Moreover, they cannot account for goal-directed aspects of addiction that necessitate contrasting, model-based formulations. Here we synthesize a growing body of evidence and propose that a latent-cause framework can help unify our understanding of several recurrent phenomena in addiction, by viewing them as the inferred return of previous, persistent "latent causes". We demonstrate that applying this framework to Pavlovian and instrumental settings can help account for defining features of craving and relapse such as outcome-specificity, generalization, and cyclical dynamics. Finally, we argue that this framework can bridge model-free and model-based formulations, and account for individual variability in phenomenology by accommodating the memories, beliefs, and goals of those living with addiction, motivating a centering of the individual, subjective experience of addiction and recovery.
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Affiliation(s)
- Sashank Pisupati
- Limbic Limited, London UK
- Princeton Neuroscience Institute & Department of Psychology, Princeton University, Princeton NJ, USA
| | - Angela Langdon
- National Institute of Mental Health & National Institute on Drug Abuse, National Institutes of Health, Bethesda MD, USA
| | - Anna B Konova
- Department of Psychiatry, University Behavioral Health Care & Brain Health Institute Rutgers University, New Brunswick NJ, USA
| | - Yael Niv
- Princeton Neuroscience Institute & Department of Psychology, Princeton University, Princeton NJ, USA
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3
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Houston AR, Snyder-Young D, Perry M, Flessen M, Lincoln AK. 'Let Others Love You Back to Health': The Role of Performance-based Support Groups for People in Recovery. Community Ment Health J 2023; 59:1097-1108. [PMID: 36692703 DOI: 10.1007/s10597-023-01089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023]
Abstract
Peer support groups have become widely utilized among those in recovery from problematic substance use. Yet, these peer-based programs vary and research examining their effectiveness has yielded mixed results. Relatively less is known about the impacts of arts-based peer recovery programs. Some research suggests that theatre may offer a powerful tool to address biopsychosocial changes among individuals in recovery. To explore the role of arts-based peer support programs, we draw on qualitative interviews with performers in two arts-based recovery programs. Our findings suggest that arts-based peer recovery programs may aid individuals in recovery in four main ways. Performing allowed participants to build relationships with others in recovery, channel experiences creatively while challenging stigma, foster confidence and recovery-identity formation, aiding participants in working through emotional impacts of prior substance use. These findings support emerging scholarship examining the role of performance in challenging stereotypes about substance use to aid those in recovery.
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Affiliation(s)
- Ashley R Houston
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA.
| | - Dani Snyder-Young
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA
- College of Arts, Media and Design, Northeastern University, Boston, USA
| | | | - Maren Flessen
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA
- College of Arts, Media and Design, Northeastern University, Boston, USA
| | - Alisa K Lincoln
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA
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4
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Ekendahl M, Karlsson P, Månsson J, Heimdahl Vepsä K. Self-interpellation in narratives about craving: Multiple and unitary selves. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1391-1407. [PMID: 36031748 PMCID: PMC9804802 DOI: 10.1111/1467-9566.13534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
The concept of addiction seeks to explain why people act contrary to their own best interest. At the centre stage of addiction discourse is craving, conceptualised as a strong urge to use substances. This article analyses how talk therapies such as relapse prevention and self-help groups shape identity constructions and understandings of craving among clients. Drawing upon interviews with individuals who have engaged in talk therapies in Sweden, we analyse how craving is made up through 'self-interpellation', that is, personal narratives about past, present or future thoughts, feelings and actions. The main 'self-interpellation' included multiple selves, where craving was elided by the true self and only felt by the inauthentic self. Less dominant were narratives which drew on a unitary self that remained stable over time and had to fight craving. The notion of multiple selves appeared as a master narrative that the participants were positioned by in their identity constructions. We conclude that this multiplicity seems ontologically demanding for people who try to recover from substance use problems. A demystification of craving, in which neither substance effects nor malfunctioning brains are blamed for seemingly irrational thoughts and actions, may reduce the stigmatisation of those who have developed habitual substance use.
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Affiliation(s)
- Mats Ekendahl
- Department of Social WorkStockholm UniversityStockholmSweden
| | - Patrik Karlsson
- Department of Social WorkStockholm UniversityStockholmSweden
| | - Josefin Månsson
- Department of Social WorkStockholm UniversityStockholmSweden
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5
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Ochterbeck D, Forberger S. Is a brain-based understanding of addiction predominant? An assessment of addiction researchers' conceptions of addiction and their evaluation of brain-based explanations. Drug Alcohol Rev 2022; 41:1630-1641. [PMID: 35915578 DOI: 10.1111/dar.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/22/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Brain-based explanations of addiction have become a prominent explanatory model in recent decades. Although opposing views have been published, there is no large-scale study of researchers' opinions, unlike for treatment staff, the public and affected individuals. Therefore, this study aimed to examine international addiction researchers' perspectives on: (i) brain-based explanations of addiction; (ii) the perceived dominance of the concept in science, society, treatment and among those affected; and (iii) researchers' general conception of addiction in terms of ontologies and causes. METHODS A sample of 1440 international addiction researchers was compiled. Views were assessed online via LimeSurvey using a 'mixed methods light' approach (Likert-type scales, free-text fields). Qualitative content analyses of free-text comments complemented descriptive statistics. RESULTS One hundred and ninety researchers participated (13.19% response). The classification of substance use disorders as brain diseases/disorders was shared by about 60% of the respondents. Approximately 80% considered it the dominant view in science, but fewer in treatment, society and affected persons. Approximately 75% found it an oversimplification, but regarded it as helpful for understanding substance use disorders. Altogether, various biological, psychological and social factors were considered causal. Comments indicated that an over-simplistic nature of brain-based explanations of addiction was viewed as particularly problematic. DISCUSSION AND CONCLUSIONS A rejection of a simplistic view of addiction in favour of a multi-causal concept in which the brain plays a role seems to be the majority view of participating researchers. Therefore, the orientation of future research, treatment and support for addicted persons need to be reconsidered accordingly.
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Affiliation(s)
- Doris Ochterbeck
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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6
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Zhang C. Negotiating SHI-FEI and shifei: Pursuing a Moralist Self in China's Community-Based Addiction Treatment Programs. Cult Med Psychiatry 2022; 46:435-455. [PMID: 34169449 DOI: 10.1007/s11013-021-09724-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
Based on 16 months of fieldwork conducted at drug addiction treatment facilities in Yunnan, Southwest China, this article examines how Chinese drug users invent moralist selves during the frequent occurrences of shifei incidents. Shìfēi, meaning literally right/wrong, is a crucial concept in Chinese society with two contradictory meanings: (1) moral norms/judgment that ought to be discerned and followed (SHI-FEI); (2) "troubles" or "quarrels" that are often morally undesirable (shifei). By delving into a typical incident of shifei, this article analyzes the logic, motivation, and interpretations of the drug users and addiction treatment facility staff who are involved in the local moral world. It argues that for drug users, the relationship between SHI-FEI and shifei is not oppositional, as often assumed. Instead, both are valuable moral experiences and useful cultural means in response to users' moral demands and tensions. Negotiating SHI-FEI and shifei enables an ambiguous space in which drug users seek, claim, and practice their moralist selves. This article also argues that under various sociopolitical and moral constraints, drug users' moral selves are characterized by an inward focus on claims of morality and legitimacy. This inward focus reflects a process of moral involution. This study contributes to understandings of moral self-making in stigmatized situations.
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Affiliation(s)
- Chaoxiong Zhang
- Institute of advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, 519087, China. .,China Academy of Social Management/School of Sociology, Beijing Normal University, Beijing, China.
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7
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Barrios-Anderson A, McLaughlin NCR, Patrick MT, Marsland R, Noren G, Asaad WF, Greenberg BD, Rasmussen S. The Patient Lived-Experience of Ventral Capsulotomy for Obsessive-Compulsive Disorder: An Interpretive Phenomenological Analysis of Neuroablative Psychiatric Neurosurgery. Front Integr Neurosci 2022; 16:802617. [PMID: 35273481 PMCID: PMC8902594 DOI: 10.3389/fnint.2022.802617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Ventral Capsulotomy (VC) is a surgical intervention for treatment-resistant Obsessive-Compulsive Disorder (OCD). Despite clinical studies, little is known about patient perception and lived experience after neurosurgery for severe OCD. To examine the lived experiences of patients who have undergone VC for severe, treatment-resistant OCD through qualitative analysis. We conducted semi-structured interviews with six participants treated with VC for OCD. Interviews were analyzed using Interpretive Phenomenological Analysis. The following themes emerged: (1) After years of conventional treatments, patients felt neurosurgery was their “last hope” and described themselves as “desperate,” (2) While some described the surgery as a “supernatural experience,” patients also demonstrated understanding of the scientific procedure, its risks and potential benefits, (3) The surgical experience itself was positive or neutral, which was linked to trust in the clinical team, (4) Post-surgery, participants described months of heightened fear as they awaited lesion formation and functional improvement. (5) Patients consistently contextualized outcome in the context of their own life goals. Patients undergoing VC have positive views of this neurosurgical intervention, but psychiatric neurosurgical teams should anticipate patient discomfort with the time needed to achieve behavioral improvement following surgery and emphasize the importance of post-operative psychiatric care.
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Affiliation(s)
- Adriel Barrios-Anderson
- Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
- *Correspondence: Adriel Barrios-Anderson,
| | - Nicole C. R. McLaughlin
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Morgan T. Patrick
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
| | - Richard Marsland
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
| | - Georg Noren
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
| | - Wael F. Asaad
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Neuroscience, Brown University, Providence, RI, United States
- Carney Institute for Brain Science, Brown University, Providence, RI, United States
| | - Benjamin D. Greenberg
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
- Center for Neurorestoration and Neurotechnology (CfNN), Providence VA Medical Center, Providence, RI, United States
| | - Steven Rasmussen
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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8
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Ogilvie L, Carson J. Trauma, stages of change and post traumatic growth in addiction: A new synthesis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1905093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Mort SC, Díaz SR, Beverly EA. Using contact-based education to destigmatize opioid use disorder among medical students. TEACHING AND LEARNING IN MEDICINE 2021; 33:196-209. [PMID: 33196302 DOI: 10.1080/10401334.2020.1820869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
All first- and second-year (i.e., pre-clinical) medical students at a large, Midwestern medical school with three campuses were invited to participate in a two-arm, parallel educational study comparing the efficacy of two types of curricular interventions. Students at the main campus attended the modified contact-based education panel or the didactic lecture in person, while students at the two distance campuses attended the modified contact-based education or lecture remotely using the University's videoconferencing system. Impact: A total of 109 students participated in the study (average age 24.2 years (SD = 2.6), 64.2% female, 79.8% white, 56.0% second-year students, 67.9% attended on main campus, lecture = 52 participants, modified contact-based = 57 participants). Baseline responses were similar across groups. Following the session, participants in both interventions rated drug abuse (percent increase = 21.2%, p < .001) and prescription drug diversion (percent increase = 7.6%, p = .004) as more serious problems. Participants from both interventions expressed increased confidence in caring for patients with OUD (percent increase = 45.5%, p < .001) and increased interest in pursuing MAT training (percent increase = 21.5%, p = .04). Both curricular interventions were equally effective at reducing OUD stigma with a significant 8.2% decrease in total stigma scores and a large effect size (p < .001, ηp2 = .34). Lastly, participants with lower post-assessment OUD stigma scores were more likely to indicate that they would pursue additional training to provide MAT (p = .02). Lessons learned: Exposure to opioid-specific education with a focus on MAT and recovery, regardless of education type, positively affected opioid-related postgraduate intentions and reduced OUD stigma. Notably, these findings suggest that there are multiple efficacious techniques to reduce OUD stigma during preclinical training.
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Affiliation(s)
- Sophia C Mort
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Graduate College, Translational Biomedical Sciences Program, Ohio University, Athens, Ohio, USA
| | - Sebastián R Díaz
- Dean's Office of Medical Education, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, USA
| | - Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Diabetes Institute, Ohio University, Athens, Ohio, USA
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10
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Damiescu R, Banerjee M, Lee DYW, Paul NW, Efferth T. Health(care) in the Crisis: Reflections in Science and Society on Opioid Addiction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E341. [PMID: 33466370 PMCID: PMC7795923 DOI: 10.3390/ijerph18010341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/21/2022]
Abstract
Opioid abuse and misuse have led to an epidemic which is currently spreading worldwide. Since the number of opioid overdoses is still increasing, it is becoming obvious that current rather unsystematic approaches to tackle this health problem are not effective. This review suggests that fighting the opioid epidemic requires a structured public health approach. Therefore, it is important to consider not only scientific and biomedical perspectives, but societal implications and the lived experience of groups at risk as well. Hence, this review evaluates the risk factors associated with opioid overdoses and investigates the rates of chronic opioid misuse, particularly in the context of chronic pain as well as post-surgery treatments, as the entrance of opioids in people's lives. Linking pharmaceutical biology to narrative analysis is essential to understand the modulations of the usual themes of addiction and abuse present in the opioid crisis. This paper shows that patient narratives can be an important resource in understanding the complexity of opioid abuse and addiction. In particular, the relationship between chronic pain and social inequality must be considered. The main goal of this review is to demonstrate how a deeper transdisciplinary-enriched understanding can lead to more precise strategies of prevention or treatment of opioid abuse.
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Affiliation(s)
- Roxana Damiescu
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, 55128 Mainz, Germany;
| | - Mita Banerjee
- Department of English and Linguistics, Obama Institute for Transnational American Studies, Johannes Gutenberg University, 55128 Mainz, Germany;
| | - David Y. W. Lee
- McLean Hospital, Harvard Medical School, Boston, MA 02478, USA;
| | - Norbert W. Paul
- Institute for History, Philosophy and Ethics of Medicine, Johannes Gutenberg University Medical Center, 55128 Mainz, Germany;
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, 55128 Mainz, Germany;
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11
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Morck C, Kappel N, Martinsen B. The Lived Experience of Alcohol Dependence: A Reflective Lifeworld Research among Outpatients in Alcohol Treatment. Issues Ment Health Nurs 2020; 41:421-428. [PMID: 31939694 DOI: 10.1080/01612840.2019.1663569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Alcohol dependence is a major health problem. Existing literature is sparse on the lived experience of alcohol dependency. Nurses may find it difficult to care for patients with alcohol dependence. The purpose of this study was to explore the lived experience of alcohol dependence among outpatients in alcohol treatment to get a comprehensive understanding from the patients' perspective. The study used a phenomenological descriptive approach and in-depth interviews were conducted with five patients in outpatient alcohol treatment. Five constituents illuminated the essence. Alcohol dependence is associated with physical, psychological and relational suffering: feelings of shame emerged as a significant theme.
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Affiliation(s)
| | - Nanna Kappel
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark.,University College Copenhagen, Copenhagen, Denmark
| | - Bente Martinsen
- University College Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Nursing, Aarhus Universitet, Aarhus, Denmark
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12
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Bornstein AM, Pickard H. "Chasing the first high": memory sampling in drug choice. Neuropsychopharmacology 2020; 45:907-915. [PMID: 31896119 PMCID: PMC7162911 DOI: 10.1038/s41386-019-0594-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/21/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
Although vivid memories of drug experiences are prevalent within clinical contexts and addiction folklore ("chasing the first high"), little is known about the relevance of cognitive processes governing memory retrieval to substance use disorder. Drawing on recent work that identifies episodic memory's influence on decisions for reward, we propose a framework in which drug choices are biased by selective sampling of individual memories during two phases of addiction: (i) downward spiral into persistent use and (ii) relapse. Consideration of how memory retrieval influences the addiction process suggests novel treatment strategies. Rather than try to break learned associations between drug cues and drug rewards, treatment should aim to strengthen existing and/or create new associations between drug cues and drug-inconsistent rewards.
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Affiliation(s)
- Aaron M Bornstein
- Department of Cognitive Sciences, University of California, Irvine, CA, 92617, USA.
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, 92697, USA.
- Institute for Mathematical Behavioral Sciences, University of California, Irvine, CA, 92697, USA.
| | - Hanna Pickard
- Department of Philosophy, Johns Hopkins University, Baltimore, MD, 21218, USA.
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA.
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13
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Dingel MJ, Ostergren J, Koenig BA, McCormick J. "Why did I get that part of you?" Understanding addiction genetics through family history. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2019; 28:53-67. [PMID: 29947292 PMCID: PMC6342673 DOI: 10.1177/0963662518785350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Scientists have sought to uncover the genetic bases of many diseases and disorders. In response, scholars defined "geneticization" to describe genetic infiltration of understandings of health and illness. In our research, we interviewed 63 individuals in addiction treatment programs to identify what form of geneticization best fits individuals' description of their own addiction. Individuals' narratives of their lives, which include family history and are influenced by cultural and structural factors, affect respondents' reactions to a potential genetic basis of addiction. Most who had a family history of addiction subscribed to a notion that addiction "runs in families," while most who lacked a family history of addiction used this fact to reject the notion of genetic inheritance of addiction. We conclude that though we see elements of several different versions of geneticization, Nikolas Rose's version, that genetics affects peoples' perceptions of addiction in small but important ways, best describes our respondents' views.
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14
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Copoeru I. Portraying addiction as a disease: A phenomenological answer. J Eval Clin Pract 2018; 24:1101-1106. [PMID: 30133053 DOI: 10.1111/jep.13022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/11/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
This paper stems from the concern that, in certain situations, categorization may lead to the annihilation of the subject. It attempts to answer the question whether there is a way of framing addiction without necessarily putting the addicted persons in categories that hurt them. After showing, in the first section, how stigma is part of the process of becoming (and remaining) addicted, I will turn to the phenomenological tradition in order to re-consider the main descriptive categories that have been used so far to capture addiction as a "pathological" or "deviant" experience. The second section addresses addiction as an experience of hetero-transformation of the psycho-physical unity of the individual, which presupposes a genuine sense of the power of the bodily subject, while the third focuses on the modifications of temporality in addiction, especially in the horizon of trauma. The paper concludes that understanding addiction depends on framing the experience of addiction primarily as a non-pathological form of expression and looking at it as an attempt to restore the capabilities of a vulnerable subject.
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Affiliation(s)
- Ion Copoeru
- Department of Philosophy, Babeş-Bolyai University from Cluj-Napoca, 1. Kogalniceanu Street, 40081, Cluj-Napoca, Romania.,ICUB, University of Bucharest, 36-46 Bd. M. Kogalniceanu, 5th District, 050107, Bucharest, Romania
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15
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Dingel MJ, Ostergren J, Heaney K, Koenig BA, McCormick J. "I don't have to know why it snows, I just have to shovel it!": Addiction Recovery, Genetic Frameworks, and Biological Citizenship. BIOSOCIETIES 2017; 12:568-587. [PMID: 29552089 PMCID: PMC5851475 DOI: 10.1057/s41292-017-0045-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The gene has infiltrated the way citizens perceive themselves and their health. However, there is scant research that explores the ways genetic conceptions infiltrate individuals' understanding of their own health as it relates to a behavioral trait, like addiction. Do people seeking treatment for addiction ground their self-perception in biology in a way that shapes their experiences? We interviewed 63 participants in addiction treatment programs, asking how they make meaning of a genetic understanding of addiction in the context of their recovery, and in dealing with the stigma of addiction. About two-thirds of people in our sample did not find a genetic conception of addiction personally useful to them in treatment, instead believing that the cause was irrelevant to their daily struggle to remain abstinent. One-third of respondents believed that an individualized confirmation of a genetic predisposition to addiction would facilitate their dealing with feelings of shame and accept treatment. The vast majority of our sample believed that a genetic understanding of addiction would reduce the stigma associated with addiction, which demonstrates the perceived power of genetic explanations in U.S. society. Our results indicate that respondents (unevenly) ground their self-perception of themselves as an addicted individual in biology.
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Affiliation(s)
- Molly J Dingel
- University of Minnesota Rochester, 300 University Square, 111 South Broadway, Rochester, Minnesota, 55904, USA, , (507) 258-8206
| | - Jenny Ostergren
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, USA,
| | - Kathleen Heaney
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, USA,
| | - Barbara A Koenig
- University of California, San Francisco, Institute for Health & Aging, 3333 Calif. St, Laurel Heights, San Francisco CA 94143,
| | - Jennifer McCormick
- Pennsylvania State University, 1743C Humanities, Hershey Medical Center, Hershey, PA 17033
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17
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Heather N. Q: Is Addiction a Brain Disease or a Moral Failing? A: Neither. NEUROETHICS-NETH 2017; 10:115-124. [PMID: 28725283 PMCID: PMC5486515 DOI: 10.1007/s12152-016-9289-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/02/2016] [Indexed: 11/05/2022]
Abstract
This article uses Marc Lewis' work as a springboard to discuss the socio-political context of the brain disease model of addiction (BDMA). The claim that promotion of the BDMA is the only way the general public can be persuaded to withhold blame and punishment from addicts is critically examined. After a discussion of public understandings of the disease concept of addiction, it is pointed out that it is possible to develop a scientific account of addiction which is neither a disease nor a moral model but which the public could understand. Evidence is reviewed to suggest that public acceptance of the disease concept is largely lip-service and that the claim the BDMA removes stigma among the public and professionals is unsupported by evidence. Further, there is good evidence that biogenetic explanations of mental/behavioural disorders in general have been counterproductive in the attempt to ally stigma. A model of addiction as a disorder of choice may attract special problems in public-facing communications and risks being misunderstood. However, ways of presenting this model to the public are suggested that may avoid such risks. Lastly, the claim that the BDMA is the only way of ensuring access to treatment and of maintaining research funding for addiction is disputed and a way in which these benefits can be retained under a disorder-of-choice model proposed. The article concludes by enthusiastically endorsing Lewis' call for a third stage in the governing image of addiction.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Northumbria University, 8 Roseworth Terrace, Newcastle on Tyne, NE3 1LU UK
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Frank LE, Nagel SK. Addiction and Moralization: the Role of the Underlying Model of Addiction. NEUROETHICS-NETH 2017; 10:129-139. [PMID: 28725284 PMCID: PMC5486499 DOI: 10.1007/s12152-017-9307-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/01/2017] [Indexed: 10/28/2022]
Abstract
Addiction appears to be a deeply moralized concept. To understand the entwinement of addiction and morality, we briefly discuss the disease model and its alternatives in order to address the following questions: Is the disease model the only path towards a 'de-moralized' discourse of addiction? While it is tempting to think that medical language surrounding addiction provides liberation from the moralized language, evidence suggests that this is not necessarily the case. On the other hand non-disease models of addiction may seem to resuscitate problematic forms of the moralization of addiction, including, invoking blame, shame, and the wholesale rejection of addicts as people who have deep character flaws, while ignoring the complex biological and social context of addiction. This is also not necessarily the case. We argue that a deficit in reasons responsiveness as basis for attribution of moral responsibility can be realized by multiple different causes, disease being one, but it also seems likely that alternative accounts of addiction as developed by Flanagan, Lewis, and Levy, may also involve mechanisms, psychological, social, and neurobiological that can diminish reasons responsiveness. It thus seems to us that nondisease models of addiction do not necessarily involve moralization. Hence, a non-stigmatizing approach to recovery can be realized in ways that are consistent with both the disease model and alternative models of addiction.
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Affiliation(s)
- Lily E. Frank
- Department of Philosophy and Ethics, Technische Universiteit Eindhoven, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Saskia K. Nagel
- Department of Philosophy, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
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Meurk C, Morphett K, Carter A, Weier M, Lucke J, Hall W. Scepticism and hope in a complex predicament: People with addictions deliberate about neuroscience. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:34-43. [PMID: 27142450 DOI: 10.1016/j.drugpo.2016.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 02/22/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND According to the 'brain disease model of addiction', addiction is a chronic condition the symptoms of which reflect persistent changes in neural functioning produced by long-term drug use. Scholars have argued both for and against the validity and usefulness of this way of conceptualising addiction, which has been variously described as emancipatory and detrimental to addicted persons. In this paper we explore how people with addictions make sense of the brain disease concept and the extent to which they find it useful. METHODS We conducted 44 semi-structured interviews with persons in treatment for drug and alcohol addiction recruited through a variety of channels. Transcripts were analysed by combining a health identity approach with thematic analysis. RESULTS We describe participants' understandings of how they became addicted and what role, if any, neurobiological conceptions play in their explanations. Our findings highlight the hopeful and sceptical viewpoints of addicted individuals on the value of addiction neuroscience ideas and neurotechnologies. CONCLUSIONS These viewpoints shed some light on the diverse and divergent ways that people with addictions make sense of neurobiological ideas and technologies. It also describes when, and how, neurobiological explanations and the 'brain disease' model can be helpful to addicted persons. Some of the limitations of the brain disease model become apparent in the complex ways in which neurobiological explanations and labels are incorporated into lay understandings. In order to be more useful to addicted persons, neurobiological explanations should be provided as part of a more complex explanation of addiction and the brain than the BDMA offers, and should not be given a 'disease' label.
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Affiliation(s)
- Carla Meurk
- UQ Centre for Clinical Research, University of Queensland, Royal Brisbane and Women's Hospital Site, Australia; Faculty of Health and Behavioural Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Australia.
| | - Kylie Morphett
- UQ Centre for Clinical Research, University of Queensland, Royal Brisbane and Women's Hospital Site, Australia
| | - Adrian Carter
- UQ Centre for Clinical Research, University of Queensland, Royal Brisbane and Women's Hospital Site, Australia; Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Megan Weier
- Faculty of Health and Behavioural Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Australia
| | - Jayne Lucke
- UQ Centre for Clinical Research, University of Queensland, Royal Brisbane and Women's Hospital Site, Australia; Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Wayne Hall
- UQ Centre for Clinical Research, University of Queensland, Royal Brisbane and Women's Hospital Site, Australia; Faculty of Health and Behavioural Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Australia
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Andreae MH, Rhodes E, Bourgoise T, Carter GM, White RS, Indyk D, Sacks H, Rhodes R. An Ethical Exploration of Barriers to Research on Controlled Drugs. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:36-47. [PMID: 26982922 PMCID: PMC4849133 DOI: 10.1080/15265161.2016.1145282] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We examine the ethical, social, and regulatory barriers that may hinder research on therapeutic potential of certain controversial controlled substances like marijuana, heroin, or ketamine. Hazards for individuals and society and potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of these substances. Overly strict regulations, fear of legal consequences, stigma associated with abuse and populations using illicit drugs, and lack of funding may, however, limit research on their considerable therapeutic potential. We review the surprisingly sparse literature and address the particular ethical concerns pertinent to research with illicit and addictive substances, such as undue inducement, informed consent, therapeutic misconception, and risk to participants, researchers, and institutions. We consider the perspectives of key research stakeholders and explore whether they may be infected with bias. We conclude by proposing an empirical research agenda to provide an evidentiary basis for ethical reasoning.
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Meurk C, Fraser D, Weier M, Lucke J, Carter A, Hall W. Assessing the place of neurobiological explanations in accounts of a family member's addiction. Drug Alcohol Rev 2015; 35:461-9. [DOI: 10.1111/dar.12318] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 06/26/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Carla Meurk
- UQ Centre for Clinical Research; Royal Brisbane and Women's Hospital Site; University of Queensland; Brisbane Australia
- Faculty of Health and Behavioural Sciences; Centre for Youth Substance Abuse Research; The University of Queensland; Brisbane Australia
- School of Public Health; The University of Queensland; Brisbane Australia
| | - Doug Fraser
- UQ Centre for Clinical Research; Royal Brisbane and Women's Hospital Site; University of Queensland; Brisbane Australia
| | - Megan Weier
- Faculty of Health and Behavioural Sciences; Centre for Youth Substance Abuse Research; The University of Queensland; Brisbane Australia
| | - Jayne Lucke
- UQ Centre for Clinical Research; Royal Brisbane and Women's Hospital Site; University of Queensland; Brisbane Australia
- Australian Research Centre in Sex, Health and Society; Faculty of Health Sciences; La Trobe University; Melbourne Australia
| | - Adrian Carter
- UQ Centre for Clinical Research; Royal Brisbane and Women's Hospital Site; University of Queensland; Brisbane Australia
- Monash Clinical and Imaging Neuroscience; School of Psychological Sciences; Monash University; Melbourne Australia
| | - Wayne Hall
- UQ Centre for Clinical Research; Royal Brisbane and Women's Hospital Site; University of Queensland; Brisbane Australia
- Faculty of Health and Behavioural Sciences; Centre for Youth Substance Abuse Research; The University of Queensland; Brisbane Australia
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Abstract
The question I wish to consider is: how do we approach people with dementia? I want to suggest that the approach we take should be the aesthetic one. I shall need to say what this is. My question is not an empirical one. I am not asking how weactuallyapproach people with dementia. My question has an ethical bent to it: howoughtwe to approach people with dementia? In asking this question, however, I am not after an explanation suggesting we should act with kindness, compassion, honesty, integrity and so forth. We ought to do all these things, of course, and I hope such virtues will flow from the account I shall give. But I am really after something somewhat deeper, a philosophical understanding of what it is to be a person with dementia and, consequently, how we ought to stand as human beings in relation to this person.
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Affiliation(s)
- Julian C Hughes
- Northumbria Healthcare NHS Foundation Trust and Newcastle University,UK
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Hammer R, Dingel M, Ostergren J, Partridge B, McCormick J, Koenig BA. Addiction: Current Criticism of the Brain Disease Paradigm. AJOB Neurosci 2013; 4:27-32. [PMID: 24693488 DOI: 10.1080/21507740.2013.796328] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To deepen understanding of efforts to consider addiction a "brain disease," we review critical appraisals of the disease model in conjunction with responses from in-depth semistructured stakeholder interviews with (1) patients in treatment for addiction and (2) addiction scientists. Sixty-three patients (from five alcohol and/or nicotine treatment centers in the Midwest) and 20 addiction scientists (representing genetic, molecular, behavioral, and epidemiologic research) were asked to describe their understanding of addiction, including whether they considered addiction to be a disease. To examine the NIDA brain disease paradigm, our approach includes a review of current criticism from the literature, enhanced by the voices of key stakeholders. Many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma. We conclude that it is not necessary, and may be harmful, to frame addiction as a disease.
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