Motivation and emotion/Book/2013/Illicit substances and motivation

Overview
An illicit drug can be defined as a drug that is prohibited from manufacture, sale or possession (Western Australia Drug and Alcohol Office, 2012). Although not prohibited from sale or possession, prescription drugs (i.e.Benzodiazepine ) can be classified as an illicit drug when subjected to inappropriate use. According to the Australian Crime Commissions (ACC) illicit drug report (2013), the number of illicit drug seizures across Australia has increased by 62% over the past decade, with 23.8 tonnes of illicit drugs seized in 2011-2012, a 154% increase from the 9.3 tonnes seized in 2010-2011. The ACC illicit drug report, the only report of its type in Australia, also revealed that the illicit drug arrests in 2011-2012 of 93, 148 people were the highest recorded arrests for the past decade.

As Everitt and Robbins (2005) note, an individual initially starts using illicit drugs as a voluntarily action because it has a reinforcing effect. Unfortunately, the motivation to use illicit drug will become overpowering so that a loss of control over the voluntary behaviour occurs, and behaviour becomes habitual and compulsive. Once voluntary behaviour has been extinguished, Addiction has occurred. Drug addiction is a gradual process of escalation, whereby chronic exposure and consumption becomes excessive and difficult to control (Ahmed, Walker, & Koob, 2000).

This book chapter will look to identify the motivational theories of illicit drug use. The three broad motivational theories incorporated into this chapter include biological, psychological and sociological theories, which each containing their own subcategories. This chapter will provide information on how, once addiction has occurred, and individual can motivate themselves to change their behaviour, and finally provide a list of motivational treatment options designed to enhance a participant’s motivation

 Consider the following statement :

There are no differences between illicit substance users, and individuals who do not use illicit substances. In fact, everyone has the exact same odds of becoming addicted to an illicit substance.

Do you tend to agree, or disagree with this statement?

Theories of illicit substance motivation
This chapter will focus only on three broad theories that explain the Motivation for an individual to pursue illicit substances. Under each broad theory of illicit substance use sit subcategories, each of which primarily focus on a different range of factors that they deem crucial in determining the motivation to use illicit substances. The three broad theories that will be covered in this chapter are: biological theories, psychological theories, and sociological theories.

Biological theory
The first theory of illicit substance motivation is the biological theory. The biological theory sets out to understand how drugs work in the brain and what biological differences exist among individuals in their susceptibility to abuse drugs (U.S. Congress, office of Technology Assessment, 1993). The first subcategory amongst the theory of biological motivation is the theory that genetics predetermine an individual’s likelihood of using illicit substances.

Genetics
Genetics theory sets out to determine whether inherited factors exist, and if so, what these inherited factors are. Unfortunately, the vast majority of research has been targeted towards alcohol rather than illicit drugs (U.S. Congress: OTA, 1993). To examine whether genetics affects an individual’s susceptibility to seek out illicit drugs, extensive research investigates family, twin and adoption studies to determine heredity influences. These studies distinguish three major contributors to each individual: genetic factors, shared environmental factors, and nonshared environmental factors (McGue, 1997). To determine the exact contribution of genetics on drug and alcohol abuse without incorporating environmental factors, a mathematic model was created. McGue (1997) provides the most simplistic model: ‘heritability is estimated as twice the difference between the correlation coefficient of genetic factors to alcoholism in MZ twins and the correlation in DZ twins (i.e. 2[MZ–DZ]). Thus, if the correlation for drug risk is 0.7 for MZ twins and 0.4 for DZ twins, the correlation of heritability would be 0.6 While studies categorically support the role genetics play in alcohol and drug abuse, there is one overarching criticism of the genetic theory: genetic theory is yet to provide information about what it is exactly that is inherited (U.S. Congress: OTA, 1993) Studies have attempted to identify genes that might be associated with alcoholism in humans, but yet all research has returned inconclusive.

Empirical support
A majority of all research investigating the role genetics plays on an individual’s predisposition towards a substance has been predominately investigating Alcohol as the substance rather than illicit drugs. In fact, very little research has been based around how genetics predisposition children towards illicit substances. One study in which investigates genetics and illicit substances is Kendler et al. (2012):

Objective: The objective of their study was to determine how genetic factors contribute to the risk of children suffering from drug abuse as well as the environmental factors that may have contributed. Participants: The studies participants consisted of individuals of both genders born between 1950 and 1993 in Sweden and who had been adopted and records were readily available through adoption databases. For participants to be eligible for the study, information had to be readily available on both the adoptive parents (non-biological) and at least 1 biological parent. Individuals who were adopted by biological relative or by an adoptive parent living with a biological parent were excluded from this study. The final study included 18 115 adopted children born between 1950 and 1993; 78 079 biological parents and siblings; and 51 208 adoptive parents and siblings (Kendler et al. 2012). Method: For evidence to be gathered, Kendler et al. accessed nine public databases (1961-2009) of adopted children and their biological and adoptive relatives. The nine public databases included: Results: The results of the study indicated that of the 18, 115 adopted individuals, 4.5% of the participants had a drug abuse problems which was identified by the nine public databases mentioned above. The study indicates that the risk of drug abuse among children whose biological parents had a drug abuse problem, was 8.6%, which was substantially and significantly more than adopted children whose biological parents had no drug abuse problem (4.2%). Adopted children had double the risk of drug abuse if their biological sibling had a drug abuse problem; however, the risk of drug abuse would be the same if their adoptive siblings -- those who had no biological connection to them -- had abused drugs, indicating environmental influences (Kendler et al. 2012).
 * 1) The Swedish hospital discharge register from 1964 to 2009. Every record had the main discharge diagnosis and 8 secondary diagnoses
 * 2) The Swedish prescribed drug register. It is complete list of all prescriptions registered at the National Board of Health and Welfare.
 * 3) The Swedish mortality register contained all causes of death and time of death from 1961 to 2009
 * 4) The national censuses data which provided information on education and marital status in 1960, 1970, 1980, and 1990
 * 5) The total population registry which included annual data on education and marital status from 1990 to 2009.
 * 6) The multi-generation register which provided information on family relationships from 1932 to 2009 including all adoptions and adoptive and biological parents and siblings.
 * 7) The outpatient care register which included information from all outpatient clinics in Sweden from 2001 to 2009
 * 8) The primary health care register which included outpatient care data on diagnoses and time of diagnoses from 2001 to 2007, and finally
 * 9) The Swedish crime register which included national complete data on all convictions including those for substance abuse from 1973 to 2007

The brain reward system
Studies have shown that direct stimulation of areas in the brain that are involved in the reward system, produce extreme pleasure that has a strong reinforcing effect, even in the absence of any goal-seeking behaviours (U.S. Congress: OTA, 1993). The brains reward system is made up of various structures. The central component of the reward system is a neuronal pathway that interconnects structures in the middle of the brain (i.e.,Hypothalamus ) to structures in the front of the brain (i.e., frontal cortex). These structures and pathways are thought to play a role in the reinforcing properties of illicit substances, however the exact mechanisms involved in illicit substance abuse lacks a thorough description (U.S. Congress: OTA, 1993). Research indicates that animals which have had electrodes implanted in these areas of the brain, which produce a pleasurable sensation, will repeatedly press a bar, or do any other required task, to receive electrical stimulation (U.S. Congress: OTA, 1993). Both natural rewards and illicit substances stimulate the release of Dopamine from neurons into the nucleus accumbens, causing euphoria and reinforcement of the behaviour (Camí, & Farré, 2003).

Psychological theory
Psychological theories of illicit substance seek to determine the role behaviour plays in motivating individuals to pursue illicit substances. The first psychological theory that describes the role motivation play in seeking illicit substances is positive and negative reinforcement.

Positive and Negative reinforcement
Psychological theories suggest that two fundamental principles of illicit substance motivate behaviour; positive reinforcement and negative reinforcement (Bozarth, 1994). Positive reinforcement is where presentation of some stimulus event increases the probability the behaviour it follows (Bozarth, 1994).On the other hand, negative reinforcement describes the situation where the termination of a stimulus increases the probability or frequency of the behaviour its termination follows. Put simply, positive reinforcers follow the behaviour they reinforce, while negative reinforcers precede the behaviour they reinforce (Bozarth, 1994). According to positive reinforcement theory, individuals initially consume illicit substances to experience a high sensation of pleasure, and thus are motivated to repeat what caused the sensation of pleasure (Ahmed, & Koob, 2005). According to the negative reinforcement theory, individuals consume illicit substances to relieve withdrawal distress and discomfort; hence they become motivated to repeat the actions that relieved them of their pain (Bozarth, 1994).

Self-derogation perspective
According to the self-derogation perspective, self-devaluation and low self-esteem in the course of an individual’s membership group results in (1) the loss of motivation to conform to social norms, and the acquisition of motivation to deviate from the these norms, and (2) the tendency to seek behaviours in which an individual can achieve self-accepting attitudes (Kaplan, Martin, & Robbins, 1984). According to Kaplan et al. peer-rejection and social stigma anticipate the adoption of substance abuse and other deviant responses.

Sociological theory
Sociological theories of motivation towards illicit substances focus on the social activity, socialization, culture, social interaction, social inequality, deviance, and group membership as the key motivators as to why individuals use drugs (Goode, 2011). As Goode notes, Sociological theories examine the differences between and among societies, social categories, and individuals in the population. The first sub category under the Sociological theory is social control theory.

Social control theory
According to social control theory proponents, law-abiding behaviour and conformity are due to ‘bonds’ to people (parents), beliefs (religion), institutions (job), and activities (Goode, 2011). Social control theory states that individuals do not want to threaten or undermine these ‘bonds’ by engaging in illicit drug use. Therefore university students with high career aspirations, religious or are married are much less likely to be motivated to use illicit drugs than individuals who do not have any of these (Goode, 2011). To social control theorists, drug use is contained by ‘bonds’, thus the absence or weakness of such ‘bonds’ explains illicit drug use

Self-control theory
Self-control theorists believe that motivation to pursue illicit drugs starts at childhood. The reason individuals pursue drugs is due to lack of or low self-control, which can be attributed to poor and inadequate parenting (Goode, 2011). According to Goode, children who are raised in a household in which their parents are unable or unwilling to monitor and control their behavior, will develop a pattern of engaging in uncontrolled, impulsive, high-risk, and, short- term rewarding behaviour such as illicit substance use. Individuals who lack self-control are reckless, careless and act with no concern for consequences of their actions.

Social learning theory
Social learning theory is in stark contrast to both control theories mentioned above, as social learning theorists argue that people are not “naturally” predisposed to using drugs; instead, they have learned the positive value of non-normative behaviours (Goode, 2011). According to social learning theory, the motivation to use illicit substances originates from the specific attitudes and behaviours of people who serve as a role model (Petraitis, Flay, & Miller, 1995). According to Petraitis et al. a role model that uses illicit substances will have three sequential effects on an individual. Firstly, an individual will observe and imitate the substance-specific behaviours, secondly, social reinforcement will occur through the form of encouragement and support for illicit drug use, and finally they will hold high expectations of positive social and physiological consequences from future drug use.

From the research and evidence provided so far, the statement for consideration at the start of the chapter is clearly false. If the statement had been true, no theory would be capable of accounting for illicit substance use. Theorists assume that by examining the differences amongst substance users, an explanation can be devised in order to explain why certain individuals are motivated to pursue illicit substances

Motivation to change
The above research and theory has explained what motivates individuals in their pursuit of illicit substances. However, once the voluntary behaviour of using illicit substances stops and addiction has occurred, motivation plays just as important role in seeking help and in recovery. A significant change has occurred, with researchers and clinicians shifting attention from motivation to pursue substances, towards an increased interest in the concept of motivation to change (DiClemente, Bellino, & Neavins, 1999). Awareness of a participant’s motivational level is important as it can help clinicians develop more realistic treatment goals and use appropriate treatment techniques (Ziedonis, & Trudeau, 1997) The following research indicates the role in which motivation plays in an individual’s pursuit to change current illicit substance use behaviour.

Intrinsic and extrinsic motivation to change
According to research and theory, an individual’s motivation to engage in a certain behaviour can either be intrinsic; reflecting a desire to achieve an internal reward, or extrinsic; reflecting a desire to receive an external reward (McBride et al. 1994). Evidence suggests that intrinsic motivation is more desirable than extrinsic motivation when it comes to motivation to change. Generally, intrinsic motivation is associated with long-term change, whilst research revealed extrinsic motivation such as financial incentives were less effective in both short term and long term changes (DiClemente et al. 1999).

Stages of change
Research has outlined the following ‘stages of change’ which describes the process and amount of motivation that an individual goes through when making a behavioural change (DiClemente et al. 1999). Stage one is described as pre-contemplation (i.e., not yet considering change). Individuals who were identified in the pre-contemplation stage are likely to lack motivation to change as they deny illicit substances are an issue for them. Stage two is described as contemplation (i.e., considering change but not taking action). Individuals who are assessed at stage two contemplate changing their behaviour after weighing the positive and negative aspects of change. Stage three is known as preparation (i.e., planning to change). In the preparation stage, the individual increases their commitment to change. Stage four is considered the action stage (i.e., making changes in one’s behaviour), In the action stage, a specific behavioural strategies to is formulated. Finally, stage five is maintenance (i.e., changing one’s lifestyle to maintain new behaviour) the individual strives to avoid relapse by developing a lifestyle that supports the changes in their substance use (DiClemente et al. 1999). According to the stages of change model, to successfully recover from illicit substance addiction, motivation is important throughout the entire process, especially during the first three stages.

Motivational treatment
The following is a brief list of different treatment approaches that are designed to enhance a participant’s intrinsic motivation, thus eliciting a change in behaviour.

Brief motivational intervention
A brief motivational intervention consists of few sessions whereby the focus is primarily on the negative consequences of illicit drug use (DiClemente et al. 1999). The facilitators advise participants on the need to reduce their substance use by offering feedback on the effects of their drug use, which is designed to increase the participant’s motivation to reduce or stop. The aim is to advice participants by providing personally motivating information such as risk of death and disease.

Motivational interviewing:
Motivational interviewing(MI) is much more beneficial for participants who severely lack motivation compared to motivational intervention. MI primarily focuses on enhancing a participant’s intrinsic motivation (DiClemente et al. 1999). MI uses various techniques in order to increase motivation. Technique one includes listing the pros and cons of changing their behaviour, which may help participants realistically evaluate whether the pros outweigh the cons. A second technique uses assessment data to provide the participant with personalised feedback regarding their substance use as a means of increasing their self-awareness and highlight discrepancy between their current behaviour and their target behaviour (DiClemente et al. 1999).

Summary
This book chapter has identified three theories that explain the motivation to pursue illicit substances. Biological theorists believe biological differences exist among individuals in their susceptibility to pursue illicit substances, with adoption studies indicating genetics play a role in ones vulnerability to pursue illicit substances. On the other hand, psychological theorists believe behaviour plays a role in motivating individuals to pursue illicit substances through reinforcement of their actions, whilst sociological theorists believe social activity, socialization and culture determine what motivate someone to pursue illicit substances. Finally, motivation not only plays a key role in the pursuit of illicit substances, but also plays a major role in the pursuit for help from these substances. Motivational interviewing and brief motivational intervention are just two approaches to increasing an individual’s motivation to change.