Motivation and emotion/Book/2019/Motivation to overcome substance use addiction

Overview
Substance use involves the intake of both illegal drugs such as cannabis, cocaine and heroin as well as legal drugs or substances such as alcohol and nicotine. The personal affect usage can be detrimental, causing health problems, being unable to function in society, spending excess money and possibly gaining money unlawfully to purchase drugs. On a wider scale, substances can have an impact on the whole society, as it can lead to overdosing and other medical health issues that use up resources that would have otherwise benefited others. Consequently while people are under the influence, people can become disorderly and damage personal and public property.

However, people can make the decision to overcome addiction for many different reasons, such as for themselves or for family. Rose & Walters (n.d.) state that when people are making choices, they are attempting to satisfy three basic needs: autonomy, relatedness and competence. There are several psychological theories that can help explain how and why some people make the decision to overcome addiction, and the motivation behind their choices to maintain their goals; with research that can support the theories.

Self determination theory
The self-determination theory (SDT) is a theory of human motivation, highlighting that people have an inborn tendency to pursue growth and make change in their lives (Deci & Ryan, 2008). The theory focuses on how different types of motivation occur and each supports the basic needs in different magnitudes. Amotivation, extrinsic motivation and intrinsic motivation are the three categories which constitute the taxonomy of motivation created by Ryan and Deci to explain how they can thwart, or support individuals drive to learn based upon fulfillment or lack thereof of the basic needs. The SDT proposed there are 3 basic needs: Autonomy, Competence and Relatedness.


 * Autonomy reflects ones need to feel a sense of control
 * Competence reflects ones innate tendency to feel sufficiently skilled
 * Relatedness reflects ones need to feel a sense of belonging in social groups.

Maslow's hierarchy of needs
Maslow's Hierarchy of needs is based on a tier of needs that an individual meets in order to move up and reach self-actualisation, as seen in figure 2. In this theory, the individual is seen as the most important factor, as their agency overrules other motivations. Maslow believed that every person has the desire to realise their own full potential, and make actions to achieve certain needs to be all they can fully be [SOURCE].

Arousal theory
The arousal theory suggests that people are driven to complete certain tasks in order to maintain an optimum level of psychological arousal. The theory suggests that each individual has a scale of arousal, that when unsatisfied we actively seek to increase. For example, if arousal levels stoop to low, an individual may actively seek stimulation by going out with friends and socialising. On the contrary, if an individual is overstimulated, they may seek out an activity that is relaxing and allows their arousal level to return to its state of equilibrium. This concept is closely linked to the drive reduction theory.

Incentive theory
Explanation with source.

Intrinsic vs extrinsic motivation
Intrinsic motivation is internally sourced. It is driven by internal rewards such as elated feelings of pleasure and fun. This includes partaking in hobbies.

Extrinsic motivation is an externally sourced by environmental triggers. It is an unconscious state of motivation, driven by the desire to gain an external reward. This includes working for incentives e.g. people go to work to receive a pay check or students study to receive a good grade.

Biological elements of motivation and substance use


There are many neurotransmitters and regions of the brain that play a role in motivation and substance use. The nucleus accumbens is a structure near the centre of the brain that is the foundation of rewards and pleasure, activating the motivational system, as shown in figure 4. It is involved with planning, allowing to help create goals and evaluate situations to make changes. Crucial to motivation, making goals are important as individuals can track their progress and after reaching goals, confidence levels can increase causing people to keep changing their behaviours. The dorsolateral prefrontal cortex (DLPFC), located in the frontal lobe as shown in figure 5, is involved in executive functions such as working memory, cognitive flexibility, decision making and planning. It is also linked to suppressing temptation and maximising personal gain. If the DLPFC is dysfunctional and has a weaker connection than usual, it is common to see substance use, due to the increase in risk behaviours. The striatum, as shown in figure 4, coordinates different aspects of cognition. With a particular interest in decision making, motivation, reward perception and reinforcement, the striatum is linked with addiction as it reinforces the affects of drugs with the release of dopamine. Alongside the nucleus accumbens, the DLPFC and striatum are needed to make the decision for an individual to make the change and stop drug use, and using planning to make the steps towards being drug free.

The insular cortex, shown in figure 6, is involved in many roles in consciousness, emotions and homeostasis. It has been also identified with bodily self-awareness and sense of agency. With a link to substance use, the insular cortex is activated when users are exposed to an environment that has triggers for use. Along with intrinsic motivation, it is important for an individual to be aware of ones self and know that they are autonomous in life.

The ventral tegmental area (VTA) is located in the mid brain and contains several neurons which are primarily dopaminergic, as shown in figure 4. It plays a major role in motivation, reward and addiction. When someone takes drugs, it is rewarded by the activation of dopamine.

Dopamine is both a neurotransmitter and a hormone, and plays a major role in reward-motivated behaviour. Dopamine levels can be increased when rewards are anticipated. In relation to substance use, dopamine levels are increased by substances which can lead to addiction. Similarly, endorphins are involved in the reward system of the brain, with evidence being shown that these chemicals play a role in drug dependence due to the "feel good" component.

Statistics

 * 42.6% of people in 2016 had used illicit drugs within their lifetime.
 * Cannabis is the highest consumed illicit drug in 2016, with 34.8% of people having consumed it in their lifetime.
 * The percentage of at risk alcohol drinkers has decreased to 17.1%.
 * A larger number of people are abstaining from alcohol, with a percentage of 22.9% in 2016.

Drug use in Australia over 12 months

 * Methamphetamine: 2%
 * Alcohol: 78.8%
 * Hallucinogens: 1%
 * Ketamine: 0.3%
 * Cocaine: 3%
 * Cannabis: 10.4%

Overcoming substance use through theory
Intrinsic motivation refers to a person doing a specific behaviour for their own sake. Intrinsic motivations underlie most of the psychological theories of motivation. It is important for the individual to decide that they want to change their own behaviours as they have the ability to do so and be autonomous. Intrinsic factors can go both ways, as intrinsic motivations can also be what causes people to use drugs. There are many reasons why a person may start taking drugs, it could be they enjoy them or use them as a coping mechanism. However, research has found that substance users were more engaged in programs and experienced a lower occurrence of relapse when they were highly intrinsically and autonomously motivated [SOURCE?].

Extrinsic motivation is the environmental factors that can provide motivations for an individual to change their behaviours. They can be divided into four types: external regulation (control and demand), introjected regulation (behaviour based on avoiding shame, guilt or by obligation), identified regulation (values an action as important), and integrated regulation (behaviour due to external reason while it is important to ones own values and goals). Introjected regulation, when involved in substance use would be best explained as a reason to change behaviours, as most of society looks down on people who use drugs and think they are less than. A person may use this as motivation to stop the use of drugs to stop the judgements. Also, stopping usage due to obligation would be one of the most common motivations, as drug use is illegal Many companies require staff to be drug free and individuals would need to keep clean, especially with any previous drug use convictions to uphold parole conditions. However, research has found that extrinsic motivation is not substantial motivation when withdrawing from drugs, and it is more likely to drive individuals to engage in drug use or other deviant behaviours (Chan, Lo, Tam & Lee, 2019).

Incentives are driven by internal factors, which helps motivated behaviour to develop individual direction. This is important as a person who abuses substances can use external factors to be motivated to stop. Individual motivations can differ, however some common examples may include wanting to avoid trouble with the law and subsequently staying out of prison. Other motivations could be doing better for their family or becoming more sufficient in society by maintaining a job.

In terms of the Maslow's theory and substance use, people may come to realise that they are "better" than using drugs, and find that they need to change their behaviours for a more fulfilling life. This theory can also be used when overcoming addiction, as people need to fulfil their sense of belonging and safety before they start to change substance abuse behaviours.

Research into the self determination theory showed that those who are internally motivated to make changes to their lives are more confident, resulting in better outcomes and overall well-being (Rose & Walters, n.d.). In terms of motivations to overcome substance use, the self determination theory is one of the most substantial theories, as it explains intrinsic values are most important for change, and that stopping drug use is all up to the individuals own desire to change and their belief that they can.

Empirical evidence
Intrinsic Motivation and Psychological Connectedness to Drug Abuse and Rehabilitation: The Perspective of Self-Determination (Chan, Lo, Tam & Lee, 2019).

This study looked into the importance of intrinsic motivation in drug rehabilitation, focusing on the satisfaction of the users psychological needs and their willingness to reach autonomy, competence and relatedness. The study used a qualitative research method to explore the experiences people who are drug users and have experience drug relapse, in order to understand their psychological experience in choosing to take drugs and/or quit drugs.

The study involved a sample of 102 people (50% male & 50% female, age range of 11-70 years), and data was collected through interviews and focus groups. More than 65.3% used drugs more than six times a week, with the most popular drug used being methamphetamines (67%). The highest reported reason for taking drugs was peer influence.

The results showed that many of the participants had quit due to their autonomous decisions, mainly to stop experiencing negative effects. They felt that drug taking ruined their relationship with family and friends, as well a negative inﬂuence on physical and psychological well-being. Drugs made the participants want to get rid of the inﬂuence of drugs. With these reasons reﬂecting that participants quit drugs based on their intrinsic motivation; understanding the value of quitting drugs highly encourages them to do so.

Although the study found evidence that intrinsic motivation towards autonomy was successful in individuals becoming motivated to stop drug use, one of the limitations of the study is it is based on the self determination theory, so it did not cover other social and environmental factors that can go alongside intrinsic motivations in order to strengthen motivations and decisions to stop using drugs.

Conclusion
It has been found that for an individual to become motivated to overcome substance use they must be intrinsically motivated, know they have the power to make and change their own behaviours. It does not matter what may be the ultimate reason, but research has shown that intrinsic motivation has more evidence to work. Also, the Self Determination Theory has the most evidence and theoretical support when it comes to the outcomes of stopping drug use. Maslow's Hierarchy of Needs can explain some minor motivations to change behaviour, as people need to have certain needs met before they can reach the level of improving themselves. However, it does not have a wide support of it working consistently in changing behaviours and cannot be confidently applied to each individual and situation.