User:Aalcock

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Overview
Many people do not understand why or how other people become addicted to drugs. It is often mistakenly assumed that drug abusers lack moral principles or willpower and that they could stop using drugs simply by choosing to change their behavior (NIH, 2012). However drug addiction and the motivation behind drug taking behaviours is far more complex.

An illicit drug can be defined as drugs that are illegal to make, sell, or use and they include things like cocaine, amphetamines, heroin, and hallucinogens (UNODC, 2015). An illicit drug addiction may be one of the most dangerous types of addictions as it can be described as a chronic brain disease with a relapsing nature (NIH, 2012). A drug addiction causes the addicted individual to compulsively seek drugs despite the harmful consequences it can cause for themselves and those they love. Due to the changes in the brain (which will be discussed later) that occur during an addiction it challenges the addicted person’s self control and ability to resist urges and impulses to take drugs.

According to the 2014 Australian’s Crime Commission’s illicit drug data report found that the number of illicit drug seizures has increased from 86 918 in 2013 to an alarming 93 086 in 2014 (ACC, 2014). With disturbing statistics and negative consequences like these and many more, the question has to be asked, what motivates people to pursue illicit substances? Research has shown that initially taking drugs is a voluntary behavior but unfortunately the motivation to take drugs becomes overpowering and then an addictive behaviour takes control.

This book chapter aims to recognise and discuss the theories of biological factors, psychological factors and social-environment factors and how there influence in motivation in illicit drug use. It will also identify effective treatment options for addictive individuals and how to motivate a drug addict to become clean.

What motivates people to take drugs knowing it could turn into an addiction?

Theories of Illicit Substance Motivation
Not everyone tries drugs and not everyone who tries drugs becomes addicted. So what motivates people to take drugs? And what causes some people to become addicted and others do not? These questions have to be asked as no single factor can predict whether a person will become addicted to drugs. Risk for addiction is influenced by a combination of factors that include individual biology, psychological factors and social environment The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction.

No single factor determines whether a person will become addicted to drugs!:

Biological Theory
When a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit (NIH, 2012). As a result there is a lessening of dopamine’s impact on the reward circuit. This decrease forces the addicted person to keep abusing drugs hoping to bring the dopamine function back to normal, but now larger amounts of the drug are required to achieve the same dopamine high, this effect is known as tolerance (NIH, 2012). Long-term abuse can cause changes in other brain chemical systems and circuits, specifically glutamate which is a neurotransmitter. Glutamate influences the reward circuit and the ability to learn, but when the ideal concentration of glutamate is altered by drug abuse, the brain attempts to compensate which can impair cognitive function (NIH, 2012). Brain imaging studies of drug-addicted individuals have shown changes in parts of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Meaning that, these changes can drive an abuser to seek out and take drugs compulsively despite adverse, even devastating consequences—that is the nature of addiction (NIH, 2012).

Inherited Factors
Majority of the research relating to genetics and motivation have been directed towards alcohol rather than illicit drugs due to the low prevalence and illicit nature of drug abuse make subject recruitment and data collection difficult, most of these studies have “collapsed subjects across drug class or gender, although epidemiological, clinical, and animal studies have shown drug abuse liability to vary by both variables” (Van den Bree, 1998). However there have been a few studies conducted with twins which have proven beneficial in this area of research. Van Den Bree’s (1998) study aimed to find whether or not genetics and environmental influences influenced drug use and addiction in male and female twin’s genetics. The results found that genetic and environmental influences did contribute to both illicit drug use and to the clinical diagnosis of illicit drug abuse/addiction proving that genetics motivates individuals to pursue illicit drugs (Van den Bree, 1998). In relation to other studies these results were similar with a few minor discrepancies (Van den Bree, 1998), for example Pederson (1981) reported a significant relationship between hereditary and female drug use however Pederson did not find a large significant relationship between hereditary and males compared to Van den Bree’s study (Pedersen, 1980). Whilst genetic theory has reasonable evidence to determine whether inherited factors motivate drug use further research is needed to develop this theory. Both T studies also found that possible environmental factors such as peer groups, substance availability and family factors contributed to drug pursuit motivation.

The Brain Reward System Theory
Neuroscience defines the reward system as a collection of “brain structures that are involved in the regulation of behaviors that are associated with desirable, approachable, or intrinsically positive stimuli” (Kelley, 2002), meaning that addictive drugs act as a reward system on the brain. However the brain evolved to respond to appropriate and natural rewards (e.g; food and sex) that were linked to survival, reproduction and fitness; not to drugs. Although through the evolution of humans and science it was discovered how to stimulate this system artificially with drugs (Kelley, 2002). Kelley’s study reported that drugs can impact the brain reward systems to produce addiction in three ways. Firstly, drug rewards might activate the same brain systems as intense natural rewards. Addiction theories based on pleasurable drug hedonia or positive reinforcement suppose that drugs act as natural rewards. Secondly, addictive drug rewards might also change the quantitative scaling of some reward components, fragmenting and distorting normal reward processes to cause compulsive behavior. Thirdly, addictive drugs could induce new brain processes, such as aversive withdrawal states, which may play larger opponent-process roles for addiction than for normal rewards (Kelley, 2002).

Personality Traits
Many studies have aimed to determine the differences between people who have substance use problems and other people. However, these studies do not support the notion that people with substance use problems have different personalities than others (Keller, 1972). Keller’s Law develop din the 1970’s states that whatever trait was considered, the results would show that alcoholics have either more or less of it (Keller, 1972). The results suggest that dug and alcohol usage is more common among adolescents who show pre–drug use signs such as; rebelliousness, other adjustment problems, depression, sensation seeking. Although no “specific pre–drug use traits or clusters of traits have been shown to fully account for the onset or maintenance of drug use in adolescents or others” (Keller, 1972).

Positive and Negative Reinforcement
Two factors of psychological theory that motivate illicit substance taking behaviour are positive and negative reinforcement (Elements of Behavioural Health, 2015). Reinforcement is an action that encourages a behavior to be repeated more frequently, for example, a child completing their homework knowing they will receive a treat (Elements of Behavioural Health, 2015). This is know as positive reinforcement and receiving a reward for good behavior means that the child is likely to repeat it. Similarly, negative reinforcement causes a behavior to be repeated, but in this case, the action causes a bad feeling or situation to go away or be removed. “For example, some people repeatedly self-medicate with prescription drugs, alcohol or other substances because it removes unpleasant feelings of stress or anxiety”(Elements of Behavioural Health, 2015). Baker and Piper (2004) developed a a negative reinforcement model of addiction formulated from the results of their study which emphasised the pivotal role of negative affect in motivating drug use (Baker, 2004).

Self-Derogation and Interpersonal Theory
The self-derogation theory suggests that low self -esteem of an individual results in the loss of motivation to conform to social norms and instead individuals tend o deviate in behaviour (Mason, 2001). Also individuals are easily influenced by others in order to be accepted and Kaplan also states that peer rejection and social stigma can motivate the pursuit of illicit substances or other deviant behaviour (Mason, 2001). According to Interpersonal theory, relationships shape personality and depending on the relationship it can influence one to be deviant or anxious etc. (Mason, 2001). In other words our behaviour is determined or influenced by our relationships and relationship situation with others.

Socio-Environmental Theory
A person’s environment includes many different influences, from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting can greatly influence the occurrence of drug abuse and the escalation to addiction in a person’s life (NIH, 2012). Sociological theories unlike biological and psychological direct there attention away from individuals and instead to both the immediate and more distant social worlds around them. The socoiological theories that will be discussed are social control theory, self-control theory and social learning theory.

Social Control and Self-control Theory
Social control theory is situated amongst other sociological theories that focus on the role of social and familial bonds as influences for substance abuse motivation. Unlike other theories that seek to explain why people engage in substance abuse behaviour, control theories take the opposite approach and question why people refrain from taking drugs (Baumeister, 2007). Social control theorists believe that the bonds an individual have with family, friends, beliefs, religion, job and community will influence and help determine our behaviour. Therefore if an individual is exposed to illicit drugs and does not see the consequences they will be more motivated to try drugs. Self-control theory was developed from social control theory and instead focuses on internalised control rather than social control (Baumeister, 2007). It focuses on the role of parenting in developing and encouraging self-control during childhood, similar to other control theories which emphasise the importance of early developmental process as setting the stage for later life. Self-control theorists believe that the motivation to consume illicit substances occurs through the following process (Baumeister, 2007); (1) an impulsive personality (2) lack of self-control (3) deviant influences in social bonds (4) the opportunity to take drugs (5) deviant behaviour

Social Learning Theory
Social learning theory is based off Bandura's modelling learning theory (Akers, 1977). Social learning theorists state that the motivation behind people consuming illicit substances is influenced from the behaviours of those who were regarded as role models. This theory like social control theory and elf-control theory emphasise the importance of influences and behaviours children are exposed to as this a critical time in a child's personality development. Meaning that a child aspires to be like there role models and if the behaviours are deviant or of a drug taking nature this could motivate them to consume illicit substances when they are older, similar to their role model (Akers, 1977).

Treatment of Drug Addiction
Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual's life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives (NIH, 2012).

Effective drug addiction treatment include medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects (NIH, 2012). And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual's life, including medical and mental health services—and follow–up options (e.g., community–or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining a drug–free lifestyle (NIH, 2012).

Medication Treatment
Medications can be used to help reestablish normal brain function and to prevent relapse and diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco (nicotine), and alcohol addiction and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. Most people with severe addiction problems, however, are polydrug users (users of more than one drug) and will require treatment for all of the substances that they abuse (NIH, 2012).

Behavioural Treatment
Behavioral treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioural approaches (NIH, 2012). These include; Cognitive–behavioural therapy - seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs. Multidimensional family therapy, which was developed for adolescents with drug abuse problems—as well as their families—addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning. Motivational interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment. Motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs. Lastly, therapeutic communities which aim use group-based approach which encourages participation to achieve long-term drug addiction treatment. The approach was usually residential, with the clients and therapists living together (NIH, 2012).

Motivation to Change
According to the smart recovery education site there are six steps in the drug addiction motivation to change. Stage 1 Pre-Contemplation Unaware of problems associated with behavior. Certain that the positives of the behavior out- weigh the negative. Not interested in change. Unwilling to change. No intention to change

Stage 2 Contemplation Becomes aware of problems associated withbehavior. Ambivalent regarding positives and negatives. Explores the potential to change. Desires to change behavior but lacks confidence and commitment. Intends to change before 6 months.

Stage 3 Preparation Accepts responsibility to change behavior. Evaluates and selects techniques for behavior. Develops a plan. Builds confidence and commitment. Intends to change within one month.

Stage 4 Action Engages in self-directed behavior change effort. Gains new insights and develops new skills. Consciously chooses new behavior. Learns to overcome the tendencies for unwanted behavior. Active in action stage for less than six months.

Stage 5 Maintenance Masters the ability to sustain new behavior with minimum effort. Establishes desired new behavior patterns and self-control. Remains alert to high- risksituations. Focus is on lapse prevention. Has changed behavior for six months.

Stage 6 Termination Adopts new self-image consistent with desired behavior and lifestyle. Does not react to temptation in any situation. Expresses confidence and enjoys self-control. Appreciates healthier and happier life.

=Summary= This book chapter has aimed to determine the motivation for illicit drug usage. Three theories were identified these include, biological, psychological and socio-environemntal. Biological theory discussed the influence inherited factors/ genetics and the brain reward system influence an individuals motivation to pursue illicit substance. Adoption studies supported the role genetics play in determining a persons pursue of illicit substances. According to psychological theory behaviour is a significant factor behind the motivation to try drugs. Both positive and negative reinforcement encourage the increase of drug taking behaviour. Personality traits, self-derogation and interpersonal theory have proven to be influential factors in motivating individuals to consume or try illicit drugs. According to sociological theory childhood is a critical development period and a person's role models, family, friends, job, peers and community highly influence there behaviour and motivation to consume drugs. Studies surrounding social control theory, self-control theory and social learning theory have proven significantly beneficial in identifying motivation factors in drug usage and addiction behaviours. Also an individual’s motivation to change is vital in the treatment process for a chance at a recovery. The case study below, Diane's story shows the true struggle of drug addiction and how quickly someone can loose control but also demonstrates the willpower and motivation to change.

 My name is Diane, and today I'm celebrating 3yrs and 6 months of clean time. I will be turning 56 years old come the 13th of this month. And out of 55 years of living I spent over 33 years of my life on drugs.

What started out as curiosity turned into the nightmare of my life. My drug of choice was heroin. It only took me 5 days before my whole world turned upside down. I work as a supervisor for over 12 years, and because of being sick, needing some heroin, I walked into my job and quit.

I even decided that I didn't want to be married anymore, because my husband couldn't make me feel as good as the drug made me feel. I dropped out of college.

By the time I had turned 28 I had accepted that this was how my life would be, that I would die while on drugs...One day my granddaughter came to me and said," grandma don't you get tried of being sick." She didn't know I was dope sick, she only knew that most of time I would be sick. But the day she asked me that question, was the day I wanted something better.

I prayed for God to help me and 3 days later I went to treatment, and have not used since...... For such a long time I thought I was trusting God, when all the while I was wanting Him to trust me.....

I'm so grateful today that I no longer have to look for the dope man, and that he is not looking for me. That I no longer have to reach under my bed, to get a plate of dope to get my day started.....Thanking my higher power everyday, that if I could spend over 33 years of my life turning it upside down, I will spend the rest of my life, turning it right side up....N.A. and A.A. keeps me mindful that its all about one day at a time......

=See Also=
 * https://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction
 * http://www.smartrecovery.org/resources/library/Articles_and_Essays/Stages_of_Change/understanding_stages_of_change.htm

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