The Culture of Addiction: Part 1

This is the first of two blog posts on the culture of addiction that I first uploaded to the website back in 2013. They are strongly based on the seminal writings of William (Bill) White, in particular from his stimulating book Pathways from the Culture of Addiction to the Culture of Recovery. In this book, Bill provides key insights into how we can help people move cultures—essential in their journey along the path to recovery.

‘Culture’ generally refers to patterns of human activity and the symbolic structures that give such activities significance and importance. Wikipedia

Drug users often seek out and build relationships with other people whose drug use is similar to their own. They become part of small groups within which they can nurture the rituals of drug use. These groups interact with other drug-using groups, ultimately forming a broader network of users who share common goals and attributes. These social networks constitute a fully organised culture, one that has an existence and power that transcends individual membership.

In his book, Bill White emphasises the importance of understanding the culture of addiction. He emphasises that many addicts find it easier to break their physiological relationship with the drug than to break their relationship with the culture in which they use the drug. Clearly, one needs to understand how to move someone from the culture of addiction to the culture of recovery.

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Conditioning Models of Addiction, Part 1

There is a substantial body of research that shows that the ingestion of psychoactive substances and the development of problematic substance use or addiction involve psychological processes similar to those involved in normal appetitive behaviours such as eating, drinking and sex.

Research in laboratory animals has provided many insights into the role of reinforcement, learning and conditioning in normal appetitive behaviours, as well as in the misuse of psychoactive substances. In this regard, it is important to note that when given the opportunity, laboratory animals, such as the rat, learn to self-administer psychoactive drugs (except LSD).

Over millions of years, the brains of animals have evolved a motivational system that helps animals’ survive and reproduce. Behavioural responses that lead to positive consequences, such as the reduction of hunger, are likely to be repeated. Moreover, animals learn to escape from or avoid painful or noxious stimuli.

Operant conditioning, or instrumental learning, refers to the way in which the consequences of behaviour influence the likelihood of that behaviour being repeated. One class of consequence which can affect behaviour, positive reinforcement, is illustrated by a laboratory rat learning to press a lever to obtain food, or a dog sitting up to beg for a biscuit.

Drugs of dependence tap into the motivational system underlying this behavioural change. The drug acts as a reward, or positive reinforcer, and with repetition the association between cue, response and reward becomes stronger and stronger.

Another important principle here for understanding problematic substance use is the immediacy of reinforcement. It is well-established that the sooner a reinforcer follows a behaviour, the more powerful its effect will be on that behaviour and the more likely the behaviour is to be repeated.

A second class of consequence that can affect behaviour (negative reinforcement) can be demonstrated in the laboratory by training a rat to press a lever to avoid being punished by, for example, a small electric shock to the feet. Each time the animal receives the cue (e.g. a light predicting impending shock), it will perform an operant response to avoid the shock being delivered.

Similarly, the dependent heroin user may take the drug (perform an operant response) to avoid impending withdrawal symptoms and the associated physical and psychological discomfort.

It is important to emphasise that these instrumental learning mechanisms can operate outside conscious awareness and not involve a decision-making process.

West points out that in this model, addiction can be viewed as involving the “development of a habitual behaviour pattern that is independent of any conscious evaluation that might be taking place about the costs and benefits of the behaviour. The impulses to engage in addictive behaviour that are generated by this mechanism can be so strong that they overwhelm the desire of the addicts to restrain themselves.”

Classical (or Pavlovian) conditioning is a process that involves a neutral stimulus (such as a red light) become rewarding and influencing behaviour because it has reliably preceded a natural reward such as food.

In Ivan Pavlov’s seminal experiments at the turn of the 20th century, salivation was demonstrated in dogs presented with food. After a neutral stimulus (bell) was presented in combination with the food on a number of occasions, the bell became capable of eliciting salivation in the absence of the food. Thus, the bell had become a conditioned stimulus capable of influencing behaviour, i.e. producing a conditioned response.

Conditioned stimuli play an important part in our daily life, and they have played a significant role in evolutionary terms, in respect of the survival of the species. They allow us to react to threatening situations and alert us to such necessities as food and sexual partners; they shape behaviour.

As discussed earlier for operant conditioning, classical conditioning processes can become automatic. Behaviour can be influenced without conscious, decision-making processes.

I know this well from lighting the gas ring above an oven that had been left on for many hours: I was blown across the room, fortunately with only hairs singed. But I was left with a strong conditioned response, such that every time I heard a sound near a gas stove, I literally jumped out of my skin. The response took years to extinguish.

These stimuli, such as Pavlov’s bell, are known as secondary reinforcers because they derive their ability to influence behaviour by association. Secondary reinforcers can generalise in the sense that stimuli with similar characteristics (e.g. similar colour light) will produce a similar, but not necessarily identical, impact on behaviour.

The impact of the conditioned response can also extinguish, in that if presentation of the bell is not followed by food on a number of occasions, salivation in the dog will disappear.

In the next Briefing, we will look at the role of classical conditioning in substance use and addiction, considering conditioned withdrawal, conditioned drug-opposite responses and conditioned tolerance, and conditioned drug-like responses.

Recommended reading:

Robert West (2006) Theory of Addiction. Blackwell Publishing.

Nick Heather and Ian Robertson (2001) Problem Drinking. Oxford Medical Publications.

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> Conditioning Models of Addiction, Part 2

An Illustration of the Manner in Which Factors Facilitating Recovery Interact

This blog post is taken from part of a chapter in my recent eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction.

Research I conducted with Lucie James back in 2008 provided important insights into factors that facilitate behavioural change and a person’s path to recovery from addiction. This study involved a qualitative analysis of the views and experiences of clients on the RAPt treatment programme [1] in one male and one female prison. 

Transcripts of the semi-structured interviews with 15 males and 15 females were analysed with Grounded Theory in order to reveal identified concepts and themes. Four inter-related themes were derived from the analysis that were labelled: ‘Belonging’, ‘Socialisation’, ‘Learning’, and ‘Support’. Each of these themes impacted on a fifth theme, ‘Personal Change’, which had two key components, motivation to change and self-esteem.

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Factors Facilitating Recovery: Understanding

Here is the next section from my chapter Factors Facilitating Recovery in  my eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction.

Understanding is essential for recovery. People with substance use problems and those on a recovery journey need information and education about a variety of matters, including: the nature of addiction and their own substance use problems; the range of interventions they can use to help them overcome or manage these problems; opportunities that allow them to exercise their strengths and assets; supports they can use to facilitate their recovery journey, and self-management skills that help them cope with situations that might lead to relapse. 

Recovering people are a major source of information that can facilitate another person’s recovery journey.

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‘Willingness To Be Puzzled’ by Gabor Maté

Dr. Gabor Maté talks about how important it is to be puzzled and to ask the question “what’s really going on here?” rather than assuming that we know all the answers.

‘6 Secrets to Moving On From Serious Struggles’ by Beth Burgess

Purple-Sky“Never be ashamed of a scar. It simply means you were stronger than whatever tried to hurt you.” ~ Unknown

‘People who knew me ten years ago would probably expect me to be dead now. They wouldn’t expect me to have escaped my problems. They wouldn’t expect me to have stopped drinking, drugging, taking overdoses, and cutting my arms.

People who knew me ten years ago saw a scared shell of a girl, terrified of her own shadow and on a mission to self-destruct. They wouldn’t expect me to have turned my life around completely. They certainly wouldn’t expect me to be sharing my story and helping others to let go of their struggles, too.

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‘Mistakes are the juice of life’ by Veronica Valli

UnknownI think this new blog from Veronica Valli is a great reminder.

‘When I first got sober I was under the delusion that in order to stay sober, I had to become perfect in all areas.

It got worse when I trained to be a therapist. Because I was a therapist I thought I needed to always be serene, wise and know the right thing to say. I needed to exude a calm, reassuring confident manner with everyone, not just my clients. But no matter how hard I tried, I would f**k up.

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My Favourite Blogs: Untangling the elements involved in treatment

Unknown-4Here’s a summary of a piece of research that Lucie James and I conducted some years ago. I am very proud of this piece of work and it certainly opened my eyes to the importance of gaining a sense of belonging in the recovery journey.
   
‘To understand how treatment helps people overcome substance use problems, it is essential to understand the elements that operate in the treatment process, and how they might interact to facilitate behavioural change and a person’s path to recovery from addiction.

Lucie James and I set out to gain initial insights into these issues by using a qualitative analysis of the views and experiences of clients on the RAPt treatment programme in one male and one female prison in the UK.

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Recovery Stories Highlight: Untangling the elements involved in treatment

Unknown-4Here’s a summary of a piece of research that Lucie James and I conducted some years ago. I am very proud of this piece of work and it certainly opened my eyes to the importance of gaining a sense of belonging in the recovery journey.   

‘To understand how treatment helps people overcome substance use problems, it is essential to understand the elements that operate in the treatment process, and how they might interact to facilitate behavioural change and a person’s path to recovery from addiction.

Lucie James and I set out to gain initial insights into these issues by using a qualitative analysis of the views and experiences of clients on the RAPt treatment programme in one male and one female prison in the UK.

Read More ➔

‘Coping in Early Recovery: The Toddler Stage’ by Stephanie Brown

images-1In my last blog on Stephanie Brown’s book  A Place Called Self: Women, Sobriety, and Radical Transformation, I looked at what Stephanie describes as the Baby Stage of early recovery. Here, I look at what Stephanie says of ‘The Toddler Stage’.

‘As a baby moves into the toddler stage, she begins to acquire a new kind of learning. She begins to pick up language, which builds the foundation for understanding and forming ideas.

Similarly, the woman born newly into abstinence begins what is called cognitive learning. She listens to others telling the stories of what they did in the past and what they do now. She begins to hear a new language, the language of recovery, and, like a toddler, begins to form her new self and her new identity around the acceptance of her addiction. She comes to know the words, “I am an alcoholic” or “I am an addict” and build her new, strong sense of self on this foundation…’

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’10 Mistakes That Could Ruin Your Addiction Recovery’ by Addiction Helpline

rsz_ten-recovery-mistakesThis is an interesting article on the traps you may fall into in your recovery, published by Addiction Helpline in the UK.

‘It takes a significant amount of effort to break away from addiction. You could do all the right things, like going to rehab, yet you still end up more or less back where you started. This is a real shame, but it is always preventable. The reason people end up ruining their recovery is they go off track – this starts by falling into one of the common traps.

Here are 10 mistakes you will want to avoid to enjoy a lasting recovery:

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On Healing: Jackie

rsz_1outback-sunset-880‘Healing is a really confusing word. When I first thought of it I thought I would go along and all this pain was going to be healed and at the finish I would just walk away and I would be healed, but now I know healing means learning.

Learning about yourself – learning about looking at things in a different way. Understanding how those things came to be.

Owning your own things, but not taking on board other people’s things. Being responsible for what you are responsible for, but not for other people’s responsibilities.

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Marion’s Story: My Resilience

A number of factors have contributed to the development of Marion’s resilience and her ability to live successfully in two cultures.

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Brad’s Moment(s) of Clarity

stories-04Here’s the second of our Moment of Clarity series, taken from Brad’s Recovery Story

‘At this time, I thought willpower is what I needed to stop drinking, but I soon found out that this wasn’t the case. I was lacking a true willingness and desire to get well. I daydreamed and dreamt about stopping drinking, but I think that’s all it was at that stage. There was no real consideration of the work that would be involved in stopping.

Anyway, I decided I needed a break from the booze. I retired to bed and began going through the terror of a full-blown rattle, something I hope I never have to go through again. Five days later, I was physically dry. I then decided to see how long I could abstain from alcohol. After six weeks of no alcohol, I still wanted a drink. In fact, my desire for alcohol was worse than ever.

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Strategies to Face Adversity: Learning

Many study participants expressed that learning about their culture was an important part of survival as an Aboriginal person in today’s Aboriginal society.

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The culture of addiction: Part 1

384985_10150365241281765_1866835833_nThis is the first of two blogs on the culture of addiction. I will later look at the culture of recovery, and after that consider how we can help people move from the culture of addiction to the culture of recovery.

These articles are based on the seminal writings of William L White, in particular from his book Pathways from the Culture of Addiction to the Culture of Recovery. In this book, Bill provides key insights into how we can help people move cultures – essential in their journey along the path to recovery.

‘Culture’ generally refers to patterns of human activity and the symbolic structures that give such activities significance and importance. Wikipedia

Read More ➔

Untangling the elements involved in treatment

P4061087Here’s a summary of a piece of research that Lucie James and I conducted some years ago. I am very proud of this piece of work and it certainly opened my eyes to the importance of gaining a sense of belonging in the recovery journey.   

‘To understand how treatment helps people overcome substance use problems, it is essential to understand the elements that operate in the treatment process, and how they might interact to facilitate behavioural change and a person’s path to recovery from addiction.

Lucie James and I set out to gain initial insights into these issues by using a qualitative analysis of the views and experiences of clients on the RAPt treatment programme in one male and one female prison in the UK.

Read More ➔