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ADHD & COCAINE.   Term Paper ID:28128 Click to get this paper

Essay Subject: Relation of Attention-Deficit & Disruptive Behavior Disorders to chronic cocaine abuse. Reviews studies in relation to self-medication.... More...

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Paper Abstract: Relation of Attention-Deficit & Disruptive Behavior Disorders to chronic cocaine abuse. Reviews studies in relation to self-medication. Paper Introduction: ADHD AND CHRONIC COCAINE ABUSE Introduction In general, Attention-Deficit and Disruptive Behavior Disorders consist of three socially disruptive behavioral patterns which are: attention-deficit hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder (Davison & Neale, 2000). The diagnostic criteria for ADHD must be present for at least six months prior to the diagnosis. These criteria, according to the American Psychiatric Association (APA, 1994), include: short-attention span or easy distractibility; impulsivity; repeated tendency to interrupt or intrude; excessive movement as seen in restlessness and fidgeting behavior; and failures in listening. Although there are subtypes of ADHD, all of these reflect, to varying extents, Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. In fact, there are not only other models but some of these have alsobeen associated with supporting empirical studies (Plume, 1995). The diagnosticcriteria for ADHD must be present for at least six months prior to thediagnosis. Thus, findings areimprecise and may be confounded by the comorbidity factor including thepresence of more than one disruptive disorder, and or ADHD subtype. Conclusions The purpose of the literature review presented here was to examinethe existing research on the association of ADHD and chronic cocaine abusein relation to the Self-Medication Hypothesis which postulates thatindividuals with ADHD use cocaine to alleviate the symptoms theyexperience. Dostimulants improve self-esteem in children with ADHD and peer problems?Journal of Child and Adolescent Psychopharmacology, 9(3), 185-194. (1995). As noted by Davison and Neale (2 ), most theorists and researchersnow agree that a constellation of factors can be correlated with initiationand continuation of chemical use and dependency. Given that several studies have shown that thepreferred drug of abuse for ADHD patients is cocaine (Schubiner, Tzelepis,Milberger, Lockhart, Kruger, Kelley & Schoener, 2 ), the questionbecomes: Why would ADHD individuals prefer cocaine as a form of self-medication? According to Plume (1995), cocaine has been found to operate toreduce or alleviate certain difficult emotional states. The Self-Medication Hypothesis In his original formulation of the Self-Medication Hypothesis,Khantzian (1985) suggests that preferred drugs of abuse are not chosenrandomly or purely circumstantially. (2 ). Thisfairly consistent finding has lead many psychologists and psychiatrists toformulate explanative models of the nature of the association between adiagnosis of ADHD and chronic abuse of cocaine (Davison & Neale, 2 ). Thus, it is thought thatindividuals with ADHD may be using cocaine to "self medicate" these diseasesymptoms and so rid themselves of the unpleasant sensations and concomitantemotional reactions associated with these symptoms. While some may say that the pharmacotherapeutic approach is reallyonly creating more controllable form of addiction, it is really doing morethan this in that developed medications are likely to reduce cravings fordrug and to, unlike cocaine, be non-toxic or less toxic to the system.Indeed, one fairly successful example of pharmacologic treatment is the useof Methadone for heroin addicts. Thus, theaddictive behavior of substance abusers is really a form of self-medicationengaged in to alleviate psychoemotional symptoms associated with existingpsychological disorders. Similarly, across the range of personsaffected by substance abuse, there are wide variances in precipitatingfactors and motivations for continued use. (1993). First, Plume (1995) notes that several supporting studies of the Self-Medication Hypothesis were non-blind, non-placebo clinical studies. Several researchers haveused ADHD samples without attempting to weed out other mental and/orphysical problems in some of the sample subjects. This can be considered against some very current findingsshowing that stimulant medication tends to alleviate this problem in ADHDchildren. Langrod (Eds.), Substance abuse: A comprehensivetextbook (Second Edition). In otherwords, medications can be used to alleviate the symptoms associated withADHD making the need for chronic abuse no longer necessary. Although there are subtypes of ADHD, all of thesereflect, to varying extents, the basic pattern of poor concentration,excessive movement, and frequent interruption (APA, 1994). & Rounsaville, B.J. Attention deficit hyperactivitydisorder and anxiety: is there an association with neurodevelopmentaldeficits? & Luk, E.S. Several benefits have been associated withswitching addicts to methadone and it is likely that there will be similarbenefits for any pharmacologic treatments developed for ADHD patients whoare chronic cocaine abusers due to the need to self-medicate. Third, substance abuse in general is known to be multiply determinedby cognitive, biophysical, and psychosocial factors (Davison & Neale,2 ). One of the non-supportive findings is that stimulantmedication given to ADHD individuals as adults may in fact create negativeemotional states as opposed to reducing them. Thereview of literature presented here examines one of the these models,namely the Self-Medication Hypothesis which was originally developed byKhantzian (1995). No single explanationappears adequate in most cases. Thus, itsbasic efficacy must be judged as no more than moderate in scope as of thispoint in the ongoing research effort to investigate the cocaine/ADHDconnection. In a comprehensivereview of the literature on the self-medication hypothesis, Plume reportedthat longitudinal studies tend to show that many behaviors andpsychological symptoms in males with ADHD believed to be the result of druguse were actually present before drug use. There are many studies of cocaine abusers with and without ADHDwhich indicate that the tendency to abuse cocaine is much stronger amongyoung ADHD adults than among older ADHD adults; further, the researchindicates that one is more likely in some situations to abuse cocaine thanin other situations (Davison & Neale, 2 ). 7) Plume (1995) does report that the existing research in this area issparse and some of it is confounded by difficulties in equating samplegroups. Abnormal psychology (8th ed.) NY:Wiley.Frankel, F., Cantwell, D.P., Matt, R. The self-medication hypothesis of addictivedisorders: Focus on heroin and cocaine dependence. Empirical ResearchLiterature That Supports The Self-Medication Hypothesis If the self-medication hypothesis is correct, then it might beexpected that empirical testing would suggest or indicate some sort ofcausal relationship between substance abuse and psychopathology in generalas well as between ADHD and cocaine abuse specifically. Article available at:www.druglibrary.org/ schaffer/cocaine/addhyp.htm. Khantzian (1985) himself presents several case studies to support theSelf-Medication Hypothesis. (1985). As to the utility of the model, to the extent that it aptlycharacterizes the connection between ADHD and chronic cocaine abuse, it canbe quite useful to both clinicians and researchers in that it carries withit a number of implications for making treatment of the abuse problem moresuccessful. (1998). However, it also offerssupport for other theoretical postulates concerning the connection betweenchronic cocaine abuse and ADHD. In this regard, itcan be noted that the existing knowledge base does offer some support forthe validity of the Self-Medication Hypothesis. For example, there are learning models which postulate that certainareas of the brain, when stimulated, produce pleasurable feelings. Thus, it is likely that the model mayexplain a component or aspect of the connection in some ADHD individualsbut not the entire relationship between cocaine abuse and ADHD. Thus, it is unlikely that drugsare themselves causative of the behaviors and more likely that drug use maybe associated with efforts to mitigate ADHD symptoms. For example, Frankel, Cantell, Myatt and Feinberg (1999) compareda group of ADHD children given stimulant medication with a group of ADHDchildren who did not receive medication. The model further holds that if their emotional discomfort isrelieved by cocaine, they will persist in using this substance to continueachieving such results. With respect to the foregoing,, in a review of the ADHD literature,Vance and Luk (1998) reported that ADHD patients often experience a greatdeal of anxiety which is associated with a poor response to psychostimulantmedication. Regarding the model's basic efficacy, this must be related to thedegree to which the literature supports its validity. History and significance ofchildhood attention deficit disorders in treatment-seeking cocaine abusers.Comprehensive Psychiatry, 34(2), 75-82. It is possible, however, that ongoing research and refinementsin the model will increase its basic efficacy as an explanative model ofwhy so many ADHD patients are also chronic cocaine abusers. Davison, G.C. Gardner, E.L. These includesymptoms clearly associated with ADHD such as having a sense of boredom andemptiness, experiencing difficulties associated with poor attention andconcentration, and experiencing the excessive movement associated withhyperactivity. It is noted that more research must be conducted before strongconfidence can be placed in these findings. Khantzian's (1985) Self-Medication Hypothesis does not adequately address or explain the greatvariability of reliance on drugs and addiction in the same individuals oversituations and life span.Consideration of the Quality of The Existing Research Before deciding on the efficacy and the utility of the Self-Medication Hypothesis it is necessary to first determine the generalquality of the existing research in the area as quality determines thedegree of confidence that can be placed in general findings. (1999). These studies indicate that in terms of bothself-report and neurological data, the use of cocaine calms ADHD patients.Also, it helps them to reduce their excessive movement and to experiencefairly normal sleeping and eating patterns. (1992). References American Psychiatric Association. Further, it reduces theirimpulsive behavior and thoughts.Literature That Does Not Support The Self-Medication Hypothesis What needs to be recognized is that while there is some support forthe self-medication hypothesis, there are some results from studies that donot support it. According to Plume(1995), there has been supporting research in this area. Brain reward mechanisms. Indeed, many ADHDpatients also have other disruptive disorders such as conduct disorder.Moreover, there has been almost no attempt to separate ADHD subtypes instudies of the association between ADHD and cocaine. Related to the foregoing is the conceptual failings of the modelitself. Prevalence of attention-deficit/hyperactivity disorder and conduct disorder among substanceabusers. In other words, the relianceon the substance, and the nature and quality of the addiction varies acrosslife circumstances and over the life-cycle. Rather, it is held that individualsdiscover that the specific actions or effects of each class of drugsrelieve or change a range of painful affect (emotional) states. Journal of Clinical Psychiatry, 61(4), 244-251. Thesemodels hold that psychoactive substances are capable of acting on thesebrain mechanisms to produce these sensations. Australian and New Zealand Journal of Psychiatry, 32(5), 65 -67 .----------------------- 12 Almost none of the existing studies have attempted to parcel out thecontribution of this constellation of known factors (e.g., genetic,psychosocial, cognitive, etc.) and the propensity to self-medicate as itrelates to the association between ADHD and cocaine abuse. The authors reported that their findings showed that stimulants wereassociated with significantly higher self-esteem. (4th ed.) Washington, DC:American Psychiatric Association Press. Further,it was found that higher doses were actually associated with higher self-esteem. & Schoener, E.P. & Neale, J.M. Specifically, it wasfound that children with ADHD prescribed stimulants reported feeling moreintelligent and more popular than unmedicated children with ADHD. What is needed is to determinewhether ADHD patients with high levels of anxiety tend to become substanceabusers, especially cocaine abusers, in significantly reduced numbers whencompared to ADHD patients with low levels of anxiety. Another problem with the Self-Medication Hypothesis is that it is notthe only explanative model of the association between ADHD and cocaineabuse. Some indirect support for the Self-Medication Hypothesis also comesfrom studies showing that ADHD individuals often report that the use ofcocaine helps them to deal with problems of low self-esteem (Davison &Neale, 2 ). ADHD AND CHRONIC COCAINE ABUSE Introduction In general, Attention-Deficit and Disruptive Behavior Disordersconsist of three socially disruptive behavioral patterns which are:attention-deficit hyperactivity disorder (ADHD), conduct disorder, andoppositional defiant disorder (Davison & Neale, 2 ). & Feinberg, D.T. This study shows not only that stimulants (of which cocaine is one)can operate to reduce ADHD symptoms; it also suggests that ADHD adults whoare abusing cocaine may well be doing so to alleviate self-esteem problems. American Journal ofPsychiatry, 142(11), 1259-1264. Lowinson, P.Ruiz, R.B. These pleasurable feelingsthen become reinforcers that drive the continued use of the substances.According to Gardner (1992), a good deal of support has been found forlearning mechanisms such as reinforcement as at least one contributor toaddiction. Diagnostic and statisticalmanual of mental disorders: Primary care version. (1995). Interestingly, a good deal of research has indicated that asubstantial proportion of the population of teens and adults diagnosed withADHD are also chronic cocaine abusers (Carroll & Rounsaville, 1993). (p. In other words,there has been little exploration for the extent to which other factors maymodify or augment the ADHD/cocaine connection and as such, the existingbody of research is incomplete making any model that is based on it, atbest, imprecise. In J.H. The self-medication hypothesis: ADHD and chroniccocaine abuse. Indeed, Plume (1995) notes that cocaine is a central nervous system(CNS) stimulant with pharmacological properties similar to the stimulantmedications Ritalin, Cylert, and Dexedrine that are commonly used to treatattention-deficit hyperactivity disorder. Second, there is the problem of comorbidity. A second implication of the Self-Medication model is that asubstantial reduction of chronic cocaine abuse in ADHD populations islikely to be reduced through pharmacotherapeutic interventions. It then goes on to discuss the empirical literaturethat both supports and fails to support the model; this discussion of theresearch includes a consideration of the quality of the existing research.Based on the presented examination of these studies, the review closes withthe formulation of conclusions concerning the model's basic efficacy andutility. Baltimore: Williams & Wilkins. Thus, at least some ADHD patients may not obtain any beneficialeffects from cocaine or other stimulants. In this regard, itis noted by Plume that: In studies comparing adolescents treated for ADHD with stimulant medications and adolescents without ADHD treatment for ADHD was seen to decrease the risk for future adult drug and alcohol use...Adolescents appropriately treated for ADHD showed similar, and in some cases, less incidences of substance abuse than controls. So far this researchhas not been conducted. Support for learning and other models suggests that the Self-Medication Model may explain some but not all of the association betweenchronic cocaine abuse and ADHD. First, the model supports the notion that the best way to avoid thenegative consequences of substance abuse is abstinence; this due to thefact that the model basically postulates a underlying powerlessness of theperson to control their behavior once the drugs begin to work their effectsin terms of symptom alleviation. Carroll, K.M. These criteria, according to the American PsychiatricAssociation (APA, 1994), include: short-attention span or easydistractibility; impulsivity; repeated tendency to interrupt or intrude;excessive movement as seen in restlessness and fidgeting behavior; andfailures in listening. Vance, A.L. Schubiner, H., Tzelepis, A., Milberger, S., Lockhart, N., Kruger, M.,Kelley, B.J. The presented review first delineates and describes the Self-Medication Hypothesis. Suchresearch lacks the rigorous controls over confounding factors found inexperimental research. In thisregard, Plume (1995) has pointed out that the existing knowledge basesuffers from a plethora of studies with problematic methodologies. Plume D. Some important questions that can be asked regarding the Self-Medication Hypothesis as it applies to ADHD and chronic cocaine abuse are:(1) Does the existing literature support the notion of self-medication; and(2) If there is support for self-medication, how strong is this support?The next section of the presented review examines literature relevant toanswering these questions. Similarly, Plume (1995) reports that some studies suggest thepossibility that when ADHD adolescents receive stimulant medications, thererisk of cocaine abuse in the future may be reduced--findings that arestrongly supportive of the Self-Medication Hypothesis. Khantzian, E.J. (2 ). Millman & J.G. As such, the degree of confidence that can be placedin the findings that emerged from this research must, therefore, be low tomoderate. If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.