Content uploaded by Eduardo J. Pedrero-Pérez
Author content
All content in this area was uploaded by Eduardo J. Pedrero-Pérez on Aug 11, 2015
Content may be subject to copyright.
A preview of the PDF is not available
Salud Mental y Adicción
Abstract and Figures
El trabajo traza un recorrido desde la historia del concepto de adicción hasta la actual perspectiva dominante, impuesta por la psiquiatría biológica, de "enfermedad cerebral crónica" y "patología dual". Se plantean muchas evidencias que refutan esa concepción de la adicción como enfermedad. Finalmente, se proponen los nuevos hallazgos de la neurociencia y la psicología, planteando cuestiones como el paradigma del enriquecimiento ambiental, el modelo de empoderamiento y el paradigma de la recuperación de la adicción, como alternativas científicas, pero también como enfoques respetuosos con las personas.
The work traces a path from the history of the concept of addiction to the current dominant view imposed by biological psychiatry, of "chronic brain disease" and the "dual pathology". A great amount of evidence to refute this concept of addiction as a disease arise. Finally, it propose the new findings of neuroscience and psychology, raising questions as the paradigm of environmental enrichment, the empowerment model and the paradigm of recovery from addiction, as scientific alternatives, but also as more respectful approaches to people with addictive behaviors are proposed.
DOI: 10.13140/RG.2.1.3386.8649
Figures - uploaded by Eduardo J. Pedrero-Pérez
Author content
All figure content in this area was uploaded by Eduardo J. Pedrero-Pérez
Content may be subject to copyright.
... There has been much criticism of this model, as can be imagined [e.g., de Leon, 2015;Hall, Carter, & Forlini, 2015;Hammer et al., 2013;Levy, 2013;Pedrero, 2015;Pérez, 2013). ...
Background: In recent years, we have repeatedly been told that addictions
are a brain disease, leaving aside their classic biopsychosocial explanation.
Objective: To describe both models and discusses the weakness and
reductionism of the brain disease model following the consumption
of heroin by North American soldiers in the Vietnam war in the 1970s.
Method: A literature review of the Vietnam Veteran Study in relation to drug
consumption. Results: The soldiers greatly increased their consumption of
heroin in Vietnam, but almost all of them ceased using it upon returning
home. The analysis of the environmental factors related to this self-healing
is a critique of the brain disease model of addictions because it cannot
explain this or other studies. Conclusion: The biopsychosocial model
is still the best model to guide the fi eld of addiction due to its utility,
coherence, and effi cacy in treatment.
Keywords: Addiction, brain disease, biopsychosocial, Vietnam Veteran
Study, heroin.
118 n el volumen 507 de la prestigiosa revista Nature , se publicó el 6 de marzo de 2014 una carta al director con el título " Addiction: not just brain malfunction " [Adicción: no sólo un mal funcionamiento cerebral] firmada por Derek Heim (2014). A pie de pá-gina del mismo le acompañaban 94 firmantes, relevan-tes investigadores, clínicos, directores de revistas de adicciones, de centros de tratamiento, etc., de varios pa-íses, criticando la consideración de " la adicción como una enfermedad cerebral " ya que " el abuso de sustan-cias no puede ser separado de sus contextos sociales, psicológicos, culturales, políticos, legales y ambientales; no es simplemente una consecuencia del mal funciona-miento cerebral " (p. 40). E insistían en que " tal perspec-tiva miope socava el enorme impacto de las circunstancias y las elecciones de las personas que tie-nen en las conductas adictivas. Trivializa los pensamien-tos, emociones y conductas de los adictos actuales y de los que lo han sido " (p. 40). Algunos de los firmantes son personas bien conocidas como Estamos ante un tema importante, central en la concep-tualización de las adicciones y que tiene claras repercu-siones sobre la prevención, el tratamiento y la política de drogas. También sobre el rol profesional de distintas pro-fesiones, como la psicológica. Desgraciadamente, en los últimos años la conceptualización biológica-cerebral de las adicciones está cogiendo un derrotero reduccionista, por estar supeditado a claros intereses y grupos de pre-sión alrededor del mismo y por la ruptura, o distancia-miento, a la que estamos asistiendo después de décadas de colaboración fructífera entre distintas disciplinas en el campo de las adicciones. En estas páginas analizamos qué hechos han permiti-do llegar a la situación actual y qué nos depara el futuro desde una lectura psicológica. ¿QUÉ ES LO QUE HA LLEVADO A ESTA SITUACIÓN? Los primeros planteamientos de la adicción como una enfermedad cerebral Han sido varios los modelos que han predominado en el campo de las adicciones a lo largo de la historia has-ta que se convirtió en un importante problema social, en-tre los años 60 y 80 del pasado siglo, en la mayoría de los países desarrollados. En los últimos años se ha ido consolidando la idea en el campo médico-psiquiátrico de que la adicción es una " enfermedad cere-bral " , como ya así recoge el DSM-5. En este articulo se analiza cómo ha surgido y se ha consolidado esta idea, las críticas que ha recibido, las consecuencias profesionales si este modelo se hace hegemónico, junto a los intereses subyacentes al mismo. Se concluye defendiendo la necesidad de mostrar como psicólogos nuestras claras aportaciones al campo de las adicciones, como el de las variables psicológicas que son necesarias para la comprensión de las adicciones, para su prevención, junto con el papel central del tra-tamiento psicológico por su eficacia en las mismas. También debemos denunciar los reduccionismos, como el que representa el modelo de enfermedad cerebral frente a un modelo biopsicosocial de las adicciones. Palabras clave: Adicción, Drogas, Enfermedad cerebral, Psicología. The idea that addiction is a " brain disease " has gradually been consolidated in the medical-psychiatric field over the last years, as it appears in the current DSM-5. In this paper we analyse the way this idea has arisen and been consolidated, as well as the criticisms that it has received, the professional consequences if this model becomes hegemonic, and the underlying interests. The conclusion defends the need to show, as psychologists, our clear contributions to the field of addictions, and the psychological variables that are necessary in order to understand and prevent addictions, as well as the central role of psychological treatment due to its effectiveness. We must also denounce the reductionism that the model of brain disease represents in comparison with a biopsychosocial model of addiction.
En los últimos años se ha ido consolidando la idea en el campo médico-psiquiátrico de que la adicción es una “enfermedad cerebral”, como ya así recoge el DSM-5. En este articulo se analiza cómo ha surgido y se ha consolidado esta idea, las críticas que ha recibido, las consecuencias profesionales si este modelo se hace hegemónico, junto a los intereses subyacentes al mismo. Se concluye defendiendo la necesidad de mostrar como psicólogos nuestras claras aportaciones al campo de las adicciones, como el de las variables psicológicas que son necesarias para la comprensión de las adicciones, para su prevención, junto con el papel central del tratamiento psicológico por su eficacia en las mismas. También debemos denunciar los reduccionismos, como el que representa el modelo de enfermedad cerebral frente a un modelo biopsicosocial de las adicciones.
The idea that addiction is a “brain disease” has gradually been consolidated in the medical-psychiatric field over the last years, as it appears in the current DSM-5. In this paper we analyse the way this idea has arisen and been consolidated, as well as the criticisms that it has received, the professional consequences if this model becomes hegemonic, and the underlying interests. The conclusion defends the need to show, as psychologists, our clear contributions to the field of addictions, and the psychological variables that are necessary in order to understand and prevent addictions, as well as the central role of psychological treatment due to its effectiveness. We must also denounce the reductionism that the model of brain disease represents in comparison with a biopsychosocial model of addiction.
Choice, Behavioural Economics and Addiction is about the theory, data, and applied implications of choice-based models of substance use and addiction. The distinction between substance use and addiction is important, because many individuals use substances but are not also addicted to them. The behavioural economic perspective has made contributions to the analysis of both of these phenomena and, while the major focus of the book is on theories of addiction, it is necessary also to consider the behavioural economic account of substance use in order to place the theories in their proper context and provide full coverage of the contribution of behavioural economics to this field of study. The book discusses the four major theories of addiction that have been developed in the area of economic science/behavioural economics. They are:â hyperbolic discountingâ meliorationâ relative addictionâ rational addiction The main objective of the book is to popularise these ideas among addiction researchers, academics and practitioners. The specific aims are to articulate the shared and distinctive elements of these four theories, to present and discuss the latest empirical work on substance abuse and addiction that is being conducted in this area, and to articulate a range of applied implications of this body of work for clinical, public health and public policy initiatives. The book is based on an invitation-only conference entitled, Choice, Behavioural Economics and Addiction: Theory, Evidence and Applications held at the University of Alabama at Birmingham, March 30 - April 1, 2001. The conference was attended by prominent scientists and scholars, representing a range of disciplines concerned with theories of addiction and their consequences for policy and practice. The papers in the book are based on the papers given at the above conference, together with commentaries by distinguished experts and, in many cases, replies to these comments by the presenters.
The article which follows this introduction was originally published as a Special (Cover) Article in the American Journal of Psychiatry in the November, 1985 issue, the same month in which the First International Drug Symposium, sponsored by The Bahamas Ministry of Health and The Embassy of the United States of America, was convened to discuss the rock-cocaine epidemic in the Bahamas and other Caribbean Islands. Based on my article, I was invited to participate in the Symposium and to speak about some of my views on the psychological predispositions for drug dependence in general, and in particular, on the psychological predisposition for cocaine dependence. At first, I did not grasp the seriousness and scope of the cocaine problem, but I accepted the invitation, believing I might make a contribution to the Symposium. I was not long in attendance at the Symposium before I realized that the Bahamian citizens, professionals, and health care leaders were facing a major crisis as a consequence of the cocaine epidemic.
Objective: The purpose of this study was to determine the most clinically relevant baseline predictors of time to remission for patients with borderline personality disorder. Method: A total of 290 inpatients meeting criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R for borderline personality disorder were assessed during their index admission with a series of semistructured interviews and self-report measures. Diagnostic status was reassessed at five contiguous 2-year time periods. Discrete survival analytic methods, which controlled for baseline severity of borderline psychopathology and time, were used to estimate hazard ratios. Results: Eighty-eight percent of the patients with borderline personality disorder studied achieved remission. In terms of time to remission, 39.3% of the 242 patients who experienced a remission of their disorder first remitted by their 2-year follow-up, an additional 22.3% first remitted by their 4-year follow-up, an additional 21.9% by their 6-year follow-up, an additional 12.8% by their 8-year follow-up, and another 3.7% by their 10-year follow-up. Sixteen variables were found to be significant bivariate predictors of earlier time to remission. Seven of these remained significant in multivariate analyses: younger age, absence of childhood sexual abuse, no family history of substance use disorder, good vocational record, absence of an anxious cluster personality disorder, low neuroticism, and high agreeableness. Conclusions: The results of this study suggest that prediction of time to remission from borderline personality disorder is multifactorial in nature, involving factors that are routinely assessed in clinical practice and factors, particularly aspects of temperament, that are not.
Edited by Benjamin L. Hankin and John R. Z. Abela, Development of Psychopathology: A Vulnerability-Stress Perspective brings together the foremost experts conducting groundbreaking research into the major factors shaping psychopathological disorders across the lifespan in order to review and integrate the theoretical and empirical literature in this field. The volume editors build upon two important and established research and clinical traditions: developmental psychopathology frameworks and vulnerability-stress models of psychological disorders.
