Basics of qualitative research: Grounded theory procedures and techniques

This article presents an introduction to the Health Belief Model (HBM). The HBM states that the perception of a personal health behavior threat is influenced by at least three factors: general health values, interest and concern about health; specific beliefs about vulnerability to a particular health threat; and beliefs about the consequences of the health problem. Once an individual perceives a threat to his health and is simultaneously cued to action, if his perceived benefits outweighs his perceived costs, then the individual is most likely to undertake the recommended preventive health action. Key words: health promotion, health belief model, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy. Content available only in Romanian.

Health Belief Model

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

This article reviews scientific advances in the prevention and treatment of substance-use disorder and related developments in public policy. In the past two decades, research has increasingly supported the view that addiction is a disease of the brain. Although the brain disease model of addiction has yielded effective preventive measures, treatment interventions, and public health policies to address substance-use disorders, the underlying concept of substance abuse as a brain disease continues to be questioned, perhaps because the aberrant, impulsive, and compulsive behaviors that are characteristic of addiction have not been clearly tied to neurobiology. Here we review recent advances in the neurobiology of addiction to clarify the link between addiction and brain function and to broaden the understanding of addiction as a brain disease. We review findings on the desensitization of reward circuits, which dampens the ability to feel pleasure and the motivation to pursue everyday activities; the increasing strength of conditioned responses and stress reactivity, which results in increased cravings for alcohol and other drugs and negative emotions when these cravings are not sated; and the weakening of the brain regions involved in executive functions such as decision making, inhibitory control, and self-regulation that leads to repeated relapse. We also review the ways in which social environments, developmental stages, and genetics are intimately linked to and influence vulnerability and recovery. We conclude that neuroscience continues to support the brain disease model of addiction. Neuroscience research in this area not only offers new opportunities for the prevention and treatment of substance addictions and related behavioral addictions (e.g., to food, sex, and gambling) but may also improve our understanding of the fundamental biologic processes involved in voluntary behavioral control. In the United States, 8 to 10% of people 12 years of age or older, or 20 to 22 million people, are addicted to alcohol or other drugs. 1 The abuse of tobacco, alcohol, and illicit drugs in the United States exacts more than $700 billion annually in costs related to crime, lost work productivity, and health care. 2-4 After centuries of efforts to reduce addiction and its related costs by punishing addictive behaviors failed to produce adequate results, recent basic and clinical research has provided clear evidence that addiction might be better considered and treated as an acquired disease of the brain (see Box 1 for definitions of substance-use disorder and addiction). Research guided by the brain disease model of addiction has led to the development of more effective methods of prevention and treatment and to more informed public health policies. Notable examples include the Mental Health Parity and Addiction Equity Act of 2008, which requires medical insurance plans to provide the same coverage for substance-use disorders and other mental illnesses that is provided for other illnesses, 5 and the proposed bipartisan Senate legislation that From the National Institute on Drug Abuse (N.D.V.) and the National Institute of Alcohol Abuse and Alcoholism (G.F.K.) — both in Bethesda, MD; and the Treatment Research Institute, Philadelphia (A.T.M.). Address reprint requests to Dr. Volkow at the National Institute on Drug Abuse, 6001 Executive Bld., Rm. 5274, Bethesda, MD 20892, or at nvolkow@ nida . nih . gov.

Review Article: Neurobiologic Advances from the Brain Disease Model of Addiction

This discussion by a leading expert on drug use illuminates the factors that permit some people to use such highly addictive and dangerous substances as alcohol, marijuana, psychedelics, and opiates in a controlled fashion.

Understanding and Controlling Drug Users@@@Trafficking in Drug Users: Professional Exchange Networks in the Control of Deviance.@@@Substance Abuse, Habitual Behavior, and Self-Control.@@@Drug, Set, and Setting: The Basis for Controlled Intoxicant Use.

This research compared real-time measurements of alcohol consumption with retrospective accounts of alcohol consumption to examine possible discrepancies between, and contextual influences on, the different accounts.

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"I have no clue what I drunk last night" using Smartphone technology to compare in-vivo and retrospective self-reports of alcohol consumption.

To assess the validity of the research into alcohol-related outcome expectancies a systematic review of 80 articles published between 1970 and 2013 was conducted. Participant gender, age, and contextual influences are highlighted as possible causes of the observed variations in research findings. There is a need for fuller consideration of the influences of demographics and environmental and social contexts on research findings. It is recommended that alcohol intake measures should be standardized to a greater degree in future research. Contextual influences on expectancies also require extensive future investigation to increase the validity of research and improve alcohol-related interventions.

https://www.tandfonline.com/doi/pdf/10.3109/10826084.2013.787097

A critical systematic review of alcohol-related outcome expectancies.

The purpose of this study was to examine the effect of environmental contexts on alcohol norms, expectancies, and efficacy ratings. University students (n = 177) recruited via opportunity sampling completed questionnaires in either university lecture theaters or in a student bar. Positive social, fun, and tension reduction outcome expectancies were higher and social drink refusal self efficacy was lower in those participants questioned in a student bar relative to those questioned in a university lecture theater. These differences were found while controlling for between-groups variations in typical alcohol consumption quantities. Although hitherto largely unexamined by research, context appears to be a potentially important moderator of alcohol-related cognitions. Such findings require further exploration to inform more effective intervention approaches and have implications for the validity of existing literature.

Environmental context effects on alcohol-related outcome expectancies, efficacy, and norms: a field study.

Background: This research used context aware experiential sampling to investigate the effect of contexts on in vivo alcohol-related outcome expectancies. Method: A time-stratified random sampling strategy was adopted in order to assess 72 students and young professionals at 5-daily intervals over the course of a week using a specifically designed smart-phone application. This application recorded respondents' present situational and social contexts, alcohol consumption and alcohol-related cognitions in real-time. Results: In-vivo social and environmental contexts and current alcohol consumption accounted for a significant proportion of variance in outcome expectancies. For instance, prompts which occurred whilst participants were situated in a pub, bar or club and in a social group of friends were associated with heightened outcome expectancies in comparison with other settings. Conclusion: Alcohol-related expectancies do not appear to be static but instead demonstrate variation across social and environmental contexts. Modern technology can be usefully employed to provide a more ecologically valid means of measuring such beliefs.
Key Words: Alcohol, Social cognition, Social cognition models, Context, Expectancies, Smartphone technology, Real-time sampling

A Real-Time Examination of Context Effects on Alcohol Cognitions

Although much is known about the effect of one's cognitions on alcohol consumption, there has been considerably less examination of their contextually varying nature. Using panoramic filming and projection as a system of controlled contextual cueing the present study examined the effect of social influence and environmental cues on alcohol-related cognitions. A 2 × 2 factorial design simultaneously varied environmental cues (bar or lecture based panoramic videos) with social influence (peer group or solitary assessment). Results indicated that participants' positive outcome expectancies were higher, and drink refusal self efficacy was lower, when they were assessed as part of a group rather than alone. Participants exposed to pub, as opposed to lecture-based cues, also showed greater expectancies and lower drink refusal self efficacy. An interactive effect of social influence and environmental cues was observed for both positive and negative expectancies. Group testing and alcohol-related cueing also resulted in higher ratings of participants' own and others' alcohol consumption when compared with solitary testing and neutral cueing conditions. It is concluded that environmental and social contextual factors may be important mediators of alcohol-related cognitions, a finding that potentially has implications for the delivery of interventions.

Rebecca L. Monk

Papers

"I have no clue what I drunk last night" using Smartphone technology to compare in-vivo and retrospective self-reports of alcohol consumption.

A critical systematic review of alcohol-related outcome expectancies.

Environmental context effects on alcohol-related outcome expectancies, efficacy, and norms: a field study.

A Real-Time Examination of Context Effects on Alcohol Cognitions

Panoramic projection: affording a wider view on contextual influences on alcohol-related cognitions.