User talk:MedicalEdits

Peer Review
First off, great job! I think that you have made a great improvement to this article!!

-I like that you took out what was in the mechanism section. I agree that it is going to be too much primary research of very technical topics. (I have included an idea for how to approach a new mechanism section at the bottom, but that is probably a project for the next student)

-I also like that you took out the experimental drugs for the detox and “opposition to common views” section. I agree with what you say on your talk page that sticking with the conservative medical definition is better than trying to address the weeds in an encyclopedia.

-I also think the legality section that you removed was not relevant to the use disorder topic.

-I like the new section on diagnosis and especially the severity piece. Good plain wording

Things to work on:

-The causes section is really confusing. I don’t really get the mediating vs moderating. I think explanation of “a mediating variable is a characteristic or event that increases risk of developing substance abuse while a moderator variable does *** “ as the first or second sentence would be helpful because I got very confused. Also I would change the wording of the first paragraph to say “increases the risk of substance abuse or dependence “ instead of “in turn leads to the outcome, which is *always* substance abuse or dependence” and “leads to substance abuse or dependence” because these are associated risks, not definitive pathways. (I realize that the *always* verbiage is talking about in the chart, but it sounds like you are saying the mediating variable *always* results in the outcome of substance abuse)

-Diagnosis number 2: inability to cut down despite desire to *do* so. Add in the “do”

-recheck the stats from the introduction (I think they may have been from the last person and not you). It says that 137k people died from alcohol use disorders and then in your epidemiology section you say that excessive alcohol consumption accounts for 88k lives lost per year (in the US). I don’t know if the 137k is global or if it is US only Im not sure what one stat is including and the other isn’t, but there seems to be some disparity here that could be clarified.

-New Mechanism section where you put 4-6 sentences saying nucleus accumbens is where scientists think the reward pathway lies. many substances and activities including sugar, sex, and substances cause this pathway to activate and make us associate the activity with pleasure. Other areas of the brain like the VTA (which does motivation and emotional processing) have been found to have association with the withdrawal symptoms in substance abuse disorder.

Once again, great job! I would prioritize bullets 1-3 on Things to work on and let the new mechanism section (bullet 4) be food for thought for the next person unless you have extra time.

Barnecar92 (talk) 19:21, 8 December 2018 (UTC)

removal of section on risk factors
I have decided to remove the section on risk factors due to length, use of primary sources, and lack of accessibility to a general non-psychology-trained audience. I will attempt to begin adding a few sentences on some common risk factors, but encourage others to come and fill this section out with easily accessible writing.

section deleted: As demonstrated by the chart below, numerous studies have examined factors which mediate substance abuse or dependence. In these examples, the predictor variables lead to the mediator which in turn leads to the outcome, which is always substance abuse or dependence. For example, research has found that being raised in a single-parent home can lead to increased exposure to stress and that increased exposure to stress, not being raised in a single-parent home, leads to substance abuse or dependence. The following are some, but by no means all, of the possible mediators of substance abuse.

Predictor Variables	Mediator Variables	Outcome Variable Single-parent Home	Exposure to Stress, Association w/ Deviant Peers	Substance Abuse or Dependence Child Abuse/Neglect	PTSD symptoms, Stressful Life Events, Criminal Behavior	Substance Abuse or Dependence Parental Substance Abuse Witnessing Violence

Physical/Sexual Abuse Delinquency Status

Substance Abuse or Dependence As demonstrated by the chart below, numerous studies have examined factors which moderate substance abuse or dependence. In these examples, the moderator variable impacts the level to which the strength of the relationship varies between a given predictor variable and the outcome of substance abuse or dependence. For example, there is a significant relationship between psychobehavioral risk factors, such as tolerance of deviance, rebelliousness, achievement, perceived drug risk, familism, family church attendance and other factors, and substance abuse and dependence. That relationship is moderated by familism which means that the strength of the relationship is increased or decreased based on the level of familism present in a given individual.

Predictor Variables	Moderator Variables	Outcome Variable Psychobehavioral Risk	Familism Family Church Attendance

Substance Abuse or Dependence Victimization Effects	Race/Ethnicity Physical/Sexual Abuse

Substance Abuse or Dependence Family History of Alcoholism	Gender	Substance Abuse or Dependence Examples of mediators and moderators can be found in several empirical studies. For example, Pilgrim et al.’s hypothesized mediation model posited that school success and time spent with friends mediated the relationship between parental involvement and risk-taking behavior with substance use (2006). More specifically, the relationship between parental involvement and risk-taking behavior is explained via the interaction with third variables, school success and time spent with friends. In this example, increased parental involvement led to increased school success and decreased time with friends, both of which were associated with decreased drug use. Another example of mediation involved risk-taking behaviors. As risk-taking behaviors increased, school success decreased and time with friends increased, both of which were associated with increased drug use. A second example of a mediating variable is depression. In a study by Lo and Cheng (2007), depression was found to mediate the relationship between childhood maltreatment and subsequent substance abuse in adulthood. In other words, childhood physical abuse is associated with increased depression, which in turn, in associated with increased drug and alcohol use in young adulthood. More specifically, depression helps to explain how childhood abuse is related to subsequent substance abuse in young adulthood.

A third example of a mediating variable is an increase of externalizing symptoms. King and Chassin (2008) conducted research examining the relationship between stressful life events and drug dependence in young adulthood. Their findings identified problematic externalizing behavior on subsequent substance dependency. In other words, stressful life events are associated with externalizing symptoms, such as aggression or hostility, which can lead to peer alienation or acceptance by socially deviant peers, which could lead to increased drug use. The relationship between stressful life events and subsequent drug dependence however exists via the presence of the mediation effects of externalizing behaviors.

An example of a moderating variable is level of cognitive distortion. An individual with high levels of cognitive distortion might react adversely to potentially innocuous events, and may have increased difficulty reacting to them in an adaptive manner (Shoal & Giancola, 2005). In their study, Shoal and Giancola investigated the moderating effects of cognitive distortion on adolescent substance use. Individuals with low levels of cognitive distortion may be more apt to choose more adaptive methods of coping with social problems, thereby potentially reducing the risk of drug use. Individuals with high levels of cognitive distortions, because of their increased misperceptions and misattributions, are at increased risk for social difficulties. Individuals may be more likely to react aggressively or inappropriately, potentially alienating themselves from their peers, thereby putting them at greater risk for delinquent behaviors, including substance use and abuse. In this study, social problems are a significant risk factor for drug use when moderated by high levels of cognitive distortions."

MedicalEdits (talk) 19:57, 14 December 2018 (UTC)

Made a few changes
Further details that are useful I have also placed below. For example please add ISBNs for books and page numbers for books. Best Doc James  (talk · contribs · email) 23:05, 14 December 2018 (UTC)

Welcome
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