Understanding Addiction

Theories of Addiction

Theory	Description	Application	Strengths	Limitations	Ethical Concerns
Evolutionary Theory	Addiction arises through interaction of evolutionary ancient systems, designed to promote the pursuit of natural rewards, and contemporary environments where purified and potent forms of drugs are readily available (Durrant & Thakker, 2003). Serotonin, dopamine, norepinephrine,   and acetylcholine require adequate nutrition for their manufacture; accounts for drug seeking behavior.	Because motivational–emotional systems that underpin addiction have important adaptive functions, selection against   drug use would target specific drug-related metabolic processes, rather than underlying neural mechanisms that drugs act on (Durrant, Adamson, Todd, & Sellman, 2009). Strategies include a combination of targeting the mesocortico-limbic reward pathway with pharmacological agents, enhancing self-regulatory capacities, and through restructuring of the social environment to regulate availability and promote increased levels of social control.	Accounts for developmental patterns in problem drug use, explains the existence of behavioral addictions, such as problem gambling (Durrant & Thakker, 2003). Offers a compelling explanation of why drug use is virtually ubiquitous throughout history and across cultures (Durrant & Thakker, 2003). However, because of the fact that repeated drug use can have adverse effects on evolved motivational systems suggests that drug addiction is largely a recent phenomenon (Durrant, Adamson, Todd, & Sellman, 2009).	Testability of evolutionary concepts; historical process, operating in ancestral environment (Durrant & Ward, 2011).	Critics are concerned evolutionary explanations   for human behavior may be used to legitimize or make more acceptable unwanted behaviors or practices (Durrant & Ward, 2011).
Psycho-dynamic Theory	From a psycho-analytic perspective, addiction is a maladaptive response to unconscious emotional needs that result from experiences that occurred early in life (Karasaki, Fraser, Moore, & Dietze, 2013).	The client examines unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in the need and desire to abuse substances. (CSAT, 1999). Brief psycho-dynamic therapy for substance abuse carried out in 25 to 40 sessions.	Effective used alone or in conjunction with other treatments, in groups or individual psycho-therapy (CSAT, 1999).  Evidence-based Practice.	Time constraints: The therapeutic alliance between client and therapist is the central theme (CSAT, 1999). The more severe the client's disorder, the more time it will take to develop this alliance.  May take years to complete therapy.	Similar to limitations. Time constraints: Generally, in utilizing psycho-dynamic therapy, the healing and change process typically requires at least 2 years of sessions 2 or more per week (CSAT, 1999). In many substance abuse treatment programs a Brief intervention is carried out in 25 to 40 sessions.
Biopsycho-social Model	Amalgamates biomedical, psychological and sociological theories (Karasaki, Fraser, Moore, & Dietze, 2013).   Substance misuse is the net result of a complex interaction between a combination of biological, psycho-logical,   social, and spiritual determinants.	Assessments match the client needs to the most appropriate and expeditious intensity of care and treatment modality (CSAT, 1999). Outpatient substance abuse treatment. Therapeutic community residential treatment.	Regard for differences not only in the   severity and types of identified issues but also to the cultural or environ-mental context in which they are encountered, the types of substances abused, and differences in gender, age, education, social, economic stability (CSAT, 1999). Clients then tend to stay in treatment longer, are more likely to complete treatment, and have better post-treatment   outcomes (CSAT, 1999).	There does not seem to be any real limitations as the applications are numerous. However, some critics may regard a biopsycho-social approach as unnecessary if biomedical treatment is used. Also there is increasing demand for treatment facilities to provide the most cost-effective types of treatment (CSAT, 1999). Unless carried out with brief interventions, a biopsycho-social approach incorporates more services for the client.	Similar to limitations: Ethical concerns would involve limiting the client’s biopsycho-social treatment due to costs, not involving the model itself.

  

Biopsychosocial Model

The biopsychosocial model amalgamates biomedical, psychological and sociological theories.  Social theories view addiction as the product of history, culture and environment (Karasaki, Fraser, Moore, & Dietze, 2013).  Drug use is produced in social practice, and drug experiences surface from the interaction of the drug, the individual user, and their environment.  Psychosocial processes include cognitions, emotions, behaviors, social interactions, while cultural-historical factors encompass norms, values, beliefs, and practices that developed over time.  And just as psychosocial and cultural factors play a role, biological processes such as genetic factors, physiological processes, neurotransmitter systems, and abnormalities in the brain’s biochemical structure play a role in abuse and dependency (Durrant, & Thakker, 2003).  Increasingly dominating addiction theories in the past few decades, the biomedical theories view addiction as a chronic and relapsing brain disease (Karasaki, Fraser, Moore, & Dietze, 2013).  Therefore addiction results from the exposure to drugs that cause abnormalities in the brain’s biochemical structure in physiologically susceptible individuals who may have certain genetic predispositions.  This effect triggers uncontrollable compulsions, cravings, and intense withdrawal symptoms, leading to the addicted individual’s irrational and involuntary drug-seeking behaviors.

However, since substance misuse is viewed as the net result of a complex interaction between a combination of biological, psychological, social, and spiritual determinants, the biopsychosocial models are becoming more accepted in addictions treatment (Karasaki, Fraser, Moore, & Dietze, 2013).  In a drug-free outpatient addictions treatment facility, the biopsychosocial model is commonly implemented.  Utilizing a variety of counseling and therapeutic techniques, psychoeduction skills training, and educational supports with very little or no pharmacotherapy, effort is made to address the specific needs of clients moving from active substance abuse to abstinence (Center for Substance Abuse Treatment, 1997).  The treatment approach may vary in intensity, duration of care, and staffing patterns, depending upon the level of care needed for the client.  Biopsychosocial assessment includes a thorough background of the client’s health history, family and social factors, legal and financial state, and psychological and substance use history. Clients may be seen once or twice weekly for individual and group counseling, or more often for intensive outpatient treatment.  Stress management, lifestyle coaching, vocational rehabilitation counseling, family counseling, mental health counseling and psychotherapy for substance use disorder and co-occurring disorders are often found in the treatment plan. 

 References

Center for Substance Abuse Treatment (CSAT). (1997). A Guide to Substance Abuse Services for Primary Care Clinicians. Treatment Improvement Protocol (TIP) Series, No. 24. Chapter 5—Specialized Substance Abuse Treatment Programs. Rockville, MD: U.S. Substance Abuse and Mental Health Services Administration. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK64815/

Center for Substance Abuse Treatment (CSAT). (1999). Brief Interventions and Brief Therapies for Substance Abuse. Treatment Improvement Protocol (TIP) Series, No. 34, Chapter 1—Introduction to Brief Interventions and Therapies. Rockville, MD: U.S. Substance Abuse and Mental Health Services Administration. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK64950/

Center for Substance Abuse Treatment (CSAT). (1999). Brief Interventions and Brief Therapies for Substance Abuse. Treatment Improvement Protocol (TIP) Series, No. 34, Chapter 7—Brief Psychodynamic Therapy. Rockville, MD: U.S. Substance Abuse and Mental Health Services Administration. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK64952/

Durrant, R., & Thakker, J. (2003). Substance use and abuse: Cultural and historical perspectives. Sage Publications.

Durrant, R., & Ward, T. (2011). Evolutionary explanations in the social and behavioral sciences: Introduction and overview. Aggression And Violent Behavior, 16(Evolutionary Approaches to Explaining Violence), 361-370. doi:10.1016/j.avb.2011.02.010

Durrant, R., Adamson, S., Todd, F., & Sellman, D. (2009). Drug use and addiction: Evolutionary perspective. Australian and New Zealand Journal of Psychiatry, 43(11), 1049-1056.

Karasaki, M., Fraser, S., Moore, D., & Dietze, P. (2013). The place of volition in addiction: Differing approaches and their implications for policy and service provision. Drug and Alcohol Review, 32(2), 195-204. doi:10.1111/j.1465-3362.2012.00501.x