Theories of Addiction

♧ Behavior Model of Addiction

Rather than viewing "addiction" as anything particularly mysterious, behaviorists see addictive behaviors as part of a larger class of "excess" behaviors: an operantly conditioned response that, as a result of the individual's history of prior reinforcement and punishment, tends to occur at a high rate relative to other more socially desirable or productive responses, and thus is maladaptive. The torments of withdrawal suffer from popular exaggeration; for example, in an attempt to describe heroin withdrawal in objective terms, experts have said that it is roughly equivalent to a severe case of an intestinal or flu virus, with chills, shakes, cramps and nausea - unpleasant, yes, but life-altering...?

With respect to the widely-used narcotic pain-killers just referred to, yes, most of those who use these prescriptions do report experiencing withdrawal when they stop, but they still stop. In other words, there is good reason to believe that the behavior of addicts might be nothing more complicated than a habit. They engage in the behavior because that is what they are in the habit of doing, that's how they have been conditioned to behave.

Behavioral concepts and principles can be applied in many ways to addiction:

♤ Psychoactive drugs can be very potent reinforcers, both positive (euphoria, potency, sociability, peer acceptance) and negative (tension-reduction, escape from boredom, "drowning one's sorrows,")

♤ Relief from withdrawal symptoms by resumed use of drugs can be a very potent negative reinforce. The reinforcers of substance use might be stronger than their punishers (hangovers, arrests, social disapproval, getting fired), and the reinforcers are usually more immediate and certain while punishers are often delayed and uncertain

♤ The desire or craving can generalize to a variety of stimuli that prompt the behavior, and there might be a failure to discriminate when to use or not use, or when one has had too much. With so many reinforcers and conditioned stimuli, extinction can be hard to achieve, and spontaneous recovery (relapse) is common

Behaviorists use these and other concepts to deal with four separate issues: the factors associated with initiation of use, maintenance of use, cessation of use, and slip or relapse (resumption of use).

To a behaviorist, the behavior of consuming alcohol or some other drug can be understood in terms of conditioning of specific associations, also known as expectancies:

♤ The expectation of taking a drug (which to a "mentalist" would be understood in terms of "need" or "desire" or "craving," terms that behaviorists try to avoid)

♤ The expectation of the type of effect that taking the drug will produce.

♤ The expectation of the consequences that will occur as a result of taking the drug

Some studies suggest that alcoholics cannot easily determine their degree of intoxication on internal cues alone and if given external cues, or feedback, they are much less likely to drink to intoxication ("blood alcohol discrimination")

♧ Bio-psychosocial model of Addiction

Addiction is recognized as a complex disorder that involves biological, psychological, social, and spiritual components and therefore must be conceptualized and treated utilizing the biopsychosocial-spiritual model.

A clinical and preventative approach to addiction is much more effective than the traditional punitive approaches taken by the criminal justice system. As we move away from the past approaches to addiction toward more innovation, we now understand that addiction is a “brain disease” that affects all areas of life and requires long-term comprehensive integrated treatment.

Many variables have shaped the understanding of addiction over time including historical, cultural, political, economic, and societal influences, which in turn have determined our approaches to managing the devastating and far-reaching consequences of substance misuse and related addictive behaviors. As the addiction treatment field has evolved, it continues to move away from punitive dogmatic approaches to more client centered holistic approaches.

Strengths based models of addiction treatment integrate a variety of influential components that enhance the understanding and ability to effectively treat the entire individual within his or her social, cultural, psychological, and biological contexts.

Effective and integrated treatment models offer hope, guidance, dignity, and respect for the suffering individual. When treating individuals suffering from substance use disorders and co-occurring disorders one of the most valuable messages offered is the unwavering belief that recovery is possible and that the individual possesses the inherent capacity to heal and find wholeness again.

Addiction brings the individual to a place characterized by complete hopelessness and despair. Strengths based treatment modalities offer the individual a restored sense of possibility and hope. Without this, the suffering individual is unlikely to take the necessary steps toward positive change which reduces the shame and stigma often associated with addiction. It is through compassion, fellowship, and the resilience of the human spirit that destructive beliefs and assumptions can be challenged and replaced with an appreciation for the individual’s inherent strengths and ability to heal.

Addiction, once considered to be an inherent moral failing, is now better understood as a “brain disease” that requires a biopsychosocial-spiritual approach to treatment. The strengths-based approach to addiction treatment highlights the individual’s inherent resilience and ability to recover, as opposed to more traditional perspectives from the past that focus exclusively on pathology. This paradigmatic shift in understanding of mental illness is a key component to reducing the stigma associated with addiction.

This proactive approach to addiction treatment that includes preventative measures and compassionate innovative treatment that empowers and educates individuals, the hope is that recovery is becoming more accessible and successful than it has been before. The integration of a variety of treatment approaches and options coupled with cultural shifts in the conceptualization of addiction are yielding encouraging outcomes and growing opportunities to continue positive developments in the field of addiction treatment.