Often the question arises, "Why do people get addicted"? Each proponent of a theory states that they know the answer - the fact remains that there still appears to no 100% difinitive answer - below you will find a number of the most widley used theories / models of addiction.
Models / Theories of Addiction
Collated by Greg Christodoulu (2013)
Addiction has been around for as long as society however Addiction Theories / Models have only come about in the last 100 years.
In today’s society the increase and excessive use of drugs, alcohol, gambling, personal image, internet, sex etc has in many ways reignited arguments and opinions among proponents of the various theories/models.
Below are some models / theories that have developed re addiction, each model / theory gives it’s very own view on how addictions develop.
Following the Models/Theories I have outlined definitions of addiction given by the experts e.g. WHO; EMCDDA; Government Agencies.
Medical Issue> Progressive Illness > Medical Model > Treatment
Chronic Allergic reaction
No cure – in recovery for life
No recovery without formal treatment
Treatment goal > Total abstinence
AA / NA / 12 step Model
The Disease model has been responsible for the change in society’s view of “Alcoholism” – no longer seen as Deviant / Sinful behaviour. However it is questionable if AA/NA are responsible for this.
Implies that individuals have the ability to refrain from substance use that it is a decision based on “choice” by the individual, that it is a “moral weakness” in those who use substances excessively/problematically.
The Moral Model disputes that biological, genetic, psychodynamic or medical factors
are contributor’s to addiction.
In the early 19th century alcoholism was associated with a variety of socially
unacceptable behaviors such as criminal activity, poverty, sin, domestic violence and
Recovery from substance in this model centers on strengthening the individuals motivation to behave in an “upright manner”.
Moral Reconation Therapy (MRT) is used in the US.
Drug use is a symptom of another primary mental disorder, e.g. depression, personality disorder.
No recovery without treatment.
Attention focused on diagnosing and treating co-existing psychiatric (won’t treat, won’t look beyond drug) illness.
Genetic Theory / Physiological Model/Theory
Some studies and assessments re children of alcoholics support genetics as a contributing factor to alcoholism.
It is less clear for other drugs however some scientists acknowledge a genetic influence on susceptibility to substance use.
Questions and concerns re Sole Causality or Primacy to Genetic Factors.
Different individuals may become addicted to many behaviours.
Biological or genetic differences do not explain all the cultural, situational, and intra-personal differences among addicted individuals and addictive behaviours.
Some researchers question whether children are predisposed to genetic factors or whether the issue concerns children accepting family traditions / rituals / norms / values / learned behaviour.
Physiological factors have been the re-enforcer for this theory i.e. physical symptoms such as withdrawal, craving, physical effects related to the substance (heroin, alcohol, nicotine).
Personality characteristics may be related to the development of substance dependency such as Non-Conformity – Impulsiveness – Hyperactivity – Rebellious – Behaviour classed as Anti-Social (who defines “Social” i.e. smoking).
Other issues may be related to Self-Esteem / Worth – Control – Autonomy (females & anorexia).
There are questions re the evidence to date i.e. some scholars believe it does not support the existence of an addictive personality that predictably and reliably will result in dependence on any or all of the addictive behaviours.
AA describes alcoholism as “a result of a defect in character and a deficit if will”.
Traits and Temperaments have also been used as predictors for addiction.
Specific personality factors or underlying intrapersonal issues may in a small section of society lead to addictive behaviour.
Social / Cultural / Environmental Model/Theory
Develops and endures as a result of Social / Cultural factors e.g. Unemployment, Poverty, Violence, Family Dysfunction, Non-Nurturing, Peer Pressure, Inclusion, Exclusion, Drug Availability.
Forces > Social Stressors > Unhappiness > Substance Misuse (Specific).
Unable to cope with Life Stresses, individuals turn to their addiction for Escape / Comfort / Coping / Life Management etc.
Treatment – environmental modification – individual (social) skills.
Family Systems - Learned Behaviour, Family Traditions / Norms.
However it is clear that Substance Misuse crosses all social classes, Cannabis, Cocaine & Alcohol are three prime examples.
Communities ravaged by heroin have areas used for shooting galleries.
(St. Catherine’s Park / Grave Yard off Thomas St).
Cocaine Parties – Crack houses / Drinking Areas / Wet Houses etc.
Family Systems Model/Theory
Goal is to meet the needs of all family members.
Addresses the interdependent nature of family; how relationships serve the substance user and other family members (good or bad).
Family therapy focuses on treatment to intervene in the complex relationship patterns; to change them to enable positive change for the whole family.
Changes in one part of the family system may create changes in other parts of the family system, changes can contribute to problems or solutions.
Service provision involving the family members can improve treatment effectiveness.
Co-dependency / enabling will be explored.
Substance misuse > net result of complex interaction between a combination of Biological, Psychological, Social & Spiritual determinants
Variety of symptoms – Multi Causality in becoming – maintaining and stopping addictive behaviour.
Recovery may or may not require abstinence – depends on level of severity.
Difficulties are expressed by some regarding intervention and treatment of multiple areas at the same time; it is felt some areas may suffer due to inadequate attention.
Psychological Model – psychoanalytic; behavioural; cognitive.
Psychoanalytic – repression and unconscious mental process.
Behavioural > conditioning and cues.
The ‘needle high’, IV drug user who only needs to insert a needle with saline solution to get a partial replication of the actual drug-taking experience, supports a form of conditioning.
Pleasant experience Rewarding or Unpleasant Punishing Consequences.
Cognitive – focus’s on way people interpret and account for their life experiences, cognitive ideas in exploring dependency self-efficacy, self-esteem / worth.
Synthetic / Prime Model/Theory
Identifies that motivation is central to addressing addiction. The Prime theory/model developed from the Excessive Appetites Theory.
The Prime Theory/Models rational is that addiction develops from a number of distortions in the Motivational System.
Moment-to-moment generation of plans, responses, impulse and inhibition, motives (wants and needs) and evaluations (beliefs about what is good and bad).
Synthetic/Prime theory believes that because of past associative learning, the substance user consistently believes they want/need to engage in the substance use/addictive behavior more than he/she wishes not to.
The Transtheoretical Model/Theory (TTM)
Transtheoretical = across theories / eclectic approach
A persons choices are influenced by Character & Social Forces.
Focuses on how individuals Change Behaviour.
Must be participation of the addicted person / journey through a process of intentional change.
Risk and protective factors that influence whether the individual becomes addicted and whether he/she leaves the addiction.
Human behaviour change is a developmental perspective. Change in humans takes place over time, at different points in the life cycle and usually involves a sequence of events.
Addiction and recovery occur in the context of human development and of an individual’s life space, this includes Physiological / Psychological Events and Transitions.
Tools such as the Wheel of Change (proponents of the TTM are DiClemente and Prochaska).
Diagnostic Tools Commonly Used re Addiction
ICD – 10 (World Health Organisation)
ICD-10 = Coding system (info gathering form) designed to classify mental and behavioural disorders due to the use of psychoactive substances.
The word Disorder is used instead of Illness or Disease to avoid potential problems associated with these words (illness / disease may cause Stigma)
Disorder refers to clinical symptoms or behaviour associated with distress and issues re personal functioning.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association (1994) changed the definition of Drug Abuse and Dependence. The distinction based solely on physiological tolerance was eliminated. Therefore other substances such as cocaine, crack, alcohol (legal), cannabis, gambling, eating disorders etc. may be included as the effects (high) reinforce patterns of behaviour associated with substance addiction.
DSM–IV (1994) Avoids the term addiction, preferring instead to use the diagnoses of substance abuse and dependence, collectively referred to as substance use disorders. (http://pubs.niaaa.nih.gov/publications/arh312/93-95.htm).
Oxford English Dictionary traces the term addiction to Roman law, under which addiction was a “formal giving over by sentence of court; hence, a dedication of person to a master.” This notion of relinquishment of control by the addicted person is the central feature of many lay and professional definitions of the term. The study of addictive behavior crosses several disciplines, including, among others, behavioral neuroscience, epidemiology, genetics, molecular biology, pharmacology, psychology, psychiatry, and sociology.
The most recent text revision of the DSM (DSM–IV–TR; APA 2000, p. 192) identifies impaired control over substance use as the essential feature of dependence, which is “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems.” (http://pubs.niaaa.nih.gov/publications/arh312/93-95.htm).
What is Addiction?
The Experts Views
Repeated use of a psychoactive substance or substances, to the extent that the user (referred to as an addict) is periodically or chronically intoxicated, shows a compulsion to take the preferred substance (or substances), has great difficulty in voluntarily ceasing or modifying substance use, and exhibits determination to obtain psychoactive substances by almost any means http://www.who.int/substance_abuse/terminology/who_lexicon/en/
Addiction - there is a psychological/physical component; the person is unable to control the aspects of the addiction without help because of the mental or physical conditions involved.
Habit - it is done by choice. The person with the habit can choose to stop, and will subsequently stop successfully if they want to. The psychological/physical component is not an issue as it is with an addiction http://www.medicalnewstoday.com/info/addiction/
Addiction is a condition that results when a person ingests a substance (alcohol, cocaine, nicotine) or engages in an activity (gambling) that can be pleasurable but the continued use of which becomes compulsive and interferes with ordinary life responsibilities, such as work or relationships, or health. Users may not be aware that their behavior is out of control and causing problems for themselves and others.
Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.
Reference Information (Evidence Base)
Ghodse, H. (1995) Drugs and Addictive Behaviour, A Guide to Treatment, 2nd Edition.
DiClemente, C. (2003) Addiction and Change, How addictions develop and addicted people recover. Guilford Press, New York.
Ghodse H. & Maxwell D. (1990) Substance Abuse and Dependence, An introduction for caring professionals. Macmillan Press.
Other references included in main body of work