Theories of Addiction

Disease Model of Addiction

• Assumes addiction originates within the individual
• Considers addiction as a sickness or disease caused by a breakdown of healthy neurochemical or behavioral processes
• Addiction is not a continuous state, but rather an illness that can be treated through lifetime withdrawal
• Addicts are unable to control their consumption and are overcome with strong urges when unable to obtain the substance

12 Step Models of Addiction

• Views dependence as a 'spiritual disease' and a 'lack of control'
• Main premises:
  • Alcoholism is an 'all or nothing' condition, where individuals are either seen as having a problem or not having a problem
  • Individuals struggling with alcoholism are powerless over alcohol and their experiences
  • Alcoholism is a progressive disease that cannot be cured, but rather managed
  • Support is provided through attending groups, peer support, and submitting to a higher power

Advantages of 12 Step Models

• Drug use is viewed as a health issue, not just a legal issue
• Addicts can better understand their behavior
• This treatment strategy (abstinence) may be effective for certain individuals and minimizes feelings of shame associated with addiction

Disadvantages of 12 Step Models

• Removes user responsibility
• Provides only one treatment option (abstinence) that may not be appropriate for many individuals, especially young people
• Lacks evidence-based support
• Treatment outcomes are related to increased friendship, spiritual connection, and finding meaning in life (Kaskutas, 2009)

What Constitutes Psychological Theory?

• Describes a behavior
• Makes predictions about future behavior
• Must have evidence to support the idea
• Must be testable

Importance of Theories

• Explains why a drug is more or less addictive in one society than another, for one individual and not another, or for the same individual at one time and not another
• Makes sense of similar behavior (e.g., compulsive)
• Explains the cycle of growing problematic drug use
• Must accurately reflect the actual human experience

Psychological Theories of Substance Use

Moral Theory

• Originated in the early-mid 1800s with the Temperance movement
• Views addiction as a sin, a fault on one's character and a moral weakness
• Users are characterized as 'misfits', 'no-hopers', or as objects of pity
• Dealers are routinely described as 'scum', 'vermin', or 'an evil menace'
• Focuses on choice, highlighting the progression from voluntary substance use to loss of control
• Concerns: stereotyping, reluctance to seek aid, and reduced self-esteem

Effects of Drug Use on the Brain

• Flipping the lid demonstrates how drug use affects the brain, leaving the lower brain in control
• Flipping the lid occurs in response to immediate danger or intense emotions like anger and stress
• Alcohol and drug use weaken the higher brain and strengthen the lower brain, leading to impulsive decision-making based on memory, reward, and pleasure
• The impact of alcohol and drugs on brain function persists even after substance use has ceased, affecting decision-making and recovery

The Brain

• The brain stem (or base brain) controls basic functions critical to life, such as heart rate, breathing, and sleeping
• The limbic system (or lower brain) contains the brain's reward circuit, linking brain structures that control and regulate pleasure, emotions, impulses, and memory

Psychoanalytic Theory

• Holds that drug use is a sign of underlying psychological disorders
• Severe psychopathology is considered to cause substance misuse
• Addiction is considered a universal disorder
• Example: unconscious processes of the id, ego, and superego
• Fixation at the 'oral' stage can lead to personality traits associated with this developmental phase
• Id operates based on the pleasure principle and is focused on immediate gratification
• Ego functions based on the reality principle and mediates between the id and superego

Attachment Theory

• Attachment styles by Bowlby:
  • Secure attachment style is characterized by a healthy balance of independence and intimacy
  • Ambivalent-avoidant insecure attachment style involves mixed feelings of closeness and discomfort with intimacy
  • Anxious-avoidant insecure attachment style shows a fear of rejection and reluctance to trust others
  • Disorganized-insecure attachment style displays inconsistent behaviors in relationships

Personality and Addiction

• Certain personality traits distinguish alcoholics/drug users from the general population
• Limited evidence supports the concept of an 'addictive personality' as a predisposing factor
• Personality predictors of drug use include behavioral disinhibition, emotional negativity, sensation seeking, non-conformity, social isolation, and tolerance for deviance

Cognitive and Cognitive Behavioral Theory

• Focuses on the thoughts/beliefs and their impact on behaviors and feelings
• The way people interpret specific situations influences feelings, motivations, and actions
• Layers of beliefs -- core beliefs/schemas
• Cycle of conflicting desires leads to a cycle of behavioral, emotional, and thinking patterns

Expectancy Theory

• Addictive behaviors are chosen over other behaviors due to our expectancies
• Two specific cognitions: outcome expectancy and self-efficacy

Motivation and Change Theories

• Transtheoretical approach: increase client's awareness of problems, consequences, and risks to initiate behavior change
• Motivational interviewing emphasizes intrinsic motivation for change

Family and Systems Theory; Socio-Cultural

• Determinants of behavior are based on an individual's role within a system
• Focuses on society as a whole and not just on individuals
• Family and other systems (e.g., peers) have a role in initiating and maintaining substance use
• The type of society in which people live has an impact on their drug use