Theories of Addiction
A look at the various possibilities that
could explain why some people
become alcoholics or addicts
There are many theories about why people
become addicted. No one theory explains it fully.
My belief is that people become addicted for a
variety of reasons, with some people becoming
addicted because of more than one reason. We
will begin by looking at the biological model, also
known as the disease model, which sees
addiction as a condition that is often genetic in
origin, has a progression, symptoms and course
(prognosis).
Disease model
Alcoholism is a disease characterized by:
Chronicity it is not a single episode (occurrence) but rather a
series of occurrences. Like other chronic, recurring conditions
(high blood pressure, heart disease, hypertension, diabetes) it
tends to return even after periods where it goes away
Progression It gets worse over time. When an alcoholic stops
for a period of time and then resumes drinking he/she will quickly
pick up where they left off, if not worse
Incurable once a person meets the criteria for alcoholism they
cannot return to normal drinking on a regular basis
Loss of control While an alcoholic can exhibit control on a
single occasion they cannot predict when they will lose control,
which they inevitably will
The
disease model believes that:
It is primary rather than a symptom of
something other condition (a mental health
diagnosis, for example)
The use of any mood altering substance
recreationally is next to impossible (as it
affects the same areas of the brain) and that
mood altering medications are potentially
dangerous for the alcoholic
The disease model implies (and this is where
many people who say they believe in the
disease model have trouble accepting it
completely and adopt a moral model of
addiction)
Some alcoholics have more severe forms of the
disease than others
Not all alcoholics are capable of becoming sober (but
we dont know which ones are & arent, so we should
treat them all as if they are capable)
A highly motivated person can relapse
Modern Origin of the Disease
Model
Jellineks
research led to classifying
alcoholism as a disease in 1956
Developed Jellinek chart listing progression of
alcoholism
Now the standard approach used to treat all
drug addictions in America
Financed by Smithers, head of IBM & a
recovering alcoholic ( Jellinek wasnt)
Founded National Council on Alcoholism
Paid for research into alcoholism ( but squelched
research that disagreed with disease model)
Jellineks theory challenged
Poor
research by present standards
Only surveyed A.A. members
Straight progression simplistic
Loss of control challenged
It was applied to other drugs, despite fact that
only research was involving alcohol
What about the individuals role?
Very rigid model that really only fits a relatively
small percentage of alcoholics
My thoughts
Despite
flaws model advanced field of
addiction greatly
People respond best if its treated as a
disease, regardless of whether it is
Public disagrees with disease model
Sees it as making excuses for unacceptable
behavior
Hard to comprehend loss of control
Defines success as abstinence, which
usually doesnt occur ( & those abstinent
generally not visible)
Genetic research that supports the
disease model
Runs in families
Adoption studies indicate that children of alcoholics
are more likely to become alcoholic even when
raised by non-alcoholic adoptive parents
Twin studies indicate that identical twins (same
genetic make-up) have a higher concordance
(when one has it so does the other) of alcoholism
than fraternal twins (different genetic make-up)
Numerous animal studies indicate that response to
alcohol is influenced by heredity
Challenges to genetic
inheritance
Why
dont all family members get the
disease?
What about environment?
What about personal choices?
Really, heredity, environment and personal
choices all are factors in whether a person
will get a chronic disease or not.
Type I & 2 alcoholism possible
forms of inherited alcoholism
Type
I sex parent to
From
either
either sex child
Loss of control occurs
later - have some history
of social use
Less co-morbid problems
such as legal troubles,
mental health issues
Poverty makes it more
likely, so not just genetics
Type 2
Only passed on from
father to son
Problems almost
immediately after start of
drinking
Likely criminal behaviors
Frequently occurs even
when raised in an
adoptive home
Alcoholism is a learned behavior
the behaviorism model
Behaviorism
has these assumptions
People will repeat behaviors if they are
rewarded for those behaviors
People will alter their behavior if they are
punished (or ignored) for their behavior
Immediacy is a factor in the strength of the
reward or punishment
People are basically animals with no internal
drives, we simply respond to what we have
learned in the past through our experiences or
seeing what others have experienced
Addiction is an involuntary, learned
response
Alcohol and other drugs of abuse
are inherently pleasurable were
wired to enjoy alcohol/drugs
They provide both positive and negative
reward
The enhance our self-confidence and provide
euphoria (positive reward)
They remove negative feelings such as
anxiety or depression (negative reward)
As
a result, addiction is really not a
disease but rather an over learned bad
habit
Negative consequences are
necessary to unlearn addiction
There are various subtypes of
learning theories
Social
learning
Society provides reinforcement by giving
rewards and punishments depending upon
which drugs we use, how we use them and
when
Culture tells us how we should or shouldnt
use substances
Our social circle socializes us to use in a
certain way where we are expected to
conform to group expectations
Some groups are expected to
consume in excess
Learning theories
Individual expectations
People become socialized to expect good things to
happen (getting drunk & meeting a new partner)
People then use so that good things happen
People may then use in other situations with the belief
that things will turn out well
People equate using with having fun (Boy did I have
a good time last night I cant remember anything
past 11PM). How does one know they had a good
time if they cant remember what they did?
Learning theories
Modeling
(also known as vicarious
learning)
People learn by watching what
happens to others
If people see good things happening
they will mimic others behaviors
AOD may be seen as a way of
becoming more popular or enhancing
interpersonal or work relationships
Learning theories
Personality theories
People with certain personality
traits are drawn to certain drugs
Those who are anxious will use
sedative drugs, those who see
themselves as thrill-seekers will
use stimulants
Those who are antisocial will use
socially unacceptable drugs
People with a history of being
abused are more likely to abuse
alcohol or other drugs
They are attempting to selfmedicate with AODA.
They harbor guilt, shame and poor
self-esteem
THESE SEEM TO BE OFTEN TRUE
People have addictive
personalities
These people seem destined to
switch from one addiction to
another because of their
personality traits
These personalities cause
addiction and predate AODA
THERE IS NO EVIDENCE THAT
THE ADDICTIVE
PERSONALITY EXISTS!
The personality traits often seen
are the result, rather than the
cause of addiction.
All the addictive personality
belief really states is that there are
people who switch from one
addiction to another but that is a
behavior, not a display of any
personality characteristics
Personality theories
Not all alcoholics
have an underlying
problem, although
some do. Some
otherwise welladjusted people end
up with
alcoholism/drug
addiction ( this is not
what personality
theory believes,
though)
Personality theories
Disease of the human spirit
Typified by Alcoholics Anonymous
Believes that addiction is the result of a physical and
spiritual disease
Therefore, a physical and spiritual healing is
necessary
The spiritual disease is a disconnect from a sense of
purpose and meaning in life
The alcoholic/addict attempts to find meaning in a
drug
Therefore, a spiritual connection must be established
if the alcoholic/addict is to become well
Willful misconduct (the one theory
that I dont endorse but the one
thatsare
the
most
popular)
Alcoholics
self-centered people who
choose to disregard the effects their
drinking has on themselves and others
They lack willpower and use other
models as an excuse to continue to do
what they want to do
They are immoral people who need to
be punished or find God to get them to
conform to societal expectations
Two-path theory-the belief that
there are two different causes
Environmentally
caused
Later onset
Fewer co-existing
problems
Slower progression
Better prognosis
Some say more likely
female
Biologically
(genetically) caused
More severe
symptoms
Earlier onset
More co-existing
conditions
Poorer
This is a relatively new model
and has prognosis
nothing to do with Jellineks research
There is no one theory that appears to explain
all alcoholism. More likely, there is a certain
amount of truth to all of them. While there
certainly appears to be a biological aspect, most
researchers also agree that there are
environmental triggers that must be present for
the alcoholism to manifest itself.
THE END
