REVIEW OF THE CAUSES OF ADDICTIONS

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REVIEW OF THE CAUSES OF ADDICTIONS
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your assumptions about the causes of addictive
behaviour strongly influence how and what you
assess
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SIMPLISTIC MODELS
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MORAL MODEL

• result of willful overindulgence and moral
  degradation
• cure willpower and a desire to abstain
• Associated with temperance movement (1919-1933
  prohibition)

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DISEASE MODEL

• medical, physical reasons for vulnerability to
  and development of addiction
• strongly associated with Alcoholics Anonymous
• disease is progressive
• very little control over the disease
• disease always there
• only treatment abstinence

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BIOLOGICAL MODEL

• a similar but more sophisticated model
• because of genetic inheritance, some peoples
  brains bodys make them more or less
  susceptible to addictions
• children of alcoholic parents 3-4 times more
  likely to develop alcoholism (30-40), whether
  they are raised by their biological parents or
  not (adoptee studies)
• Concordance rates for drug abuse much higher for
  monozygotic versus dyzygotic twins (twin
  studies)
• physical mechanism
• sons of alcoholics show decreased physiological
  and psychological reactions to moderate doses
  compared to others
• prefrontal differences resulting in less
  inhibition and impulse control (high comorbidity
  with risk taking, hyperactivity, legal problems)

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BEHAVIOURAL MODEL

• fundamental principle of learning (operant
  conditioning) is that things that are followed
  by reward are engaged in more frequently in the
  future
• we get addicted to things that are associated
  with pleasure (sex, food, drugs, money)
  furthermore, the types of drugs we get addicted
  to all largely pleasure producing
• Treat addictions by changing the reward system
  (reward nonuse or punish use)

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FAMILY ENVIRONMENT MODEL

• best predictor of alcoholism is being raised in a
  home with alcoholic parents (regardless of
  whether you are biologically related to them)
• This is due to
• modeling
• lack of parental monitoring/control
• abuse (prevalence of reported childhood abuse is
  59 for women alcoholics and 30 for men)
• Alternatively, an overly involved and protective
  family -gt anxiety -gt alcohol for self-medication

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SOCIOCULTURAL MODEL

• Cultural norms shape the rates of addiction
• Low rates of alcoholism in cultures where
  drunkenness is frowned upon and alcohol is an
  incorporated part of social and religious
  functions (Greece, Jews, Italy, southern
  Europeans, Chinese)
• High rates of alcoholism in cultures where
  excessive drinking is tolerated and alcohol is
  not an incorporated part of social and religious
  functions (Irish, British, northern European,
  American)
• Aboriginals adopted drinking practices of cowboys
  who got drunk and were unrestrained (virtually
  all tribes north of Mexico without any
  intoxicating beverages prior to coming of the
  Europeans) also the prohibition of alcohol on
  reserves discouraged learning social drinking

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OTHER MODELS

• Transpersonal
• addiction as a misguided attempt for connection
  with 'God' . Addiction as a substitute or
  deep-seated form of idolatry

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All these models are too simple!

• The psychological models (Moral Transpersonal)
  fail to address
• the progressive involuntary (disease) nature of
  later stages of addiction
• the biological/genetic contributions to
  addictions
• the familial and cultural contributions to
  addictions
• The biological models (Disease Genetic) fail to
  address
• the psychological aspects of addictions
  (motivation is still one of the best predictors
  of treatment success)
• the familial and cultural contributions to
  addictions (Chinese Natives same biology but
  different prevalence of alcoholism)
• The environmental models (Family Sociocultural
  Behavioural) fail to address
• the progressive involuntary (disease) nature of
  later stages of addiction
• the biological/genetic contributions to
  addictions
• the psychological contributions

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BIO-PSYCHO-SOCIAL MODEL
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• The accepted model in the scientific/academic
  community
• addiction is determined by a complex interaction
  between biological, psychological and
  environmental variables

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Biology Genetic Inheritance
creates a brain and nervous system that increases
or decreases susceptibility to engagement in
potentially addictive behaviours and actual
addiction
Environment Environmental Experience further
increases or decreases risk of initiation and
ongoing use
Abusive/neglectful upbringing ?
Nurturing/disciplined
Parental modeling of ? Parental noninvolvement
in high-risk behaviour
high-risk behaviour Deviant peer
group ? Prosocial peer group Poor
schools/teachers ? Good schools/teachers ve
early learning experience ? -ve early learning
experience Poor social support
? Good social support Severe frequent
stressors ? Absence of severe stressors
Addicting substance ? Addicting
substance not readily
available readily available
Addicting substance ? Addicting substance not
culturally acceptable
culturally acceptable
Naturally self-controlled
? naturally impulsive
risk aversive ? prone to risk taking
resilient to stress ?
vulnerable to stress good
intellect/skills ? poor intellect/skills
brain has unpleasant brain has
pleasant response to potentially ?
response to potentially
addicting behaviour addicting behaviour

• Once the behaviour is regularly engaged in,
  the reinforcing effects of the addicting
  substance/behaviour/etc. increase the frequency
  of the behaviour and the physiological processes
  underlying it. It then becomes progressively
  more difficult to willfully resist the behaviour.