What are models of addiction?

Addiction Models

There are two predominant models to explain addiction: the disease model of addiction and the life-process model of addiction. The disease model considers addiction to be a life-long affliction arising from altered genetic and biological mechanisms. The life-process model considers addiction to be a learned behavior and source of gratification that can be explained through the context of social experiences and relationships.

Disease Model of Addiction

The disease model of addiction stresses the idea that addicts are born, not made. This model gained acceptance in scientific and government circles in the early 1960s when E. M. Jellinek discussed the model in his book The Disease Concept of Alcoholism (1960). Jellinek suggested that the disease model should be used because of the lack of clarity in the psychological pathologies that psychiatrists suggested were behind addiction. The model is now recognized by the World Health Organization and the American Medical Association and is utilized by both Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) in their treatment and recovery plans.

Four stages of addiction comprise the disease model. In the presymptomatic stage, the use of the substance is not associated with any significant problems. In the prodromal stage, there is an increase of problems caused by the use of the substance, problems including psychological duress and increased consumption. In the crucial stage, the person attempts to control the substance abuse but fails; consequences increase with continued substance use. Finally, in the chronic stage, the addict consumes large amounts of the substance with great psychological and physiological repercussions.

The underlying neuronal mechanism implicated in the disease model of addiction is the dysregulation of the dopaminergic and glutamatergic pathways in the brain. These systems influence drug reward, dependence, and craving. In addition, long-term neuroadaptation to drug abuse can lead to drug tolerance. Withdrawal from drugs is characterized by depression, anxiety, irritability, and sleep disturbances, all of which lead to cycles of relapse. Withdrawal becomes a serious medical issue because of severe somatic symptoms associated with the withdrawal.

One of the fundamental aspects of the disease model of addiction is that a person cannot control his or her use of alcohol or drugs; furthermore, the person will feel compelled to consume the substance. The duration of time in which the person becomes addicted is variable (days or months). As evidenced by the results of the AA and NA programs, treatment is specific and can be generalized to the whole population. However, the best recourse for the addicted person is abstinence.

Life-Process Model of Addiction

The life-process model of addiction directly opposes the disease model by stressing that the addiction can be controlled by the person addicted. Proponents of this model argue that specific biological mechanisms for addiction, as claimed by the disease model, have not been identified.

Addiction as explained through the life-process model is a way of coping with life experiences. Each person’s addiction is singular to that individual and can be explained only through the context of each person’s respective situation. In other words, a person becomes an addict for his or her own reasons, be it psychological or social. Reasons include stress, abuse, and an inability to cope. No specific or outlined progression of addiction exists. Consequently, the life-process model emphasizes treatments that are specific to the person and that stress changing the person’s behavior and environment.

Individualized treatment employed in the life-process model varies greatly from those provided by group therapies like AA and NA. The individual, perhaps with the help of a therapist or mentor, discovers the source of the addiction and applies a specialized remedy. Unlike the disease model, the life-process model suggests that the individual does not need to indefinitely abstain from the addictive substance.

Summary

As a chronic disease, addiction is the culmination of biological, psychological, and social maladjustments. It is a complex disorder shaped by substance exposure, genetic susceptibility, and environmental influences. Therefore, better understanding of the neurobiological factors and analysis of cognitive and social learning models would aid in the development of novel therapeutic interventions for drug-dependent persons.

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