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Essay Title: The Disease and Learning Models of Addiction
Author: Albert Muraya
Supervisor: Catherine Ngarachu
severe symptoms of withdrawal upon cessation of use. The first states that chemical dependency is condition with genetic and biological underpinnings. The Learning models are based on the idea that all behaviours are learned. compulsive gambling and eating disorders. This dependence is unhealthy. Whilst the phenomenon of addiction encompasses process addictions such as sex addiction. I will examine the criteria and outline the rationale employed by those who put forward this argument. and the Learning Models of Addiction. namely the Disease Model of Addiction. I’ll limit myself to chemical addiction or dependency. and acute longing for the substance or activity when not using. the afflicted individuals find they are unable to the cease or moderate the activity without outside help. or their engagement in processes that alter moods. This essay will examine two of the theories put forward to explain this phenomenon. has deleterious effects on both mind and body. and thus develop an unhealthy dependence on either the chemical or process.Introduction Addiction is a condition in which individuals are unable to control their consumption or use of chemical compounds. Despite the harm that the dependency generates. the environment in which they exist must be understood. because it involves a preoccupation with the drug or activity. These theories have been developed from what are known as the principles of social-learning. and that it satisfies the accepted criteria for a condition to be termed a disease. Finally I will compare the two models for their implications on possibilities for addiction prevention and implications for treatment interventions and outcomes. and that in order to understand and moderate them. . Addiction tends to be a progressive disorder characterised by increasing tolerance for the substance. to the point of complete loss of control. I will explain the different theories that fall under this category.
By William L. the painful suffering occasioned by its withdrawal or discontinued (withdrawal). this concept was further developed and refined. E. (“Addiction as a Disease”. characterised by loss of control over the drug(s) of choice. and later in 1784 by Dr. Several models have been put forward to explain the phenomenon of addiction and the behaviours that they spawn. He introduced a more medicalized language into the discussion of intemperance by describing 'persons addicted to ardent spirits' and by declaring that chronic drunkenness was an 'odious disease' and a 'disease induced by a vice. The Disease Model or concept of addiction states that addiction to alcohol or other drugs is a primary. The Counsellor Magazine. pp. . culminating in the Dr. White.' He offered medical speculation about the causes of this disease. that is characterised by an increasingly heightened need for a drug or process (tolerance). v. October 2000. 73) Throughout the 19th and early 20th centuries.1. 46-51. Benjamin Rush's “Inquiry into the Effects of Ardent Spirits on the Human Mind and Body”. including the Disease Model and the Learning Models of addiction.1. n. compulsive-obsessive relationship with any substance or process. The disease model was first postulated in the late 18th century by philanthropist and social reformer Anthony Benezet.Jellinek's Disease Concept of Alcoholism (1960). MA. Rush later used this embryonic disease concept to call for the creation of a special facility (a 'sober house') to care for the drunkard. Rush achieved five things with this highly influential pamphlet: • • • • • He medically catalogued the signs of acute and chronic drunkenness.' He medically confirmed Benezet's observation about the progressiveness of intemperance by noting that such episodes 'gradually increase in their frequency. continued use of the drug and denial of the problem despite adverse consequences.The Disease and Learning Models of Addiction Addiction can be defined as a destructive.M. progressive disorder. or upon commencement (craving). and fixation with the drug or process either when not using/doing. chronic. He provided the first recommended treatments for chronic drunkenness based on a disease concept of addiction.
Left untreated. thus chemical dependency satisfies the condition that a disease should not be intentionally caused. and cancer. Margolis and Jean E. and studies on the sons of alcoholic fathers. an inherited or genetic component. a clear biological basis. end-stage dependency. the evidence for which is found in a considerable body of research evidence pointing to a biochemical or genetic basis for addictive behaviour. it has been noted. have common signs and symptoms which satisfy the second condition for identification as a disease. The progressive nature of addiction is similar to other chronic disorders such as heart disease and gout. twin studies. it matches other chronic diseases in its biological causation.C.) The disease concept views addiction as having as a primary causative factor. addiction qualifies as a disease because in its nature. In summary. This research indicates that “alcoholism is a true medical disease rooted in abnormalities in brain chemistry biochemical aberrations that are inherited by the majority of alcoholics and. . and a pattern of relapsing. addiction is comparable to other chronic diseases such as asthma. diabetes. car accidents (due to inebriation). A predictable course and outcomes. with secondary environmental exposure elements. research points to not just the development. progression and identifiable symptoms. Numerous studies have been conducted that compare the effects of environment over genetic factors in alcoholics and addicts — adoption studies. Zweben. loss of control over use of the drug. but also the progression of the condition as being determined by heredity. This fits the first criteria. Since a constituent part of the ailment is loss of volition. animal studies. A lack of internal causation. addiction is nearly always fatal either directly through damage to vital organs. Addictions. there are established criteria that need to be met. in some cases. These include increased tolerance for the drug (normally followed by a precipitous drop in tolerance). the aetiology (cause) of the condition and its course are outside the control of the addict. or indirectly through consequential factors like suicide. acquired through intense and sustained exposure to alcohol and other drugs”. (“Treating Patients with Alcohol and Other Drug Problems: An Integrated Approach”.In order for a condition to be characterised as a disease. 1998 Washington D. continued use despite the personal and social cost. Addiction follows a continuum of progression from early abuse to chronic. namely: a) b) c) d) A clear biological basis. By Robert D. A set of unique identifiable symptoms. As such. drug–related violence and so on. APA. Further. The third criterion is a predictable course and set of outcomes.
the disease is merely dormant and should they try to resume usage of the chemical. The learning models on the other hand. This demonstrated the effect of expectations on learned behaviour. The disease model suggests that abstinence is the only possible remedy for the affliction. and that “addictive behaviours represent a category of bad habits including problem drinking” (Marlatt G & Gordon J (1995) “Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviours”. they hold very different possibilities for either prevention or treatment. and include classical conditioning. These models or theories are “derived from the principles of social-learning theory. With the disease model. Abrams & Brinkoff 1988) have shown that the mere expectation of the potency of a drug will produce the same effects from a placebo of the drug (tension reduction. Further. that whatever had been learned (addictive behaviours) can be . whilst minimising the role of heredity in addiction aver. Studies (Marlatt & Gordon 1980.The learning models postulate that addiction like all human behaviour is learned. The first difference between the learning and disease models of addiction is therefore in the ways the different concepts view the initiation and maintenance of addiction and addictive behaviours. Marlatt goes on to state that “Addictive behaviours are viewed as overlearned habits that can be analyzed and modified in the same manner as other habits” (ibid). that whilst the addict is abstinent. are almost invariably going to become addicts. Monti. learning theorists place more weight on the role of personality and (ir)rational choice in the causation of addiction. cognitive psychology. In the learning model. operant conditioning. and that conversely. Rohsenhow. and that one can only arrest it. the disease would be reactivated. and experimental social psychology” (ibid). addicts are seen as individuals with a genetic predisposition to addiction as evidenced from a genogram. This follows on from the notion that addiction is a disease that is incurable. all human behaviour is learned. New York. and are essentially reversible by changing the behaviour pattern. The Guilford Press – pg9). Any changes in the physiology of the addict including changes in brain chemistry are the result of this dysfunctional usage. and to the extent that they expose themselves to the addictive chemical. This brings up the issues of prevention and treatment. euphoria) as the drug. compulsive use (Margolis & Zweben – pg55). they perceive addictive behaviours as being on a range or continuum of behaviour from responsible or social use to addictive. Given the differences in the rationale for addiction that the two models hypothesize. its adherents see addiction as a pattern of behaviour that stems from learning or adopting maladaptive habits and reinforcing them through conditioning (repetition). Whilst acknowledging that addictive behaviour can bring about diseases. and modelling theories. All these models are based on the notion that there is no behaviour that can be put down to genetic factors.
but also a rich tapestry of treatment strategies and possibilities. . would facilitate the addicts making a safe choice around any given situation. They therefore focus on and seek to alter the addict’s cognitive (thinking and reasoning) processes. because they can be applied to a broad spectrum of usage paradigms – social-users to serious abusers. The differential approach on the significance and nature of the environment distinguishes one learning theory from another. Cognitive– behaviour therapy. as well as a psycho-social component in the development and sustainability of addictive disorders. cravings to use are set off by environmental triggers such as the sight or smell of the addict’s drug of choice.modified by the same processes that created them to begin with. alternative solution. As such. both models have been combined in recent years. learning theories offer greater relapse prevention potential. and for the relapser a more achievable target than the disease model. either as an end in itself. goes some way in not just providing a viable and sustainable definition of addiction. in addition to which the learning models have controlled using and harm reduction as a possible target for treatment. Modelling behaviour seeks to change behaviour by having the addict copy the behaviour of a positive role model. They have available to them more treatment outcome possibilities than does the disease concept whose only potential outcome is abstinence. Further. replacing them with more appropriate ones. or as a stop-gap measure to eventually complete abstinence. and the BioPsycho-Social model of addictions has emerged which explains the phenomena of addiction from both viewpoints – there is a variable genetic susceptibility with some addicts. because they specifically deal with external factors and relationships and how to deal with high-risk situations are more practical and flexible than the pure disease model. the environment in which they maintain their habit and their emotional responses to their environment. It is particularly useful when dealing with adolescents. By attacking the association and questioning the rationale for the addict to expose themselves to such situations. The learning models also provide for greater scope in the prevention of the condition of addiction. by enhancing the addict’s self-efficacy or self-assurance and questioning and bolstering the addict’s coping skills. cognitive–behavioural therapies seek to remove or modify irrational thinking and feelings. the learning models. and focuses on changing this response in the same situation. Neither model on its own sufficiently explains addiction in its entirety. The real attractions of the learning models are their applicability in a treatment scenario. In practice. but when combined. Whilst the disease model offers real options in treatment. In classical conditioning. getting them to pattern their behaviour on that of someone positive and away from their destructive patterns. this learning model suggests a viable. The corollary is that they must avoid high-risk situations about which they are not strong or confident. Operant conditioning on the other hand questions the addict’s response to the stimuli.
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