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