Theoretical Models and Approaches of Addiction

            There are eight main theoretical models and approaches to addiction and substance use. These models help to explain the questions that surround substance use, addiction, and their etiology. The eight models include the moral models, the psychological models, the family models, the disease models, the public health models, the developmental models, the biological models, and the sociocultural models. However, it is now believed that there is not one model that completely explains substance use, addiction, and its etiology (Capuzzi & Stauffer, 2016). It would appear that the etiology of substance use and addiction is often multi-causal. Therefore, having an understanding of these models and how they interrelate is crucial in the treatment of the individual. This paper will discuss four of these models by providing an overview of each one, providing a biblical worldview or truths, and answering why each model helps to explain the etiology of substance use and addiction.

Psychological Models

            Psychological Models approach substance use and addiction through a mental and emotional lens. There are four specific models within this category with the goal of discovering the root or etiology of addiction including learning theory, personality theory, cognitive-behavioral theory, and psychodynamic theory (Capuzzi & Stauffer, 2016, p. 7). Learning theory and cognitive behavioral theory share some similarities in supposition in that substance use is a reaction to the need to control unpleasant psychological conditions such as stress, anxiety, and/or tension. (Capuzzi & Stauffer, 2016, p. 7). More specifically, learning theory approaches addiction as cause and effect resulting in a maladaptive learned response (Capuzzi & Stauffer, 2016). Cognitive-behavioral theory goes beyond learning theory and considers a range of motivations for substance use from escape, curiosity, creativity, pleasure, religious exploration, performance, and/or mind-altering experiences (Capuzzi & Stauffer, 2016, p. 7). Additionally, personality theory takes the approach that certain people have a genetic predisposition to substance use thereby developing an addictive personality (Capuzzi & Stauffer, 2016). Lastly, psychodynamic theory posits that substance use and addiction are rooted in an undeveloped ego occurring in early childhood (Capuzzi & Stauffer, 2016).

            Redemption and sufficiency in Jesus Christ are two Christian principles that relate to the four models discussed in this paper. Jesus Christ atoned for the sins of humanity by paying the ransom that was owed through his death on the cross at Calvary. In Paul’s epistle to the Hebrews, he says, “And for this cause He is the Mediator of the New Testament, that by means of death, for the Redemption of the transgressions that were under the First Testament, they which are called might receive the Promise of Eternal Inheritance” (King James Bible, 1769/2017, Hebrews 9:15).  Often those with substance addictions are consumed with guilt and shame over their actions but refuse to admit that they have a problem and need help with it (Erickson, 2015). Furthermore, they may believe that God has turned His back on them. Clinton and Hawkins (2009) explain that with spirituality, “Addiction at its core is rebellion against God” and “Addicts often have illogical or irrational thoughts that cause them to forget their identity as children of God” (Clinton & Hawkins, 2009, p. 20). Illogical thoughts, therefore, are at the root of the psychological models of substance use and addiction.

            Psychological Models differ somewhat from the other four models by focusing on the individual and their emotions and mindset when it comes to substance use. Overall, these models focus on the wants and desires of the individual and the inability to manage unpleasant psychological conditions. At the core of substance use and addiction is a maladaptive belief system. Wanigaratne (2006) explains that cognitive-behavioral theory theorizes that addiction is the product of core schemas and the maladaptive reactions to them. As mentioned earlier, cognitive-behavioral theory and learning theory parallel one another with maladaptive learned behaviors and coping mechanisms. Wanigaratne (2006) states “This explanatory model of cognitive processes involved in the addictive behavior enables the construction of individually based interventions” (p. 456). Furthermore, Wanigaratne (2006) explains that the psychodynamic model has traditionally been the approach for understanding substance use and addiction through the therapist-client relationship of transference, countertransference, and projection (p. 458). Although the personality model is grouped under the psychological models approach, genetic predisposition is theorized to be the etiology of addiction. Franken et al. (2006) conducted a study based on Gray’s (1993) neuropsychological personality theory that confirmed those individuals with higher behavior approach systems (BAS) are at a greater risk of developing a substance use disorder or addiction than those with a lower BAS. Franken et al. (2006) further conclude that these findings could lead to improved interventions within at-risk populations.       

Family Models

            This category of addiction models includes behavioral theory, family systems theory, and family disease theory (Capuzzi & Stauffer, 2016, p. 9). All three models approach substance use and addiction with the family and not just the individual. The behavioral model posits that the addictive individual’s behavior is reinforced by another family member(s) either not knowing what to do or wanting to maintain the status quo out of fear of the unknown (Capuzzi & Stauffer, 2016, p. 9). The family systems model builds upon the behavioral model by examining the roles of the family members and how they relate to one another. Capuzzi and Stauffer (2016) explain that the thought of changing or realigning roles within the family is often met with resistance to avoid the anxiety of upsetting the family dynamics. Moreover, the family disease model takes the most extreme approach to substance use and addiction by viewing the whole family as a problem or disease. Therefore, family disease therapists expect all family members to enter counseling to advance the healing of the addicted individual (Capuzzi & Stauffer, 2016, p. 9).

            A biblical worldview and the family models approach to substance use and addiction integrates well in counseling. Throughout the Bible, family is a gift and is at the heart of Christian doctrine. Paul reminds the Corinthians of the importance of family and says, “Now I beseech you, Brethren, by the Name of our Lord Jesus Christ, that you all speak the same thing, and that there be no divisions among you; but that you be perfectly joined together in the same mind and in the same judgment” (King James Bible, 1769/2017, I Corinthians 1:10).

            Approaching addiction from the family perspective in theory could be the ideal approach for assisting the addicted individual. The biggest drawback, however, is encouraging all family members to participate in counseling together. The family models approach is therefore different from family systems therapy whereby not all family members participate in counseling (Capuzzi & Stauffer, 2016, p. 9). However, Bacon (2019) reveals that although the field of addiction counseling is vast, it tends to focus on the individual and their struggles and states, “It should be noted that family systems theories see all of these illnesses as symptoms of a family disease with the most vulnerable individual in the family becoming symptomatic” (p. 64). Although Bacon (2019) agrees that a family models approach is needed to help heal the family as a whole, she discusses multiple barriers to this type of treatment including health insurance companies and cost, lack of research, and the lack of mental health therapists specifically trained in family therapy.

The Disease Model

            In consideration of the disease model, one cannot overlook the contribution and theory of Jellinek (1960) and his book The Disease Concept of Alcoholism (Kelly, 2019). This model parallels the medical modal of addiction that believes that substance use and more specifically addiction is an inherited disease (Capuzzi & Stauffer, 2016). Moreover, it is believed that addiction is the primary issue and not the result of a primary issue being suffered by the individual (Capuzzi & Stauffer, 2016). Furthermore, it is thought the individual suffering from addiction will always suffer from addiction and can be in recovery through abstinence, but never be cured (Capuzzi & Stauffer, 2016). Alcoholics Anonymous (AA) was born from this disease model and operates from the premise of recovery and not cure (Kelly, 2019). Kelly (2019) summarizes Jellinek’s (1960) work as, “Subsequently, perhaps the most noteworthy and biggest contribution of Jellinek’s work was the attempt to delineate a typology to enhance understanding and clinical effectiveness in treating the broad range of alcohol problems” (p. 114). It should be noted that there has been criticism of the disease model and Jellinek’s (1960) work. Jellinek (1960) based his research on a 158-question survey that excluded women (Capuzzi & Stauffer, 2016).

            Excess and indulgence are synonymous with addiction and the focus on the individual. They also help to explain the disease model. Addiction affects more than just the addict. However, the addict often cannot see the resulting destruction of their actions on others. The Bible speaks to excess and indulgence throughout its teachings. Luke reminds us, “And take heed to yourselves, lest at any time your hearts be overcharged with surfeiting, and drunkenness, and care of this life, and so that day come upon you unawares” (King James Bible, 1769/2017, Luke 21:34).

            The disease model was one of the first theories posited for substance use and addiction. As mentioned earlier, Alcoholics Anonymous (AA) is rooted in this model and integrated with Christian principles. Furthermore, Alcoholics Anonymous (AA) has been highly successful in helping those with addictions move into recovery. Jellinek (1960) spoke of addiction being a disease because of the neurocognitive changes that occur within the brain. Although some question the word disease to describe addiction, the overall impact on the brain cannot be denied (Kelly, 2019). Therefore, the theory behind the disease model can be explained through cause and effect.       

Biological Models

            The category of biological models theorizes that addicts have a genetic predisposition to substance use and addiction. The biological models also parallel the disease model (Capuzzi & Stauffer, 2016). Within the biological models, there are genetic models and neurobiological models that further explain addiction etiology (Capuzzi & Stauffer, 2016). Genetic models have not been able to identify the specific marker that leads to addiction; however, the statistical data cannot be dismissed. The data shows causal relationships in addiction among biological family members even if the individual was adopted by another family (Capuzzi & Stauffer, 2016). Neurobiological models are even more complex when examining the brain and the role of the neurotransmitters and the limbic system (Capuzzi & Stauffer, 2016). The limbic system is the primitive part of our brain that helps us survive as human beings. The limbic system is believed to be the location where addiction originates with dopamine as the driver (Capuzzi & Stauffer, 2016).

            In viewing the biological models of addiction through biblical truths, we cannot overlook sin. Sin is within us all. More specifically, the neurobiological models theorize that addiction is rooted in the limbic system where dopamine is the neurotransmitter for gratification. Gratification therefore leads to addiction and perhaps sin. Matthew writes, “Watch and pray, that you enter not into temptation: the spirit indeed is willing, but the flesh is weak” (King James Bible, 1769/2017, Matthew 26:41).

            Potenza (2013) reviewed current studies on biological models and explanations of addiction and substance use in his article. Potenza states that dopamine within the limbic system initiates the urge or compulsion for addiction. Furthermore, he discusses the neurocognitive changes that occur from substance use and addiction and states, “Using the aforementioned frameworks to consider the neurocircuitry involved in addictions, it is important to consider that changes may occur over time in the structure and function of these brain motivational pathways” (p. 525). These changes may interrupt motivational functions leading to continued substance use and addiction thereby making it more difficult to quit the maladaptive behavior (Potenza, 2013).

                                                                      References

Bacon, M. (2019). Family therapy and the treatment of substance use disorders: the family matters model. Routledge, Taylor, and Francis Group. https://doi.org/10.4324/9781315192253

Capuzzi, D. & Stauffer, M. D. (2016). Foundations of addictions counseling (3^rd ed.). Pearson.

Clinton, T. & Hawkins, R. (2009). The quick-reference guide to Biblical counseling. Baker Books.

Erickson, M. J. (2015). Introducing Christine doctrine (3^rd ed.). Baker Academic.

Franken, I. H. A., Muris, P., & Georgieva, I. (2006). Gray's model of personality and addiction. Addictive Behaviors, 31(3), 399-403. https://doi.org/10.1016/j.addbeh.2005.05.022

Kelly, J. F. (2019). E. M. Jellinek's disease concept of alcoholism. Addiction (Abingdon, England), 114(3), 555-559. https://doi.org/10.1111/add.14400

King James Bible. (2017). Cambridge University Press. (Original work published 1769).

Potenza, Marc N., M.D., Ph.D. (2013). Biological contributions to addictions in adolescents and adults: Prevention, treatment, and policy implications. Journal of Adolescent Health, 52(2), S22-S32. https://doi.org/10.1016/j.jadohealth.2012.05.007

Wanigaratne, S. (2006). Psychology of addiction. Psychiatry (Abingdon, England), 5(12), 455-460. https://doi.org/10.1053/j.mppsy.2006.09.007