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Assumptions About Substance Abuse: An Opinion

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Assumptions About Substance Abuse:  An Opinion

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego;  http://www.DrJulieMyers.com

 

There are many different models of addiction, including moral, psychological (cognitive-behavioral, learning, psychodynamic, and personality), biological (genetic, biomedical, disease, medical) and socio-cultural (McNeese, 2005.)  Each of these different models operates under a different set of assumptions.  The disagreement between the models rests on the different political motivations, ideologies, personal interests, and professional training of the individual (McNeese, 2005.)  Substance abuse counselors, for example, have generally adopted the 12-step approach to the disease model, since it is what they themselves experienced.  Probably the most commonly held is the disease model. “The disease model of addiction rests on three primary assumptions: a predisposition to use a drug, loss of control over use, and progression” (Krivanek, 1988, p. 202.)  It has its roots in Alcoholics Anonymous (Yalisove, 1998.)

The World Health Organization has adopted the word drug dependence to describe the addiction process. “The general term (drug dependence) will help to indicate a relationship by drawing attention to a common feature associated with drug abuse and at the same time permit more exact description and differentiation of specific characteristics according to the nature of the agent involved.” (WHO, 1964.)

Perhaps the stress-diathesis model best describes substance abuse, dependence, and addiction.  This model describe a basis of genetic and neurological susceptibilities to addiction, either because of the genetic susceptibility to the substance (or behaviors) or because of the genetic susceptibility to certain mental disorders, which increases the likelihood of self-medication and the abuse of substances (or behaviors.)  For example, those with Bipolar
Disorder have a 50-80% increase in substance abuse, which is thought to be largely self-medication. Given a person’s susceptibility, the environmental factors then influence whether or not any one individual develops a problem with substances (or behaviors.)  Upbringing, peers, experiences, and culture all shape one’s use of substances.  How the individual responds and copes with environmental stressors in large part determines their use.  Addictions represent a maladaptive coping mechanism to these environmental stressors.

It may not be necessary to know the etiology of substance abuse to treat it.  Although such information is interesting scientifically, and it can perhaps lead to better identification of susceptible individuals, treatment should concentrate on identifying those individuals with addictive problems and implementing effective treatment.  The identification of addiction problems can be culturally influenced.  Although the scope of the problem throughout the world is massive, the definition of it as an “addiction”, “abuse” or “dependence” must be understood in light of cultural norms.

The DSM-IV (APA, 1994) defines substance abuse and dependence as:

  • Substance Abuse is a maladaptive pattern of substance use which results in clinically significant impairment, with one (or more) categories occurring within a 12 months:  failure to fulfill major obligations, use in hazardous situations, legal problems, or social problems.
  • Substance Dependence is a maladaptive pattern of substance use, which results in clinically significant impairment, with three (or more) categories occurring in the same 12 months: physical tolerance, withdrawal symptoms, a large amount consumed over a long period, a lot of time spent, negative consequences, and continued use despite recurrent problems.

Although the DSM criteria states that three criteria must be met, in my opinion, for any particularly individual, simply displaying one of these criteria could signify abuse/dependence.   For example, continued use, despite knowledge of significant problems may be enough to signify that there may be an addictive disorder.  Setting the criteria for dependence as three/five criteria may be necessary for those individuals for whom there is less clear evidence of maladaptive behaviors.

Julie Myers, PsyD, MSCP

Licensed Psychologist, MS Clinical Psychopharmacology, Master Addiction Counselor, Board Certified Biofeedbachttp://www.DrJulieMyers.com.  

Copyright (2011):  Julie Myers, PsyD.  All Rights Reserved

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APA.  (1994).  Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington DC: American Psychiatric Association.

Bergh, C., T. Eklund, P. Sodersten, & C. Nordin (1997).  Altered dopamine function in pathological gambling.  Psychological Medicine, 27: 473-475.

Doweiko, H. (2006). Concepts of chemical dependency. 6th ed. Belmont, CA: Thompson .

Goudriaan, A., J. Oosterlaan, E. de Beurs, & W. Van Den Brink (2004). Pathological gambling: a comprehensive review of biobehavioral findings.  Neuroscience & Biobehavioral Reviews.  28(2), pp.123-141.

Krivanek, (1988), p. 202., Addictions.  Sydney: Allen & Unwin.)

McNeese, C. & D. DiNitto (2005).  Chemical Dependency. United States: Pearson Education, Inc.

Sunderwirth, S., &H. Milkman (1991). Behavioral and neurochemical commonalities in addiction, Contemporary Family Therapy , 13(5 ) pp. 421-433

WHO (1964), Expert Committee on Addiction-producing Drugs: Thirteenth report, p. 53 -55.

Yalisove, A. (1998). The origins and evolution of the disease concept of treatment.  Journal of Studies on Alcohol, 59, 469-476.