The American Society of Addiction Medicine positions itself the definitive voice of addiction treatment in America.
The research and treatment guidelines they publish have sought to maintain that position since the association’s inception in 1954. The disease model is strong is their corner of the world. With a growing majority of voices in the addiction treatment constituency, rather than making a bold, foolish statement like “the disease-concept is outmoded and antiquated,” it seems more practical and constructive to offer opportunities for some of the other voices in the choir to chime in.
The experiential model – Supported by Dr. Stanton Peele, this model starts with the premise that addictions occur in the wake of experiences of varying kinds of involvements, some drug-related, some not. Peele regularly writes for to Psychology Today. Peele also practices as a fierce opponent of the 12-step crowd, which is what initially placed him on my radar.
Peele is very active in the public arena, and his columns for Psychology Today and the Huffington Post are rarely far from my bedside table iPad.
The free-will model, also known as the life-process model, was brought to light by the late SUNY Syracuse professor Thomas Szasz. Life-process maintains a similar position to the experiential model, but in a more strict libertarian context. The free-will model is defined exactly as it sounds, placing heightened emphasis on the idea that addiction cannot be a illness, because it is essentially a behavior (i.e.
a series of choices). The APA and NIMN do not agree with this model, for somewhat apparent reasons, but humanists continue to appreciate it. Since Szasz’s passing, Dr. Jeffery A. Schaler has held the line, further refining the ideas central to free-will in the context of substance dependency.
Schaler seeks “to place responsibility for excessive drug-taking where it is usually absent in public discussion: on the individual drug-user.”
The pleasure model was first introduced by Nils Bejerot, who is most famous for coining the term Stockholm Syndrome. Bejerot is an impressively prolific academic, publishing more than 600 papers most of which promote a zero tolerance approach to drug laws, including cannabis.
Through the lens of the pleasure model, addiction “is an emotional fixation acquired through learning, which intermittently or continually expresses itself in purposeful, stereotyped behavior with the character and force of a natural drive, aiming at a specific pleasure or the avoidance of a specific discomfort.” Bejerot goes on: “Stimulation with drugs is only one of many ways, but one of the simplest, strongest, and often the most destructive.” The knee-jerk position on addiction prompted sweeping changes to official drug policy in Sweden and Bejerot’s notoriety also placed him in front of the US Senate, offering testimony in front of a subcommittee on cannabis in 1974.
The opponent-process model is a largely theoretical model that promotes a semi-simplistic cause/effect, in which psychological state A, is followed in turn by psychological state B. The name of opponent-process was derived from opponent-process color theory. Staring at the color red, followed immediately by looking at a gray area of color will result in making you believe you’re seeing green. Soloman was something of a heavyweight in the ranks of American East Coast academia with degrees from Brown and Harvard.
He went on to be elected to both the American Academy of Arts & Sciences as well as the National Academy of Sciences. Opponent-process w/r/t addiction looks at events that occur at the sensory level of experience, eventually translating downstream into habit-forming behavior.
The premise is that hedonistic states that feel good are in modulated by mechanisms (I read this as neural, metabolic; basically inertia, most generally) that seek to diminish the intensity of the state. In time, opponent-process obeys the law of diminished returns.
The more positive feelings the drug-user experiences, the more accustomed they become of them, the more you want to use to return to that previous state of mind, etc, etc, ad morten.
The cultural model is a different, semi-simplistic approach which seeks to place addictive behavior into the cultural context in which it began. Through this perspective, Saudis have lower incidence of alcoholism because liquor is forbidden in Saudi Arabia.
The explosion of in gambling addiction in the US in the final two decades of the 20th century can be explained by growth in the gambling industry. Slightly dubious reasoning, from a statistical perspective, as correlation may or may not indicate causality. Roughly half of patients diagnosed as alcoholic come from family situations where Alcohol Rehab Tennessee is used excessively, indicating more realistically both genetic and cultural causal factors.
The moral model and the rational addiction model regard addiction as a behavior, rational or otherwise. The moral model places more emphasis on defects of character which lead to the choice to consume illicit substances, and exclude biological factors in drug consumption. The moral model is fairly cut and dried, and has fallen out of favor as having very much redeeming therapeutic significance.
No one I speak with regards highly the “great moral strength” it takes to overcome addiction. There has been, as noted in Jeffrey Schaler’s free-will model, a focus on the personal choices that a individual makes who participates in addictive behavior, so perhaps the baby is not entirely out with this particular bathwater.
The chemical model is probably the most clinically focused upon w/r/t to new research, largely for its potential in new pharmaceutical discovery. The “pleasure circuit” of the human brain includes the ventral tegmental area of the midbrain, the amygdala, and the nucleus accumbens.
The particular regions are not as important for new drug discovery, but are still a priority for behaviorists. Drug discovery to heal addiction looks at a number of specific neuroreceptors, for example, the anadamid receptor or the enkephalin receptor, to research how brain chemistry functions w/r/t stimulus.
It’s worth mentioning that a developing epigenetic model of addiction should begin to more clearly emerge in the coming future. Epigenetic changes have recently discovered to be heritable, bringing into light new questions about the particulars of nature versus nurture and the role of behavior and outside stimuli in genetic heritability.
Blended model, you guessed it, blends the points of all other models to develop a therapeutic approach to treating addiction. My own biases lean me toward the blended model for what should be apparent reasons. No two people are alike, and even when encountering individuals with dependencies on the same substances, there are often nuances that have to be taken into account when developing an appropriate (i.e.
effective) treatment profile.
The disease and the genetic models of drug dependency treatment are far too hot too confront. In short, the 12-Step crowd has some vocally pronounced opinions when it comes to the disease model. Evidence-based science has to sort out ongoing updates to academic and lab-based findings.
In my experience, both of these camps could learn a lot from each other. Addiction is rarely treated in a group. My own biases lean away from both camps, but take into consideration years of both research and experience, while trying my best to remain current.
Addiction does not geteffectively treated in a vacuum. At the end of the day, this is an all too human affair.