What causes addiction? Part 1 of 2

Photo: Contributed

Before I became a therapist, I had an experience which later made me wonder about the nature of addiction. I was walking in downtown Los Angeles when I saw a ravaged elderly man propped against a doorway, guzzling a bottle of Scope. I was stunned, and wondered how he had become a dead-man-walking. The voices of my social education conspired to make me believe that there was something intrinsically defective within him; that he had failed to meet the challenges of a troubled life. Early in my training as a substance abuse counsellor, I realized how wrong I had been.

My judgment had emerged out of the prejudices of popular culture. These erroneous biases are represented by the moral perspective. It sees the problem of addiction as a moral failing: alcoholics drink because they are more hedonistic and self-centered than other people; they are oriented to immediate reward; they lack religious values; they are impulsive; and they are dishonest. This perspective is based on values rather than data.

The medical model is supported by the idea that there are psychological and biological factors that are prerequisites to addiction. These factors are expressed in symptoms like continuing to use despite serious circumstances; being preoccupied with substances to a degree that narrows the scope of life; and experiencing increased tolerance and withdrawal. This model allows for the measurement of the severity of addiction by standardized assessment instruments. The only treatment approach is abstinence.

The social learning model is captured in a quote from one of its adherents: “An addiction is a habit that gets out of hand.” That habit is learned in a social context (family, poverty…) through a complex process of reinforcement. If you grow up in a chaotic family where substance abuse is the norm you will learn from that experience about using substances to deal with your emotional problems. Your habit will be reinforced by those around you as well as by the fact that when you take the substance you feel better (numb out). But there is hope because what is learned can be unlearned; thus, there is a great emphasis on acquiring skills for dealing with things like triggers and cravings.

The disease model, also known as the Minnesota Model, reasons that addiction is a disease characterized by loss of control over consumption. Substance abuse is perceived as an involuntary, progressive illness with distinct stages; the final one being death. A percentage of the population is viewed as being genetically predisposed to alcohol addiction and that abstinence is the only way to manage or contain the disease. The addicted person can only be placed in remission because relapse is ever imminent. Even after twenty years of sobriety, one relapse will force the person to start from the beginning. This view is central to 12-step programs.

Many models, like those described above, have been created to explain underlying causes. Each has its own perspective on treatment, and it is wise for the person seeking help to know a little about them. They will influence how he will be approached in the counselling experience. In part two of this series the newest view on addiction will be introduced. It is called the bio-psycho-social-spiritual model, presenting a comprehensive approach to treating substance abuse.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.