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The Biopsychosocial Model of Addiction Monica C CHAPTER 6 The Biopsychosocial Model of Addiction Monica C. Skewes*, Vivian M. Gonzalez$ *University of Alaska Fairbanks, Fairbanks, AK, USA, $University of Alaska Anchorage, Anchorage, AK, USA OUTLINE Biopsychosocial vs. Biomedical Models of Addiction 61 Spouses and Intimate Partners 67 Other Individual Difference Variables that Influence Conceptual Models of Addictive Behavior 62 Substance Use 67 Biopsychosocial Model of Addiction 62 Ethnicity and Culture 67 Gender 67 Biological Factors and the Development of Environmental Influences on Substance Use 67 Addictive Behaviors 63 The Biopsychosocial Model and Addiction Psychosocial Factors and the Development of Treatment 68 Addictive Behaviors 64 Natural Recovery 68 Risk Factors in Children 64 Medication 68 Personality and Temperament 64 Classical and Operant Conditioning 64 Psychosocial Factors in the Treatment of Addiction 69 Outcome Expectancies 65 Readiness to Change 69 Self-efficacy 66 Self-efficacy 69 Social Influences on Substance Use 66 Summary 69 Families 66 Peers 66 BIOPSYCHOSOCIAL VS. BIOMEDICAL Contemporary medical disease models acknowledge the MODELS OF ADDICTION influence of social, psychological, and behavioral dimensions of addiction; however, these dimensions The biopsychosocial model of addiction posits that are viewed as relatively less important in the etiology biological/genetic, psychological, and sociocultural and treatment of addiction. The medical disease model factors contribute to substance use and all must be taken favors reductionism, whereby underlying biomedical into consideration in prevention and treatment efforts. causes for addiction are primarily implicated in the This model emerged in response to criticisms of the etiology/cause of the disorder, and mind–body dualism, biomedical model, which has historically dominated where the mind and the body are viewed as separate the field of addiction studies. The traditional biomedical and as not significantly affecting one another. Despite model was developed and is espoused by medical scien- widespread favor among many scientists and healthcare tists for the study of disease, and its proponents also practitioners, evidence from research studies of addic- view addiction as a chronically relapsing brain disease tive behaviors does not support the medical disease with a genetic/biochemical cause. The biomedical or model of addiction; instead, a biopsychosocial model disease model of addiction views addiction as the mani- that gives equal importance to biological/genetic, festation of disturbances in measurable biochemical or psychological, and sociocultural factors better fits the neurophysiological processes in the afflicted individual. available data. Principles of Addiction, Volume 1 http://dx.doi.org/10.1016/B978-0-12-398336-7.00006-1 61 Copyright Ó 2013 Elsevier Inc. All rights reserved. 62 6. THE BIOPSYCHOSOCIAL MODEL OF ADDICTION In 1977, psychiatrist George Engel authored a seminal the addictive problem and the responsibility for solving paper calling for the abandonment of the biomedical the addictive problem. The moral model holds that model of illness in favor of a biopsychosocial model. people who suffer from problems of addiction are Engel identified numerous problems with the biomed- responsible for both acquiring and solving the problem. ical model that would be alleviated by the adoption of People who become addicted are seen as morally weak a biopsychosocial model that recognizes biological, with poor willpower, and they must will their way psychological, social, and cultural influences on illness. through addiction in order to recover. There is little For example, the biomedical model views biochemical support for this model in the literature. The enlighten- abnormalities as the cause of any illness, and posits ment model holds that the person is responsible for that correcting the biochemical abnormality will cure developing the addiction, but is not responsible for the illness. However, in many disorders, a person may solving the problem. The enlightenment model is remain ill after the biochemical abnormality has been espoused by Alcoholics Anonymous and other 12-step corrected and, conversely, a person may never become philosophies, and requires people to seek recovery by ill even in the presence of an abnormality. For example, turning the problem over to a higher power. Only when infected with the virus that causes the common a higher power can cure addiction, and it is the person’s cold, some research participants become ill and some task to form and strengthen a relationship with a spiri- do not. The biomedical model does not account for the tual entity so that this entity can solve the addiction finding that, among people with similar genetic predis- problem. The medical/disease model emerged in positions or physiological problems, some people response to the moral and enlightenment models that develop an illness while others remain well. Engel placed blame on the addict for his or her problem. In surmised that psychological and sociocultural factors the medical model, the addict is responsible neither for must explain the differences in the disease state among the development of the problem nor for its resolution. people with the same biochemical abnormalities. This model posits a biological/genetic predisposition It has been well established that illness is not merely for addiction, an underlying disease process, and assumes the result of biochemical dysfunction or abnormality, as that the disease is progressive. The medical/disease some people become ill in the absence of an abnormality model fails to account for the finding that many people or dysfunction. The effects of stress on illness have been with problems of addiction do recover without profes- well supported in the literature, as has the role of expec- sional treatment. Finally, the compensatory model holds tation on illness and health. The placebo effect, where an that people are not responsible for developing the addic- inert ingredient can result in biochemical reactions for tive problem, but are responsible for their own recovery. the person who believes he or she is ingesting a drug, In the compensatory model, the role of multiple factors is evidence for the role of expectation in illness, and in the development of addictive behavior is noted supports Engel’s view of a connected mind–body expe- (including biological predisposition, early experiences, rience. There also is evidence for the importance of the and social and cultural variables), and the continued patient–provider relationship in healing; if psychosocial use of substances is viewed as a way to cope with stress. variables were not important, it would not make sense Of these four models, the compensatory model is the for rapport building and communication between the most similar to the biopsychosocial model. physician and the patient to have such strong influences on health outcomes. Moreover, if illness is caused only by the existence of a physical abnormality, then it should BIOPSYCHOSOCIAL MODEL OF be cured by correcting the deviance, but this is not ADDICTION always the case. Most illnesses, disorders, and syndromes, including disorders of addiction, are caused Science has not discovered a single factor that can by the interaction of numerous factors – biological, explain why some people are able to use substances psychological, social, cultural, cognitive, and environ- without progressing to addiction, while others abuse mental. Therefore, these factors must be addressed in or become dependent on substances. Instead, the avail- order to result in a recovered state. able evidence suggests that biological, genetic, person- ality, psychological, cognitive, social, cultural, and environmental factors interact to produce the substance CONCEPTUAL MODELS OF ADDICTIVE use disorder, and multiple factors must be addressed in BEHAVIOR prevention and treatment programs. The interaction of these factors to produce substance use problems is the A discussion of helping and coping by Brickman and core tenet of the biopsychosocial model of addiction. colleagues identified four models of addiction based on This model is a way to understand and explain the beliefs about attributions of responsibility for acquiring problem of addiction, but has not generated testable I. THE NATURE OF ADDICTION BIOLOGICAL FACTORS AND THE DEVELOPMENT OF ADDICTIVE BEHAVIORS 63 hypotheses as have theories of behavior change like the consumption. Further, sons of an alcohol-dependent Health Belief Model or the Theory of Reasoned Action/ parent have decreased EEG alpha rhythms, also found Theory of Planned Behavior (TRA/TPB). The essence of in people with current alcohol dependence. Other the model is that the mind and the body are connected studies have found that the sons of an alcohol-dependent and both the mind and the body affect the development parent have lower language functioning, lower learning and the progression of addiction within a social and achievement, lower verbal intelligence, and other neuro- cultural context. Only by considering all of these factors psychological differences when compared to controls. can addiction be accurately conceptualized. There is evidence that children of an alcohol-dependent parent who become alcohol dependent themselves have a worse prognosis than alcohol-dependent people who BIOLOGICAL FACTORS AND THE are not the children of alcohol-dependent parents. For DEVELOPMENT OF ADDICTIVE example, the children of an alcohol-dependent parent BEHAVIORS show
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