WORKSHEET: Models of Addiction Activity

Activity: Understanding Assessment

Purpose: Participants will examine their understanding of the models of addiction
Time: 10-15 min

Jim, age 16, seems to be even moodier than normal lately. He isn’t eating much in the evening
and complains that he has a stomach ache or isn’t hungry. You remember when he was so picky
about his looks and clothing, but notice that he isn’t showering often and is wearing dirty
clothing to school. The worst part is that he no longer wants to talk about his day or his life like
he used to do in the evenings. Instead, he snaps if you ask him questions or yells that you need to
stay out of his business. You are so worried and wonder if his grades, like his home life, are
suffering. You believe he might be using drugs, because he’s smelled odd a few times and
yesterday, you found what looked like marijuana in his pant pockets. You desperately think back
to what has been going on in his world as you search for clues to his possible drug use.

The statements below agree with one of the models of addiction and show what you might say to
yourself if you held particular beliefs about addiction. Please match the following models to the
statements: Disease Model, Moral Model, Nature Model, Psychological Model, or Sociological
Model

_Soc______ Jim is using because he’s around those kids at school. I just know that they
convinced him that Pot (or whatever that was) is okay to use. I’m going to get
him away from that group at all costs.

_Psy______ Jim seems so lonely this year. I’m thinking that he’s depressed since his
girlfriend moved out of state. Perhaps it might be a good idea to take him to a
counselor or to our pastor for a talk.

_Moral____ I’ve told Jim multiple times about my rules in this house. Finding that
marijuana, or at least what I thought was marijuana, was the last straw. I’m
going to ground him and then we’re going to talk to that school counselor.

_Nature____ I know that all teens want to experiment. Heck, even I did that when I was in
school and I turned out okay. It’s probably just a phase. I shouldn’t worry so
much. After all, what’s a bit of Pot.

_Disease___ I know that drug and alcohol addiction run in our family, but I’m not sure that
Jim knows this. He needs to understand about my dad’s use and how Dad
never could kick the habit – even when he tried. Dad used to say that alcohol
made him feel “normal.” I think I’ll talk with Jim about what is going on in
his life and see if I can get him into a teen group to help him figure this out.

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The statements below agree with one of the models of addiction and show what Jim might say to
himself if he held particular beliefs about addiction. Please match the following models to the
statements: Disease Model, Moral Model, Nature Model, Psychological Model, or Sociological
Model

__Moral___ I know that I made that choice to use and I should be able to just stop. I’ve
tried to stop over and over again. I’m so ashamed of myself. The others all say
that they can drop it anytime, but I can’t. I can’t tell my parents; they would
hate me for being a bad son.

_Nature____ It’s my right to do what I want with my own body and no one can tell me
anything different. It’s normal to want to de-stress after a hard day at school,
and this makes me feel so good. So, what is the issue! It’s just like Pot and
everyone knows that it’s basically harmless.

__Disease__ Jenny told me not to start using drugs. She said that it would change the way I
think and make it hard to remember stuff for the tests. She was right and I
tried to stop after I failed the last test. The problem was that all I could think
about after stopping was when and where I could get some more. I sure wish
I’d never seen the stuff.

__Psy_____ I’m so depressed lately and the Spice seems to help. I think of it as my
medication… my way of coping with this awful high school life.

__Soc_____ I live in a community where drug use is just what everyone does. I’m not on
the “hard” stuff, so I think I’m doing pretty good. I’ll stop when I get into
college and out of this place.

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 WORKSHEET Core 1, Slides 9-11: Knowledge Check: Use Misuse, or Use Disorder
Purpose – To assess understanding about the differences between substance use, misuse, and use
disorders.
Total Time – 10 minutes
Read the following questions and choose the term that best describes the person’s behavior.
1. A 16-year old teenager has a bad cold with a soupy-sounding cough. Lucy, her best friend,
feels sorry for her and gives her a dose of prescription cough medicine with codeine. The
medicine helps a lot and her coughing subsides.
a. Substance use
b. Substance misuse
c. Substance use disorder
2. An 18-year old takes a prescription antidepressant for treatment of depression. As directed
by his doctor, the 18-year old takes this medication once a day.
a. Substance use
b. Substance misuse
c. Substance use disorder
3. A 17-year old teenager smokes a blunt each night and e-vapes at least two dabs of budder
each day. He decided to stop using and experienced irritability, anxiety, depression,
sweatiness, and headache about a week later.
a. Substance use
b. Substance misuse
c. Substance use disorder
4. A teenager gets into a major car accident after a night of using N-Bomb with his friends. His
car was totaled, but fortunately, no one was seriously hurt.
a. Substance use
b. Substance misuse
c. Substance use disorder
5. The doctor prescribed a muscle relaxant for Toby after a soccer injury that severely strained
his neck and left shoulder. Toby takes the medicine as prescribed twice a day and says that it
makes him sleepy. Today, while driving to school, Toby was stopped for failure to render
right of way to a teen in a crosswalk. After talking to Toby, the police told him to step out of
his car. Toby admitted that he’d taken a muscle relaxant, but insisted that it was prescribed.
He was arrested anyway and charged with DUI.
a. Substance use
b. Substance misuse
c. Substance use disorder
 INFORMATION SHEET:
HOW WE DEFINE SUBSTANCE USE, MISUSE, AND DEPENDENCE
Substance Use
Substance use is the consumption of low and/or infrequent doses of alcohol and other drugs such
that damaging consequences may be rare or minor. Substance use might include an occasional
glass of wine or beer with dinner, or the legal use of prescription medication as directed by a
doctor to relieve pain or to treat a behavioral health disorder.

Substance Misuse
Substance misuse is the use of a substance for a purpose not consistent with legal or medical
guidelines. This term often describes the use of a prescription drug in a way that varies from the
medical direction, such as taking more than the prescribed amount of a drug or using someone
else's prescribed drug for medical or recreational use.

Substance-Related Addictive Disorders

American Psychiatric Association. (2013). Substance-Related and Addictive Disorders in the
Diagnostic and statistical manual of mental disorders: (5th ed.). pp. 481-589.

Substance Use Disorder

Per the American Psychiatric Association’s Diagnostic and Statistical Manual, 5th Edition
(DSM-5), substance-related disorders cover “10 separate classes of drugs: alcohol; caffeine;
cannabis; hallucinogens…; inhalants; opioids; sedatives, hypnotics, and anxiolytics;
stimulants…; tobacco; and other…substances (p. 481). Substance-related disorders are further
classified into Substance-Induced Disorders and Substance Use Disorders. Substance-induced
disorders include reversible substance-specific symptoms of “intoxication, withdrawal, and other
substance/medication-induced mental disorders” (p. 485). Gambling Disorder is an addictive
disorder also included in the DSM-5, because gambling behaviors activate the brain’s reward
centers in similar fashion as substance of abuse.
Substance use disorder is “a cluster of cognitive, behavioral, and physiological symptoms
indicating that the individual continues using the substance despite significant substance-related
problems” (American Psychiatric Association’s Diagnostic and Statistical Manual of Mental
Disorders, 5th Ed., 2013, p. 483). Characteristics of substance use disorders include a pattern of
behaviors fitting into one of four criteria groups: impaired control, social impairment, risky use,
and pharmacological criteria. Specific criteria include (pp. 483-484):

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Criterion 1: Impaired Control
1. The individual may take the substance in larger amounts or over a longer period than was
originally intended.
2. The individual may express a persistent desire to cut down or regulate substance use and may
report multiple unsuccessful efforts to decrease or discontinue use
3. The individual may spend a great deal of time obtaining the substance, using the substance, or
recovering from its effects
4. Craving is manifested by an intense desire or urge for the drug that may occur at any time, but
is more likely when in an environment where the drug previously was obtained or used.

Criterion 2: Social Impairment

5. Recurrent substance use may result in a failure to fulfill major role obligations at work, school
or home.
6. The individual may continue substance use despite having persistent or recurrent social or
interpersonal problems, caused or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities may be given up or reduced because
of substance use.

Criterion 3: Risky Use

8. Recurrent substance use in situations in which it is physically hazardous
9. The individual may continue use despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated by the
substance.

Criterion 4: Pharmacological Criteria

10. Tolerance by requiring a markedly increased dose of the substance to achieve the desired
effect or markedly reduced effect when the usual dose is consumed.
11. Withdrawal occurs when the blood or tissue concentration of a substance declines in an
individual who had maintained prolonged heavy use of the substance.

Substance Use Disorder is classified by a range of severity based on the number of diagnostic
criteria endorsed. Mild Substance Use Disorder means that the individual meets two to three of
the symptoms. Moderate Substance Use Disorder means that four to five symptoms have been
endorsed. Finally, Severe Substance Use Disorder means that the individual displays six or more
of the diagnostic symptoms.

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 INFORMATION SHEET: MODELS OF ADDICTION

Moral Model
Etiology:
The association of morality, or right versus wrong, with substance use behaviors and disorders
has been in existence for centuries and stems from our belief that humans have self-
determination and free will (Mosher & Atkins, 2007; Schaler, 2000). This model suggests that
drug use, gambling, looking at porn, or other potentially addictive behaviors are voluntary,
hedonistic actions that we choose because they feel good. The underlying etiology of dependence
includes a lack of morality, character, strength, or will power over the substance or behavior, and
a consequence of our personal choice to use psychoactive substances. Ultimately, we alone are
responsible for our actions.

Idioms indicative of a moral model:

 Just say no
 Loss of control
 Drug of choice
 Addictive personality
 Pull up your bootstraps and…

Recovery & Relapse:

Beliefs that substance use dependence is a moral issue comes at the price of stigma, shame, and a
rejection of new scientific information about how addiction hijacks our brain. This model is
associated with greater support for punishment, including incarceration. When successful
sobriety is the hallmark of our personal effort to “make good choices” or “do the right thing,”
those with substance dependence may be stigmatized and shame may accompany relapse.

Nature Model
Etiology:
Andrew Weil (1972), commonly associated with the 1960s drug revolution and hippie counter
culture, postulated that humans possess and innate and universal drive to alter their
consciousness. Support for this assertion can be drawn from the use of psychoactive substances
around the world and risk-taking, consciousness-altering activities such as skydiving, speeding,
bungee jumping, children spinning, and extreme sports. As such, use of psychoactive substances
and other “addictive” behaviors are practical solutions to a normal drive to feel an endorphin
rush.

These statements could indicate a belief in the nature model:

 It can’t be that bad if everyone’s doing it
 I tried it when I was a teen and I turned out just fine
 Taking risks is a normal part of growing up
 XX substance should be legalized
 I have the right to do what I want with my own body
 Just cut down

Recovery & Relapse:

The Nature Model supports personal independence and choice, while rejecting the need for
recovery or abstinence from the problematic drug or behavior. Instead, the individual might be
encouraged to “just cut down” or to manage use (e.g., not using when intending to drive). This
harm reduction approach reduces the harm associated with use rather than insisting upon
abstinence and sobriety.

Psychological Model
Etiology:
The Psychological Model examines the issue of use, misuse, abuse, and use disorders from a
“micro-level” perspective “within the context of social learning, reinforcement, dysfunctional
coping mechanisms, and personality” characteristics (Broadus, 2012, p. 31). This model
considers causal factors stemming from within the individual. These might include emotional
factors (e.g., low self-esteem), mental health issues (e.g., depression, anxiety, body perception
issues), maladaptive beliefs (e.g., use will make me feel better), or personality characteristics
(e.g., low resilience, tendency toward risk-taking, or difficulty regulating emotions). Substance
use also may result from a lack of education or skills to effectively cope with personal issues.
Initially, the substance use or addictive behavior “high” may reinforce the coping mechanism.

Recovery & Relapse:

Belief in the Psychological Model is associated with greater compassion toward individuals with
substance use disorder and a greater focus on treatment rather than punishment. This belief
asserts that recovery is possible IF the underlying psychological issue is addressed.

Sociological Model
Etiology:
The Sociological Model stems from efforts in the 1980s and beyond to find explanations for the
increasing problem of drug-related crime and substance use (Broadus, 2012). This model
examines causal factors that are external to the individual, yet impact behavior. Such factors
include economic strain (e.g., poverty, homelessness, etc.), social conflict (e.g., terrorism, war,
crime, family/social relationships, etc.), and social/cultural norms that promote or normalize use
(e.g., pro-use communities, peer pressure, college expectations, etc.).

Recovery & Relapse:

Similar to the Psychological Model, the Sociological Model is associated with greater
compassion and the belief in treatment rather than punishment. This model also asserts that
reduction in addictive behavior and recovery are possible AFTER the external issues are
addressed or the individual is given the skills to deal with those issues.
Disease/Genetic Model
Etiology:
The Disease/Genetic Model reflects current advances in science that addiction is a “chronic,
relapsing brain disease characterized by compulsive drug seeking and use, despite harmful
consequences” (NIDA: The Science of Drug Abuse, 2016). This model asserts that substance use
results in changes within the brain, which impair our decision-making and motivation processes.
Substance dependence is chronic, progressive, and may lead to permanent damage or death.
Vulnerability toward dependence is inherited, but excessive substance use or addictive behaviors
can result in dependence even when there is no familial history of substance use issues.
Substance use also may be triggered or exacerbated by existing neurobiological factors such as
chronically low dopamine levels. In these cases, individuals indicate that use makes them “feel
normal.”

A core purpose of the Disease/Genetic model of addiction is to help us understand the individual
with the disease of substance or process dependence. Through understanding, we can increase
compassion and tolerance toward those with the disease of addiction and reduce the stigma
associated with this disease. Ultimately, understanding the science behind this disease may help
us to address and break the cycle of addiction.

Recovery & Relapse:

The Disease/Genetic Model equates substance use disorder to other chronic medical issues (e.g.,
Hypertension, Diabetes, Asthma, etc.). Similar to these other medical issues, the person may be
“in recovery” or the disease is “successfully managed,” but there is no cure. Once an individual
has a substance use disorder, they will always be vulnerable to relapse and a reoccurrence of the
dependence. As with many other chronic diseases, changing one’s behavior is very difficult. Just
think about trying to change your diet or quick smoking. Relapse is part of the process of
learning how to live a healthier life. For those with substance use or gambling disorders, any use
of the substance or exposure to gambling may trigger a relapse – even years after the person has
maintained sobriety. For this reason, this model asserts that abstinence is essential.

Biopsychosocial Model
Etiology:
Addiction therapists have noted that no one belief model covers all of the risk factors leading to
substance use, misuse, or addiction – and no one set of risk factors (e.g., just the psychological
causal factors) may prove to be strong enough or large enough to result in substance use, misuse,
or dependence. It could be that substance-related disorders result from an interaction between the
biological, psychological, and sociological factors. The biopsychosocial model of beliefs about
addiction offers a solution by bringing the biological, psychological, and sociological risks under
one umbrella. The downside of this model is that it does not encompass those beliefs included in
the Nature or Moral model – and as we’ve seen, these beliefs can be important to choices
regarding use and treatment of those with dependence.
Recovery & Relapse:
This model view substance use and process disorders as complex disease encompassing our
biological vulnerability, genetics, psychological trauma, emotional issues, and negative thinking,
and sociological issues such as SES, culture, and education. The recovery process must address
these complexities through prevention AND treatment, and must be flexible enough to meet
people where they are in their disease. In addition, we must consider gender, age, ethnicity,
cultural values, and sexual orientation as we develop our prevention and treatment programs.