Models of Addiction

WHAT IS AN ADDICTION?
• Traditionally, the term addiction has been used to identify self-
destructive behaviors that include a pharmacological
component.
• The most stringent application would limit the term addiction
and the companion label of ‘addict’ to individuals with a
physiological dependence on one or more illegal drugs.
 WHAT IS AN ADDICTION?
• This definition usually includes a strong physiological craving,
withdrawal symptoms, and the need for more of the drug to
get the same effect (American Psychiatric Association, 1980,
2013)
• However, the scope of the term has expanded to include any
substance use or reinforcing behavior that has an appetitive
nature, has a compulsive and repetitive quality, is self-
destructive, and is experienced as difficult to modify or stop
(Orford, 1985).
 WHAT IS AN ADDICTION?
• Expanded use of the term addiction has also included
problematic relationships, excessive work behaviors, and even
what some are calling positive addictions (e.g., exercise,
meditation).
• Treatment professionals, addicts, and the public are confused
by this shifting scope of meaning, and among scientists and
practitioners in the field there is real concern about the
continuing expansion of the term’s application
 WHAT IS AN ADDICTION?
• If what is labeled “addiction” becomes too broad, the word will
become meaningless.
• However, labeling a broader range of behaviors as addictions
would be justified if they display common features that
increase our ability to understand addictive problems and
expand society’s capacity to intervene.
 WHAT IS AN ADDICTION?
The critical dimensions for an addiction are,
1. the development of a solidly established, problematic pattern
of an appetitive—that is, pleasurable and reinforcing—
behavior;
2. the presence of physiological and psychological components of
the behavior pattern that create dependence; and
3. the interaction of these components in the individual’s life that
make the behavior very important and resistant to change.
 WHAT IS AN ADDICTION?
• Addictive behavior patterns are repeated and become
predictable in their regularity and excess.
• Powerful reinforcing effects motivate continued use, although
these effects may shift from seeking pleasure to avoidance of
negative consequences (Volkow, Koob, & McClellan, 2016).
 WHAT IS AN ADDICTION?
• Dependence is the second necessary and critical dimension to define
addiction. The term dependence indicates that there is a reliance on
the behavior or its effects and that the pattern of behavior involves
poor self-regulation, continues despite negative feedback, and often
appears to be out of control.
• Moreover, reinforcers for engaging in this behavior often become
proponent in the life of the individual and an integral part of the way
of life and coping.
• Reinforcers are both physiological (with a strong neurobiological
component) and psychological (with a strong coping component).
 WHAT IS AN ADDICTION?
• They combine to create a powerful reward system that clouds
awareness of problematic consequences related to the
behavior and makes change difficult and, at times, seemingly
impossible.
• In fact, failure to change, despite the outward appearance that
change would be both possible and in the best interest of the
individual, is considered a cardinal characteristic in defining
addictions.
 WHAT IS AN ADDICTION?
• So, change is the antithesis of addiction, similar to freedom
being the opposite of enslavement.
• The polarities of change and addiction, then, can be viewed as
central themes for understanding how people become
addicted and how they can free themselves from an addiction.
 WHAT IS AN ADDICTION?
Habits most clearly associated with addiction include
• tobacco dependence,
• alcohol misuse and dependence,
• legal and illegal substance and
• prescription medication use disorders,
• a range of eating disorders (including overeating and bulimia), as well as
• gambling disorders

(National Academy of Sciences, 1999)

 WHAT IS AN ADDICTION?
The DSM-5 specifically lists nine types of substance addictions within this
category,

Alcohol Caffeine
Cannabis Hallucinogens
Inhalants Opioids
Sedatives (Hypnotics, Anxiolytics) Stimulants
Tobacco

They are not fully distinct because all drugs taken in excess activate the brain’s
reward circuitry, and their co-occurrence is common.
 WHAT IS AN ADDICTION?
The clear similarities across these behaviors, which in their excessive forms
are labeled addictions, include the following elements:
1. They represent habitual patterns of intentional, appetitive behaviors.
2. They can become excessive and produce serious consequences.
3. These problematic behavior patterns are stable over time.
4. They become important and salient in the life of the individual.
5. There are interrelated psychological and physiological components
underlying the behavior.
6. Finally, in every case, an individual who becomes addicted to these
behaviors has difficulty stopping or modifying them.
 Alcohol

Ach Dopamine Reward

Alcohol Serotonin Relax sedative

Long term
Out of control
induction of Shakes, BP rise
Synaptic Firing
Excitatory NT
 Smoking

Ach Dopamine Reward

Nicotine Glutamate Memory Memory loop to

reinforce the habit

Calms Neurons Provoke

GABA <20 mins repeated use
 Gambling

Winning Dopamine Reward

Gambling
Anticipation of
Near Miss Future Reward
More Excitation
 MODELS of ADDICTION
Many different theories and models of addiction have been proposed.
The most prominent explanatory models include
1. social/ environment models,
2. genetic/ physiological models,
3. personality/ intra-psychic models,
4. coping/social learning models,
5. conditioning/ reinforcement behavioral models,
6. compulsive/ excessive behavior models, and
7. an integrative bio-psycho-social model.
 Social/Environment Models
The social/environment perspective emphasizes the role of societal
influences, peer pressure, social policies, availability, and family systems as
mechanisms responsible for developing and maintaining addictions. Certain
types of drug use and individual addictive behaviors occur more frequently
in some subgroups. This has encouraged researchers to examine subcultures
related to drug use and to explore the importance of environmental-
contextual influences in the search for risk and protective factors. Patterns
related to specific drug use behavior support interesting, well-defined
sociocultural connections.
 Social/Environment Models
Drug users and abusers often have more family and friends who use drugs,
make a clear case for the importance of social context in the acquisition of
addictive behaviors,
In addition, conformity to some social norms as well as deviance from others
are offered by some investigators as explanations for addictions (Kaplan &
Johnson, 1992). Illegal drug use, abuse, and dependence are viewed as
deviant behaviors in many sociological models. Deviance then becomes an
underlying cause, while a particular addictive behavior may reflect a
response to the social context of peers
 Social/Environment Models
Some proponents of the social/environment models have concentrated on
the more intimate environment of family influences as a central factor
contributing to the onset of addictive behaviors. Family influences support
both a genetic, nature-based pathway of influence and a nurture-based path
focused on family interaction or family system
 Social/Environment Models
Additional support for the social/environment perspective comes from data
indicating that availability and social policies, such as restrictions in use and
taxation, influence use and abuse of certain substances. Policies restricting
cigarette smoking and advertising have made important contributions to the
declining rate of cigarette consumption.
 Genetic/Physiological Models
The most convincing information concerning the role of genetics in
addictions is available in alcohol use disorders. Early family studies indicated
increasing risk ratios for individuals as the number of alcoholic relatives rises
and as the number and severity of familial alcohol problems rise.
The role of genetics for other drugs of abuse varies by type of drug and
whether one is focusing on initiation or progression as well as the age of the
adolescent. Most scientists acknowledge a genetic influence on susceptibility
to substance abuse.
 Genetic/Physiological Models
However, the search is not for a single “alcoholism gene”; rather, the
consensus is that the heritable component of addictive behavior will be
polygenetic and complex.
Moreover, there seem to be many generic genetic risk factors that include
inherited risk for externalizing and internalizing disorders and a common
factor called behavioral disinhibition.
There are also some interesting anomalies that both support and challenge the
genetic/physiological explanations of addictions.
 Personality/Intrapsychic Models
Addictive behaviors have often been conceptualized as a symptom of more
historical, intrapsychic conflicts, often labeled disorders of personality.
Proponents of this perspective point to the frequent correspondence
between drug abuse and a diagnosis of antisocial personality disorder or its
predecessor, conduct disorder and juvenile delinquency, as evidence of
drugs being a symptom of a larger psychological problem.
 Personality/Intrapsychic Models
On the other hand some pre-alcoholic personality characteristics seem to be
related to later alcohol dependence: impulsivity, nonconformity, antisocial
behavior, independence, and hyperactivity.
In the related eating disorder arena, the literature on anorexia nervosa often
describes a typical adolescent female with low self-esteem and an intense
desire for control and autonomy.
 Coping/Social Learning Models
Appraisal-focused coping, problem-focused coping, and emotion-focused
coping are considered important domains of coping responses.
Addictions often are considered the result of poor or inadequate coping
mechanisms. Unable to cope with life stresses, addicts turn to their addiction
for escape or comfort. From this perspective, individuals use substances as
alternative coping mechanisms and rely on their addictions to manage
situations, particularly those that engender feelings of frustration, anger,
anxiety, or depression.
 Coping/Social Learning Models
Emotion-focused coping is considered an important dimension. Alcohol, for
example, has been viewed as addictive because of its tension reduction or
stress response dampening effects.
Because alcohol’s effects on stress and tension are quicker and often more
effective in dealing with a stressful event than other, natural coping
responses, alcohol becomes the preferred, and possibly the only, coping
mechanism.
 Coping/Social Learning Models
The social learning perspective also emphasizes the role of peers and
significant others as models. Advertisers who use sports figures to promote a
product clearly employ social influence principles. Alcohol and cigarette
promotions in sports arenas offer more subtle examples of the power of
modeling as an influence on substance use.
The influence of expectancies is not limited to substances of abuse. The
popularity of lotteries and the well-promoted jackpot for a lucky individual
as well as our societal devotion to being thin play a clear role in promotion of
gambling and eating disorders, respectively.
 Coping/Social Learning Models
Coping and social learning perspectives have become quite popular among
addiction researchers and clinicians.
However, many successful businessmen and athletes who appear to have
good general coping skills, or at least skills good enough to become
successful in a competitive environment, get fascinated by addictive
behaviors. Generalized poor coping cannot be the only reason individuals
become addicted. That seems particularly true for people who engage in the
behavior because of the positive enjoyment effects and not simply the relief
of problematic emotions.
Hyperactive who are successful to become slow, and then to fail.