Models of Addiction
Doctors, religious leaders, psychologists and other professionals have long argued about the nature of addiction or dependency. For better or worse, here are some of the models proposed over the years.
The moral model is based on beliefs or judgments of what is right or wrong, acceptable or unacceptable. Those who advance this model do not accept that there is any biological basis for addiction. There is something morally wrong with people who use drugs heavily. The moral model is widely applied to dependency on illegal substances, perhaps purely for social or political reasons, but is no longer widely considered to have any therapeutic value. Elements of the moral model, especially a focus on individual choices, have found enduring roles in other approaches to the treatment of dependencies. This model contributes little to our understanding of why people use drugs heavily, and offers no real help to those battling with dependency. Some suggest the legal system is still influenced by the moral model, as we lock up “immoral” users in jail.
The opponent-process model states that for every psychological event, A will be followed by its opposite psychological event B. For example the pleasure one experiences from heroin is followed by an opponent process of withdrawal. There are many examples of opponent processes in the nervous system including taste, motor movement, touch, vision, and hearing. Addiction follows from our wanting to avoid withdrawal symptoms.
The disease model holds that addiction is an illness, and comes about as a result of the impairment of healthy neurochemical or behavioral processes. While there is some dispute among clinicians as to the reliability of this model, it is widely employed in therapeutic settings and forms the basis for Alcoholics Anonymous, Narcotics Anonymous and Nar-Anon. Most treatment approaches involve recognition that dependencies are behavioral dysfunctions, and thus involve some element of physical or mental disease.
The genetic model posits a genetic predisposition to certain behaviors. It is frequently noted that certain addictions “run in the family”, and while researchers continue to explore the extent of genetic influence, there is strong evidence that genetic predisposition is often a factor in dependency. Researchers have had difficulty assessing differences, however, between social causes of dependency learned in family settings and genetic factors related to heredity.
The cultural model recognizes that the influence of culture is a strong determinant of whether or not individuals fall prey to certain addictions. For example, alcoholism is rare among Saudi Arabians, where obtaining alcohol is difficult and using alcohol is prohibited. In North America, on the other hand, the incidence of gambling addictions soared in the last two decades of the 20th century, mirroring the growth of the gaming industry. Half of all patients diagnosed as alcoholic are born into families where alcohol is used heavily, suggesting that familiar influence, genetic factors, or more likely both, play a role in the development of addiction.
The blended model attempts to consider elements of all other models in developing a therapeutic approach to dependency. It holds that the mechanism of dependency is different for different individuals, and that each case must be considered on its own merits.
The habit model, proposed by Thomas Szasz, questions the very concept of “addiction.” He argues that addiction is a metaphor, and that the only reason to make the distinction between habit and addiction “is to persecute somebody”. (Szasz, 1973)
