03 Feb Ch 1: Introduction to Psychological Models of Addiction Theories and Biological Basis of Addiction

Throughout clinical medicine, diagnostic cut-offs are set by consensus, commonly based on an evolving understanding of thresholds above which people tend to benefit from available interventions. Because assessing benefits in large patient groups over time is https://thechigacoguide.com/top-5-advantages-of-staying-in-a-sober-living-house/ difficult, diagnostic thresholds are always subject to debate and adjustments. It can be debated whether diagnostic thresholds “merely” capture the extreme of a single underlying population, or actually identify a subpopulation that is at some level distinct.

Neuroethics and the Brain Disease Model

• For alcohol addiction, meta-analysis of twin and adoption studies has estimated heritability at ~50%, while estimates for opioid addiction are even higher [44, 45].
• Eventually it became clear that the quest to “maximize utility” could not capture human preference (44) nor would it apply to disorders such as addiction.
• According to these principles, anything that could not be objectively verified and explained at the level of cellular and molecular processes was ignored or devalued.

Changes in brain function and structure in addiction exert a powerful probabilistic influence over a person’s behavior, but one that is highly multifactorial, variable, and thus stochastic. Philosophically, this is best understood as being aligned with indeterminism, a perspective that has a deep history in philosophy and psychology [84]. In modern neuroscience, it refers to the position that the dynamic complexity of the brain, given the probabilistic threshold-gated nature of its biology (e.g., action potential depolarization, ion channel gating), means that behavior cannot be definitively predicted in any individual instance [85, 86].

Subtypes in addiction and their neurobehavioral profiles across three functional domains

It is a model based on Engel’s original biopsychosocial model (Engel 1977) for which he argued that to develop a scientific and comprehensive description of mental health, theories that promote biological reductionism should be dismissed in favour of those that adhere to general systems theory. The contemporary model, adapted for addiction, reflects an interactive dynamic for understanding substance use problems specifically and addressing the complexity of addiction-related issues. The empirical foundation of this model is thus interdisciplinary, and both descriptive and applied. The degrees in which self-control is exerted, free choice is realized and desired outcomes achieved are dependent on these complex interacting biopsychosocial systems.

• The model, therefore, allows for diverse and multidimensional aspects of knowledge to be drawn upon depending on the concern to be addressed, and the tools available to address them (Cochrane 2007).
• Other authors believe that restricting the ability of physicians to write prescriptions is only a short-term fix (30).
• It has been argued that growing up in a nurturing environment could promote a more effective distress regulation system and a greater ability to refrain from overindulging in recreational drugs (Fonagy et al., 2004).
• Yet many other elements are idiosyncratic, such as the intensity of the experience of reward and the functioning of the individual’s mesolimbic dopaminergic pathway in the brain.
• Examples are needle-sharing despite knowledge of a risk to contract HIV or Hepatitis C, drinking despite a knowledge of having liver cirrhosis, but also the neglect of social and professional activities that previously were more important than substance use.
• Socrates was a nativist, as revealed by his insistence that it was human nature to select the virtuous option.

Understanding the Biopsychosocial Model of Health and Wellness

Evidence of generally intact decision making does not fundamentally contradict addiction as a brain disease. For the foreseeable future, the main objective of imaging in addiction research is not to diagnose addiction, but rather to improve our understanding of mechanisms that underlie it. The hope is that mechanistic insights will help bring forward new treatments, by identifying candidate targets for them, by pointing to treatment-responsive biomarkers, or both [52]. Developing innovative treatments is essential to address unmet treatment needs, in particular in stimulant and cannabis addiction, where no approved medications are currently available. Although the task to develop novel treatments is challenging, promising candidates await evaluation [53].

• The SMH proposes a mechanism where emotion guides or significantly influences behaviour, particularly decision-making.
• As humans became aware of psychoactive substances, they quickly discovered that these substances produced numerous effects of potential value.
• While the practicality of biopsychosocial systems model may allow for a more integrative explanation for addiction, it does not explain addiction entirely.
• The goal of the present review is to evaluate the value of neurobiological and psychodynamic perspectives to inform our understanding of addiction, particularly substance-use disorders.

The hard work of obtaining, paying for, and using substances becomes all-consuming [37, 47]. Most people who develop SUD either manage their substance-induced life problems adequately or are able to quit on their own or with help from family and friends [42]. For a smaller group of people, substances have too many negative consequences, and they need help and treatment from professionals. In Norway, such treatment is provided in both local-community Top 5 Advantages of Staying in a Sober Living House and specialised healthcare facilities, including short-term and long-term inpatient and outpatient treatment. Understanding SUD is crucial because it affects legal regulations, support and treatment services, and the attitudes of both service providers and the public regarding people with SUD. Social learning theory, as originally proposed by Albert Bandura, followed 2000 years of intellectual inquiry into the determinants of human behavior.

This statement, while correct in pointing out broad heritability of behavioral traits, misses a fundamental point. The fact that normal anatomy shapes healthy organ function does not negate that an altered structure can contribute to pathophysiology of disease. Critics further state that a “genetic predisposition is not a recipe for compulsion”, but no neuroscientist or geneticist would claim that genetic risk is “a recipe for compulsion”. However, as we will see below, in the case of addiction, it contributes to large, consistent probability shifts towards maladaptive behavior.

Mental health and behavior can be cyclical; for example, an individual who self-isolates as a symptom of depression may experience increased depressive symptoms as a result of isolation. The biopsychosocial model is an approach to understanding mental and physical health through a multi-systems lens, understanding the influence of biology, psychology, and social environment. Dr. George Engel and Dr. John Romano developed this model in the 1970s, but the concept of this has existed in medicine for centuries. There are a variety of psychological approaches that help us understand behaviours, treatment, and recovery. For example, helpers may look at how and why the behaviour is maintained; they may also engage in understanding the behaviours that are happening while a person is under the influence of a substance (24).