CHAPTER 26
The Biopsychosocial Model of the Addictions
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
•
26.2: Describe the biopsychosocial model and the separate components of
this model
•
26.4: Describe the reactions against the separate components of the model
•
26.5: Consider the reactions to the biopsychosocial model as a whole
CHAPTER OUTLINE
Biology: The “Bio” Part of the Bio/Psycho/Social Model
Definition
History
Process
Biological Determinism
Jellinek’s Work
The Genetic Inheritance Theories
Epigenetics
Neurobehavioral Theories
Applications of the Biological Component of the Bio/Psycho/Social Model
Reactions Against the Biological Component of the Bio/Psycho/Social Model
Philosophical
Methodological
Reactions Against the Jellinek Model
Genetic Inheritance Theories
Reactions to the Epigenetics Model
Reactions Against the Dopamine D2 Receptor Site Hypothesis
Biological Vulnerability Studies
Challenges to the Neuroplasticity Aspects of the Disease Model
Challenges to the Brain Imaging Studies
Challenges to the Genetic Modification Treatment Approaches
The Medical Model and Individual Responsibility
Spontaneous Recovery
Section Summary
The Psychological Components of the Bio/Psycho/Social Model
Definition
The Moral Model
Learning Theory
Coping Systems Theory
Personality Defense Theories of Substance Use Disorders
Behavioral Psychology Theories
Cognitive Behavioral Theories (CBT)
Psychoanalysis
The Addictive Personality
Applications of the Psychological Component of the Bio/Psycho/Social Model
Assessment
Neuropsychological Assessment
Individual or Group Psychotherapy
Cognitive Dissonance
Marital and Family Therapy
Reactions Against the Psychological Models of the Substance Use Disorders
Reactions to the Moral Model of the SUDs
Reactions to the “Alcoholic” (or “Addictive”) Personality Theories
Challenges to the “Characteristic Defenses” Theory
Challenges to the Behavioral Psychology Theories of the SUDs
Criticism of the Behavioral Psychology Approach
Challenges to the Learning Theories of the SUDs
Reactions Against the Coping Skills Theories
The Social Component of the Bio/Psycho/Social Model
Definition
Overlap with the Biological Model
The Role of Substance Use in a Culture
Social Factors Influencing Individual Substance Use Decisions
Applications of the Social Component of the Bio/Psycho/Social Model
Psycho-Educational Intervention Programs
Reactions to the Bio/Psycho/Social Model
CHAPTER OVERVIEW
The purpose of this chapter is to examine the various components of the biopsychosocial model.
The strengths and weaknesses of the various theories used to explain substance use disorders
(SUDs) are covered. Although there is no “grand unifying theory” of addiction, the
biopsychosocial model does help to explain the variety of impacts on an individual who develops
an SUD.
DISCUSSION QUESTIONS
Break-out discussion # 3 is possibly controversial. It is important to remember that there is
marked variation between individuals with SUDs. For some persons, a history of traumatization
is an apparent distal factor in the development of an SUD. For other persons, such a history
provides a convenient excuse for continued substance misuse. In yet other cases, the truth lies
somewhere in between these extremes. It is the job of a skilled therapist to determine the degree
to which trauma induces substance use in an attempt at self-medication. This point should be
made after the students begin to debate.
Break-Out Discussion # 1:
Are we close to the era of mind control? If, as the medical model postulates, the mind and
personality are nothing more than the result of chemical interactions within the central nervous
system (CNS), then the advances in molecular pharmacology would suggest that we stand on
the brink of being able to manipulate these interactions. To date, such efforts have been to find
medications that calm troubled persons, an admirable goal for psychopharmacology. Others
argue that the psychopharmaceuticals are doing more harm than good.
As neuropharmacologists better understand the biology of the neurons in the CNS, eventually
they will be able to design drugs that could produce desired mood states at will. This is the basis
of the SUDs: the individual desires to change his or her mood state, albeit with chemicals that
This increased knowledge about the neurobiology of the brain will be a double-edged sword.
Who will decide what a normal neurochemical balance is? Can we be assured that the person
making this determination has a brain that is functioning normally, or should their brain
chemistry be assessed and adjusted before they attempt to determine whether another
person’s brain chemistry is normal? Then who assesses the neurochemistry to the person who
assesses the assessor’s neurochemistry, etc.?
Questions
1. As psychopharmaceuticals become more sophisticated, how should their use be regulated?
Who should be able to set the boundaries of how these compounds can be used? Whose views
would you trust?
2. How might more sophisticated psychopharmaceuticals be misused, either on a small scale or
on a large scale? How many of these scenarios do you believe could actually happen? Which
ones would probably not happen? Why?
3. Would you refer to any current uses of psychopharmaceuticals as mind control? Why or why
not?
Break-Out Discussion # 2:
Is self-esteem a causal factor in SUDs? In substance rehabilitation circles, it is not uncommon to
hear one staff member or another discuss whether patient such-and-such might suffer from low
self-esteem. The patient might indeed suffer from low self-esteem, and this might be a clinical
issue that needs to be addressed in that patient’s rehabilitation program. But does low self-
esteem contribute to the SUDs?
Consider the narcissistic or antisocial personality disorders (both Cluster “B” personality
disorders). It would be hard to say that people with one of these personality types, who usually
view themselves as being the laws and rules that govern those of us doomed to be mere
mortals, suffer from low self-esteem. Yet persons with either personality type do become
Research has not demonstrated that people with high self-esteem are more or less likely to
become addicted, or successful in life. What percentage of the general population suffers from
low self-esteem but does not have an SUD? This is a perfect example of how correlation does
not imply causality!
Questions
1. Are people with high self-esteem more productive than people with low self-esteem? Do you
believe that those with high self-esteem are more likely to develop an SUD? How could this
factor either protect them or trap them?
2. What percentage of the population suffers from low self-esteem? Are they more or less prone
to developing an SUD? Could their low self-esteem provide a protective force against the
possibility of developing an SUD? How?
3. Is high (or low) self-esteem a factor in the SUDs, or just a co-occurring issue? What do you
think, and why?
Break-Out Discussion # 3:
When do psychosocial factors become an excuse for continued substance use? While this
section is not to dismiss the importance of psychosocial forces in shaping the individual’s
substance use behavior, can psychosocial factors just become an excuse for continued
substance use? Consider the following hypothetical interview between a substance
rehabilitation counselor and an individual with an AUD in treatment for the fourth time:
Counselor: We are meeting today to try and develop a plan that will help you abstain from
slipping back into active drinking after you are discharged from treatment. Do you
have any ideas on this subject?
speak of . . .
Counselor [breaking in]: So, it seems that you are saying that one thing that would help is
being able to practice asking for help. That is a skill that we can help you learn, here.
We can role-play a variety of scenarios so that you can feel comfortable asking for
help if you should feel the urge to drink. Can you think of anything else?
Counselor: All right. You seem to be saying that you want to learn how to trust others: The
signals to look for in a person who perhaps cannot be trusted, signs that a person
might be trusted, and how to build a healthy friendship or friendships. These are
good starting places. Can you think of anything else?
Client: Well, no, I can’t.
In this interview, notice how the client kept trying to blame the AUD on the abuse that was
suffered as a child. The counselor, however, while not dismissing the reports of abuse by the
client, kept the focus on what will help you abstain now rather than looking for root causes of
the client’s AUD. This hypothetical client has been in treatment on three prior occasions, and
Questions
1. “If you focus on the negative, then only the negative can emerge from treatment.” Do you
agree with this statement? Why or why not?
2. Do you think that the treatment approach presented in the above dialogue is a valid one in
light of this client’s history? Why or why not? What would you do differently?
KEY CONCEPTS AND TERMS
∆FosB (delta FosB): A compound found in neurons that controls the process of manufacturing
proteins within the neuron. ∆FosB is one of the genetic transcription factors, which control
Pre-alcoholic stage: The individual is no longer drinking on a purely social basis, but has started
to engage in what is called “relief drinking”
Prodromal stage: During this stage the individual begins to demonstrate alcohol-related
problems, such as blackouts, guilt over one’s behavior while intoxicated, and the urge to hide
one’s drinking from others
Messenger RNA: A molecule that is formed within the cell nucleus by copying half of the DNA
molecule and then carrying these genetic instructions through the nucleus wall to the cell. This
then “programs” the cell to follow the instructions on the messenger RNA molecule
Amygdala: A region in the brain that is shaped like an almond, located in each temporal lobe.
This region is thought to be involved in the process of attaching emotional context to memory
and modulating emotional responses to external reality. This includes behaviors centered on the
process of obtaining reward(s), and the anxiety and panic responses
Hippocampus: A region of the brain that is thought to be involved in processing sensory
information, as well as the formation and retrieval of memories. In normal healthy adults, it
appears to shrink by 0.5% per year, although the importance of this data to the addictions is not
Neurogenesis: Growth of new neurons
Vagus nerve: Also referred to as the tenth cranial nerve, this nerve is actually comprised of a
pair of nerves. The vagus nerve complex shares control of the cardiac rhythm through the
parasympathetic nervous system, and thus is indirectly involved in dietary regulation, social
relationships, and social relationships
Gene expression: The strength with which the information encoded on a gene influences the
biological function of the cells in the body
Neuroplasticity: Ability of neurons to form new neural pathways in response to new
experiences (what we call learning), and, to some degree, after neurological trauma
Functional magnetic resonance imaging (fMRI): Modification of the magnetic resonance
Biology: The “Bio” Part of
26.2: Describe the
3d: theories and etiology of addictions
Law of unintended consequences: A rule that whenever a change is made, it alters the system
in unforeseen ways, resulting in stressors and complications that were not expected when the
original change was made.
An excellent example of this law is the application of high-cost, labor-intensive medical care to
Denial: A defense mechanism that is a form of unconscious self-deception
Projection: A defense mechanism in which material that is not acceptable to oneself is projected
onto others instead
Rationalization: A defense mechanism used to justify otherwise unacceptable behaviors
through cognitive justifications
Minimization: A defense mechanism with which an individual consciously or unconsciously
reduces the impact of a socially unacceptable behavior or its effects on others
Illusion of correlation: The tendency to remember events that confirm preconceptions and
dismiss or forget information that fails to do so
Attachment bonds: Ties to others that initially begin with parents or caregivers, and over time
to a broader sphere of people
Placebo effect: A phenomenon that illustrates how much power expectations have over the
actual effects of a chemical(s). We expect that a drug or medication will have a certain effect on
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard—CACREP
Biology: The “Bio” Part of
the Bio/Psycho/Social
Model
The Psychological
Components of the
Bio/Psycho/Social Model
The Social Component of
the Bio/Psycho/Social
Model
26.1: Understand
the various models
of addictions
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
3f: systemic and environmental factors
that affect human development,
functioning, and behavior
the Bio/Psycho/Social
Model
The Psychological
Components of the
Bio/Psycho/Social Model
The Social Component of
the Bio/Psycho/Social
Model
biopsychosocial
model and the
separate
components of this
model
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
3f: systemic and environmental factors
that affect human development,
functioning, and behavior
Applications of the
Biological Component of
the Bio/Psycho/Social
Model
Applications of the
Psychological Component
of the Bio/Psycho/Social
Model
Applications of the Social
Component of the
Bio/Psycho/Social Model
26.3: Review the
typical applications
for the separate
components of the
biopsychosocial
model
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
3f: systemic and environmental factors
that affect human development,
functioning, and behavior
Reactions Against the
Biological Component of
the Bio/Psycho/Social
Model
Reactions Against the
Psychological Models of
the Substance Use
Disorders
26.4: Describe the
reactions against the
separate
components of the
model
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
Reactions to the
Bio/Psycho/Social Model
26.5: Consider the
reactions to the
biopsychosocial
model as a whole
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
3f: systemic and environmental factors
that affect human development,
functioning, and behavior