What exactly is the biopsychosocial model of addiction?
Source: Image by 4924546 from Pixabay
In light of the detrimental consequences of addiction on individuals, their families, communities and society in general, it is understandable that many people want to know the answer to the question: What causes addiction? Why does one person end up compulsively using substances despite very negative consequences, while another person may occasionally use substances without loss of control?
Addiction can arise regardless of a person’s character, virtue or moral fiber. Several decades ago, the prevailing belief was that addiction was the result of bad choices made by a morally weak person. However, this view has long been discredited by scientific research. We now know that biology plays an essential role in the disease. In fact, in 1956, the American Medical Association declared alcoholism to be a disease that should be treated with medical and psychological approaches (Mann et al., 2000).
However, given its biological makeup only has its drawbacks, and research efforts have shown that addiction is not that simple. There is no “addiction gene” or genetic sequence that accounts for all of the variance in the experience of addiction. Instead, it is now known that many factors contribute to the development of addiction. Grisel (2019) noted that “the bottom line is that there are probably as many avenues to becoming addicted as there are addicts”.
The biopsychosocial model
So how do we conceptualize the cause of addiction? Multifaceted disorder needs a multifaceted conceptualization, and we find that in the biopsychosocial model of addiction (Marlatt & Baer, 1988). Rather than spotting the a thing which causes addiction, we now understand that a constellation of factors contributes to a person being more or less at risk of addiction.
Some aspects are universal (eg activation of the reward system by drugs of abuse). Yet many other things are idiosyncratic, such as the intensity of the reward experience and the functioning of the individual’s mesolimbic dopamine pathway in the brain. The biopsychosocial model provides a way to consider the myriad of factors that may contribute to the risk of addiction. Let’s take a look at each dimension of the model.
The meaning of “organic”
Genetics and biology are part of the picture, but not the whole. Although there is no “addiction gene” to definitively identify a person as being at risk for addiction, it is evident through studies of twins, adoption studies, family studies and more recently. epigenetic studies that addiction has a genetic component. People genetically predisposed to addiction enter the world with an increased risk of becoming addicted at some point in their lives.
There are many hypotheses to explain this genetic predisposition, such as the Deficiency syndrome as a reward (Blum et al., 1996; Blum et al., 2014), who postulates that some people are born with an underactive reward circuit (called hypodopaminergic functioning) which subsequently prepares them to be more sensitive to the gratifying effects of drugs. (Febo et al., 2017).
Additionally, many neurotransmitters are involved in the reward experience (dopamine, opioids, GABA, serotonin, endocannabinoids, and glutamate; Blum et al., 2020). Thus, deficiencies in any combination of these neurochemicals can contribute to a predisposition to addiction. It is important to note that one person’s reaction to the reward experience can be very different from another’s. This awareness should help us cultivate empathy for drug addicts – it’s very likely that others really don’t know how drugs make them feel.
The meaning of “Psycho”
Along with genetics, another factor contributing to the risk of addiction is psychological makeup. This factor is as broad as it sounds and includes personality traits (such as sensation seeking and impulsivity), mental health issues (such as anxiety and depression), psychological constructs (such as self-esteem and self-esteem) and the psychological impact of an individual’s life experiences (such as trauma). Some people may be more affected by the rewarding effects of drugs because they do their best to regulate painful emotions.
For example, researchers have found a strong association between trauma and substance abuse (Dube et al., 2002, 2003; Giordano et al., 2016). Indeed, in the original Adverse childhood experiences (ACE), Felitti et al. (1998) found that more ACEs increased the risk of subsequent drug and alcohol use. One explanation for this trend is that toxic stress caused by trauma leads to a deregulated stress response. An individual’s stress hormones (cortisol and adrenaline) are chronically elevated (Burke Harris, 2018; van der Kolk, 2014).
These people may experience constant hyperarousal, hypervigilance, anxiety, and drug abuse may be an effective way to regulate these emotional experiences (Fellitti et al., 1998). Thus, many factors and psychological experiences can increase the risk of change what you feel (or the regulation of emotions) via drugs of abuse.
The meaning of “social”
The third factor in the biopsychosocial model is the social environment. Social norms, availability, accessibility, legality, modeling, expectations, societal approval, visibility, targeting practices, and cultural beliefs all influence the experience of addiction. A person exposed to drug use at an early age may be influenced by social modeling (or learning by observation). In addition, some environments have specific social norms related to drug use (eg, “Everyone has a bit of a drug use in college”).
In addition, some communities are target more strongly with alcohol and tobacco ads and have greater availability of drugs of abuse than others, especially impoverished communities (Primack et al., 2007; Rose et al., 2019). Consequently, the social environment in which one evolves contributes to their risk of addiction.
Put it all together
The factors that increase an individual’s risk of addiction are numerous, but they all find their place in the biopsychosocial model of addiction (Marlatt & Baer, 1988). Taken together, this model provides a holistic conceptualization of addiction that recognizes the complexity of the disorder and provides guidance towards a solution, which must necessarily be multifaceted and holistic too. The more we know about the biopsychosocial model, the more we can foster specific empathy for addicts and work towards effective treatment and prevention efforts.