Sober living

The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry PMC

Beginning at birth, most of the knowledge we acquire about our world is obtained via our interactions with others, and it is other individuals who determine many, if not most, of the environmental contingencies that control our behavior. It wasn’t until the middle of the 20th century before the impact of social learning on our behavior was fully recognized. As humans became aware of psychoactive substances, they quickly discovered that these substances produced numerous effects of potential value. Once discovered, a compound was typically adapted for use as a medicine, as a tool for cultural preservation and advancement, and/or as a conduit to the spiritual world.

Addiction Neuroethics in the Clinical Context

Drug use may be transmitted socially by a number of mechanisms (Strickland and Smith, 2014; 2015), and several of these mechanisms have received empirical support. The impact that other people have on an individual’s drug use is directly related to their physical proximity – with intimate partners, family members, and close friends having the largest impact on drug use (Salvy et al., 2014; Kendler et al., 2013; Kuperman et al., 2013). The BPS Perspective incorporates all of the factors and levels discussed in this paper and recognizes environmental, psychosocial, biological, as well as their mediating factors. This single cohesive framework considers the interdependency of the entire system, drawing its conceptual roots from socio-ecological models (188, 189) including Ecosocial Theory (23). The BPS Perspective suggests the risk factors and protective factors that influence substance-seeking behavior at the individual and population level, and how they may impact health outcomes.

4. Pavlov, Skinner, and behaviorism

Engel’s perspective is contrasted with a so-called monistic or reductionistic view, in which all phenomena could be reduced to smaller parts and understood as molecular interactions. Nor did he endorse a holistic-energetic view, many of whose adherents espouse a biopsychosocial philosophy; these views hold that all physical phenomena are ephemeral and controllable by the manipulation of healing energies. Rather, in embracing Systems Theory,2 Engel recognized that mental and social phenomena depended upon but could not necessarily be reduced to (ie, explained in terms of) more basic physical phenomena given our current state of knowledge. He endorsed what would now be considered a complexity view,9 in which different levels of the biopsychosocial hierarchy could interact, but the rules of interaction might not be directly derived from the rules of the higher and lower rungs of the biopsychosocial ladder.

biopsychosocial theory of addiction

Biological Factors

The environment in which one resides is a known predictor of consumption behavior (39), thus behavioral economics is a conceptual system to understand how one’s access and exposure will predict demand and subsequent intake (40–43). 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. Behavioral economics is a scientific discipline at the intersection of economics and psychology as it pertains to health-related behavior (45). It has been used to study decision making in the context of substance use disorders (SUD) (46–48) including alcohol (49) and other health behaviors such as food and drink consumption (40, 50).

For many of these compounds, their intoxicating effects were an end to itself – people would take these drugs to achieve the presumably pleasurable states of inebriation they produced when consumed (Grilly, 2011). The Jekyll-and-Hyde-like dichotomy of drugs was thus apparent as early as 2500 years ago, with intoxicating agents seen as holding the potential for both personal and societal advancement, as well as personal and societal destruction. The present paper is a response to the increasing number of criticisms of the view that addiction is a chronic relapsing brain disease. In many cases, we show that those criticisms target tenets that are neither needed nor held by a contemporary version of this view. Common themes are that viewing addiction as a brain disease is criticized for being both too narrow (addiction is only a brain disease; no other perspectives or factors are important) or too far reaching (it purports to discover the final causes of addiction). With regard to disease course, we propose that viewing addiction as a chronic relapsing disease is appropriate for some populations, and much less so for others, simply necessitating better ways of delineating the populations being discussed.

  • Its role and effectiveness is entangled with the ancillary services available, drug policies, and treatment philosophy” (p.262).
  • Going forward, these same principles can be used to guide the development of metacontingency-based interventions to aid recovery.
  • They are useful to the extent that they focus our thinking and action in helpful ways (eg, they contribute to health, well-being, and efficient use of resources), but when taken too literally, they can also entrap and limit us by creating boundaries that need not exist.
  • For evidence, just look at relapse rates after inpatient treatment – especially for those individuals who do not continue with any form of aftercare (Ries, 2014).

We will be exploring substance use disorders as a biopsychosocial phenomenon and  unpack biological, psychological and social theories of substance abuse. You may choose to explore other theories, there are links to multiple theories of substance use disorders in additional resources. Socrates was a nativist, as revealed by his insistence that it was human nature to select the virtuous option. In other words, we select what is good because we know it innately – not via interacting with our sensory world.

Adverse Childhood Experiences

Notably, Speranza and colleagues (2017) redefined this apparent breakdown of reasoning and discourse observed in the AAI into a more flexible and clinically meaningful “low-coherence CC” category, which is characterized by emptiness, inconsistency, and fragmentation. Consequently, absent or traumatically ruptured attachments are expected to impact the development of personal identity and affect regulation (Berner, Carlos, & Whipple, 2010; Fonagy et al., 2004; Speranza et al., 2017). Robert K. Merton observed that, “In the modern world, the visibly practical accomplishments of a science largely affect the social value placed upon it” (Merton 1961, 697).

  • For our argument, we use the term “addiction” as originally used by Leshner [1]; in Box 1, we map out and discuss how this construct may relate to the current diagnostic categories, such as Substance Use Disorder (SUD) and its different levels of severity (Fig. 1).
  • In beginning to address this notion, the goal of the present review is to evaluate whether the consideration of neurobiological and psychodynamic perspectives provides insight to our understanding of addiction, particularly substance-use disorders (SUDs).
  • In other words, each and every goal-directed action is determined by an individual’s history with environmental contingencies similar to those that are operating in the environment at that precise moment (Skinner, 1981).
  • This ‘cannot classify’ category is important to the current discussion given the high index of early childhood adversity, rejection, neglect, and low support in their upbringing, that has been reported in substance-abusing populations (Kaltenbach, 2013; Suchman et al., 2012).
  • Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others.

Effective treatment interventions should thus target all nodes of the model and the functional relationships between them, and they must constantly evolve with the progression of the disorder. An argument is thus constructed that emphasizes the need for an organized structure of metacontingencies, operating within an individual’s social Top 5 Advantages of Staying in a Sober Living House environment, that targets the functional relationships between the factors that drive drug use. For instance, medications designed specifically for substance use disorders target the central nervous system in ways to minimize the effectiveness of the addictive substance (e.g., buprenorphine/naloxone for opioid use disorder).

Likewise, numerous studies have found that unresolved and insecure attachment representations are more common in mothers with SUDs than in those without SUDs (Espinosa, Beckwith, Howard, Tyler, & Swanson, 2001; Isosävi et al., 2016; Medrano et al., 2002; Sokolowsky, Hans, Bernstein, & Cox, 2007; Suchman et a., 2012). What is more, those with dismissive and intrusive internal representations are also more likely to lose custody of their children (Suchman et al., 2006). Thus, an attachment-based perspective begins to illuminate mechanisms that may underscore intergenerational transmission of risk for addiction vulnerability. Taken together, these theories consider addictions as originating during the earliest stages of human interaction, whereby constitutional vulnerabilities –paired with demanding environments– lead to a more overarching failure in the individual to recognize, understand, contain, and regulate difficult affective states.

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