Many models of addiction could be criticised for failing to attend sufficiently to social and environmental factors (Copello and Orford 2002). There have been several attempts to amalgamate the biological, psychological and sociological theories of drug and alcohol addiction into a megatheory – the bio-psychosocial perspectives (Galizio and Maisto 1985, Kumpter et al. 1990, Wallace 1990). Even though the focus here is on biological and psychological processes, social factors are also included in this model through learning, perceiving and interpreting the world about us as well as through the person’s social relationships and larger cultural environment.
The bio-psychosocial model takes into consideration a broad range of factors which interact resulting in addiction. Thus, drug and alcohol addiction are viewed as the result of multi-factorial causation rather than having uni-dimensional cause. Kumpter et al.’s (1990) bio-psychosocial ‘vulnerability model’ includes biological factors (genetic inheritance, physiological differences), psychosocial factors and environmental factors (family, community, peer or social pressure). In addition, another component may be added to the bio-psychosocial theory, that is the spiritual dimension. The model views these factors ‘as temporarily ordered in its interactions’ that lead to addiction. Whether the goal is prevention, treatment or research, the health care professionals can understand the individuals from a holistic perspective. By adopting a multi-dimensional approach, the bio-psychosocial theory has provided a new conception of alcohol and drug misuse that focuses attention towards a new set of questions about the nature and process of addiction. A summary of the advantages of the bio-psychosocial model is presented in Table 4.1.
ACTIVITY 4.1
There is only one correct answer to the following multiple-choice questions
Which of the following is not a major theory of addiction? a. Genetic
b. Adaptation c. Moral d. Psychological
Which statement is incorrect?
a. The moral theory is based on the belief that using alcohol or drug is a sign of moral weakness
b. The moral theory accepts that there is any biological basis for addiction c. According to the moral theory, individuals are responsible for their
behavioural choices and their own recovery
d. ‘Victim-blaming’ approach is evident in the moral theory
Which statement is incorrect? The disease theory of addiction
a. Maintains that addiction is a disease due to either the impairment of behavioural and/or neurochemical processes
b. Claims that the cause of the disease is not attributed to the genetic or biological make up of the individual
c. Holds that alcohol and drug addiction are unique, irreversible, and pro- gressive diseases
d. Holds that while alcohol or drug addiction cannot be cured, abstinence is the only option
Which statement is incorrect? The genetic theory of addiction
a. Put forward a genetic predisposition to alcohol or drug addiction b. Maintains that early-onset alcoholism is genetically determined
Table 4.1 Characteristics and focus of the bio-psychosocial theory Characteristics Focus
The bio-psychosocial theory unifies prior biological, Multidimensional and multi-professional approach psychological and social theories of addiction to addiction
This theory postulates a role for social and spiritual factors in the development of and recovery from substance misuse and allows for future analysis of these elements
A conceptual framework that allows attention to be Provision of a comprehensive range of services focused on all problems related on a continuum,
from experimental users to those who are dependent on psychoactive substances
Characterises the population of substance misusers Meeting individual or holistic needs as heterogeneous
Supports the concept of a hierarchy of harm reduction Allows for the delivery of harm reduction services outcome goals including abstinence-related goals
Congruent with other modern theories of health and Diversity of health needs within a population or
education community. Matching needs to services or
treatment. Measuring treatment outcomes on all dimensions
Source: Adapted from Adult Addictions Services Branch, Alcohol and Drug Services (1996) British Columbia Ministry for Children and Families, Victoria
c. Is based on evidence mainly from drug research studies
d. Incorporates the psychosocial factors in the development of addiction
Which statement is incorrect?
a. Asians encompass the only race that exhibits Asian flushing b. Acetaldehyde is an important enzyme for alcohol metabolism c. American Indians and Eskimos are genetically identical d. Flushing is common amongst white Europeans
Regarding genetic studies of addiction, which statement is incorrect? a. Twin studies are the most powerful
b. Twins reared apart studies are the most powerful c. Family studies are scientifically sound
d. Adoption studies are easy to do because good records are kept
Which statement is false?
a. Family studies have shown an increased incidence of alcoholism in families
b. Adoption studies have not shown any correlation between addiction and genetics
c. Twins reared apart studies are the most powerful
d. Monozygotic twins and diszygotic twin studies show slightly different outcomes
Which one of the following factors is not considered to be a component in psychological theories?
a. Psychoanalytical b. Genetic
c. Personality d. Social learning
Which statement is incorrect? The psychoanalytic theory of addiction
a. Stems from the belief that addiction stems from the unconscious death wishes
b. Includes the notions of conflict between a repressed idea and the defence against it
c. Proposes that aetiology of alcohol or drug dependence is assumed to develop from the avoidance of pain or anxiety
d. States that use of alcohol or drug (smoking) is related to the ‘fixation’ at the anal stage of development
Which one of the following is not considered in behavioural theories? a. The theory makes provision for individual differences (genetic factors) b. The use of psychoactive substances is viewed as an acquired behaviour c. Behaviour is learned through the process of classical conditioning and
operant conditioning
d. The theory of classical conditioning does not include social factors or the expectations of drug effects
Which one of the following is not considered in social learning theories?
a. The theory is formed and maintained through the process of positive and negative reinforcement
b. Behaviour is through role-modelling and need to conform
c. In order to understand the effects of alcohol or drug, cognitive processes must be considered in relation to other factors
d. An individual’s prior experience with alcohol or drug and the social setting in which drinking or drug taking occurs are least important in the theory
Which one of the following is not considered in socio-cultural theories?
a. In the systems theory, behaviour is determined and maintained by the ongoing demands of interpersonal systems in which an individual interacts b. In the cultural theory, behaviour is through role-modelling and the
satisfaction of a hierarchy of needs
c. The availability theory suggests that the greater the availability the greater the prevalence and severity of substance use problems in society
d. Cultural and religious attitudes have been considered to be a defensive shield against alcohol and drug addiction
Which one of the following is not considered in bio-psychosocial theories? a. In the bio-psychosocial theory, behaviour is mainly determined and
maintained by the genetic factors
b. The theory includes genetic inheritance, physiological differences, family, community, peer or social pressure
c. This theory postulates a role for social and spiritual factors in the development of and recovery from addiction
d. The theory supports the concept of a hierarchy of harm reduction outcome goals including abstinence related goals.
KEY POINTS
• The moral theory is based on the belief that using alcohol or drug is a sign of moral weakness.
• The disease theory of addiction maintains that addiction is a disease caused by the impairment of either behavioural or neurochemical processes or both.
• The genetic theory of addiction puts forward a genetic predisposition to alcohol or drug addiction.
• Family studies have shown an increased incidence of alcoholism in families. • The psychoanalytic theory of addiction stems from the belief that addiction stems
from the unconscious death wishes.
• Behaviour is learned through the process of classical conditioning and operant conditioning.
• In social learning theory, in order to understand the effects of alcohol or drugs, cognitive processes must be considered in relation to other factors.
• In the socio-cultural theories, behaviour is determined and maintained by the ongoing demands of interpersonal systems in which an individual interacts.
• In the bio-psychosocial theory genetic inheritance, physiological differences, family, community, peer or social pressure are all considered.
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