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The Addiction Counselor’s Desk Reference
- By Misc Author
- Published 11/16/2007
- Addiction Research
- Unrated
Selected excerpts from the book The addiction Counselor’s Desk Reference, by Robert Holman Coombs and William A. Howatt.
The term addiction (derived from the Latin root addicere, meaning “to adore or surrender oneself to a master”) also applies to behaviors beyond drugs and alcohol such as sex, work, gambling, buying, eating, and the Internet.
Although “there is no single definition of addiction and a universally accepted, comprehensive theory of addiction has yet to be developed” (Doweiko, 2002, p. 21), here are the best known models of addiction, some of which share similar characteristics.
MORAL MODEL
This model, dating to the 1850s, defines an addicted client as weak in character. It is based on the idea that individuals have free choice and are responsible for their behaviors. As an example of this model, Lemanski (2001) cites a religionbased program (Oxford Group Movement/Moral Re-Armament) whose mission is to develop among clients morals that are aligned with God.
This approach has influenced public policy and the American judicial system.
Additional Resources -- For more information on the moral model, see May, C. (1997). Habitual drunkards and the intervention of alcoholism: Susceptibility and culpability in nineteen century medicine. Addiction Research, 5(2), 169–188; and A History of Alcoholism.
Available from http://www.hoboes.com/Politics/Prohibition/Notes/Alcoholism_History/
SELF-MEDICATION MODEL
This view, originating in the 1960s among psychoanalysts, assumes that people self-medicate to cope with life problems. A person in emotional pain will selfmedicate to find relief, and this can eventually lead to addiction.
This selfmedication hypothesis, Khantzian (1999) asserts, “should be considered in parallel with other approaches and not in competition with them” (p. 5).
Additional Resources -- For more information, see Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244.
Also see Self-Medication Hypothesis’ web site at http://self-med-hypothesis.tripod.com/
MEDICAL/DISEASE MODEL
First proposed in 1810 by Dr. Benjamin Rush (White, 2005), addiction was identified as a disease, rather than a mental disorder or moral failure. Disease is defined as a severely harmful, potentially fatal condition that manifests itself in an irreversible loss of control over use of psychoactive substances.
Although the disease may go into remission, there is no known cure, and since the disease is progressive and often fatal, complete abstinence is the treatment goal. In 1945, the American Medical Association formally accepted this definition of addiction.
Since then, the disease definition has been officially adopted by such professional organizations as the World Health Organization, the American Psychiatric Association, the National Association of Social Workers, the American Public Health association, the National Council on Alcoholism, and the American Society for Addiction Medicine.
Additional Resources For more information, see White, W. (2000). Toward a new recovery movement: Historical ref lections on recovery, treatment and advocacy. Available from www.ncaddillinois.org/whitelong.htm.
Ron Raizen’s Rains Report (www.roizen.com/ron/rr11.htm) provides a critical review of Jellinek’s (1960) report.
SPIRITUALITY MODEL
This model assumes that addictive disorders stem from a lack of spirituality, that is, of being disconnected from a “Higher Power,” the source of light, truth, love, and wellness.
“Every addiction is, in the final analysis, a disease of the spirit,” notes Doweiko (2002, p. 49). Alcoholics Anonymous and its many derivatives help participants recover by developing a viable relationship with this Higher Power.
Additional Resources -- For more information, see Kannaday, P., The spiritual model, available from http://ihcf.homestead.com/files/The_Spiritual_Model2.htm.
To review The Big Book web site (where the text is online), see http://www.recovery.org/aa/bigbook/ww/index.html
IMPULSE-CONTROL DISORDER
A relatively new definition of addiction, this view assumes that either neurobiological or genetic deficiencies make a person unable to control and regulate impulsive behavior(s).
Under certain conditions, such individuals will put themselves at risk and find temporary relief with self-destructive behaviors such as kleptomania, pyromania, and/or drug abuse (Hollander, Buchalter, & De- Caria, 2000).
Additional Resources -- For more information, see Mental Health Matters Information on Impulse Control Disorders.
Available from http://www.mental-health-matters.com/articles/art_cat.php?catID=31
REWARD DEFICIENCY AND NEUROPHYSIOLOGICAL ADAPTION
This model assumes that chemical imbalance is manifested as one or more behavioral disorders called the “reward deficiency syndrome” (Blum, Cull, Braverman, & Comings, 2000, para. 3).
This disorder, and others like it, are linked by a common biological substrate, a “hard-wired system in the brain (consisting of cells and signaling molecules) that provides pleasure in the process of rewarding certain behaviors” (Blum et al., 2000, para. 3).
He suggests that this reward deficiency syndrome may cause a predisposition, or vulnerability, to addiction that includes alcohol, cocaine, heroin, nicotine, sugar, pathological gambling, sex, and other behavior disorders.
Additional Resources -- For more information, see Blum, K., & Payne, J. E. (1991). Alcohol and the addictive brain: New hope for alcoholics from biogenetic research. New York: Free Press.
GENETIC MODEL
Research over the past 20 years has identified a genetic predisposition in some individuals to alcohol, tobacco, and other substances of abuse (Doweiko, 2002). Epidemiological studies indicate that 40% to 60% of an individual’s risk for an addiction to alcohol, opiates, or cocaine is genetic (Kendler, Karkowski, Neale, & Prescott, 2000; Tsuang, Bar, Harley, & Lyons, 2001).
A growing number of genetic researchers now believe different classes of substances may be connected to unique genetic preference and may help account for the individual’s drug of choice (Blum et al., 2000).
Additional Resources -- For more information, see Nestler, E. J. (2002). The genetic basis of addiction. Available from www.psychiatrictimes.com/p020256.html.
BIOMEDICAL MODEL
The 1990s gave rise to another disease theory of addiction that draws from both the biological and behavioral sciences. “Using drugs repeatedly over time changes brain structure and function in fundamental and long-lasting ways that can persist long after the individual stops using them” (Leshner, 2001, para. 3).
Once the addiction impacts the brain, the client is driven behaviorally to support the demands made by the brain to prevent becoming ill from withdrawal.
SOCIAL LEARNING MODEL
Social reinforcement causes individuals to model the drug use behaviors of their parents, older siblings, and peers.
Social learning theorist Albert Bandura (1977, 1986) indicates four stages of social learning: (1) Attention—The individual makes a conscious cognitive choice to observe the desired behavior; (2) Memory—The individual recalls what he has observed from the modeling; (3) Imitation—The individual repeats the actions that she has observed; and (4) Motivation—The individual client must have some internal motivation for wanting to carry out the modeled behavior.
Additional Resources -- For more information, see Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall; and Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
Available from http://catalogs.mhhe.com/mhhe/home.do.
For information on behavioral theory, see Behavioral & Learning Theory at www.aa2.org/philosophy/bahavioral.htm.
ERRONEOUS THOUGHT PATTERNS
This model assumes that illogical thinking underlies addiction. Ladouceur, Gaboury, Dumont, and Rochette (1988) explain that, to help addicted clients, counselors must challenge erroneous thinking, correct flawed thinking, and teach them how to reason correctly.
For example, when a compulsive gambler thinks, “I have a system that will beat this slot machine; I just need to stick to it long enough,” educate the person about the laws of probability and how they are stacked against the gambler.
Teach the person that gamblers cannot “beat the odds,” and that this flawed repetitive thought leads to addictive problems.
Additional Resources -- For more information, see Toneatto, T., Blitz-Miller, T., Calderwood, K., Dragonetti, R., & Tsanos, A. (1997). Cognitive distortions in heavy gambling. Journal of Gambling Studies, 13, 253–266.
BIOPSYCHOSOCIAL MODEL
Developed in the 1980s, this view holds that addiction vulnerability is affected by the complex interaction between one’s physical status (functioning of the body), psychological state (how one views and perceives the world), and social dynamics (how and with whom one interacts).
Chiauzzi (1991) points out that looking at addictions through these three windows allows for more flexibility in determining root cause and treatment. Additional Resources For more information, see Kumpfer, K. L., Trunnell, E. P., & Whiteside, H. O. (1990). The biopsychosocial model: Application to the addictions field. In R. C. Engs, Controversies in the addiction’s field (chap. 7).
Available from http://www.indiana.edu/engs/cbook/chap7.html.
PUBLIC HEALTH MODEL
The Institute of Medicine (1989) defines addiction from a public health perspective, identifying three etiologic factors: (1) Agents—the psychoactive drugs; (2) Hosts—individuals who differ in their genetic, physiological, behavioral, and sociocultural susceptibility to various forms of chemicals; and (3) Environment— the availability and accessibility of the agent (Coombs, 1997, pp. 176–177).
Additional Resources -- For more information, see the Institute of Medicine. (1989). Prevention and treatment of alcohol problems: Research opportunities [Report of a study by the Committee of the IOM, Division of Mental Health and Behavioral Medicine]. Washington, DC: National Academy Press.
Also see Addictions are an illness: A Public Health response to the war on drugs. The American Public Health Association.
Available from www.medicalcaresection.org/2000_bullet_2.html.
The term addiction (derived from the Latin root addicere, meaning “to adore or surrender oneself to a master”) also applies to behaviors beyond drugs and alcohol such as sex, work, gambling, buying, eating, and the Internet.
Although “there is no single definition of addiction and a universally accepted, comprehensive theory of addiction has yet to be developed” (Doweiko, 2002, p. 21), here are the best known models of addiction, some of which share similar characteristics.
MORAL MODEL
This model, dating to the 1850s, defines an addicted client as weak in character. It is based on the idea that individuals have free choice and are responsible for their behaviors. As an example of this model, Lemanski (2001) cites a religionbased program (Oxford Group Movement/Moral Re-Armament) whose mission is to develop among clients morals that are aligned with God.
This approach has influenced public policy and the American judicial system.
Additional Resources -- For more information on the moral model, see May, C. (1997). Habitual drunkards and the intervention of alcoholism: Susceptibility and culpability in nineteen century medicine. Addiction Research, 5(2), 169–188; and A History of Alcoholism.
Available from http://www.hoboes.com/Politics/Prohibition/Notes/Alcoholism_History/
SELF-MEDICATION MODEL
This view, originating in the 1960s among psychoanalysts, assumes that people self-medicate to cope with life problems. A person in emotional pain will selfmedicate to find relief, and this can eventually lead to addiction.
This selfmedication hypothesis, Khantzian (1999) asserts, “should be considered in parallel with other approaches and not in competition with them” (p. 5).
Additional Resources -- For more information, see Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244.
Also see Self-Medication Hypothesis’ web site at http://self-med-hypothesis.tripod.com/
MEDICAL/DISEASE MODEL
First proposed in 1810 by Dr. Benjamin Rush (White, 2005), addiction was identified as a disease, rather than a mental disorder or moral failure. Disease is defined as a severely harmful, potentially fatal condition that manifests itself in an irreversible loss of control over use of psychoactive substances.
Although the disease may go into remission, there is no known cure, and since the disease is progressive and often fatal, complete abstinence is the treatment goal. In 1945, the American Medical Association formally accepted this definition of addiction.
Since then, the disease definition has been officially adopted by such professional organizations as the World Health Organization, the American Psychiatric Association, the National Association of Social Workers, the American Public Health association, the National Council on Alcoholism, and the American Society for Addiction Medicine.
Additional Resources For more information, see White, W. (2000). Toward a new recovery movement: Historical ref lections on recovery, treatment and advocacy. Available from www.ncaddillinois.org/whitelong.htm.
Ron Raizen’s Rains Report (www.roizen.com/ron/rr11.htm) provides a critical review of Jellinek’s (1960) report.
SPIRITUALITY MODEL
This model assumes that addictive disorders stem from a lack of spirituality, that is, of being disconnected from a “Higher Power,” the source of light, truth, love, and wellness.
“Every addiction is, in the final analysis, a disease of the spirit,” notes Doweiko (2002, p. 49). Alcoholics Anonymous and its many derivatives help participants recover by developing a viable relationship with this Higher Power.
Additional Resources -- For more information, see Kannaday, P., The spiritual model, available from http://ihcf.homestead.com/files/The_Spiritual_Model2.htm.
To review The Big Book web site (where the text is online), see http://www.recovery.org/aa/bigbook/ww/index.html
IMPULSE-CONTROL DISORDER
A relatively new definition of addiction, this view assumes that either neurobiological or genetic deficiencies make a person unable to control and regulate impulsive behavior(s).
Under certain conditions, such individuals will put themselves at risk and find temporary relief with self-destructive behaviors such as kleptomania, pyromania, and/or drug abuse (Hollander, Buchalter, & De- Caria, 2000).
Additional Resources -- For more information, see Mental Health Matters Information on Impulse Control Disorders.
Available from http://www.mental-health-matters.com/articles/art_cat.php?catID=31
REWARD DEFICIENCY AND NEUROPHYSIOLOGICAL ADAPTION
This model assumes that chemical imbalance is manifested as one or more behavioral disorders called the “reward deficiency syndrome” (Blum, Cull, Braverman, & Comings, 2000, para. 3).
This disorder, and others like it, are linked by a common biological substrate, a “hard-wired system in the brain (consisting of cells and signaling molecules) that provides pleasure in the process of rewarding certain behaviors” (Blum et al., 2000, para. 3).
He suggests that this reward deficiency syndrome may cause a predisposition, or vulnerability, to addiction that includes alcohol, cocaine, heroin, nicotine, sugar, pathological gambling, sex, and other behavior disorders.
Additional Resources -- For more information, see Blum, K., & Payne, J. E. (1991). Alcohol and the addictive brain: New hope for alcoholics from biogenetic research. New York: Free Press.
GENETIC MODEL
Research over the past 20 years has identified a genetic predisposition in some individuals to alcohol, tobacco, and other substances of abuse (Doweiko, 2002). Epidemiological studies indicate that 40% to 60% of an individual’s risk for an addiction to alcohol, opiates, or cocaine is genetic (Kendler, Karkowski, Neale, & Prescott, 2000; Tsuang, Bar, Harley, & Lyons, 2001).
A growing number of genetic researchers now believe different classes of substances may be connected to unique genetic preference and may help account for the individual’s drug of choice (Blum et al., 2000).
Additional Resources -- For more information, see Nestler, E. J. (2002). The genetic basis of addiction. Available from www.psychiatrictimes.com/p020256.html.
BIOMEDICAL MODEL
The 1990s gave rise to another disease theory of addiction that draws from both the biological and behavioral sciences. “Using drugs repeatedly over time changes brain structure and function in fundamental and long-lasting ways that can persist long after the individual stops using them” (Leshner, 2001, para. 3).
Once the addiction impacts the brain, the client is driven behaviorally to support the demands made by the brain to prevent becoming ill from withdrawal.
SOCIAL LEARNING MODEL
Social reinforcement causes individuals to model the drug use behaviors of their parents, older siblings, and peers.
Social learning theorist Albert Bandura (1977, 1986) indicates four stages of social learning: (1) Attention—The individual makes a conscious cognitive choice to observe the desired behavior; (2) Memory—The individual recalls what he has observed from the modeling; (3) Imitation—The individual repeats the actions that she has observed; and (4) Motivation—The individual client must have some internal motivation for wanting to carry out the modeled behavior.
Additional Resources -- For more information, see Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall; and Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
Available from http://catalogs.mhhe.com/mhhe/home.do.
For information on behavioral theory, see Behavioral & Learning Theory at www.aa2.org/philosophy/bahavioral.htm.
ERRONEOUS THOUGHT PATTERNS
This model assumes that illogical thinking underlies addiction. Ladouceur, Gaboury, Dumont, and Rochette (1988) explain that, to help addicted clients, counselors must challenge erroneous thinking, correct flawed thinking, and teach them how to reason correctly.
For example, when a compulsive gambler thinks, “I have a system that will beat this slot machine; I just need to stick to it long enough,” educate the person about the laws of probability and how they are stacked against the gambler.
Teach the person that gamblers cannot “beat the odds,” and that this flawed repetitive thought leads to addictive problems.
Additional Resources -- For more information, see Toneatto, T., Blitz-Miller, T., Calderwood, K., Dragonetti, R., & Tsanos, A. (1997). Cognitive distortions in heavy gambling. Journal of Gambling Studies, 13, 253–266.
BIOPSYCHOSOCIAL MODEL
Developed in the 1980s, this view holds that addiction vulnerability is affected by the complex interaction between one’s physical status (functioning of the body), psychological state (how one views and perceives the world), and social dynamics (how and with whom one interacts).
Chiauzzi (1991) points out that looking at addictions through these three windows allows for more flexibility in determining root cause and treatment. Additional Resources For more information, see Kumpfer, K. L., Trunnell, E. P., & Whiteside, H. O. (1990). The biopsychosocial model: Application to the addictions field. In R. C. Engs, Controversies in the addiction’s field (chap. 7).
Available from http://www.indiana.edu/engs/cbook/chap7.html.
PUBLIC HEALTH MODEL
The Institute of Medicine (1989) defines addiction from a public health perspective, identifying three etiologic factors: (1) Agents—the psychoactive drugs; (2) Hosts—individuals who differ in their genetic, physiological, behavioral, and sociocultural susceptibility to various forms of chemicals; and (3) Environment— the availability and accessibility of the agent (Coombs, 1997, pp. 176–177).
Additional Resources -- For more information, see the Institute of Medicine. (1989). Prevention and treatment of alcohol problems: Research opportunities [Report of a study by the Committee of the IOM, Division of Mental Health and Behavioral Medicine]. Washington, DC: National Academy Press.
Also see Addictions are an illness: A Public Health response to the war on drugs. The American Public Health Association.
Available from www.medicalcaresection.org/2000_bullet_2.html.
