III. Explaining the Cause & Maintenance of Alcoholism & Drug Abuse

The Biopsychosocial Model1 views the development and maintenance of substance use as influenced by a number of factors. In other words, there are a number of variables that influence substance-using behaviors, including biological, psychological (i.e., emotional and mental health), and social factors.

a. Biological Influences:

• An individual’s biology and genetic make-up can have a very strong influence on the development of substance use.

• There is a good deal of evidence that suggests that children who have a parent with an alcohol problem are 3 to 4 times more likely to develop alcoholism compared to children who do not have a substance-abusing parent.

• Twin and adoption studies have shown the influence of genetics in the transmission of alcohol problems, even when the children were not raised by their biological parents.

To determine the biological influences on substance-using behaviors, an individual’s physical condition and make-up are evaluated. A physician is the most helpful resource in investigating these questions.

•    What types of medications does the person take?

•    Is there a past or current illness that the individual is struggling with?

•    What is the neurological and chemical make-up of the individual? Is there too much of
a certain hormone or is the brain having difficulty processing information and communicating it to the rest of the body?

•    Is there physical damage to the body or body systems?

•    Was there an injury requiring medical intervention, resulting in addiction to painkillers?

b.   Psychological Influences:

•    The desire to change ones feelings or outlook on life may lead to substance use. Wanting to feel happy, relaxed, sexy, powerful, or just like everyone else can be motivating factors that lead to substance-using behaviors.

•    Individuals may rely on the effects of alcohol or drugs to help cope with stressful life events (i.e., relationship break-up, childhood abuse, injuries, poor health, work overload).

• Parents and siblings may model the use of alcohol or drugs as a method of coping with problems, stress, and uncomfortable feelings. As a result, these individuals are more likely to display this behavior and are less likely to use healthy coping strategies for dealing with stress.

Substance use can be psychologically rewarding. For example, substance use can have positive results on negative feelings (i.e., decreased tension and anxiety, increased positive feelings, escaping problems and avoiding conflict); thus promoting and encouraging continued substance-using behavior.
 
In addition, personality characteristics and behaviors that can influence substance use include impulsivity, avoidance, mental illness, sociopathy, pessimism, and neuroticism.

c Social Influences:

• Family, community, peers, context and environment, and culture can influence substance- using behavior by encouraging or providing consequences that promote, discourage or maintain substance use.

o Families:
- May have traditions (i.e., holidays, family get-togethers, or dinners) that include the use of substances, particularly alcohol.
- May engage in care-taking behaviors (i.e., cleaning up after a weekend binge, calling in sick, and making excuses for the substance user at family events) which unintentionally reward the substance use.

▪    When family members cover up for the substance abuser, the family can avoid public scenes, protect the family, and avoid conflict. Moreover, the substance abuser is then able to avoid criticism and going to family functions, and continue his or her use. In such cases, a certain degree of family balance is maintained; unfortunately, so is the substance use.

▪ Family members may also intend to apply negative consequences for substance use.

Behaviors may include:
- avoiding the substance abuser
- remaining silent about the use
- resisting the desire to complain
- making critical verbal comments directed at the substance-abusing family member

Unfortunately, though well intended, all these consequences can actually promote use. While family members and/or the partner believe they are discouraging or punishing the substance abuser for his or her substance use, an undesired effect may occur: the substance-using family member is driven farther away from the family and perhaps into using substances in secret or outside of the home.

o Peers
- Influence experimentation with substances and influence patterns of use.
- Social rewards include gaining acceptance, attractiveness, and popularity.

o Culture: race and religion
- Influence patterns of use through routine practices and rituals which may offer acceptance or punishment of use.

o Context and environment
▪    Refers to the where and when one might be exposed to substance use and influence use patterns.
√ Sporting events, bars, Friday and Saturday nights, weddings, or other social gatherings.

For more information refer to:
1 Engel, G.L. (1977). The need for a new medical Model. Science, 196, 129-136.

2. Treatment Implications

a. Biological Interventions:

• Medications have long been used to help people reduce or stop substance use.

• Medications can be helpful in promoting desired change, whether the medication is targeting substance use, a physical illness, or psychological problem.

A number of medications are listed in the section titled Building Support for Abstinence. The section titled How Do You Know if You or a Loved One Needs Help? includes a list of resources that can be referred to for further information.

b. Psychological Interventions:

• Stress management and monitoring feelings, such as relaxation techniques, exercise, anger management, development of fun hobbies, and participation in recreational activities can all serve to assist individuals who lack healthy, effective coping mechanisms.

• These interventions can help individuals learn to reduce tension and negative feelings without resorting to the use of alcohol or drugs.

• Personal counseling is also recommended to help make these important lifestyle adjustments.

c. Social Interventions:

• The goals of these types of interventions are to: (1) reduce triggers and consequences that contribute to the use of substances; and (2) increase satisfaction with self, partner, and one's family as a whole.

A number of techniques and skills are listed and explained in detail throughout this workbook.

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See more of this publication at Sobriety: A Couple’s Workbook

Learning Sobriety Together: A Couple’s Workbook is also available as a pdf download – see list of manuals on the Addiction and Family Research Group site
http://addictionandfamily.org/