For instance, substance use and addiction have negative effects on the quality of intimate relationships, domestic partnerships, and family dynamics (Center for Substance Abuse Treatment, 2004; Fals-Steward, 2003; Martin et al., 1996). Moreover, substance use leads to changes in group affiliation as the person exits native groups and enters groups that are more open to drug use by their members (McCabe et al., 2005; Poulin et al., 2011; Scalco et Top 5 Advantages of Staying in a Sober Living House al., 2015). When the social environment changes in ways that lead the individual to affiliate with social groups that promote drug use over abstinence, there is a further increase in the likelihood that a person will escalate their drug use over time. LCP is a way of understanding human development and adaptation from an intergenerational approach considering all factors contributing to health outcomes, and how these factors accumulate over time.

biopsychosocial theory of addiction

Understanding the Impact of Close Relationships

Five informants had received inpatient treatment for substance use and mental health problems or detox several times since they left Tyrili. A lot more is going on in clinical care than decisions as to what treatments to recommend, including personal, interpersonal, and institutional processes. Engel says a lot of interesting things about all these things in his 1997 paper and others around that time (Engel, 1980, 1982), and they can be considered as part of what is covered by the BPSM. The clearest clinical implications of the BPSM, in contrast as always with the narrower BMM, is accommodation of psychological and social factors as well as biological factors relevant to clinical management and treatment.

How Healthcare Professionals Use the Biopsychosocial Model

The neurobiological perspective provides a considerably structured and empirically-based approach, acknowledging that substance use leads to a series of neurochemical reactions in the brain that have structural and functional neuroadaptations. The opponent-process approach (Solomon & Corbit, 1974) suggests that the shift from substance use to substance abuse is generated by the transition from positive to negative reinforcement processes motivating continued substance use. From the perspective of incentive sensitization (Robinson & Berridge, 1993), the shift reflects an associative learning process mediated by a neurobiological sensitization to substance-related cues. Taken together, and according to incentive-learning principles (Bouton & Nelson, 1998), it is possible that before drug-related cues become meaningful enough to ‘incentivize’ drug use, they first need to be paired with the consequences of drug-use via repetition and reinforcement. Notwithstanding the specific mechanism, it seems that an important factor leading to substance dependence may be the (internal and external) context in which the individual and its addiction are embedded. To sum up, the cognitive revolution in psychology endorsed the relevance of mind to science by constructing causal explanatory models of behavior in terms of mental (or cognitive-affective) states.

biopsychosocial theory of addiction

Addiction, Social Learning, and the Path Forward

Underlying the analysis of power in the clinical relationship is the issue of how the clinician handles the strong emotions that characterize everyday practice. On the one hand, there is a reactive clinical style, in which the clinician reacts swiftly to expressions of hostility or distrust with denial or suppression. An individual who is struggling with their mental health might need social support and environmental changes just as much as they need therapy or medication intervention for their symptoms. When we use classical conditioning in the field of substance use disorders, we examine the relationship between the substance use and its connection with the environment.

Supporting someone with a porn addiction can be challenging, especially if they do not want help or do not agree that they have a problem. While you can provide resources and support, you can’t do the work of recovery and managing the behavioral addiction for them. Nobel Prize winner and biologist Nikolaas Tinbergen coined the term “supranormal stimulus.” The theory is that porn stimulates the brain’s reward system beyond what human ancestors typically encountered and experienced, making it possible and plausible for someone to develop an addiction. This article is for anyone wondering if their porn use is crossing the line into addiction and for anyone wondering if someone they care about is experiencing porn addiction.

  • Reflecting on these concerns, the authors stated “we [had] to be clear in our ethics applications and in our informed consent process with participants that HAT will not be available outside the context of the study” (p. 267).
  • Some forms of frustration may be social norms and boundaries, social rejection, loneliness, or loss (Bazan & Detandt, 2013; Loose, 2002).
  • Every brain, and every person is different; we must look at biology as one potential factor in a substance use disorder.
  • Environmental stress has the potential to alter lifelong hypothalamic-pituitary-adrenal (HPA) axis function and to induce subsequent neurodevelopmental maladaptation (51) (path A).
  • This is particularly troubling given the decades of data showing high co-morbidity of addiction with these conditions [25, 26].

Converging research suggests that addiction and attachment have overlapping neural pathways. Specifically, addiction and attachment may engage the mesocorticolimbic and nigrostriatal dopaminergic systems as well as the oxytocinergic system (Buisman-Pijlman et al., 2014; Johns, Lubin, Walker, Meter, & Mason, 1997; Strathearn, 2011). Data suggest that early stress and traumatic attachment experiences may hinder the development of the endogenous oxytocinergic system, increasing vulnerability to future addictive behaviors (Ammerman, Kolko, Kirisci, Blackson, & Dawes, 1999; Bremner & Narayan, 2008; Chaplin & Sinha, 2013; Sinha, 2001; Tops et al., 2014). This resonates with the aforementioned object relations theories, where early mother-infant interactions become embedded into the child’s psyche as mental representations of soothing, caregiving, and interacting that influence behavior and attribution biases across the lifetime. For many people, the process includes stable periods and periods characterised by emotional, relational, and social pain and trouble [6].

  • We considered that to be sufficient to answer the research question about how the informants perceived and reflected on the recovery process after they were discharged from inpatient treatment; hence data saturation had been achieved [20, 24].
  • Studies have emphasized how extreme childhood experiences, including trauma, abuse, and adversity, can be barriers to coherent and secure attachment representations (Speranza, Nicolais, Vergano, & Dazzi, 2017).
  • For Darwin, an animal’s interaction with its environment was entirely reflexive – each and every behavior was an automatic response elicited by a specific stimulus in the environment.
  • I outline in this section two general ways in which post-dualist, cross-disciplinary theories have been developed over recent decades, critical to formulating a biopsychological model.

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From a philosophical standpoint, a model based on reciprocal determinism is attractive because it considers addiction as determined by factors both internal and external to the individual. It acknowledges the importance of an individual’s personal characteristics – including past experiences and current “mindset”. It also acknowledges the role of the individual’s behavior – including behaviors involved in the acquisition of drugs, the use of drugs, and ultimately, the abstinence from drugs. Most importantly, it recognizes the functional relationships and interdependence between these factors. It’s a model that also points an accusatory finger at the specialty scientists and clinicians (the present author included!) who are interested in only one aspect of the phenomenon. Addiction is bigger than the person who needs help and the person who offers it – organizing principles are needed to describe it and organized structures are needed to heal it.

Adverse Childhood Experiences

Much of the critique targeted at the conceptualization of addiction as a brain disease focuses on its original assertion that addiction is a chronic and relapsing condition. Epidemiological data are cited in support of the notion that large proportions of individuals achieve remission [27], frequently without any formal treatment [28, 29] and in some cases resuming low risk substance use [30]. For instance, based on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study [27], it has been pointed out that a significant proportion of people with an addictive disorder quit each year, and that most afflicted individuals ultimately remit. These spontaneous remission rates are argued to invalidate the concept of a chronic, relapsing disease [4]. However, adverse caregiving experiences in early life may in particular foster the aforementioned deficits, as they lead to conflicting mental representations of self and others (Fonagy & Target, 2008). Such disorganized mental representations may thwart the individual’s ability to make sense of their own mental and physical experience, and consequently motivate substance use and abuse to escape discomfort (Kernberg, Diamond, Yeomans, Clarkin, & Levy, 2008).