Theories on Addiction as a Disease and Treatment Options
Deeanna M. Moore
University of Mississippi
This paper will discuss 8 scholarly journals that report on the theories of addiction as a disease in terms of either psychological theories or moral theories, as well as treatment options available for recovering addicts. The articles discussed will vary on their definitions of addiction and how addiction begins, persists, and is treated. The “Theories of Addiction” section will focus more on psychological theories, and how psychologists theorize addiction begins and persists. Moral theories discussed will seem to be more opinion-based, and therefore will vary across the individuals who take that stance. After the theories have been discussed, treatment options will be reviewed. Since treatment options may vary based on an individual’s needs, not all treatment options are available for discussion.
Keywords: addiction, theories, moral problems, disease, treatment, psychology
Theories on Addiction as a Disease and Treatment Options
Determining whether addiction is a complex disease of the brain and the body or whether addiction is a moral decision has become a focal point for policy makers. When looking at the history of the United States of America, we could easily assume that policy makers once believed that addiction is the result of moral and behavioral issues. The Prohibition Act is a prime example of how the United States government attempted to put an end to alcohol use disorder and the many problems associated with it. Many could argue that substance abusers make the conscious decision to use and abuse illicit drugs. They could also very well argue that substance abusers made the choice to initially try the substance, therefore, they make the choice to continue to use the substance. The belief that addiction is a disease has become more widely accepted than the belief that addiction is a choice made by the substance user. The idea of addiction being viewed as a disease is believed to be founded by the father of American psychiatry, Benjamin Rush. Although he did not believe that there were problems with consuming alcoholic beverages, he did realize that individuals may become dependent on them.
Theories of Addiction
Like many other diseases, there are theories on how addiction begins and persists. These theories have either resulted from extensive research or have simply been opinions of those who have experienced the effects of helping an addicted loved one. Addiction usually persists because of dependence. There are two main types of dependence: psychological and physiological. Psychological dependence occurs when there seems to be an emotional or compulsive need to use a substance even though there may be risks or consequences. Physiological dependence occurs when tolerance has been established, therefore, greater amounts of the substance are needed to experience the same euphoric effect.
Psychological theories. Becoming dependent on a substance is just the beginning of the vicious cycle of addiction. Dependency usually begins with negative reinforcement. The addict begins by attempting to avoid an unpleasant experience. The next step of the cycle would involve positive punishment, which occurs when euphoria is experienced by the addict. Negative punishment begins after the substance of abuse has left the body of the addict. Positive punishment begins when withdrawal has set in. In order to get rid of this dysphoric feeling, negative reinforcement takes place to remove the withdrawal symptom by administering the substance again. In simpler terms, one could say that this vicious cycle consists of salience, mood modification, tolerance, withdrawal, conflict, and relapse (Griffiths, 2005, p. 191-197). This cycle of reinforcement and punishment has been labeled the “self-derogation theory” (Kaplan, Martin, Robbins, 1982). Classical conditioning has also been associated with the psychological theories of addiction. After addicts have been exposed to an unconditioned stimulus – such as a friend’s home or even the friend – numerous times along with the substance being abused, that unconditioned stimulus will then become conditioned. Conditioned stimuli can then prompt an impulse for an addict to abuse their substance of choice. Although there is not a specific gene that may cause addiction in an individual, psychologists do believe that there may be some type of biological or environmental predisposition for addiction. Predispositions may cause an individual to behave in certain ways that lead them to initially try the substance of abuse. If a child were to live in an environment where substance abuse is accepted and/or even encouraged, that child has been environmentally predisposed to substance abuse and will be more likely to engage in substance abuse. Another theory that has been associated the most with addiction is the differential association theory. This theory was first constructed by Edwin Sutherland. According to differential association, criminal behavior is learned in a process of communication in intimate groups (Matsueda, 2000, p.126). Although this theory is usually seen as a sociological theory, it is particularly close to the psychological theory of environmental predisposition. The principal difference between this “sociological” theory and the psychological theory is that substance abuse behavior is rewarded in the former rather than prompted in the latter.
Moral Theories. Although moral theories are no longer widely accepted, a handful of people still believe that morals are to blame for addiction. Those who do not view addiction as a disease argue that the first decision to use or abuse a substance was a moral decision. The next few decisions are also considered to be moral decisions as well. Kalivas and Volkow (2005) have accepted the belief that addiction is a choice. They have stated in their research that addicts are able to inhibit substance-seeking behaviors in response to severe consequences (Kalivas and Volkow, 2005, p.1). A second belief is that those who become addicted use substances to relieve negative feelings they may experience. This notion is similar to that of the self-derogation theory. Many addicts may claim that the substance abused has a deadening effect, or may allow them to act more freely. Since that particular substance may allow them to act more freely, this could reveal a relationship between behavioral inhibition and substance use (Earleywine and Finn, 1991). It could also account for the fact that the relief of the negative feelings may promote substance- and pleasure-seeking behavior (Earleywine and Finn, 1991). After the pleasure-seeking behavior has become routine, addiction has set in. Those who believe in the moral theories of addiction may say that the addict’s mind was entrapped into the pleasure-seeking mindset after numerous moral decisions were made to continue using or abusing an addictive substance.
Treatments for Addiction
Depending on the type of substance being used or abused, there are numerous treatment options. Treatment options can range from prescriptions that can be administered at home to rehabilitation facilities. The most common treatment options for addiction include family physician treatment, contingency management, and cognitive behavioral therapy.
Family physician treatment. Weisner, Mertens, Parthasarathy, Moore, and Lu (2001) have found that following up with a family physician – after detoxification of the substance has occurred – seemed to set a high rate of abstinence among addicts. Family physician treatment included regular check-ups as well as any services provided that helped prevent the substance use disorder from reoccurring. Having an addict check-in with a physician for cleanliness will help prompt the addict to give up substance-seeking behaviors. Addicts may often find it difficult to be dishonest if a urinalysis is required by their physician to test for abused substances.
Contingency management. According to Prendergast, Podus, Finney, Greenwell, and Roll (2006), contingency management has proven to be very effective in maintaining abstinence among addicts. Contingency management occurs when a reward is offered in exchange for a clean drug test and/or engaging in non-substance-seeking behaviors. In simpler terms, one could say that an addict is being rewarded for “staying clean.”
Cognitive Behavioral Therapy. When addicts seek rehabilitation, it is most often in the form of cognitive behavioral therapy. Cognitive behavioral therapy attempts to change the patterns of thoughts or unwanted behaviors. In many cases, cognitive behavioral therapy is often paired with medication. Riggs, Mikulich-Gilbertson, Davies, Lohman, Klein, and Stover (2007) found that medication paired along with cognitive behavioral therapy appeared to be more efficient than cognitive behavioral therapy alone.
Self-medication. Self-medication occurs when the addict “medicates” themselves to get rid of any dysphoric feeling – usually with the abused substance. Although this treatment option is not ideal in terms of treating the disorder it self, it does “help” the addict get rid of any dysphoric feelings they may experience without the substance. When an addict wants to change their lives for the better, other instances of self-medication may occur. For example, when someone addicted to cigarettes wants to quit smoking, they may decide to use nicotine patches. Although the addict is no longer smoking, they are still addicted to a somewhat smaller does of the nicotine.
In order to gain a better understanding of the psychological and moral theories of addiction, one must first begin to understand why an addict made the decision of trying the substance initially. We usually correlate the first time an individual tried a substance with the negative thoughts and emotions the individuals may have experienced. The continuation of the substance is usually dependent upon the want to eliminate any dysphoric feelings. We must also keep in mind that the treatment of substance use disorder usually varies from individual to individual. I, personally, believe that the psychological theories of addiction are more reliable and valid than the moral theories of addiction. Not only do they provide a reasonable explanation as to how substance use begins, but the justifications for the persistence of substance use is more noteworthy.
Earleywine, M. and Finn, P. (1991). Sensation seeking explains the relation between behavioral disinhibition and alcohol consumption. Addictive Behaviors, 16(3-4), pp.123-128.
Griffiths, M. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), pp.191-197.
Kalivas, P. and Volkow, N. (2005). The Neural Basis of Addiction: A Pathology of Motivation and Choice. American Journal of Psychiatry, 162(8), pp.1403-1413.
Kaplan, H., Martin, S. and Robbins, C. (1982). Application of a General Theory of Deviant Behavior: Self-Derogation and Adolescent Drug Use. Journal of Health and Social Behavior, 23(4), p.274.
Matsueda, R. (2000). Differential Association Theory. p.126.
Prendergast, M., Podus, D., Finney, J., Greenwell, L. and Roll, J. (2006). Contingency management for treatment of substance use disorders: a meta-analysis. Addiction, 101(11), pp.1546-1560.
Riggs, P., Mikulich-Gilbertson, S., Davies, R., Lohman, M., Klein, C. and Stover, S. (2007). A Randomized Controlled Trial of Fluoxetine and Cognitive Behavioral Therapy in Adolescents With Major Depression, Behavior Problems, and Substance Use Disorders. Archives of Pediatrics ; Adolescent Medicine, 161(11), p.1026.
Weisner, C., Mertens, J., Parthasarathy, S., Moore, C. and Lu, Y. (2001). Integrating Primary Medical Care With Addiction Treatment. JAMA, 286(14), p.1715.