Compare the 1960 disease model by Jellinek to one of the seven models discussed in your book. Include the following in your discussion:Provide a statement of your personal definition of addiction. (This is just how you see addiction and does not have to have any models of addiction to support it.)Respond to two of your peers’ definitions. How does your peer’s definition differ from your own? How is it similar?Include a brief overview of the 1960 disease model by Jellinek and the model you selected.Compare and contrast the 1960 disease model by Jellinek and the model you selected for their definition of addiction.The seven models you can choose from:Moral modelPsychological modelFamily modelDisease modelBiological modelSociocultural modelMulti-causal model
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Models For Explaining The Etiology of Addiction
Historically, addiction has been understood in various ways—a sin, a disease, a bad habit—each a reflection of a
variety of social, cultural, and scientific conceptions (Hammer et al., 2012, p. 713).
Substance use and abuse has been linked to a variety of societal issues and problems (crime and violence, violence
against women, child abuse, difficulties with mental health, risks during pregnancy, sexual risk-taking, fatal injury,
etc.). Given the impact the abuse of substances can have on society in general and the toll it often levies on
individuals and families, it seems reasonable to attempt to understand the etiology or causes of addiction so that
diagnosis and treatment plans can be as efficacious as possible. There are numerous models for explaining the
etiology of addiction (McNeese & DiNitto, 2005); these models are not always mutually exclusive and none are
presented as the correct way of understanding the phenomena of addiction. The moral, psychological, family,
disease, public health, developmental, biological, sociocultural, and some multicausal models will be described in
the subsections that follow.
The Moral Model
The moral model is based on beliefs or judgments of what is right or wrong, acceptable or unacceptable. Those who
advance this model do not accept that there is any biological basis for addiction; they believe that there is something
morally wrong with people who use drugs heavily.
The moral model explains addiction as a consequence of personal choice, and individuals who are engaging in
addictive behaviors are viewed as being capable of making alternative choices. This model has been adopted by
certain religious groups and the legal system in many states. For example, in states in which violators are not
assessed for chemical dependency and in which there is no diversion to treatment, the moral model guides the
emphasis on “punishment.” In addition, in communities in which there are strong religious beliefs, religious
intervention might be seen as the only route to changing behavior. The moral model for explaining the etiology of
addiction focuses on the sinfulness inherent in human nature (Ferentzy & Turner, 2012). Since it is difficult to
establish the sinful nature of human beings through empirically based research, this model has been generally
discredited by present-day scholars. It is interesting to note, however, that the concept of addiction as sin or moral
weakness continues to influence many public policies connected with alcohol and drug abuse (McNeese & DiNitto,
2005). This may be part of the reason why needle/syringe exchange programs have so often been opposed in the
United States.
Although the study of the etiology of alcoholism and other addictions has made great strides in moving beyond the
moral model, alcoholics are not immune to social stigma, and other types of addiction have yet to be widely viewed
as something other than a choice. But as we move further away from the idea that addiction is the result of moral
failure, we move closer to providing effective treatment and support for all those who suffer.
Psychological Models
Another explanation for the reasons people crave alcohol and other mind-altering drugs has to do with explanations
dealing with a person’s mind and emotions. There are several different psychological models for explaining the
etiology of alcoholism and drug addiction, including cognitive-behavioral, learning, psychodynamic, and personality
theory models.
Cognitive-Behavioral Models
Cognitive-behavioral models suggest a variety of motivations and reinforcers for taking drugs. One explanation
suggests that people take drugs to experience variety (Weil & Rosen, 1993). Drug use might be associated with a
variety of experiences such as self-exploration, religious insights, altering moods, escape from boredom or despair,
and enhancement of creativity, performance, sensory experience, or pleasure (Lindgren, Mullins, Neighbors, &
Blayney, 2010). If we assume that people enjoy variety, then it can be understood why they repeat actions that they
enjoy (positive reinforcement).
The use of mind-altering drugs received additional media attention in the 1960s, when “flower children” sang and
danced in the streets of San Francisco and other cities, sometimes living together in communities they created. Much
press was given to the use of drugs to enhance sensory experience in connection with some of the encounter groups
led by facilitators in southern California.
The desire to experience pleasure is another explanation connected with the cognitive-behavioral model. Alcohol
and other drugs are chemical surrogates of natural reinforcers such as eating and sex. Social drinkers and alcoholics
often report using alcohol to relax even though studies show that alcohol causes people to become more depressed,
anxious, and nervous (NIAAA, 1996). Dependent behavior with respect to the use of alcohol and other drugs is
maintained by the degree of reinforcement the person perceives as occurring; alcohol and other drugs may be
perceived as being more powerful reinforcers than natural reinforcers and set the stage for addiction. As time passes,
the brain adapts to the presence of the drug or alcohol, and the person experiences unpleasant withdrawal symptoms
(e.g., anxiety, agitation, tremors, increased blood pressure, seizures). To avoid such unpleasant symptoms, the
person consumes the substance anew and the cycle of avoiding unpleasant reactions (negative reinforcement) occurs
and a repetitive cycle is established. In an interesting review of the literature on the etiology of addiction (Lubman,
Yucel, & Pantelis, 2004), it was proposed that in chemically addicted individuals, maladaptive behaviors and high
relapse rates may be conceptualized as compulsive in nature. The apparent loss of control over drug-related
behaviors suggests that individuals who are addicted are unable to control the reward system in their lives and that
addiction may be considered a disorder of compulsive behavior very similar to obsessive compulsive disorder.
Learning Models
Learning models are closely related and somewhat overlap the explanations provided by cognitive-behavioral
models. Learning theory assumes that alcohol or drug use results in a decrease in uncomfortable psychological states
such as anxiety, stress, or tension, thus providing positive reinforcement to the user. This learned response continues
until physical dependence develops and, like the explanation provided within the context of cognitive-behavioral
models, the aversion of withdrawal symptoms becomes a reason and motivation for continued use. Learning models
provide helpful guidelines for treatment planning because, as pointed out by Bandura (1969), what has been learned
can be unlearned; the earlier the intervention occurs the better, since there will be fewer behaviors to unlearn.
Psychodynamic Models
Psychodynamic models link addiction to ego deficiencies, inadequate parenting, attachment disorders, hostility,
homosexuality, masturbation, and so on. As noted by numerous researchers and clinicians, such models are difficult
to substantiate through research since they deal with concepts difficult to operationalize and with events that
occurred many years prior to the development of addictive behavior. A major problem with psychodynamic models
is that the difficulties linked to early childhood development are not specific to alcoholism or addiction, but are
reported by nonaddicted adults with a variety of other psychological problems (McNeese & DiNitto, 2005).
Nevertheless, current thinking relative to the use of psychodynamic models as a potential explanation for the
etiology of addiction has the following beliefs in common (Dodgen & Shea, 2000):
1.
2.
3.
Substance abuse can be viewed as symptomatic of more basic psychopathology.
Difficulty with an individual’s regulation of affect can be seen as a core problem or difficulty.
Disturbed object relations may be central to the development of substance abuse.
Readers are referred to Chapter 12 of Slaying the Dragon: The History of Addiction Treatment and Recovery in
America by William L. White (1998) for a more extensive discussion of psychodynamic models in the context of
the etiology of addiction.
Personality Theory Models
These theories make the assumption that certain personality traits predispose the individual to drug use. An
“alcoholic personality” is often described by traits such as dependent, immature, impulsive, highly emotional,
having low frustration tolerance, unable to express anger, and confused about their sex role orientation (Catanzaro,
1967; Milivojevic et al., 2012; Schuckit, 1986).
Although many tests have been constructed to attempt to identify the personality traits of a drug-addicted person,
none have consistently distinguished the traits of the addicted individual from those of the nonaddicted individual.
One of the subscales of the Minnesota Multiphasic Personality Inventory does differentiate alcoholics from the
general population, but it may only be detecting the results of years of alcoholic abuse rather than underlying
personality traits (MacAndrew, 1979). The consensus among those who work in the addictions counseling arena
seems to be that personality traits are not of much importance in explaining addiction because an individual can
become drug dependent irrespective of personality traits (Raistrick & Davidson, 1985).
Family Models
As noted in Chapter 14, during the infancy of the field of addictions counseling, addictions counselors were used to
working only with the addict. Family members were excluded. However, it soon became clear that family members
were influential in motivating the addict to get sober or in preventing the addict from making serious changes.
There are at least three models of family-based approaches to understanding the development of substance abuse
(Dodgen & Shea, 2000).
Behavioral Models
A major theme of the behavioral model is, that within the context of the family, there is a member (or members)
who reinforces the behavior of the abusing family member. A spouse or significant other, for example, may make
excuses for the family member or even prefer the behavior of the abusing family member when that family member
is under the influence of alcohol or another drug. Some family members may not know how to relate to a particular
family member when he or she is not “under the influence.”
Family Systems
There have been many studies demonstrating the role of the family in the etiology of drug abuse (Baron,
Abolmagd, Erfan, & El Rakhawy, 2010). As noted in Chapter 14, the family systems model focuses on the way
roles in families interrelate (Tafa & Baiocco, 2009). Some family members may feel threatened if the person with
the abuse problem shows signs of wanting to recover since caretaker roles, for example, would no longer be
necessary within the family system if the member began behaving more responsibly. The possibility of adjusting
roles could be so anxiety producing that members of the family begin resisting all attempts of the “identified
patient” to shift relationships and change familiar patterns of day-to-day living within the family system.
Family Disease
This model is based on the idea that the entire family has a disorder or disease, and all must enter counseling or
therapy for improvement to occur within the addicted family member. This is very different from approaches to
family counseling in which the counselor is willing to work with whichever family members will come to the
sessions, even though every family member is not present.
The Disease Model
The disease concept follows the medical model and posits addiction as an inherited disease that chemically alters the
body in such a way that the individual is permanently ill at a genetic level (Lee et al., 2013, p. 4).
E. M. Jellinek (1960) is generally credited with introducing this controversial and initially popular model of
addiction in the late 1930s and early 1940s (Stein & Foltz, 2009). However, it is interesting to note that, as early as
the later part of the 18th century, the teachings and writings of Benjamin Rush, the Surgeon General of George
Washington’s revolutionary armies, actually precipitated the birth of the American disease concept of alcoholism as
an addiction (White, 1998). In the context of this model, addiction is viewed as a primary disease rather than being
secondary to another condition (reference the discussion, earlier in this chapter, of psychological models). Jellinek’s
disease model was originally applied to alcoholism but has been generalized to addiction to other drugs. In
conjunction with his work, Jellinek also described the progressive stages of the disease of alcoholism and the
symptoms connected with each stage. These stages (prodromal, middle or crucial, and chronic) were thought to be
progressive and not reversible. Consistent with this concept of irreversibility is the belief that addictive disease is
chronic and incurable. Once the individual has this disease, according to the model, it never goes away, and there is
no treatment method that will enable the individual to use again without the high probability that the addict will
revert to problematic use of the drug of choice. One implication of this philosophy is that the goal for an addict must
be abstinence, which is the position taken by Alcoholics Anonymous (Fisher & Harrison, 2005). In addition, the
idea that addiction is both chronic and incurable is the reason that addicts who are maintaining sobriety refer to
themselves as “recovering” rather than as “recovered.”
The vocabulary of recovery was first used by Alcoholics Anonymous in 1939. It is significant because we use the
term recovery in the context of disease or illness rather than in connection with moral failure or character deficits.
This reinforces the disease model to explain the etiology of addiction.
Interestingly, although Jellinek’s disease model of addiction has received wide acceptance (Ferentzy & Turner,
2012), the research from which he derived his conclusions has been questioned. Jellinek’s data were gathered from
questionnaires. Of the 158 questionnaires distributed, 60 were discarded; no questionnaires from women were used.
The questions about the original research, which led to the conceptualization of the “disease” model, have led to
controversy. On the one hand, the articulation of addiction as a disease removes the moral stigma attached to
addiction and replaces it with an emphasis on treatment of an illness, results in treatment coverage by insurance
carriers, and sometimes encourages the individual to seek assistance much like that requested for diabetes,
hypertension, or high cholesterol. On the other hand, the progressive, irreversible progression of addiction through
stages does not always occur as predicted, and the disease concept may promote the idea for some individuals that
one is powerless over the disease, is not responsible for behavior, may relapse after treatment, or may engage in
criminal behavior to support the “habit.”
The Public Health Model
It is interesting to note that the public health model was not originally conceptualized to focus on psychobehavioral
ailments since, from its early beginnings, the emphasis has been on promoting healthy behaviors. As noted by
Ferentzy and Turner (2012), the 20th-century psychiatrist Paul Lemkau, founding chairperson of the Mental
Hygiene department in the Johns Hopkins University School of Public Health, was one of the first to apply a public
health model to mental disorders. Lemkau promoted the establishment of community, rather than residential,
treatment centers because he believed that mental health, including the treatment of addiction, was a public rather
than a private issue. Lemkau believed that when individuals did not engage in healthy behaviors and became
addicted, it was because of the impact of social issues. He viewed addiction as a societal disease, in direct contrast to
the more dominant, individualistic conceptions associated with the disease model.
The Developmental Model
As noted by Sloboda, Glantz, and Tarter (2012), the etiology of addiction can also be explicated by applying a
developmental framework to understand the factors that increase or decrease risks for the individual to use or misuse
drugs. They posited that vulnerability is never static or unchanging, but varies across the life span. Sloboda and her
colleagues examined some of the key developmental competencies associated with the following developmental
stages: prenatal through early childhood, middle childhood, adolescence, late adolescence/early adulthood, and
adulthood. This research provided detailed examples of competencies that must be mastered during each of these
developmental stages to decrease the possibility of engaging in risky behavior that includes the use and misuse of
drugs. Readers interested in exploring the developmental model for understanding the etiology of addiction will find
the Sloboda et al. (2012) an article excellent starting point for additional study.
Biological Models
Biophysiological and genetic theories assume that addicts are constitutionally predisposed to develop dependence on
drugs. These theories or models support a medical model of addiction, apply disease terminology, and often place
the responsibility for treatment under the purview of physicians, nurses, and other medical personnel. Usually,
biological explanations branch into genetic and neurobiological discussions.
Genetic Models
Although genetic factors have never really been established as a definitive cause of alcoholism, the statistical
associations between genetic factors and alcohol abuse are very strong. For example, it has been established that
adopted children more closely resemble their biological parents than their adoptive parents when it comes to their
use of alcohol (Dodgen & Shea, 2000; Goodwin, Hill, Powell, & Viamontes, 1973); alcoholism occurs more
frequently in some families than others (Cotton, 1979); concurrent alcoholism rates are higher in monozygotic twin
pairs than in dizygotic pairs (Kaij, 1960); and children of alcoholics can be as much as seven times more likely to be
addicted than children whose parents are not alcoholic (Koopmans & Boomsina, 1995). Because of such data,
some genetic theorists have posited that an inherited metabolic defect may interact with environmental elements and
lead, in time, to alcoholism. Some research points to an impaired production of enzymes within the body and yet
other lines of inquiry point to the inheritance of genetic traits that result in a deficiency of vitamins (probably the
vitamin B complex), which leads to a craving for alcohol as well as the accompanying cellular or metabolic changes.
There have been numerous additional lines of inquiry that have attempted to establish a genetic marker that
predisposes a person toward alcoholism or other addictions (Bevilacqua & Goldman, 2010). Studies that examined
polymorphisms in gene products and DNA, the D2 receptor gene, and even color blindness as factors have all been
conducted and then later more or less discounted. Genetic research on addiction shows potential, but is a complex
activity given the fact that each individual carries genes located on 23 pairs of chromosomes. The Human Genome
Project, which is supported by the National Institutes of Health and the U.S. Department of Energy, is conducting
some promising studies (NIAAA, 2000).
Neurobiological Models
Neurobiological models are complex (Jacob, 2013) and have to do with the neurotransmitters in the brain that serve
as the chemical messengers of our brain (Hammer et al., 2012); Kranzler & Li, 2008; Wilcox, Gonzales, &
Miller, 1998). Almost all addic …
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