Theories of Addiction
Gabor Mate MD on Addiction
The Rat Park Experiments of Prof. Bruce K. Alexander
Emeritus Professor Bruce K. Alexander through his experiments with rats, demonstrated a relationship between the conditions and environment which rats lived and their choice to self administer morphine.
He proposed that substances are not addictive just in themselves, but that a more complex relationship exists between environments, living conditions, social activity and choice exists.
His 'Rat Park' study showed that rats segregated from eachother and living in cages alone, chose to self administer morphine when presented with the option. However, rats living as part of a group in a stimulating environment choose not self administer morphine when presented with the option.
This work has been largely ignored by the establishment, but once thought about and considered has profound implications for our perceptions and understanding of addiction as a society.
Professor Alexander believes social conditions and the sense that drug users may feel like they are 'living in a mental cage', are profound contributing factors to the repetitve choices people make around the choice to self administration of drugs.
Rat Park Studies Explained
Emeritus Professor Bruce K. Alexander on the global addiction culture
The disease model proposes that addiction is a result of predisposing genetic factors and environmental factors. It involves an abnormality of structure or function in the central nervous system that results in impairment. This model particularly focuses on 'craving'. Biological, neurological, genetic and environmental factors are the source of addiction according to the medical model. Admittedly it is not fully understood how these factors fully contribute to addiction, however they form the basis of such systems as those utilised by Alcoholics and Narcotics Anonymous (AA/NA). This approach provides the underpinning theory behind the 12 Step Model of Recovery, wherein an individual is helpless to his/her addictive genetics/disease.
Criticisms of this approach point out that such a theory 'labels' people as addicts, removes the elements of learning, self control and minimises historical aspects of trauma and learned behavior as potential contributary aspects of addictive behavior.
The fact that many 'addicts' stop engaging in drug or alcohol taking behavior without apparent difficulty is not considered. One day they decide enough is enough and cease.
The disease model can be viewed as a 'primary' recovery model, where the initial problem of consumption has been addressed by abstinence. 'Secondary' recovery models work toward a resolution of the contributing factors of addictive behaviour. They seek via understanding, exploration, integration and healing to resolve trauma, continue personal growth and invoke awareness and responsibility. Psychotherapy tends to be the preferred approach.
Self Regulating Model
The Self Regulating Theories focus on the area of impaired control or compulsion. The emphasis is on the commonalities between addiction, poor self management, obsessions, eating too much, aggression and many other behavioral problems. Links are made to lack of impulse control, tiredness, emotional states and environmental stimuli on self regulation. Substances in this model are theorised as in part being utilised as a way of manipulating mood states to attempt to create and regulate feelings in the face of life events / fluctuating feeling states, 'craving' and 'urges'.
Drugs and alcohol have powerful effects on the central nervous system, opiates are powerful pain killers and alcohol has a dampening effect on our emotions. In times of stress, a favoured drug or alcohol may be utilised to distress. It helps to supress uncomfortable feelings.
These theories can also incorporate 'cognitive' factors, which focus on the power of 'triggers' or 'cues' which start thinking and associative cognitive processes, where the stimuli begins a train of processes culminating in thoughts leading to addictive behavior/decisions. For example witnessing someone smoke a cigarette may 'trigger' the thought to go and have one also.
These theories explain the manner in which drugs or alcohol can be used or have been learnt to effect and regulate mood, or stem off uncomfortable mood states. They also explain the role of thinking processes and environmental stimuli to trigger urges. However they omit understanding of personal choice or higher cognitive functioning to combat or tolerate triggers.
Bio-Psycho-Social / Transpersonal Model
In these approaches, addiction is seen as a multi facted and complex human condition. Resulting from biological, psychological, social and also spiritual factors.
Emerging in some part as a response to the medical model of addiction as a biological and medical condition. Observations in treatment revealed that many recovering addicts led lives deficient in meaning or direction, and very often had traumatic and emotional neglect in their past.
The term 'wounding' is used to explain the sensitivity of the human condition and the effect emotional neglect and trauma can have on the individual. Addictive behavior can be seen as an unconscious drive to avoid this emotional pain and therefore as an attempt at personal survival. Profound wounding can create an intense sense of impending doom and fear of death. High correlations exist between early sexual trauma and opiate addiction in females.
The persuit of an altered state of consciousness via a drug can be modelled on the seeking of a higher or improved level of existence, but perused through transitory and empty methods.
Recovery is modeled around a wider context of honesty, gradual confrontation of ones fears and taking responsibility for ones life. This is supported through a model of percieving life as a process of personal unfolding and growth in persuit of meaning, congruence and a sense of place in the world and universe.
This approach is especially relevant to our modern times of fast paced consumption culture. A post modern philosophy of all things being equal has created a world where natural hierarchies and meaningful structure are removed. Where the seeking of meaning in a drug high is seens just as valid as a path of meditation or lifelong study.
These models emphasise a balance of the psychological, spiritual and biological and are now seeing a significantly increased acceptance as the preferred models of addiction treatment.
Habit, Learning and Reward Models
The Addiction, Habit, Learning and Reward Models propose that addictive behavior may have its roots deep in our evolutionary history. That addiction is a habitual behavior that is independent of any conscious evaluation process that might also be happening about the costs and benefits of the behavior. The impulses that are generated are so strong that they overwhelm the desire of the addict to restrain themselves.
Such models suggest that addiction becomes entrenched by a combination of reward and punishment stimulis, but also tie into behavioral and social forces. Addictive behaviors are linked to the release of dopamine within the brain, which is the neurotransmitter associated with learning pathways that reward the individual with a flood of positive feelings. Drugs synthetically trigger this system thereby short circuiting the dopamine system and directly but temporarily flooding the brain with the pleasurable release of dopamine. It is believed this pathway is also involved in secondary reinforcement and the effects of cues and triggers in stimulating desire.
These models therefore focus on and emphasise the manner in which drugs and alcohol effect the brain. They are low on emphasising the role personal volition, choice, will power or higher goals may impact on the biological system alone.