The biopsychosocial model history, controversy and Engel

A BPS model provides a foundation for understanding both the causes of addictive disorders and the best treatments for them. To our knowledge, this is the first US population-level study to comprehensively address risk profiles of opioid misuse using the latest national survey data available. These data are subject to the individual participant’s bias, truthfulness, recollection, and knowledge.

biopsychosocial model of addiction

The brain disease model further implies simplistic categorical ideas of responsibility, namely that addicted individuals are unable to exercise any degree of control over their substance use (Caplan 2006, 2008). This kind of “neuro-essentialism” (Racine, Bar-Ilan, and Illes 2005) may bring about unintentional consequences on a person’s sense of identity, responsibility, notions of agency and autonomy, illness, and treatment preference. It has been criticized that treatment and the ongoing recovery process focuses on substance use only [6]. Substance use was influential in informants’ narratives but closely connected to other areas of life, such as mental health, close relationships, safe housing and meaningful daytime occupations. Also, the biological and psychological impacts of using substances, as well as individual reflections on either quitting all substances or maintaining the use of alcohol or marihuana, were essential parts of the informants’ meaning-making. This suggests that professionals should not take for granted that a total absence of substances is ‘everybody’s aim and should not necessarily define periodic or sporadic substance use as failure [2, 6, 30, 39].

Social Learning and Addiction

Yes, it is clear that most people whom we would consider to suffer from addiction remain able to choose advantageously much, if not most, of the time. However, it is also clear that the probability of them choosing to their own disadvantage, even when more salutary options are available and sometimes at the expense of losing their life, is systematically and quantifiably increased. There is a freedom of choice, yet there is a shift of prevailing choices that nevertheless can kill.

biopsychosocial model of addiction

Attempts to resist these compulsions result in increasing and ultimately intractable anxiety [99]. This is in important ways different from the meaning of compulsivity as commonly used in addiction theories. In the addiction field, compulsive drug use typically refers to inflexible, drug-centered behavior in which substance use is insensitive to adverse consequences [100]. Although this phenomenon is not necessarily present in every patient, it reflects important symptoms of clinical addiction, and is captured by several DSM-5 criteria for SUD [101]. Examples are needle-sharing despite knowledge of a risk to contract HIV or Hepatitis C, drinking despite a knowledge of having liver cirrhosis, but also the neglect of social and professional activities that previously were more important than substance use.

Addiction can occur regardless of a person’s character, virtue, or moral fiber.

An individual exposed to drug use at an early age can be influenced by social modeling (or learning via observation). Additionally, certain environments have specific social norms related to drug use (e.g., “Everyone experiments a little with drugs in college”). Mental health is health, and one’s psychological well-being impacts both mental and physical health. Unhealthy and maladaptive moods, thoughts, and behaviors can all be symptoms of mental health conditions, and in turn can contribute to our overall health. Mental health and behavior can be cyclical; for example, an individual who self-isolates as a symptom of depression may experience increased depressive symptoms as a result of isolation.

These factors are not inherent in the composition of the social structure, are neither stable nor persistent, but are governed by the social values and norms of that social system or group (Bunge 2003). Psycho-social systems are concrete entities or groups whose members act in relation to each other, such as families, religious organizations, and political parties (Bunge 2004). Social processes in addiction are investigated by examining social categories such as networks, groups, organizations and subcultures that alone cannot be explained by neurobiology.

A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health

Reciprocal determinism acknowledges the value of wholistic treatments for addictive behavior, but it goes further by arguing for a need for evolving treatment strategies in response to a chronically evolving disorder. Treatment requires not only a multimodal approach but a multilevel approach that considers both the direct and indirect effects of an intervention, including those indirect effects that feed back to impact the original intervention. In contrast, network-level interventions that target the interactive processes between nodes take advantage of the positive feedback loops inherent to the system to produce effects that are greater than a simple summation of its individual parts. Reciprocal determinism demands not only a multifaceted approach, but an approach with constantly changing decision trees, if-then statements, and go/no-go decisions. This task is monumental but not impossible, and social learning theory points to a possible solution.

  • Targeted treatments for individuals who are at heightened psychosocial and biological risk may benefit from the inclusion of enhanced treatment protocols such as gut-focused nutrition therapy.
  • A BPS model provides a foundation for understanding both the causes of addictive disorders and the best treatments for them.
  • Tailored interventions could be effective for individuals reentering society from incarceration, experiencing unemployment, suffering from psychological distress, and/or using public health insurance [63].
  • Evidence of generally intact decision making does not fundamentally contradict addiction as a brain disease.
  • Somatic markers are acquired by experience and are under control of a neural “internal preference system [which] is inherently biased to avoid pain, seek potential pleasure, and is probably pretuned for achieving these goals in social situations” (Damasio 1994, 179).






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