Addiction as a brain disease revised: why it still matters, and the need for consilience Neuropsychopharmacology

The model, therefore, allows for diverse and multidimensional aspects of knowledge to be drawn upon depending on the concern to be addressed, and the tools available to address them (Cochrane 2007). Guiding an individual’s behaviour are brain processes, somatic mechanisms, the ethical rules and norms that govern society, and the nature of the interaction. The complex combination of biological, psycho-social and systemic factors may explain why it is so difficult for some individuals to refuse drugs in the face of increasingly negative consequences. An underlying feature of these interacting systems is the human subjective experience of free voluntary actions, which problematizes laws within the natural world that every event has a cause with causally sufficient explanations.

Descartes was interested in how organisms interact with their environment, believing that nonhuman animals were nothing more than biological machines. 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. But humans were different – they had a soul, which was metaphysical, given by God, and outside the realm of simple elicited reflexes (Descartes, as translated by Cress, 1993).

What Exactly Is the Biopsychosocial Model of Addiction?

However, the model argues that choice occurs at a more intimate level, as cognitive factors interpret and evaluate different possible outcomes. The individual may choose to initially use drugs for a variety of reasons (e.g., cultural practice, social inclusion, curiosity). In the absence of any obvious negative outcomes, the momentary consequences of using drugs may outweigh the momentary consequences of not using drugs. Drugs are unique as reinforcers in that they act directly (and in this sense, biochemically) on the biological systems that control motivated behavior.

78 Technology-based tools are well-positioned to meet this unmet need in this new model of care. The degrees in which self-control is exerted, free choice is realized and desired outcomes achieved are dependent on these complex interacting biopsychosocial systems. Many post-modern theorists such as Christman (2004) have challenged the original Kantian privileging and definition of autonomy. One claim is based on the fact that decisional autonomy, or rationality, is not the most valuable human characteristic, and the individual-as-independent does not adequately characterize human beings (Russell 2009). Accordingly, the matrix of a person’s socio-historical context, life narrative, genetics, and relationships with others influence intention, decision, and action, and thus shape the brain. Autonomy, therefore, is not adequately defined just by the events in the brain or the “quality” of the decision being made.

Current status of the BPS model

The informants who had periods of severe use of substances all talked about demanding situations relating to work, troubled relationships, mental health problems, or loneliness. These struggles concerned being caught up by adverse childhood experiences, situations that arose during severe substance use, or life challenges during the years after they left treatment. Environment and culture also play a role in how a person responds to a substance or behavior. A lack or disruption in a person’s social support system can lead to substance or behavioral addiction. Traumatic experiences that affect coping abilities can also lead to addictive behaviors. Simply put, alcohol or other drug use is more likely if positive outcomes are expected than if negative outcomes are expected.

  • We propose a ‘biopsychosocial systems’ model where psycho-social factors complement and interact with neurogenetics.
  • We add to that model the need to balance a circular model of causality with the need to make linear approximations (especially in planning treatments) and the need to change the clinician’s stance from objective detachment to reflective participation, thus infusing care with greater warmth and caring.
  • George Engel formulated the biopsychosocial model as a dynamic, interactional, but dualistic view of human experience in which there is mutual influence of mind and body.
  • They also distinguished between the potential harm of using different types of substances, especially they viewed alcohol and marijuana as being less harmful than the other substances.
  • Lifetime alcohol dependence was indeed stable in individuals recruited from addiction treatment units, ~90% for women, and 95% for men.

The person’s perceptions of the recovery process and their wellbeing constantly interplay with the relational, social, cultural and political surroundings as understood within a biopsychosocial approach [7, 9, 31, 41, 43]. So, although each cell type in the human body effectively contains the same genetic information, epigenetic regulatory systems enable the development of different cell types (e.g., skin, liver, or nerve cells) in response to the environment. These epigenetic marks can affect health and even the expression of the traits passed to children.

Behavioral Medicine

In other words, a person may have a genetic predisposition for a disease, but social and cognitive factors must trigger the illness. The biopsychosocial systems model implicitly calls for an integrative discussion in the ethics debate on substance use, decision-making, and responsibility. The model avoids a forced choice between brain disease and condition of a weak will, and thus provides a useful framework for overcoming a neuro-essentialist trap. Instead of focusing entirely on causal, reductive neurobiology and difficulties in decision-making, the biopsychosocial systems model places the individual in his or her social environment and integrates his or her life narrative. The model contextualizes the responsibility placed on the individual and further allows for individual members of society to reflect on their own contributions in facilitating substance misuse (Levy 2007b).

biopsychosocial theory of addiction






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