For example, although genetics may have a role in causing schizophrenia, no clinician would ignore the sociologic factors that might unleash or contain the manifestations of the illness. Engel understood that one cannot understand a system from the inside without disturbing the system in some way; in other words, in the human dimension, as in the world of particle physics, one cannot assume a stance of pure objectivity. In that way, Engel provided a rationale for including the human dimension of the physician and the patient as a legitimate focus for scientific study. Risky (hazardous) substance use refers to quantity/frequency indicators of consumption; SUD refers to individuals who meet criteria for a DSM-5 diagnosis (mild, moderate, or severe); and addiction refers to individuals who exhibit persistent difficulties with self-regulation of drug consumption.
Drugs, Health, Addictions & Behaviour – 1st Canadian Edition
The early finding that cognitive therapy for depression was effective, and moreover, more effective than an antidepressant medication (Rush, Beck, Kovacs, & Hollon, 1977), reinforced the signal that the BMM was not enough, at least not for modeling and treating depression. Research designs relevant to the BPSM are those that examine the effects of psychological and social, as well as biological factors, on health outcomes (e.g. Lacombe, Armstrong, Wright, & Foster, 2019). Immediate findings are typically of correlations or associations, and control conditions of varying levels of stringency increase confidence in inference to causation. Multivariable regression models are applicable within the BMM, including biological variables only, but the expanded BPSM framework also accommodates inclusion of psychological and social variables, estimating their independent, additive, and interaction effects (e.g. Guloksuz et al., 2019). As you have come to understand, to look at substance use disorders in a binary fashion, choosing one lens or another is not effective.
- The lack of attention is especially surprising given the serious questions raised by some existing criticisms of the BPSM.
- Factors such as drug availability within the environment can increase craving and consequently the vulnerability for relapse (Weiss 2005).
- Francisco A. Montiel Ishino and Faustine Williams, and Ms. Bonita Salmeron was supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health.
- Essential is the person’s perceptions and descriptions of their current situation regarding wellbeing, belonging to a community, and a positive sense of identity, including perceptions of a better life while living with core symptoms [44].
- A systems approach allows for the inclusion of psycho-social and socially systemic explanations of addiction, which extend well beyond neurobiology while still interacting with it (Bunge 1991).
- 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.
- This article has detailed how wayward BPSM discourse has served as a wellspring of questionable claims in medicine.
Box 1 What’s in a name? Differentiating hazardous use, substance use disorder, and addiction
“HAT is not simply a pharmacotherapy; it is a treatment approach that is situated within a context involving neighborhood factors, the local drug scene, housing, policing, medical care, and other treatment services. Its role and effectiveness is entangled with the ancillary services available, drug policies, and treatment philosophy” (p.262). The deontological principle of respect for persons is a characteristic feature of harm reduction efforts such as HAT. This ethical principle is justified and framed as a matter of human rights, which maintains that injection drug users, for example, have the right, like other less stigmatized members of society, to access medical and social services. This claim coincides with a recent emergence of a global advocacy movement that seeks to construct the use of drugs as a human right (Elliott, Csete, Wood, and Kerr 2005; Lines and Elliott 2007).
The biopsychosocial model: Its use and abuse
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].
Once whole genome sequencing is readily available, it is likely that it will be possible to identify most of that DNA variation. For clinical purposes, those polygenic scores will of course not replace an understanding of the intricate web of biological and social factors that promote or prevent expression of addiction in an individual case; rather, they will add to it [49]. Meanwhile, however, genome-wide association studies in addiction have already provided important information. For instance, they have established that the genetic underpinnings of alcohol addiction only partially overlap with those for alcohol consumption, underscoring the genetic distinction between pathological and nonpathological drinking behaviors [50]. In his classic 1960 book “The Disease Concept of Alcoholism”, Jellinek noted that in the alcohol field, the debate over the disease concept was plagued by too many definitions of “alcoholism” and too few definitions of “disease” [10].
Rather, social learning theory argues that personal factors, including the cognitively derived “self”, play a deterministic role in the production of behavior. Thus, behavior is fully determined, but personal factors in the form of intentionality, forethought, self-reactiveness, and self-reflectiveness are just as causal determinants of behavior as contingencies that operate in the environment. By the time of Darwin’s death, we had the building blocks for a new science of behavior – a science based on sensory experience, a science based on learning associations, and a science based on the notion that learning associations between relevant events in our environment is necessary for our survival. In other words, we had the beginnings of a scientific discipline that argues human behavior is determined by functional relationships with biologically relevant events that impact our survival. With the emergence of psychology as an independent discipline, scientists could now begin asking empirical questions of how these events elicit biologically relevant responses that promote our survival.
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. An individual living with an addiction is in-the-world-with-others and thus acts as a being-among-others, such that the individual’s decisions and complex engagement with the world may not be as automatic as the neurophilosophical model may suggest (Gillett 2008a, 2008b, 2009). https://wyomingdigest.com/top-5-advantages-of-staying-in-a-sober-living-house/ For that reason, individuals who live with an addiction may not completely be enslaved or forced by their brain in the way in which, as Levy (2007a) has previously deferred to Aristotle (1999), “a wind or people have [an agent] in their control were to carry him off” (p.30). Given the spectrum nature of substance use problems, decision-making capacity is therefore neither completely present nor absent, but may be, at some times in certain contexts, weakened.
Examples of wayward BPSM discourse
For instance, John Locke argued that we are born a “blank slate”, and that knowledge is based exclusively on direct experience with the sensory world. David Hume would take this a step further and argue that even the laws of causation were subject to the mental associations created by the “habitual order of ideas”, meaning that causation itself may only be a product of the mind (Robbins Sober House et al., 2002). Thomas Brown outlined many of the supposed associations that determine our behavior, describing the importance of similarity, recency, and frequency in associating the events that serve to direct our actions. Coincident with these developments, Jeremy Bentham emphasized the utilitarian consequences of these associations, particularly of those that brought happiness.
With regard to disease course, we propose that viewing addiction as a chronic relapsing disease is appropriate for some populations, and much less so for others, simply necessitating better ways of delineating the populations being discussed. We argue that when considering addiction as a disease, the lens of neurobiology is valuable to use. It is not the only lens, and it does not have supremacy over other scientific approaches. We agree that critiques of neuroscience are warranted [108] and that critical thinking is essential to avoid deterministic language and scientific overreach.