Webb Therapy Uncategorized Addiction Theories

Addiction Theories

| Mitchell WebbMitchell Webb| 0 Comment |
Categories:

There have been various theories and models proposed over time to help us understand why individuals use alcohol and other drugs, and why some people become dependent or ‘addicted’ but not others. The following are several models or theories of addiction. They reflect the political, medical, spiritual, and social forces of those times in history.

The Moral Model

Alcohol and tobacco was introduced in the Western countries during the 1500’s. The widespread use and misuse of chemical substances resulted in a range of social problems and it was thought by some that substance use was “problematic” and “morally wrong” (Lassiter & Spivey, 2018). The moral model viewed AOD dependency as a moral and personal weakness that involved a lack of self-control, and was often viewed as a potential danger to society (Stevens & Smith, 2014).

The moral model considered addiction a “sin” and a result of free, yet irresponsible, choice. Therefore, many politically conservative groups, religious groups, and legal systems tended to punish the individual who uses AOD. The moral model or attitude towards addiction can still be seen today in certain cultures. Those who still believe addiction is morally “wrong” tend to perceive the most appropriate way to treat the individuals who use AOD are through legal sanctions, such as imprisonment and fines. For example, in many countries, drivers who are caught under the influence of alcohol or other drugs are not considered for treatment programs but instead receive court sentences as punishments (Fisher & Harrison, 2017).

This model has been rejected by alcohol and other drugs professionals as unscientific and contributes to the stigma surrounding addiction and substance use (White, 1991, cited in Fisher & Harrison, 2017).

The Disease Model

This model takes up the medical viewpoint and proposes addiction as a disease or illness that an individual has. It proposed that addiction is a disease that is progressive and chronic whereby the individual holds no control as long as the substance use continues. In other words, their addiction will continue to deteriorate with the continuous AOD (Thombs & Osborn, 2019). It also proposes that individuals who uses AOD can never be cured from addiction, though it can be readily treated through sustained abstinence such as self-help fellowships and treatment community. 

In the 1940s, Jellinek proposed a disease model in relation to alcoholism, arguing that it is a disease caused by a physiological deficit in an individual, making the person permanently unable to tolerate the effects of alcohol (Stevens & Smith, 2014). Jellinek identified signs and symptoms and clustered them into stages of alcoholism, as well as progression of the disease, which form the basis of 12-step or Anon-type programs (e.g., Alcoholics Anonymous and Narcotics Anonymous; Stevens & Smith, 2014). 

Under the disease model, treatment requires complete abstinence. Once an individual has accepted the reality of their addiction and ceased substance use, they are labelled as being in recovery, but are never ‘cured’ (e.g., “Once an alcoholic, always an alcoholic”; Thombs & Osborn, 2019). Whilst originally applied to alcohol dependency, it has now been generalised to other substances and many traditional substance use treatment models are based on this model (Capuzzi & Stauffer, 2020; Stevens & Smith, 2014).

The disease model offered an alternative to the moral theory, helping to remove the moral stigma attached to addiction and replacing it with an emphasis on treatment of an illness (Capuzzi & Stauffer, 2020). Disease theory helped to explain how some people experience the physiological effects of addiction such as dependence, tolerance, and withdrawal more than others, and how these mechanisms are caused by a biochemical abnormality in an individual which increases their likelihood of developing a dependency (DiClemente, 2018). 

While the disease model was well received by a range of professionals, many criticised it because research did not find that the progressive, irreversible progression of addiction through stages always occurs as predicted (Capuzzi & Stauffer, 2020). Additionally, many in the AOD field argued that the model did not address the complex interrelated factors that accompany dependency (Stevens & Smith, 2014). Finally, some professionals argued that the concept of addiction being a disease may also convey the impression to some individuals that they are powerless over their dependency and/or not responsible for the consequences of destructive addictive behaviours, which can be counteractive to treatment (Capuzzi & Stauffer, 2020).

Genetic and Neurobiological Theories

These theories suggest that some people may be genetically predisposed to develop drug dependency. For example, individuals usually begin substance use on an experimental basis. They then continue using because there is some reinforcement for doing so (e.g., a reduction of pain, experience of euphoria, social recognition, and/or acceptance, etc.). Some people may continue to use substances in a controlled or recreational manner with limited consequences while others progress to non-medical use and eventually develop a dependency. Why? Genetic and neurobiological theories propose that this is the result of a genetic predisposition to drug dependency (Fisher & Harrison, 2017). 

Factors being considered by researchers in the genetic transmission of dependency on alcohol include neurobiological features such as an imbalance in the brain’s production of ‘feel good’ neurotransmitters or in the metabolism of ethanol, which is the key component of alcohol (Stevens & Smith, 2014). Other researchers explored genetic differences in temperament and personality traits which they argued may lead to certain individuals becoming more vulnerable in the face of challenging environmental circumstances, leading to AOD use (Stevens & Smith, 2014). Genetic predispositions such as these may explain why some individuals develop dependency on AOD while others in similar situations do not.

The Psycho-dynamic Model

This model proposes that substance use may be due to an unintentional response to some difficulties that an individual experienced in their childhood. This explanation is based on the theory that was put forward by Sigmund Freud, whereby the problems of whether we are able to cope with difficulties as adults are linked to our childhood experience. Many counselling approaches today are based on this theory which aim to seek understanding of people’s unconscious motivations and to enhance how they view themselves (Capuzzi & Stauffer, 2020).

The Psycho-dynamtic model also believes that AOD use is often secondary to a primary psychological issue. In other words, alcohol and other drugs is a symptom rather than a disorder, and AOD use is a means to temporarily relieve or numb emotional pain. For example, an individual suffering from depression might self-medicate with stimulants to relieve the enervating effects of depression or manage their anxiety by using benzodiazepines (Fisher & Harrison, 2017). 

There is evidence to support this model, whereby childhood traumatic events are associated with mental health problems and substance use disorders. Wu et al. (2010) conducted a study among 402 adults who were receiving substance use disorder treatments. They revealed that almost all (95%) of the participants experienced one or more childhood traumatic events, and 65.9% of them experienced emotional abuse and neglect from their childhood. The authors also reported that the higher the number of childhood traumatic events experienced, the higher the risk of substance use disorders and mental health problems such as post-traumatic stress disorder. 

Personality Traits

Some theorists suggest that certain individuals have certain personality traits that are linked to AOD dependency. For example, dependency on alcohol has been associated with traits such as developmental immaturity, impulsivity, high reactivity and emotionality, impatience, intolerance, and inability to express emotions (Capuzzi & Stauffer, 2020).

Social Learning Model

This model suggests that social learning processes such as observing other peoples behaviours (i.e., modelling) and cultural norms are important in the process of learning behaviours. Albert Bandura proposed Social Learning Theory which would argue that substance use is initiated by environmental stressors or modelling people around you with “perceived status”. For example, a child observes their parents use alcohol in social situations and the child is therefore more likely to perceive that AOD use for social situations is appropriate (Harrison & Fisher, 2017); the association between socialisation and alcohol has been established.

The social learning model also recognises the influence of cognitive processes such as coping, self-efficacy, and outcome expectancies. Some researchers are currently focusing on how an individuals expectation of the effects of drugs influence the pattern of AOD use and resulting dependency. Russell (1976, cited in Wise & Koob, 2013) suggested that dependency on substance is not only chemical (biological) but also behavioural and social in nature. 

It has also been suggested that substance use occurs when an individual thinks substance use is a coping mechanism. This can be learned from television and film, social medial, peer influence, or messages from caregivers during childhood. The individual hopes the AOD use will relieve from them from stress (Stevens & Smith, 2014). 

Socio-cultural Model

Different from the previous models, the socio-cultural model perceives substance use as an issue of society as a whole instead of focusing only on the individual. People tend to overestimate the influence of internal and psychological factors while underestimating the external and environmental factors, even among some alcohol and other drugs workers (Gladwell, 2000, cited in Lewis, Dana, & Blevins, 2015). Thus, this model highlights the importance of how society shapes substance use behaviours, such as cultural attitudes, peer pressures, family structures, economic factors, and more (Bobo & Husten, 2000). For example, Coffelt et al. (2006) found that parents’ alcohol use are associated with their children’s drinking behaviour, whereby when the adult’s alcohol problems increased, the likelihood of their adolescent child’s alcohol use increased. 

The Biopsychosocial Model

Substance use behaviour cannot be explained or understood scientifically or spiritually based on a single variable, antecedent, or “cause”. Biological, psychological, learning, social and cultural context all contributes to explaining why addiction develops and maintains. The interactions between these factors are presented in The Biopsychosocial Model – arguably the most commonly used model to explain addiction today. The model suggests that substance use and the progression of substance dependency can be explained by recognising that the body and mind are connected within a social and cultural context (Skewes & Gonzalez, 2013).

The model allows any combination of biological, psychological, social and cultural factors to contribute to AOD misuse and dependency, rather than a single dominating factor. This is much more holistic and integrative when attempting to understand the determinant of addiction (Stevens & Smith, 2014).

References:

  1. Bobo, J. K., & Husten, C. (2000). Sociocultural influences on smoking and drinking. Alcohol Research and Health, 24(4), 225-232. 
  2. Capuzzi, D., & Stauffer, M. D., Sharpe, C. W. (2020). History and etiological models of addiction. In D. Capuzzi, & M. D. Stauffer (Eds.), Foundations of addictions counseling (pp. 1-22). Pearson Education.
  3. Coffelt, N. L., Forehand, R., Olson, A. L., Jones, D. J., Gaffney, C. A., Zens, M. S. (2006). A longitudinal examination of the link between parent alcohol problems and youth drinking: The moderating roles of parent and child gender. Addictive Behaviours, 31, 4, 593-605. https://doi.org/10.1016/j.addbeh.2005.05.034 
  4. DiClemente, C. C. (2018). Addiction and change: How addictions develop and addicted people recover. The Guilford Press.
  5. Fisher, G. L., & Harrison, T. C. (2017). Substance abuse: Information for school counsellors, social workers, therapists, and counsellors. Pearson Education. 
  6. Lassiter, P. S., & Spivey, M. S. (2018). Historical perspectives and the moral model. In P. S. Lassiter, & J. R. Culbreth (Eds.), Theory and practice of addiction counselling. (pp. 27-46). Sage Publications. 
  7. Lewis, J. A., Dana, R. Q., & Blevins, G. A. (2015). Substance abuse counselling. Cengage Learning.
  8. Skewes, M. C., & Gonzalez, V. M. (2013). The biopsychosocial model of addiction. In P. M. Miller, A. W. Blume, D. J. Kavanagh, K. M. Kampman, M. E. Bates, M. E. Larimer, N. M. Petry, P. D. Witte, S. A. Ball (Eds.), Principles of addiction: Comprehensive addictive behaviours and disorders (pp. 61-70). Academic Press.
  9. Stevens, P., & Smith, R. L. (2014). Substance abuse counselling: Theory and practice. Pearson Education. 
  10. Teesson, M., Hall, W., Proudfoot, & Degenhardt, L. (2012). Addictions. Taylor & Francis Group.
  11. Thombs, D. L., & Osborn, C. J. (2019). Introduction to addictive behaviours. The Guilford Press. 
  12. Wise, R. A., & Koob, G. F. (2013). The development and maintainance of drug addiction. Neuropsychopharmacology, 39, 254-262.
  13. Wu, N. S., Schairer. L. C., Dellor, E., & Grella, C. (2010). Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addictive Behaviors, 35(1). 68-71. https://doi.org/10.1016/j.addbeh.2009.09.003 

Related Post

Beyond “Lazy”: Finding the Right Word for What’s Really Going OnBeyond “Lazy”: Finding the Right Word for What’s Really Going On

| Mitchell WebbMitchell Webb| 0 Comment|

“I’m just lazy.” It’s one of the most common things we say about ourselves, and it’s almost always inaccurate — or at least, it’s not the full story. “Lazy” is a character judgement. It implies a fixed trait, a moral failing, something the person simply is. In reality, what looks like so-called “laziness” from the outside is usually a specific, nameable process happening underneath: low energy, fear, overwhelm, disconnection from meaning, or a nervous system that’s stuck.

Swapping “lazy” for “unmotivated” is a good first step, but it can still flatten quite different experiences into one vague label. Below are some more precise alternatives, what they actually describe, and examples of how they show up in real life.

When the problem is getting started

Low activation
This describes difficulty initiating action even when the desire is genuinely there. The want exists; the ignition doesn’t turn over.

Example: Someone wants to reply to a mate’s text, has wanted to all day, keeps thinking about it — and still hasn’t opened the message by evening. It’s not that they don’t care.

Avolition
A more clinical term for a reduced capacity to initiate and follow through on goal-directed behaviour. It’s heavier and more diagnostic, yet accurate. It is commonly linked to major depression, bipolar disorder, and schizophrenia.

Example: A person who used to cook every night now can’t manage to put a frozen meal in the microwave, despite being hungry and having no external barrier.

Task paralysis / overwhelm-driven inaction
The task itself feels too big, too undefined, or too loaded, so the person freezes rather than starts.

Example: A person needs to “sort out their finances.” There’s no single first step, so nothing happens — not because they don’t want order, but because the whole thing feels like an unclimbable wall.

When the problem is energy or capacity

Low energy / depleted
Sometimes it’s simpler than motivation — the person is running on empty. This is especially relevant with burnout, chronic illness, or the tail end of a stressful period.

Example: A person who was previously proactive at work is now struggling to answer emails, not because the job has changed, but because they’ve been running on adrenaline for six months and have nothing left.

When the problem is avoidance

Avoidant coping
Here, the “laziness” is really a strategy — often an unconscious one — to dodge a task that triggers anxiety, shame, or fear of failure. The inaction is protective, not apathetic.

Example: A person keeps “forgetting” to start an assignment they actually care about, because starting means risking it not being good enough.

Procrastination
Useful when the issue is delay rather than total refusal — the person will eventually do the thing, but keeps pushing it to the edge. Procrastination gets treated like a single thing, but it’s usually a surface behaviour with several different engines underneath it. Here’s what tends to actually be driving it:

  1. Fear of failure (or fear of judgement): if the work is never finished, it can never be judged as not good enough. Delay protects self-esteem.
  2. Fear of success: less talked about, but real — finishing well can raise expectations, invite more responsibility, or change a relationship dynamic the person isn’t ready for.
  3. Perfectionism: not “I might fail” so much as “it has to be right, and I don’t yet know how to make it right.” The standard is so high that starting feels premature. Perfectionism is frequently a strategy for managing fear of judgement (and fear of failure), not a standalone driver in its own right. The logic is If I can make this flawless, no one can criticise it → if no one can criticise it, I’m safe from judgement → therefore I must make it flawless before I let it be seen. “It has to be right” isn’t really about the work — it’s a control mechanism aimed at the anticipated judgement. The satisfaction or reward is real too, but it’s often secondary. It’s a learned reward layered on top: the relief of having pre-empted criticism gets experienced as “getting it right” rather than “avoiding exposure.”
  4. Emotion regulation, not time management: this is the reframe from the procrastination research (Tim Pychyl, Fuschia Sirois) that’s shifted a lot of clinical thinking: procrastination isn’t primarily a planning failure, it’s an attempt to avoid a negative feeling attached to the task right now, at the cost of a bigger problem later. The person is regulating today’s mood at the expense of tomorrow’s outcome.
  5. Task aversiveness: sometimes it’s simpler — the task itself is boring, tedious, ambiguous, or otherwise unpleasant, and there’s no emotional complexity beyond “I don’t want to.”
  6. Temporal discounting: a cognitive-behavioural angle. Humans are wired to weight immediate rewards over future ones, even when the future cost is much larger. The person isn’t choosing badly on purpose; the brain is built to prefer now.
  7. Autonomy/control conflict: sometimes procrastination is a quiet act of resistance — doing the task on someone else’s timeline feels like a loss of control, so delay becomes the only lever the person has left.
  8. Low self-efficacy: the person doubts their ability to do the task well or at all, so starting feels pointless or exposing.

Example: A person always finishes reports the night before they’re due, every time, despite genuine intentions to start earlier.

When the problem is follow-through, not starting

Low follow-through / inconsistent follow-through
The person starts fine but struggles to sustain the behaviour over time. This is more behavioural and less about character, which tends to land better if you are already hard on yourself.

Example: Someone joins a gym, goes three times enthusiastically, then stops — not from laziness, but because the initial motivation (novelty, resolution energy) wasn’t backed by a system to sustain it.

Difficulty sustaining effort
Similar to the above, but useful when the task requires ongoing, low-grade output rather than one big push.

Example: A person can write a brilliant first page of a project but can’t sustain the plodding, unglamorous middle section.

When the problem is meaning or direction

Disengaged
This applies when the task doesn’t feel connected to anything the person actually values or wants. It’s not an energy or fear problem — it’s a “why would I” problem.

Example: A person who says they’re “too lazy” to network for a job they don’t actually want, in an industry someone else has pushed them into.

Ambivalent
Borrowed from motivational interviewing, this names a genuine internal split — part of the person wants to do the thing, and part doesn’t, and both parts are real and legitimate. It’s a particularly useful reframe because it doesn’t pathologise the resistance; it treats it as information.

Example: A person wants to leave a relationship and doesn’t want to leave it, in roughly equal measure — and the “laziness” they report about making a decision is really that unresolved tension.

Why the re-labelling matters

The value of a more precise term isn’t just semantic tidiness — it changes the intervention. “Unmotivated” invites a pep talk. “Avoidant coping” invites a conversation about what the task threatens. “Low activation” invites behavioural scaffolding (breaking things into smaller steps) rather than willpower-based advice. “Ambivalent” invites exploring both sides rather than pushing harder on one.

Rather than substituting one label for another, it can help to ask what’s underneath the “laziness” for them specifically. Low energy, fear of failure, unclear goals, overwhelm, and disconnection from meaning can look identical from the outside — someone just not doing the thing — but they call for very different responses. Naming the actual mechanism tends to land better than any single re-labelling word ever could.

Read MoreRead More

Acceptance and Commitment Therapy (ACT)Acceptance and Commitment Therapy (ACT)

| Mitchell WebbMitchell Webb| 0 Comment|

I was recently browsing some of the units I completed for my counselling diploma – for revision. The human memory has not evolved to store, organise, categorise and recall all the large amounts of information we collect every day, nor is our memory always accurate. It’s important for counsellors and therapists to keep up to date with new approaches to counselling, and it doesn’t hurt to read over learned materials from college days. I thought I’d provide some learning about Acceptance and Commitment Therapy for readers.

Just to acknowledge the work of others, most of what is written below, I have retrieved and paraphrased from ACCEPTANCE AND COMMITMENT THERAPY Published by: Australian Institute of Professional Counsellors Pty Ltd.

Acceptance and commitment therapy, known as ACT (pronounced as the word ‘act’), is an approach to counselling that was originally developed in the early 1980s by Steven C. Hayes, and became popular in the early 2000’s through Hayes’ collaboration with Kelly G. Wilson, and Kirk Strosahl as well as through the work of Russ Harris. You can look them up on Youtube or Google if you’re interested in what they might have to say about ACT.

“Unlike more traditional cognitive-behaviour therapy (CBT) approaches, ACT does not
seek to change the form or frequency of people’s unwanted thoughts and emotions. Rather,
the principal goal of ACT is to cultivate psychological flexibility, which refers to the ability to
contact the present moment, and based on what the situation affords, to change or persist
with behaviour in accordance with one’s personal values. To put it another way, ACT
focuses on helping people to live more rewarding lives even in the presence of undesirable
thoughts, emotions, and sensations.”
(Flaxman, Blackledge & Bond, 2011, p. vii)

ACT interventions tend to focus around two main processes:

  • Developing acceptance of unwanted private experiences that are outside of personal
    control.
  • Commitment and action toward living a valued life (Harris, 2009)

In a nutshell, ACT gets its name from its core ideas of accepting what is outside of your personal control and committing to action that improves and enriches your life.

Cognitive Defusion is the process of learning to detach ourselves from our thought processes and simply observe them for what they are – “transient private events – an ever-changing stream of words, sounds and pictures” (Harris, 2006, p. 6). I think this component of ACT is incredibly beneficial if we practice it daily. I like to say, just like the function of the heart is to pump oxygenated blood around the body, one of the brain’s functions is to have thoughts. We can observe thoughts without taking them to mean more than what they are. Some thoughts are automatic, some are subconscious, and some are unconscious or preconscious beliefs that we consider to be true and factual and “rules” about how the world operates and how we have to operate in it. If someone is defused from their thought processes, these processes do not have control on the person; instead the person is able to simply observe them without getting caught up in them or feel the need to change/control them.

Acceptance is the process of opening oneself up and “making room for unpleasant feelings, sensations, urges, and other private experiences; allowing them to come and go without struggling with them, running from them, or giving them undue attention” (Harris, 2006, p. 7). Practicing acceptance is important because it encourages the individual to develop an ability and willingness to feel uncomfortable without being overwhelmed by it (Flaxman, Blackledge & Bond, 2011). It’s important to acknowledge that to accept something doesn’t mean we like it or have a passive attitude. It is to accept something exactly as it is and then we choose what to do with it. Think of the Serenity Prayer: Grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.

Contact with the present moment is the concept of being “psychologically present” and bringing full attention to the “here-and-now” experience (Harris, 2009). I’d also argue that to psychologically present, we must also be aware of our physical body and the sensations within it and outside of it. Because we have the ability to think about the past and about the future, sometimes it can be difficult to stay in the present (Batten, 2011; Harris, 2009). Having contact with the present moment is essential because that it where we find out anchor and power. We have the ability to pay attention in a flexible manner to the present moment and connect with that experience rather than ruminate on past events or future possibilities (Lloyd & Bond, 2015). Some of you might say “What if I can’t stand the present moment?”. True. If you have extreme emotional experiences or have a history of trauma, it may be functional for you to use distraction or talking to someone when the present moment is “too much to take”. What we want to work towards is using healthy coping strategies in the present moment mindfully, instead of behaviours that no longer serve us.

Values, and identifying them, (i.e., what is important to the individual) is a central element of ACT because it assists clients to move in the direction of living and creating a meaningful life. One of the central goals of ACT is to help clients to connect with the things they value most and to travel in “valued directions” (Stoddard & Afari, 2014).

Committed action is the process of taking steps towards one’s values even in the presence of unpleasant thoughts and feelings (Harris, 2009). Behavioural interventions, such as goal setting, exposure, behavioural activation, and skills training, are generally used to create committed action. The ACT model acknowledges that learning is not enough, one must also take action to create change.

Self-as-context, or what I prefer to call “the observing self” or simply just our self-awareness, creates a distinction between the ‘thinking self’ and the ‘observing self’ (Harris, 2009). The thinking self refers to the self that generates thoughts, beliefs, memories, judgments, fantasies, and plans, whereas the observing self is the self that is aware of what we think, feel, sense, or do (Harris, 2009). “From this perspective, you are not your thoughts and feelings; rather, you are the context or arena in which they unfold” (Stoddard & Afari, 2014). Being aware of the observing self allows an individual to have a greater ability to be mindful and in the present moment, as they can separate themselves from the thoughts, beliefs, and memories they have.

Be Good To Yourself: The ACT Matrix | Therapy worksheets, Therapy quotes, Psychology quotes
Read MoreRead More

Give Your Self A Stimulating BoostGive Your Self A Stimulating Boost

| Mitchell WebbMitchell Webb| 0 Comment|

“Laughter is anti-inflammatory”

Reasonably well supported. Research suggests laughter reduces cortisol and certain inflammatory markers. It is not a medical treatment but the physiological effect is real.

“Crying is regulating”

Well supported. Emotional tears contain stress hormones that the body is literally shedding. Most people feel a genuine physiological calm after crying — that is not imagined, it is the nervous system returning to baseline.

“Hugging is immunoprotective”

Fairly well supported. Physical touch triggers oxytocin release, which has measurable effects on stress hormones. A Carnegie Mellon study found people who received more hugs were less susceptible to illness.

“Singing is vagal toning”

Accurate and underappreciated. The vagus nerve runs through the vocal cords and throat. Singing, humming, and even gargling genuinely stimulates it, which activates the parasympathetic nervous system and promotes calm.

“Dancing is neurogenic”

Interesting claim. Neurogenesis means the creation of new neurons and it is stimulated by aerobic exercise, coordination, and rhythm. Dance combines all three, so this has a reasonable basis. Also, learning new skills, a diet rich in flavonoids, and restful sleep promote neurogenesis.

“Joy is a biological necessity”

The body does not treat joy as a luxury. Positive emotional states have measurable effects on immune function, cardiovascular health, healing rates, and longevity. Chronic joylessness is genuinely harmful physically, not just emotionally.

Read MoreRead More