legal model3 The sociocultural model
4 The psychological model
5 The medical model
In both academic circles and among those in contact with substance abusers, there is much debate, differing views, as well as criticism of these theories. Everybody seems to believe that their own opinion (or the views of their mother, father, boss, pastor, doctor or psychologist) is the correct view. Most people tend to be rather stubborn when clinging to their opinion. Their views are expressed vociferously and are often intolerant of any dissenting opinions. Much emotional energy is wasted on such arguments and these debates are ultimately not useful to the patient or their family.
The moral model of addiction
The moral model of addiction states that any addiction problem is the result of immoral conduct. In its extreme form, addiction is seen as “a sin in the eyes of God”. Anyone who is addicted to drugs has supposedly chosen this behaviour freely (and clearly made the “wrong, sinful choices”) and will ultimately have to account before their God and society. Based on this view, people who are addicted to drugs and alcohol are often blamed, ostracised and shunned. This model implies that no formal treatment other than cessation, repentance and the seeking of forgiveness is necessary. Relapsing into alcohol or drug use is seen as “an evil act” by morally weak or degenerate individuals. This model clearly fits in with the view held by some religious organisations and conservative societies which claim that the moral decay of society is imminent and results in drug abuse. They often call for “renewed family values”.
The moral model of addiction seems to be very prevalent in many societies across the world. It is a commonly held model and you are likely to find proponents of this view within your own circle of friends, family and acquaintances. Unfortunately, it seldom contributes constructively towards recovery from addiction and usually leads to further blame, guilt and discrimination. The moral model tends to be overly simplistic in that it defines the use of drugs and alcohol as “bad”, while abstaining from drugs and alcohol is thought to be “good”. Similarly, drug abusers and those dependent on drugs are also classed as “bad”, often with tragic results. Recent advances in the field of addictions have highlighted the neurobiological nature of this condition. As a result, the more acceptable, modern view has moved away from the moral model towards evidence-based models of addictions.
The legal model of addiction
The legal model of addiction states that taking any illegal drugs or alcohol is an “illegal act” and hence “a crime”. Again, using drugs or alcohol is a freely chosen behaviour for which punishment needs to be meted out. Such punishment is likely to include fines or even jail sentences. Relapse into drug and alcohol use is simply seen as “a criminal act by a criminal person”. This model advocates that no treatment is necessary. It rather calls for punishment and stricter control as a way to curb the addiction problem. Thus, people addicted to drugs and alcohol are again blamed and discriminated against.
Unfortunately, such a legalistic view on addictions is also not particularly useful in assisting drug users in their struggle to overcome their addiction and move towards recovery. Punishing drug- and alcohol-addicted individuals is ineffective and is likely to cause more suffering, unhappiness, blame and discrimination for the individual and their families. Similar to the moral model, the legal model also lends itself to an all-or-nothing pattern of thinking. It legitimises an overly simplistic view that using drugs and alcohol is clearly “wrong”, while abstaining from drugs and alcohol is clearly “right”. There is no space for reasonable and sensible debate, thought or discussion.
The sociocultural model of addiction
The sociocultural model of addiction states that alcohol and drug dependence is a sociocultural construct. It states that society as a whole, along with the prevailing norms and culture, has declared that certain actions and behaviours (such as addiction) are not acceptable. It is therefore the sociocultural view as a whole that defines and changes concepts and definitions of drugs and addictions. Different patterns of drug and alcohol use may be acceptable to different societies, for example the moderate consumption of red wine in Mediterranean countries is acceptable to their culture, while binge drinking hard liquor may not be. This can be contrasted with the European “pub culture” where individuals consume large amounts of alcohol within a short period of time in a specific social setting. Similarly, smoking used to be fashionable but it is now frowned upon in most cultures. Lastly, cannabis used to be illegal, but has become less restricted in certain societies in Europe, while it has generally always been acceptable to use cannabis in the Caribbean.
Based on the prevailing social and cultural views, certain alcohol- and drug-using behaviours may be contrary to accepted norms. Using alcohol and drugs outside these established norms is likely to lead to sanction and resultant problems. Remaining within the prevailing norms is unlikely to cause any distress or repercussions.
The psychological model of addiction
The psychological model of addiction refers to addictive behaviour as a maladaptive, learnt behaviour. Addiction is seen to be similar to other learnt behaviours. In this sense, it can also be unlearnt. The addictive behaviour is under the influence of numerous psychological factors, including conditioning, reinforcement and punishment. Treatment of substance abuse is based on recognising such psychological factors, unlearning them and developing new skills aimed at remaining abstinent. A relapse is not seen as moral weakness or an illegal act, but rather as a learning opportunity. The individual can learn from such errors and apply this newly learnt knowledge to help prevent future relapses.
The psychological model of addiction is generally easy to understand, learn and implement. It provides a reasonably good explanation for most addictive thoughts and behaviours. It is also supported by good research evidence. This model can be applied successfully to numerous addictions and various situations. It makes intuitive sense once the basics of the psychological theory are grasped. However, this model is very time consuming and relies on active patient motivation and participation. Furthermore, many healthcare professionals are not adequately trained in its practical application. Based on current evidence, psychological theory and practice should be incorporated into the assessment, detoxification, rehabilitation and recovery plans of all substance abusers.
The medical model of addiction
The medical model of addiction suggests that the “disease of addiction” is caused by an external agent – the consumed drug or alcohol in this case. The disease of addiction has characteristic symptoms and behaviours which cause pain, discomfort, suffering and impaired functioning. This disease is marked by a loss of control, craving for the drug and a compulsion to continue using it. The medical model therefore suggests that the “disease of addiction” is a specific clinical condition that anyone who is dependent on drugs or alcohol suffers from. There may be an underlying predisposition or genetic vulnerability that makes an individual susceptible to becoming dependent as soon as an external agent, such as drugs or alcohol, is used.
Proponents of this theory see patients suffering from addiction as “victims” of an illness, that is they are sick or ill. A person suffering from addiction did not freely choose their addiction, but rather became addicted through no choice of their own. Hence, patients suffering from drug- and alcohol-related problems “deserve” help and treatment. According to this model, the disease of addiction is progressive, irreversible and may ultimately cause death if the patient does not remain abstinent or receive adequate treatment. The only successful treatment is complete abstinence. Benjamin Rush conceptualised alcoholism as a disease as early as 1784. Throughout the centuries much evidence has accumulated to support this view. More recently, modern technologies such as specialised brain scans seem to support the view that addiction is a brain disease. Despite some criticism
