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(Psychological view)


There are several theories of addiction. All of them are imperfect. All of them are partial
explanations. Yet, each therapist holds certain biases. These biases influence their therapy - as
in the case of my friend's brother. For this reason, it is important to be aware of and question
addiction theories. The therapist who told my friend's mother that she caused her son's
drinking was influenced by psychoanalysis.
According to Freud, the originator of psychoanalytic theory, personality consists of three
components: the id, the superego, and the ego. The id is instinctive, impulsive, and childlike.
It wants immediate satisfaction of needs, urges, and cravings. In the case of thealcoholic, the
id craves alcohol. The superego is sometimes thought of as the parent orconscience. It is the
moral component of the personality. The superego knows "right" from "wrong" and its
function is to control the impulses of the id. Finally, the ego is similar to the adult and it
mediates the id and superego. Anxiety is a driving force in psychoanalytic theory. Anxiety
signals a threat but it can overwhelm the ego. When anxiety is overwhelming, a person relies
on defense mechanisms such as denial, avoidance, rationalization, regression, projection, etc.
as mentioned in my previous post. Denial, especially, is common among substance abusers
who frequently deny having a problem.
One contemporary psychoanalytic view of substance abuse is that it is a defense against
anxiety . Addicts abuse alcohol or other substances to protect themselves against
overwhelming anxiety and other painful emotions such as lonelinessand depression. A
common acronym in addiction circles is H-A-L-T, meaning Hungry, Angry, Lonely, and
Tired. These are emotions leading to vulnerability and subsequent substance abuse.
Unfortunately, when alcohol is used to avoid anxiety evoking situations, the abuser never
grows up. He/she never develops appropriate coping mechanisms. Instead, they just grab the
bottle (Or.....perhaps, this is an oral fixation?). For example, the solitary drinker who stays in

bed all day watching TV avoids going for a job interview, making friends, and learning how
to deal with rejection. The alcohol is used to dampen anxiety and avoid threatening situations.
Many people do not understand why or how other people become addicted to drugs. It is
often mistakenly assumed that drug abusers lack moral principles or willpower and that they
could stop using drugs simply by choosing to change their behaviour. In reality, drug
addiction is a complex disease, and quitting takes more than good intentions or a strong will.
In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is
difficult, even for those who are ready to do so. Through scientific advances, we know more
about how drugs work in the brain than ever, and we also know that drug addiction can be
successfully treated to help people stop abusing drugs and lead productive lives.

Currently there are a number of different types of drug addiction making the rounds at
treatment centers (and unfortunately, emergency rooms) around the United States. These
conditions include:

Cocaine addiction

Heroin addiction

Prescription drug addiction, including addictions to Vicodin and OxyContin

Crystal meth addiction

Percocet addiction

Marijuana addiction

What Happens to Your Brain When You Take Drugs?

Drugs contain chemicals that tap into the brains communication system and disrupt the way
nerve cells normally send, receive, and process information. There are at least two ways that
drugs cause this disruption: (1) by imitating the brains natural chemical messengers and (2)
by over stimulating the reward circuit of the brain.

Some drugs (e.g., marijuana and heroin) have a similar structure to chemical messengers
called neurotransmitters, which are naturally produced by the brain. This similarity allows the
drugs to fool the brains receptors and activate nerve cells to send abnormal messages.
Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release
abnormally large amounts of natural neurotransmitters (mainly dopamine) or to prevent the
normal recycling of these brain chemicals, which is needed to shut off the signalling between
neurons. The result is a brain awash in dopamine, a neurotransmitter present in brain regions
that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of
this reward system, which normally responds to natural behaviours linked to survival (eating,
spending time with loved ones, etc.), produces euphoric effects in response to psychoactive
drugs. This reaction sets in motion a reinforcing pattern that teaches people to repeat the
rewarding behaviour of abusing drugs. As a person continues to abuse drugs, the brain adapts
to the overwhelming surges in dopamine by producing less dopamine or by reducing the
number of dopamine receptors in the reward circuit. The result is a lessening of dopamines
impact on the reward circuit, which reduces the abusers ability to enjoy not only the drugs
but also other events in life that previously brought pleasure. This decrease compels the
addicted person to keep abusing drugs in an attempt to bring the dopamine function back to
normal, but now larger amounts of the drug are required to achieve the same dopamine high
an effect known as tolerance.
Long-term abuse causes changes in other brain chemical systems and circuits as well.
Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn.
When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to
compensate, which can impair cognitive function. Brain imaging studies of drug-addicted
individuals show changes in areas of the brain that are critical to judgment, decision making,
learning and memory, and behaviour control. Together, these changes can drive an abuser to
seek out and take drugs compulsively despite adverse, even devastating consequencesthat
is the nature of addiction.

Psychological Causes Of Addiction

Simply stated, psychology is a science devoted to understanding human behavior.
Psychologists are concerned with improving the quality of people's lives and their life
satisfaction. Psychologists consider behaviors that promote people's well-being and life

satisfaction adaptive behaviors. Behaviors that serve to limit people's functioning and
diminish life satisfaction are termed maladaptive behaviors. Since addiction is a harmful,
maladaptive behavior, psychological models are very useful for understanding why people
engage in this unhealthy behavior.
Psychologists propose several possible causes of addiction. First, people may engage in
harmful behaviors because of an abnormality, or "psychopathology" that manifests itself as
mental illness. Second, people may learn unhealthy behavior in response to their
environment. Third, people's thoughts and beliefs create their feelings. This in turn
determines their behavior. To the extent that someone's thoughts and beliefs are unrealistic or
dysfunctional, their behavior will be similarly affected. We will discuss each of these
different psychological theories in more detail.
Many of these theories have not been tested or applied to every specific type of addiction.
Nonetheless, scientist and practitioners generally assume these theories apply in some way to
all addictions. As research in this area continues, we may learn some theories are more
applicable to specific types of addiction.


(having psychological influence)

Psychopathological Model of Addiction

The psychopathological model sees mental disorders as the cause of addiction. These
disorders might include cognitive difficulties, mood disturbances, and other mental illnesses.
In fact, addiction and other mental health disorders commonly occur together (called comorbidity). Roughly, half of the people seeking addiction treatment will also have another
significant mental disorder.
Related to psychopathology is the concept of an addictive personality. Certain personality
characteristics might be the underlying factors in all addictive disorders. These may include
the denial of obvious problems, problems with emotional regulation, and problems with
impulse regulation. There isn't sufficient evidence to suggest an "addictive personality" per
se. However, addiction does most frequently co-occur with a class of disorders
called Personality Disorders.

Psychotherapy would try to identify and resolve underlying psychological disorders. This
might include restructuring the personality and/or improving a person's cognitive and
emotional functioning.
Social Learning Theory Of Addiction
According to social learning theory, our observations of other people engaging in addictive
behavior can lead to the development of addiction. When we observe the behavior and
reactions of other people using addictive substances (or activities) we may wish to repeat
what we saw. For instance, suppose we observed an agitated, frazzled parent coming home
from work. She drinks a few drinks, then becomes relaxed and fun to be around. We observed
that alcohol is a good way of coping with stress.
Developmental Model Of Addiction
Psychologists are concerned with distinguishing normal human behavior from abnormal
behavior. In order to make these distinctions psychologists study human development. This
makes intuitive sense. A normal behavior for a five year old is usually quite different from the
normal behavior of an adult. For example, it is normal for a five-year-old child to believe in
Santa Claus. The child eagerly anticipates the Christmas gifts Santa will bring. It is certainly
not normal for a 40-year-old adult to hold these same beliefs.
According to the developmental model, immaturity or developmental arrest causes addiction.
While human development occurs across the lifespan, the most significant portion of this
development occurs during childhood and adolescence. As human beings mature, they
increase their capacity to: 1) defer acting upon immediate selfish desires and emotional
impulses, 2) use rational thought to make wise choices, and 3) consider their actions in the
larger context of their relationships and society as a whole. Conversely, a lack of
development results in an immature pursuit of selfish desires, difficulty making wise choices,
and a failure to consider the "big picture." The capacity to understand ourselves in relation to
a larger context (i.e., the big picture) is what "develops" in development. That capacity is at
the root of all motivation to overcome addiction.
Sociological Causes Of Addiction
Psychology is a science that primarily concerns itself with understanding individual human
behavior. Sociology is a science that primarily concerns itself with understanding the

behavior of large groups. These groups include families, organizations, societies, and
cultures. From this perspective, addiction is a harmful behavior that affects both individuals
and groups. As such, we can only understand and correct addiction within the context of the
groups in which it occurs.
Many of these theories have not been tested or applied to every specific type of addiction.
Nonetheless, scientists and practitioners reasonably assume they apply in some way to all
addictions. As research in this area continues, we may learn some theories are more
applicable to a certain types of addiction.
Temperance Model of Addiction
According to the temperance model, addiction is caused by the mere exposure to addictive
substances (or activities). These substances and activities are dangerous for everyone.
Societies can correct addiction by eliminating the availability of these dangerous substance
and activities. An underlying premise of the temperance model is that societies have an
obligation to protect its members from these dangers. Although temperance societies have
faded away, this basic premise remains prominent. This is particularly true for certain
substances such as heroin or methamphetamine. Other substances such as alcohol and
tobacco are apparently considered less threatening.
General Systems Theory Of Addiction
General systems theory stresses the importance of groups and their influences over individual
people. We all exist within a set of nested social systems. These nested social systems can
include families, organizations, neighborhoods, societies, cultures, etc. According to this
theory, we can only understand individual behavior by considering these group influences.
According to general systems theory, addiction is caused by larger social systems that
surround an individual. To illustrate this somewhat confusing concept, consider a single cell
within an organism. In order to understand the behavior of a single cell, we need to
understand the tissue, the organ, the organ system, and the body, in which the cell is
Systems theory proposes that all systems like the maintain balance and harmony. The
common expression, "Don't rock the boat" aptly describes a system's need to maintain
balance. Therefore, every individual within any given system participates in the maintenance

of that balance. However, if the natural balance (status quo) of a system is dysfunctional, then
the system serves to maintain that dysfunction. In other words, it would "rock the boat" if we
tried to improve the systems functioning. This is how some dysfunctional systems can
promote and foster addictive behavior for some individuals in that system. With respect to
addiction, the principal system of interest is the family system.
Moral And Spiritual Causes Of Addiction
The model of addiction that we have been discussing is the Bio-Psycho-Social-Spiritual
(BPSS) model. It was previously just the Bio-Psycho-Social Model (without including
"spiritual"). Many people feel it is unnecessary to separately mention spirituality. This is
because moral and spiritual concepts are value laden and culture-specific. Thus, most
clinicians understood that the socio-cultural (social) part of this model included spirituality.
Nonetheless, spirituality is an important concept for many people. This is particularly true for
people struggling to recover from severe or fatal disorders such as addiction. So, we feel it
does merit specific mention.
Spiritual Model of Addiction
According to the spiritual model, a disconnection from God or a Higher Power causes
addiction. This separation causes people's suffering because they fail to live according to
God's will or direction.
Moral Model of Addiction
According to the moral model, a moral failure (a failure to do what is right) causes addiction.
The moral model is prominent in traditional approaches to recovery. "He just needs to
strengthen his willpower to resist temptation and get on with his life." The criminal justice
system also approaches addiction from this perspective. Punishments for addiction related
crimes (e.g., DUI, public intoxication) are intended to motivate people to behave better.
Trying to persuade someone to behave better is also a technique associated with this model.
Moral Reconation Therapy (MRT) is an evidence-based addiction treatment aligned with this
model, but MRT is not well known. Conation is an archaic psychological term referring to
our capacity for conscious and deliberate decision-making. Moral Reconation Therapy works
to raise the moral level of decision-making.
Sociocultural Model Of Addiction

According to the sociocultural model, the cultural standards of a society and the negative
effects of culture and society on individual behavior, cause addiction. Many cultural
standards are quite subtle but the effect is powerful nonetheless. For example, people in the
United States not only tolerate intoxication, but also consider it humorous. Audiences find it
entertaining when television sit-coms, movies, and comedians depict intoxicated characters in
a humorous manner. Furthermore, in many states the police may arrest you for drunk driving
several times before any severe consequence occurs. Contrast this to a hypothetical society
that executes its' citizens for a single instance of drunk driving. This rather extreme example
illustrates addiction arises because larger systems permit it.
Personal responsibility and locus of control
This issue of personal responsibility for problems and their solutions brings to the surface
deeper, underlying issues. In particular, it reveals whether we see ourselves as the actor, or
the director, of our own lives.
Throughout this series on addiction, we've suggested that each person is free to choose
between and among the various theoretical models of addiction. Ideally, people in recovery
will pick some combination of models that best fits their needs and circumstances. In this
way, they can successfully solve their addiction problem. However, these choices are largely
governed by a stable personality characteristic called "locus of control." Simply stated, this
personality characteristic describes people's sense of control over their own lives. People's
understanding of their ability to control their own lives will greatly influence which types of
recovery models are most suitable for them.
When people have an internal locus of control, they expect they will determine their own
futures because of their own actions. If we were to imagine life as a sort of theatrical play,
these people would consider themselves the directors of their own lives. Conversely, when
people have an external locus of control they do not expect to have control over their futures.
Things just happen to them. From this perspective, they have no control or influence over
their lives. Continuing with our analogy of life as a theatrical play, these folks would consider
themselves mere actors in their own lives.
Locus of control describes people's sense of control over their lives. It also describes the way
people understand the problems they experience. In a related manner, it somewhat predicts
how they will attempt to solve these problems. Locus of control is a relatively stable and

enduring aspect of personality (as are most personality characteristics). It is so stable that we
"take it for granted." We are unaware of the way our particular locus of control colors our
understanding of a problem. Nonetheless, it greatly affects our approach to solving problems.
Locus of control can change, but it changes slowly, over many years.
Since locus of control is rather stable and influences our approach to problems, it becomes
highly relevant to recovery from addiction. An approach to recovery that conflicts with your
own locus of control is almost certain to fail. This issue of personal responsibility for
problems and their solutions brings to the surface deeper, underlying issues. In particular, it
reveals whether we see ourselves as the actor, or the director, of our own lives. Throughout
this series on addiction, we've suggested that each person is free to choose between and
among the various theoretical models of addiction. Ideally, people in recovery will pick some
combination of models that best fits their needs and circumstances. In this way, they can
successfully solve their addiction problem. However, these choices are largely governed by a
stable personality characteristic called "locus of control." Simply stated, this personality
characteristic describes people's sense of control over their own lives. People's understanding
of their ability to control their own lives will greatly influence which types of recovery
models are most suitable for them.
Since locus of control is rather stable and influences our approach to problems, it becomes
highly relevant to recovery from addiction. An approach to recovery that conflicts with your
own locus of control is almost certain to fail. Therefore, find (or create) an approach to
recovery that best matches your own position on the locus of control continuum (ranging
from external to internal). If you would like, you couldtake a test to measure your locus of


A person sitting inside a crowded bus, drinking coffee and stifling a yawn with a gloved
hand, can catch the common cold. The little germs can attach to the coffee cup or the gloves,
and they hitch a ride into the persons mouth and begin to cause serious problems when they
have arrived. The person doesnt really need to do anything at all or have any specific kind of
risk factor, in order to develop that cold.

Drug abuse is often attributed to a lack of willpower or self-control, meaning that people who
have addictions make a conscious choices to engage in their destructive behavior, but experts
know that some forms of addiction have their roots deep in the cells of people who use drugs.
The role of genes can be complex, and they can play out differently in different people.
Living in an environment in which drug use is rampant may also contribute to addiction.
People may see their neighbors buying drugs on the street, and they may walk by needles,
vials and other drug paraphernalia on a regular basis. Calls from drug dealers might ring out
through the night air, and the person might be approached by dealers on a regular basis. Once
again, this behavior can normalize drug use and make the person feel as though abuse is both
common and harmless. Additionally, living in a crime-laden neighborhood like this can be
stressful, and some people may turn to drugs in order to soothe their fears and worries. Drugs
seem like a way to fit in and get relief, and the allure can be hard to resist.
The world isnt always a safe place in which to live, and from time to time, people are
exposed to trauma, including Physical altercations, Sexual abuse, Verbal abuse, Neglect,
Accidents, Natural disasters, Terrorism. These events can leave their mark on the mind, and
in time, people who are exposed to issues like this might be tempted to soothe their distress
by leaning on addictive drugs. The link between this kind of trauma during childhood and
adult substance abuse is quite clear, and its alarming, as the National Child Traumatic Stress
Network reports that one in four American children experience at least one event like this
prior to age 16. Proper therapy can help people to process these events so they wont be
tempted to lean on drugs, but those who dont get this kind of therapy may be vulnerable to
addictions down the line.
Mental Illness
The relationship between mental illness and drug abuse is quite strong, with the National
Alliance on Mental Illness reporting that more than one-half of all drug abusers are also
dealing with a mental illness issue. For some, the drug abuse comes as they attempt to deal

with the distress and pain that a mental illness can cause. For others, the drug abuse triggers a
series of chain reactions that can allow a mental illness to take root and grow. There are
others who have genetic propensities that might make them vulnerable to both addictions and
mental illnesses, although experts caution that more studies should be done on this issue
before a definitive line can be drawn. In any case, its clear that having a mental illness seems
to go hand in hand with drug abuse, and once the connection has been forged, it can be
difficult to break without help.

Influence of Peers
Its often said that teens use drugs when their friends do. Using drugs allows these young
people to fit in with their peers and blend in with the crowd, and it might also give teens
something to do when the days grow long and theyre tired of their televisions, computers
and video games. Adults, however, can also be influenced by the people they live with.
Spouses, for example, can provide a spur to drug use. If one spouse uses drugs, the other
might join in, hoping to understand the allure. The once-sober spouse might also use drugs as
a peace-making effort. Instead of fighting about the drugs, the two might use drugs together.
While it might initially seem harmonious, this act can allow an addiction to blossom.

Sometimes, the way a person thinks and the way a person reacts in a given situation can lead
to drug abuse. For example, some people are impulsive, and theyre given to simply acting on
a stimulus instead of thinking through their options and making decisions based on future
consequences and current benefits. Impulsivity like this could allow people to experiment
with drugs, while people who are more cautious might never dare to do so. A study in the
journal Health Psychology also found a link between drug use and personality factors such as
poor self-control and a difficult temperament. People like this may have few friends and an
inability connect with others, and drugs might seem like an ideal way to soothe their pain. Its
reasonable to say that personality traits like this could lead to drug abuse.



Medications can be used to manage withdrawal symptoms, prevent relapse, and treat cooccurring conditions. Withdrawal. Medications help suppress withdrawal symptoms during
detoxification. Detoxification is not in itself "treatment," but only the first step in the process.
Patients who do not receive any further treatment after detoxification usually resume their
drug use.
Relapse prevention: Patients can use medications to help re-establish normal brain function
and decrease cravings. Medications are available for treatment of opioid, tobacco, and
alcohol addiction. Scientists are developing other medications to treat stimulant and cannabis

Behavioural theapies

Behavioral therapies help patients, modify their attitudes and behaviors related to drug use,
increase healthy life skills, persist with other forms of treatment, such as medication. Patients
can receive treatment in many different settings with various approaches.
Outpatient behavioral treatment includes a wide variety of programs for patients who visit a
behavioral health counselor on a regular schedule. Most of the programs involve individual or
group drug counseling, or both. Treatment is sometimes intensive at first, where patients
attend multiple outpatient sessions each week. After completing intensive treatment, patients

transition to regular outpatient treatment, which meets less often and for fewer hours per
week to help sustain their recovery.
Inpatient or residential treatment can also be very effective, especially for those with more
severe problems. Licensed residential treatment facilities offer 24-hour structured and
intensive care, including safe housing and medical attention. Residential treatment facilities
may use a variety of therapeutic approaches, and they are generally aimed at helping the
patient live a drug-free, crime-free lifestyle after treatment.

R. Miller, William; A.Forcehimes alyssa; Zweben Allen ; Treating addiction, Guilford
express, 2011