Pursuit of a Holistic Model of Addiction
By: Nadia Boachie
Refers to Models Of Addiction: Integrating Approaches By Duncan Green
Canada is still amidst a national opioid addiction crisis.1 There is a need to take an integrated approach to model addiction and better support those suffering, but the feasibility of creating such a model is unclear. Empirical evidence has given rise to multiple models of addiction. Many of these models are not holistic in their portrayal of addiction and this has started a debate about their validity. As Duncan Green points out in his recent article, Models Of Addiction: Integrating Approaches, development of a unified, comprehensive model is due. Establishing a model of addiction that allows us to better understand its complexity will help improve treatment and in turn reduce social and financial burdens related to the chronic condition.
Different models of addiction place varying degrees of blame on the addict. At one end of this spectrum, blame or responsibility rest completely on the addict: the moral failure model. This model implies that addicts should be blamed or punished for the bad decisions they make. The brain-disease model of addiction (BDMA) places majority of the blame on the malfunctioning brain. Many scholars believed BDMA it would combat public stigmatization of addicts.2 The National Institute on Drug Abuse (NIDA) is known for its hand in promoting addiction as a disease. Researchers and public policy makers debate the evidence suggesting that framing addiction solely as a disease helps reduce public stigma.3 Nick Heather, clinical psychologist, backed by a growing number of researchers, believe that relying on the disease model is not necessary for gaining public sympathy for addicts. Perhaps, scientists should give some autonomy back to the addict.
In Models Of Addiction: Integrating Approaches, Green talks about the positives and negatives of the incentive salience model. This model describes drug addiction as an excessive amplification of psychological “wanting.”4 The incentive salience model describes changes in reward, motivation, and executive control circuits in the brain, ultimately leading to increased sensitivity to drugs and drug cues. This model incorporates aspects of sociological and environmental factors and compensates for the shortcomings of BDMA model. Unfortunately, the problem with the incentive salience model and many others like it is that it focuses on drugs and drug-associated cues at the expense of other aspects of addiction, such as physiological dependence to drugs.
Knowing which elements of addiction to piece together to form a new holistic model has proven challenging. First, psychoactive drugs have varying degrees of addictive features. Differences in addictive features means that drugs vary in abuse liabilities. Second, animal models of addiction and study designs often restricts what clinicians can study. For example, self-administration of psychoactive drugs like cannabis is very hard to teach lab animals. Third, researchers studying addiction are often in niche scientific fields. For example, scientists that study dopaminergic systems are more likely to develop a model that solely describes malfunction of the dopamine system in addiction. They are less likely to develop a model that includes contributing social factors such as childhood adversity. There are multiple models and theories of addiction, but they focus on different aspects of addictive behavior, and therefore it is difficult to compare or integrate these models. Ideally, an addiction model should incorporate all addiction aspects: its biological basis as well as the social and psychological components.
- Shum D. Toronto facing mental health and addiction crisis amid spike in overdose deaths: mayor [Internet]. Global News. 2018. Available from: https://globalnews.ca/news/4388740/toronto-mental-health-addiction-overdose-crisis/
- Leshner AI. Addiction is a brain disease, and it matters. Science. 1997 Oct 3;278(5335):45-7.
- Heather, Nick. “Q: Is Addiction a Brain Disease or a Moral Failing? A: Neither” Neuroethics vol. 10,1 (2017): 115-124.
- Robinson TE, Berridge KC. The incentive sensitization theory of addiction: some current issues. Philosophical Transactions of the Royal Society B: Biological Sciences. 2008 Jul 18;363(1507):3137-46.