There are many arguments in academic circles about how to frame and think about addiction. In my personal experience, I find one of the most helpful ways to think of addiction is the classic framework that views addiction as a ‘biopsychosocial’ disease. I like this framework because it helps us identify and then examine all of the key ingredients that go into forming and maintaining a substance use disorder. That then provides us with multiple different paths to treatment.
Bio
Addiction is a biologic disease. Studies show that genetics explain 30-50% of an individual’s addiction. This is because we have found that there are MANY genes that influence how the brain releases the chemicals that drive addiction and how our brain responds to those chemicals. All of these changes combine together to make a person’s risk of developing a substance use disorder more or less likely. Not only does biology affect the likelihood that one would develop addiction, it also plays a role in reinforcing addiction…the likelihood that an addiction will continue to grow and worsen. The brain and body progressively change their structure and pathways to adapt to having the substance around. This leads to physical dependence, tolerance, withdrawal, and cravings which can then lead to increased use.
Psych
Addiction is a psychologic disease. Decades of evidence show that those with other mental health disorders are more likely to develop substance use disorders. This includes mood disorders like depression and anxiety to disorders that involve impulsivity such as ADD to conditions which can impact how persons perceive and respond to the world such as PTSD and schizophrenia. For some the substance becomes a way to escape from the stress and negative feelings that come with these conditions. These conditions may also contribute to characteristics that make substance use more likely to occur like a tendency to be impulsive, adrenaline/novelty seeking, etc. As substance use continues, the drug use itself causes mood changes such as anxiety and depression and impulsivity. Severe use can increase the risk of traumatic experiences with resulting PTSD. We now have the original psychiatric condition compounded by substance induced psychiatric conditions and this can lead to a spiral as the person tries to use more to cope with an increasing amount of negative feelings and emotions.
How do we use this knowledge?
We can now see how there are factors at the biologic, psychologic, and societal level that can make someone more or less likely to develop a substance use disorder. Each of these factors is then in itself influenced by the ongoing use of the substance. And each of these factors is related to the other. Biology and environment influence the development of psychologic disorders. Your psychology and mental health will impact those around you and your environment. Environmental/sociologic conditions change a person’s genes and DNA through epigenetics. None of these 3 factors can be isolated from the other.
This means that the most effective treatments will be those that address all three realms together: medications for the biologic aspects, medications and counseling for the psychologic aspects, and strong community programs and supports for the sociologic aspects. We also can use now understand why what works for one person may not work for another. Some persons with severe addiction may be able to stop ‘cold turkey’ while others cannot. Perhaps their genes were different. Or their psychology was different. Or their social environments were different. Maybe ALL of it was different.
Addiction is a disease that ranges from factors as small as a strand of DNA to as large as the cities and states in which we live. Each individual with a substance use disorder will be their own unique mixture of factors. We must continue the work to bring together treatments that can meet this range of needs and ensure that all persons have equal access to the medication, counseling, and social investments that best treat substance use disorders. Unfortunately, most US treatment sites can only treat one facet at a time and few to none can treat all three. It is why if you google ‘addiction treatment’ you may find tons of places pop up. But how many are only group counseling? How many can prescribe medications? How many can prescribe medications to you even if you have no insurance and are poor? How many have case managers helping file forms for low income housing, food stamps or can link you to GED programs? Until we stop trying to piecemeal the treatment and move forward together, we are all going to continue to fail those who need our help the most.
Reuse
Citation
@online{barnes2022,
author = {Barnes, Erin},
title = {Addiction {As} a {Biopsychosocial} {Disease}},
date = {2022-11-05},
url = {https://wakeforestid.com/posts/2022-11-05-addiction-as-a-biopsychosocial-disease},
langid = {en}
}
Social
Addiction is a disease that does not happen in a vacuum. Multiple societal and environmental conditions increase the risk for addiction including poverty and how available a drug is in an environment. Substance use is also a learned behavior with multiple social theories out there to explain how someone begins to and progresses to use. This includes higher risk by hanging out with friends who use, having family members who use, having fewer extracurricular activities available, and more. As addiction progresses it is reinforced by progressive isolation of the person with the substance use disorder as they withdraw from or burn bridges with their family and friends. Shame and guilt run rampant and further isolate persons who can come to believe they have essentially become irredeemable. With decreasing ability to hold down a job, maintain relationships, and keep up with bills the amounts of societal conditions such as poverty, incarceration, further association with peers who use compared to those who don’t further worsen the isolation and other social factors associated with addiction.