Sober living

Addiction as a brain disease revised: why it still matters, and the need for consilience Neuropsychopharmacology

Recent advances in neuroscience provide compelling evidence to support a medical perspective of problematic substance use and addiction (Dackis and O’Brien 2005). Despite these developments, the science is still in its early stages, and theories about how addiction emerges are neither universally accepted nor completely understood. Current ethical and legal debates in addiction draw upon new knowledge about the biological and neurological modification of the brain (Ashcroft, Campbell, and Capps 2007). The factors that increase an individual’s risk for addiction are numerous, yet they all find their place in the https://megapolisnews.com/top-5-advantages-of-staying-in-a-sober-living-house/ (Marlatt & Baer, 1988).

  • Despite having differing theories about the root causes of substance use disorders, most researchers would agree that substance abuse is, to some extent, a learned behavior.
  • Were that the intended meaning in theories of addiction—which it is not—it would clearly be invalidated by observations of preserved sensitivity of behavior to contingencies in addiction.
  • In other cases, we believe the arguments have less validity, but still provide an opportunity to update the position of addiction as a brain disease.
  • As noted in the Introduction, Engel supposed that the BMM assumed body/mind dualism and that this was an obstacle to accounting for psychological factors in health and disease.
  • As noted above and in the Appendix, people meeting the diagnostic criteria for TMD manifest quite varied symptoms and problems (high patient heterogeneity) and also often qualify for other diagnoses (high comorbidity).

Chronic and relapsing, developmentally-limited, or spontaneously remitting?

Reciprocal determinism demands not only a multifaceted approach, but an approach with constantly changing decision trees, if-then statements, and go/no-go decisions. This task is monumental but not impossible, and social learning theory points to a possible solution. The ambiguous relationships among these terms contribute to misunderstandings and disagreements. Fundamentally, we consider that these terms represent successive dimensions of severity, clinical “nesting dolls”. Not all individuals consuming substances at hazardous levels have an SUD, but a subgroup do.

Substance Use Disorders in Children and Adolescents

biopsychosocial model of addiction

Second, although the data are nationally representative, the survey is cross-sectional, and it excludes some subsets of the population. The NSDUH only targets noninstitutionalized US citizens, so active-duty military members and institutionalized groups (e.g., prisoners, hospital patients, treatment center patients, and nursing home members) are excluded. Thus, if substance use differs between US noninstitutionalized and institutionalized groups by more than 3%, data may be problematic for the total US population [44]. A particularly notable limitation of the NSDUH is that it does not include information regarding chronic pain.

The importance of choice and agency in animal models of addiction

  • Action, subjective experience of action, and consequently responsibility for action is mediated by many factors, including psychological phenomenon such as an individual’s emotional processes.
  • Moreover, all three of these factors mutually influence one another, leading to continually evolving functional relationships that both directly and indirectly influence the use of drugs (Figure 1B).
  • These criticisms—which, we will see, are compelling—raise fundamental questions about the BPSM’s place in medicine.
  • Over time, behaviors within a social group are selectively imitated and reinforced, which in turn increases similarity within the group, which in turn increases group cohesion, which in turn increases affiliation between group members, and which in turn furthers the influence of the group on individual behavior.
  • Over the past few decades, a substantial range of epidemiological studies have established that there are social determinants of health, that is, a positive correlation between higher social status and better health, the so-called social gradient in health, which underpins health inequalities (Marmot, 2006).

For an example of the appeal-to-authority argument, consider an article on irritable bowel syndrome (IBS) by Camilleri and Choi (1997). To be diagnosed with IBS, a patient must report bowel troubles and also show no signs of “organic disease” (Camilleri and Choi 1997, 3, 8, 9, 11). Yet Camilleri and Choi classify IBS itself as “a disease.” In fact, they call it “the most common disease diagnosed Sober House by gastroenterologists” and say that “it” “affects about 20% of all people at any one time” and “has a large economic impact” (Camilleri and Choi 1997, 3). In this section I use three case studies to illustrate what wayward BPSM discourse is and how it works. These studies focus on Engel’s 1977 article and the BPSM literatures on temporomandibular disorder and irritable bowel syndrome.

Wayward BPSM discourse

Nowhere in DSM-5 is it articulated that the diagnostic threshold (or any specific number/type of symptoms) should be interpreted as reflecting addiction, which inherently connotes a high degree of severity. Indeed, concerns were raised about setting the diagnostic standard too low because of the issue of potentially conflating a low-severity SUD with addiction [116]. In scientific and clinical usage, addiction typically refers to individuals at a moderate or high severity of SUD.

National Institutes of Health (NIH) funded a major TMD study known as “OPPERA.” The OPPERA study has been highly significant in the field of TMD research. It is referenced frequently in the literature, and has provided the data underlying many claims made about TMD and its causes. In several descriptions of the OPPERA project offered by field leaders, we find additional question-begging transformations of TMD.

biopsychosocial model of addiction

Mind the dad–A review on the biopsychosocial influences of drug abuse on father-infant interaction

biopsychosocial model of addiction

Evidence that a capacity for choosing advantageously is preserved in addiction provides a valid argument against a narrow concept of “compulsivity” as rigid, immutable behavior that applies to all patients. If not from the brain, from where do the healthy and unhealthy choices people make originate? To resolve this question, it is critical to understand that the ability to choose advantageously is not an all-or-nothing phenomenon, but rather is about probabilities and their shifts, multiple faculties within human cognition, and their interaction. Yes, it is clear that most people whom we would consider to suffer from addiction remain able to choose advantageously much, if not most, of the time. However, it is also clear that the probability of them choosing to their own disadvantage, even when more salutary options are available and sometimes at the expense of losing their life, is systematically and quantifiably increased.

  • The determination of relevant evidence in the intervening decades has required the development of new research methodologies capable of determining multifactorial influences on onset, course, complications, and treatments.
  • Addiction can also send your emotional danger-sensing circuits into overdrive, making you feel anxious and stressed when you’re not using drugs or alcohol.
  • Its participants have argued that various poorly-understood states of suffering and undesirable behaviors are “diseases.” These “diseases” are often asserted to be caused by various factors that have no proven etiological significance.
  • Among high-risk individuals, a subgroup will meet criteria for SUD and, among those who have an SUD, a further subgroup would be considered to be addicted to the drug.
  • Psycho-social systems are concrete entities or groups whose members act in relation to each other, such as families, religious organizations, and political parties (Bunge 2004).
  • In his dialogues, Socrates argued that when faced with a choice between two alternatives, it is our nature to choose the alternative that is most right, most good, and most virtuous (Plato, as translated by Jowett, 2011).
  • They also influence the individual by influencing cognitive appraisals of both their behavior and their social network.

A brain disease? Then show me the brain lesion!

K6 items are from a screening instrument for nonspecific psychological distress developed by Furukawa, Kessler, Slade, and Andrews, [42] and Kessler et al. [43] Suicidality was assessed if at any time in the past year a participant had seriously thought about trying to commit suicide. The notion of addiction as a brain disease is commonly criticized with the argument that a specific pathognomonic brain lesion has not been identified. Indeed, brain imaging findings in addiction (perhaps with the exception of extensive neurotoxic gray matter loss in advanced alcohol addiction) are nowhere near the level of specificity and sensitivity required of clinical diagnostic tests. However, this criticism neglects the fact that neuroimaging is not used to diagnose many neurologic and psychiatric disorders, including epilepsy, ALS, migraine, Huntington’s disease, bipolar disorder, or schizophrenia. Even among conditions where signs of disease can be detected using brain imaging, such as Alzheimer’s and Parkinson’s disease, a scan is best used in conjunction with clinical acumen when making the diagnosis. Thus, the requirement that addiction be detectable with a brain scan in order to be classified as a disease does not recognize the role of neuroimaging in the clinic.

For instance, despite its cost-effectiveness and ease on burden of disease, the supervised injection site (SIS) in the Downtown Eastside area of Vancouver, Canada has been repeatedly threatened with closure by politicians. The threats are based on emotional and moral attitudes towards the existence of the SIS and drug addicts generally, as opposed to empirical evidence (Des Jarlais, Arasteh, and Hagan 2008). Advances in addiction research are increasingly being applied to gain deeper knowledge about the impact of drug use on brain structure and functioning, capacity, autonomy, free choice and decision-making, behaviour, treatment, and symptom reduction.