In counseling others who are struggling with addiction, it is important to have an understanding how why and how they became addicted. There are various theoretical models that explain the underlying factors that lead to addiction, therefore it is difficult to only choose one single theory to best explain it. For many counselors, integrating different models can better help explain various causes of addiction, especially since each client has different experiences. In studying addictions in this course and attending Alcoholics Anonymous, Narcotics Anonymous, and Al-Anon meetings, I can see how the integration of models is needed for each individual. Although there are so many models to incorporate, four models will be discussed in this article: Biological, Disease, Family, and Moral Model.
Part I: The Four Models
One of the models of addiction is the Biological Model. This model presents that addicts are constitutionally predisposed to develop a dependence on substances, and even genetics can contribute to the likelihood of addiction. (Capuzzi & Stauffer, 2016). The Biological Models also discuss how the limbic system of the brain will change in chemistry when substances are used (Capuzzi & Stauffer, 2016). For this model, when substances are taken, the brain chemistry changes where there eventually become dependent on the substances. When the body is without the substances, withdrawal symptoms and negative affect components can occur (Potenza, 2013). An example of addiction being best explained by the biological model is when I heard a story shared through Narcotics Anonymous online. When this individual shared their story, they explained that even though they tried to quit using drugs, it was difficult because they would experience such pain with headaches, nausea, and would get terribly shaky. They explained that doing drugs was no longer an enjoyable thing to do, but something they had to do in order for their body to quit feeling miserable with the side effects. This fits the biological model because the individual felt that their body was chemically dependent on the drugs.
Another model of addiction is the Disease Model. This model implements that the individual is inflicted with the disease of addiction which cannot be cured (Capuzzi & Stauffer, 2016). This view is the sole model for Alcoholics Anonymous, where members acknowledge that they have a disease and find a way to “arrest” it through attending Alcoholics Anonymous (Alcoholics Anonymous World Services INC, 1970). Members of AA, in view of the disease model, believe that their disease of alcoholism is incurable and that it is a constant battle against it. It is a battle that they cannot fight alone, and with the help of a Higher Power they can manage their disease (AAWS, 1970). One story that I remember when I attended AA is a gentleman who was in and out of prison because of the disease of alcohol. He expressed how the disease is always there and will never go away, even though he spent time in prison away from alcohol. In his case, time away was not a factor with his disease, but more of the will to fight against it when he got out of prison.
The third model of addiction is the Family Model. This model recognizes that families play a role in how a person becomes an addict, and even how they have difficulty getting sober because of the influence in family. Families can reinforce the behavior of the abusing member, or can feel threatened if the abuser wants to recover (Capuzzi & Stauffer, 2016). The Family Model can also include the fact that the entire family could have a disease or disorder, and the entire family seeks counsel (Capuzzi & Stauffer, 2016). Additionally, the Family Model of addiction also exudes that addicted family members can cause great pain and suffering affected family members (Orford, Velleman, Natera, Templeton, & Copello, 2013). In an example of the Al-Anon meeting I had attended, a woman talked about how her husband becomes verbally abusive when he drinks, and she has contemplated numerous times if she should leave him. The effect that alcohol has on their relationship is causing great strain, so the issue goes beyond just the abuser being addicted.
The final model of discussion is the Moral Model. This model presents that substance abusers are choosing to abuse because of a personal choice, ignoring what is right and wrong or acceptable to unacceptable (Capuzzi & Stauffer, 2016). The abusers are viewed as suffering the consequences of their choices and not because of other factors such as genetics, family systems, etc. (Capuzzi & Stauffer, 2016). The first personal experience of shame that an addict has (usually a social and moral emotion) is important in understanding their addiction and contributes to their motivation for change (Pickard, Ahmed, & Foddy, 2015). An example of the moral model is when I listened to a story at AA where a woman described that although she knew getting drunk every day was wrong, it was so hard to stop. She ignored her internal convictions and continued to drink anyway, even though it made her feel terrible about it.
Part II: Member’s Story
One story that I found very moving was when I visited Alcoholics Anonymous in Kalamazoo, MI. It was actually my first visit to a substance abuse support group. The woman who shared was in her fifties, looked very well put together with nice hair and clothes. She started out by saying that she was 26 years clean, and started attending AA when she was just 26 years old. She said her problem with alcohol began after she was of legal age and could drink at her leisure. She said that she loved going out to the bars and being social, but soon that took a turn for the worst. She mentioned that her problem wasn’t that she couldn’t keep away from alcohol, she could actually go a week or so without it – it was that once she started, she couldn’t stop. She said that she would have close to 30 beers in a single binge. When she would drink, she would go into a rage and be an angry drunk. She said at one point after drinking, she chased a man down the street shooting a gun at him because she was angry about something she can’t remember. She said even then, she didn’t believe that she had a problem or thought she was doing anything wrong. She explained that that is the problem with alcohol, is that it is always a part of her and will never go away, and she knows that if she were to take that first sip that she would spiral out of control. She did talk about alcohol being a monster of a disease that is always ready for her to take that first drink. Eventually, she said that she realized that her lifestyle was affecting her children and family and she decided to attend AA. She said that since then, she has been 26 years sober and feels that she has the
This story can have different models, but out of the models discussed, the ones that come to mind are the Moral Model and the Disease Model. The Moral Model is fitting because when she was doing her binging, she never thought she was doing anything wrong and had no concept that it was hurting her or her family. It wasn’t until she realized how wrong it was that she began to go to meetings and start changing her life. Through the Moral Model, she recognized the consequences of her actions and made the decision to stop drinking. The Disease Model of addiction is a part of her story as well because she explained how her alcoholism will always be a part of her life, such as a disease. She said that she could go without drinking, but once she started she couldn’t stop, which is why alcoholism viewed as a disease is fitting for her case. It didn’t matter how long she went without drinking, the disease of alcohol is always waiting for her.
In summary, no single model of addiction is the go-to for all understanding of addiction. Each story has its own dynamics and contributors, therefore multiple models can be used to describe a person’s reason for becoming addicted. It is important to understand all of the various models so that appropriate treatment plans are created and individualized to meet the addict’s needs for recovery. Research, attending meetings, and continuing education can help become more competent in understanding addictions for counseling in the future.
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