In unprecedented numbers, addictions in America are spiraling out of control. Dr. Tim Clinton, president and founder of American Association of Christian Counselors, puts it this way, “All hell is literally [breaking out] against us” (Clinton, 2009). Consider the following staggering statistics with alcohol and drug addictions alone:
1) For alcohol issues alone, 43% of Americans have been exposed to alcoholism in their families
2) Nearly 1 out of 4 Americans admitted to hospitals have alcohol problems.
3) 1 out of 8 Americans has a significant problem with alcohol or drugs (Clinton, 2009).
If there are approximately 300 million people living in the U.S. and the last a aforementioned statistic is true, then this would equivocate to 37.5 million Americans that are currently struggling with alcohol and drugs. To make matters worse it is important to note an equally frightening fact: less than 50 percent of those who need help with drug or alcohol problems seek treatment. In essence, if estimates are accurate, we could conceivably have around one-fourth of the entire U.S. population writhing in pain from alcohol or drug addiction at any given time.
With no desire to sensationalize the real issue of addictions in our country reaching epidemic proportions, we must realize that the above numbers do not even reflect the tens of other various addictions (e.g. sex, gambling, eating disorders, consumerism, approval, religion) that millions of other Americans struggle with besides alcohol and drugs. Granted, some of the numbers would overlap due to co-addictions, but even so the numbers would still starkly rise above 25% of the U.S. population that is in need of counseling.
There are several reasons that make treating addicts difficult. First, many do not even acknowledge they have a problem; secondly, many simply cannot afford professional help; and finally, many counselors are too narrow focused (exclude an array of causaul factors) in their approach and so render much of their treatment plans with diminished effectiveness. It is this last problem that this article is interested in addressing more thoroughly.
Theories or models of causation:
There are currently at least eight popular models or theories behind the causation of addictions. They are as follows: 1) Volitional, 2) Personality, 3 Disease, 4) Genetic, 5) Conditioning, 6) Environmental, 7) Coping and 8) Holistic or integrated. Each one has its own sets of strengths from emphasis and weaknesses (Jenkins, 2009).
The volitional model is the oldest one on the books and basically approaches addictions from a limited perspective that addiction is merely the result of a person making a bad moral choice; nothing more and nothing less. This theory puts all of its “apples in the cart” of personal responsibility.
While I agree that personal responsibility starts somewhere with everyone I would also have to say that not everyone has equal starts. Its not a matter of merely personal choice when the majority of prostitutes, strippers, and porn stars are women that come from homes where the father was either absent or abusive. Where there is a common thread playing out in sociological dynamics one needs to pay attention to not only where the thread led, but to wince it came.
This model emphasizes that the addiction of a person is caused from an underlying personality disturbance or disorder (psychological problem) that developed during the developmental years. This theory therefore demands that treatment focus on discovering what the distortion in one’s personality is and what caused it before a person can begin the much needed repair work in the area of the healing of the soul.
The limitations to this model are that research currently shows that there are no known “addictive personality” identifiable types and tends to discount the spiritual component of people.
I had a friend that recently told me that when he was 13 years-old his older sister died in a car accident. His parents never recovered emotionally and ended up withdrawing emotionally from my friend during all of his teenage years. My friend turned to drugs and alcohol in an effort to medicate his own deep soul wounds. The point of the story is that my friend didn’t have a personality disturbance but a disruption in the nurture and support (coping and environmental factors) of his parents.
Where things become complex as a clinician is diagnosing someone that has multiple causations underlying their addiction. For example, you could have someone that has a disorder in their personality, genetic and biological predispositions, as well as a poor social learning skills and a nurture deficient environment.
When people think of the disease model they often think of the addiction with alcohol specifically. While the disease model was a breakthrough in finally getting a stamp of credence as to the emphasis needed on a medical approach in treating the disease it also reduced the unhealthy stigma that levied unnecessary shame and guilt that perpetuated the addiction cycle even more.
The down side or limitation to this theory is that it opens up the door to deny personal responsibility. It excuses any work that needs to be done by the hands of the patient. And let’s be honest, any person wanting to recover from any addiction has a long hard road ahead of them that will require excruciating effort at times. This is why so many do not recover. While they hate the side effects or downside of the addiction, they often hate the work required even more. So what wins out?
While many are familiar by now that genetic or biological predispositions play a role in making one more vulnerable to certain addictions, many do not realize that there is no one particular gene that makes one addicted, but rather it is polygenetic. Therefore, the treatment or solution will also need to be of a multifaceted approach. One will need to execute research into the genealogy of past generations to figure out which genetic dispositions they lay susceptible.
Conditioning & Reinforcement:
Basically, this model believes that addictions are learned behavior; specifically, that addictive behavior is learned and reinforced through reward and negative reinforcement. Pavlov’s dog shows how one’s body can be conditioned in the same manner to set up “cues” or “triggers” that actually induce the same response as the original reward itself. For example, if a man hears bells and whistles sounding off every time he wins at the slot machine in Las Vegas, when he comes home and hears similar bells and whistles he may start to have a craving to gamble. The bells and whistles serve as a new antecedent that can actually begin the release of the pleasure chemical of dopamine in the brain even before one pulls the handle to the slot machine. This model helps shed insight into both the physiological and psychological factors involved in shaping one’s addiction.
This model focuses on societal factors such as peer pressure, laws, rules, and availability of substance of abuse as to the contribution of one’s addiction problems. This causation theory desires to look at one’s relationships with people that could have undermined or high jacked them off course. Many parents that do drugs show their kids “the ropes” and therefore their children don’t know any better and learn that drugs should be part of one’s lifestyle or environment.
A more unfamiliar model, this theory of addiction believes that certain people have absent or deficient coping mechanisms in dealing with the stresses of life. While this theory allows for cognitive and social factors in its understanding of addictions, it fails to explain why certain people who had excellent coping skills in one stage of life fall prey to addictions later.
Holistic or Integrated:
I believe this is the best approach or model to incorporate into one’s understanding and treatment of addictions. This model encompasses all the previous models mentioned above as a confluence or convergence of factors. Therefore, it must be understood that due to the complex nature of addictions at times there must be multiple pathways to recovery. Treatment must be approached from a multi-faceted angle (Jenkins, 2009).
Addictions in our country are growing at an alarming rate and unless we have healthy and effective treatment plans that account for the multi-dimensional causes that often strike a person, we will in no way be able to bring health, healing, and hope to millions of people that find themselves in anguish.
[The above eight models of addiction were adopted from Dr. David Jenkins’ lecture on “Models of Addiction”].
“Addiction & Recovery” (speaker Dr. Tim Clinton). Addiction & Recovery: An Introduction. Lesson 101. DVD. www.lightuniversity.com, 2009.
“Addiction & Recovery” (speaker Dr. David Jenkins). Models of Addiction. Lesson 103. DVD. www.lightuniversity.com. 2009.