As a next step, I will discuss some of the main models that attempt to explain the pathway it takes for an individual to pass over from a simple use, or else no use, of a substance to a full blown addiction.
Discussion of Models on the Process of Chemical Dependency
Brower et al. (1991:761) cited in Dowieko (1993:11) note that ‘severity of drug dependence may be considered a continuum’. Dowieko (1993) provides a model to explain the process of chemical addiction, arguing that any given individual might be classified as abstaining from all drugs, using one or more drugs on a social basis, abusing one or more drugs on an episodic basis, abusing one or more drugs on a continual basis and finally, being addicted to a drug or drugs. Dowieko (1993) argues that as with any continuum, movement back and forth from one stage to another is possible and the individual might fall somewhere between categories. Dowieko’s conception of addiction in terms of a physical dependency can be also highly detected in his model. Indeed, he refers to addiction in terms of the classic addiction syndrome, a perception that sees addiction in terms of serious withdrawal symptoms, and various medical complications associated with chemical abuse. The concept of chemical addiction as a primary disease is evident in this model in that the course of the illness is permanent, predictable and progressive. The model, therefore, views addiction as a progressive, chronic, potentially fatal disease which always gets worse if the person continues to use. The lens for viewing the problem in Dowieko’s model is, therefore, physiological and genetic, with the emotional, social and physical problems seen as an outgrowth of addiction.
Muisener (1994) cited in http://scholar.lib.vt.edu/theses proposed a stage-like model of the process of chemical addiction that adolescents typically go through, ranging from experimental and social use, whereby the individual learns and seeks the mood swing, to an operational and dependent use, whereby the individual is preoccupied with the mood swing and uses chemicals to feel normal. The concept of chemical use as a phenomenon that occurs in different stages along a continuum can be easily construed in Muisener’s model. For instance, whereas at the second stage of this model – the ‘seeking the mood swing’ stage – there is a certain degree of control on how much to use, however, at the third stage – the ‘preoccupation with the mood swing’ stage – the individual does not use it at an appropriate time and place, but is actually preoccupied on how to get it and where. Once a person learns that certain substances create a mood swing, he or she would be encouraged to move on as a result of varied biological, psychological and social factors. It might be interesting to point out that, unlike Dowieko’s medical view of addiction, Muisener’s model is not based on the medical model but the lens for understanding the issue is widened from a physiological predisposition to a multivariable problem, which seeks to integrate biological, adolescent psychological development, interpersonal determinants, community variables and societal influences in order to explain how young persons progress, regress through, or stay at different stages of his model.
Another model that attempts to describe the process of chemical dependency is the one proposed by Ungerleider and Beigel (1980). The model describes an individual’s journey from experimental use, i.e. participated in primarily by youth and motivated by curiosity, to compulsive drug use, i.e. obtaining drugs becomes the overriding concern of daily life. Interesting to their model is the fact that the authors based their model on various degrees or levels of drug use, not making any reference to terms like abuse or addiction whatsoever. It would seem that Ungerleider and Beigel’s model exemplifies the highly unclear distinction that exists between drug use and abuse in different cultures and societies, a distinction that is highly biased by subjective value judgments and personal experiences. Indeed, Ungerleider and Beigel (1980) cited in Fishbein and Pease (1996) point out how the last two patterns of their model, i.e. the intensified and compulsive drug use, are frequently accepted in our society, as reflected in our attitudes toward drinking alcohol and taking certain stimulants like caffeine and nicotine, whereas the media, funding and criminal justice efforts target the experimental, recreational and situational drug users. This would surely make the distinction between drug use and abuse grow ever more of a hazy argument, anything that lends itself to the way in which the observer perceives such an issue from his or her own philosophical or professional point of view and on the particular focus he or she brings to examine the problem.
Another way of looking at the process of drug addiction is based on the model of drug pathways developed by Parker et al (1998). Parker et al. (1998) identified four ‘drug status groups’ namely current users, former users, in transition and abstainers. Based on these groups, Parker et al. felt able to describe a linear development of drug use for an individual over time. Parker’s et al. model is very helpful in enabling us to distinguish adequately between types of drugs, types of drug users and diverse reasons for taking drugs. With regard to their model, Parker et al. (1998) argued that situations, actions and decisions made or chosen by young people can help shape the particular pathway journeys they take. Parker et al. (1998) also demonstrated that there can be changes of drug behaviour along these pathways, with for example some "abstainers" trying drugs when they got older, some "former users" moving back "into transition", some "current users" stopping, and some "in transition" becoming current users. In contrast to Dowieko’s model, the drug use described in the normalization thesis upon which Parker’s et al. model is based, is largely recreational and is centred on less physically addictive drugs which can be more easily accommodated by adolescents and young adult users in their busy lives. The basis of Parker et al’s model, Parker et al. (1998a) cited in point out, stems from the normalization hypothesis that basically suggests the major shift in public attitudes towards certain forms of illegal drug use, with recreational use now being normalized for young people, thus accommodating previously ‘deviant’ activities into mainstream cultural activities. Although many are those who regard the distinction between recreational drug use and problematic drug use as essential, on the other hand, Parker et al.’s model conceives of the boundaries between recreational and problematic drug use as becoming ever more blurring as a result of the changing patterns and settings of drug use behaviour. For this reason, as reflected in their model, they prefer to think of a continuum of drug use behaviour, which involves pathways, careers and journeys rather than moving from soft or recreational drug use to hard drug use.
Models of Chemical Dependency
After discussing some of the main models on the process of chemical dependency, I will now consider the potential of the main models of chemical dependency to explain why certain individuals, unlike others, proceed from little or no use of substances or involvement in an activity to an increased intake and finally to full blown addiction.
The three most important theoretical models through which one can set about explaining chemical dependency are the biological, the psychological, and the socio-cultural models.
Biological models postulate innate, constitutional physical mechanisms in specific individuals that impel or influence them either to experiment with drugs or to abuse them once they are exposed to them. Thombs (1994) explains how, within the medical model, addiction is often described as a primary disease; that is, it is not the result of another condition. This is usually taken to mean that the disease is not caused by drug use, heavy drinking, stress, or psychiatric disorders; rather, Thombs (1994) explains, it is thought to be the cause of these very conditions. In other words, drug use is a secondary symptom or manifestation of an underlying disease process known as addiction. The enduring value of this model is that it removes alcohol and other drug addictions from the moral realm, thus proposing that addiction sufferers should be treated and helped. Nonetheless, as Thombs (1994) points out, most of this model’s major hypotheses are disputed by research findings and it either ignores or underemphasizes the impact of environmental forces and the role of learning as etiological bases. Simply put, the disease model apparently does not account for the enormous complexity of the problem.
The science of the human mind – psychology - has also had its own share in trying to explain what makes individuals become chemically dependent. For instance, the psychodynamic model purports that addictive behavior, like drug use, is the result of an interaction between external events and repressed or unconscious mental processes of which the subject remains unaware, unless and until they are revealed and interpreted by psychoanalysis. The psychodynamic model proved to be very successful in shedding light onto the importance of early childhood development and parental influences as possible origins of addictive behavior, as well as recognizing that dysfunctional dynamics in an individual’s family of origin often play a role in the development of chemical dependency. Also, the psychodynamic model offers penetrating insights into the personality dynamics of drug addicts. Wurmser’s (1974) notion of an individual’s proneness (i.e. the “addictive search”) coupled with drug or alcohol availability provides an intriguing explanation for predicting vulnerability to addiction. Likewise, the conceptualization of drug taking as “affect defense” (i.e. a form of self-treatment) provided by the psychodynamic formulations of addiction, is also revealing, particularly when consideration is given to the possibility that an addict’s drug of choice is selected in order to provide relief from unwanted depressive moods. Nonetheless, the psychodynamic belief that individuals are predisposed to addiction by negative affective states is not supported by existing research findings. According to Cox (1985), there is little evidence that psychological distress leads to addiction. It appears that negative affective states are usually the consequences of years of substance abuse, not the precursors, as claimed by the psychodynamic model. Also, the abstract hypotheses of the psychodynamic model, such as the belief that addicts are regressing to unfulfilled phases of psychosexual development, do not lend themselves to scientific testing, and different analysts from the same theoretical school may often come up with completely different interpretations of a same observed phenomenon.
Unlike the psychodynamic model, behavioral models of addiction are based upon the assumption that the continued use of all drugs that stimulates euphoria is caused by their ‘extremely potent reinforcing effects’ (McAuliffe and Gordon, 1980, p.137). Many drug users are reinforced – that is, they experience euphoria - from their very first drug experience onward, and the more they use, the more intense the sensation and the greater the motivation to continue use. Also, the intake of a dose to alleviate withdrawal distress is also explained in terms of reinforcing contingencies, whereby the drug addict takes a dose to experience relief with the termination of the pain. Negative reinforcement – i.e. relief from pain – is clearly a factor in continued use by a certain segment of narcotic addicts, but it does not describe the use of all addicts, as McAuliffe and Gordon (1974) point out. Positive reinforcement applies to all drug use, insofar as taking drugs generates euphoria; on the other hand, can it explain why some individuals who experience euphoria continue taking a given drug, while others, who also experience euphoria, discontinue its use? Goode (1999) points out that the fact is that it hasn’t and, in all likelihood, it cannot. The behavioral model also tries to explain how drug-taking behaviors are acquired and maintained via the learning process through modeling or imitation of significant others, also known as social learning. In explaining drug use, social learning theory has a clear-cut application and proposes that the extent to which substances will be used or avoided depends on the extent to which the behaviour has been differentially reinforced over alternative behavior and is defined as more desirable Radosevich et al. (1980) cited in Goode (1999). Nonetheless, the theory fails to explain how a given activity, such as drug use, is liked by one individual and not by another. To make up for such a limitation, cognitive theories try to offer an explanation in terms of the way people interpret their experiences in life, and account for what has happened to them. Two explanatory ideas that emerge from this theory – self-efficacy and self-esteem – seem very important in explaining dependency. Indeed, many therapists in the drug and alcohol field regard low self-esteem as an important causative or maintaining factor. Also, with regard to self-efficacy, many distressed heroin addicts, for example, can accept that giving up would be highly desirable but do not really believe that they could tolerate detoxification, manage their emotions without the cocoon of opium, or resist temptation to use again if by some miracle they did manage to pack it in.
So, generally, psychological models of addiction succeed in taking a much wider perspective than the medical model in order to explain addiction, namely by taking into account a number of factors, including the biological, psychological and socio-cultural factors, rather than being simply based on a single explanation of addiction. Also, the psychological models of addiction do not present us with a view of addiction as necessarily progressive. Rather, there is a continuum of levels of involvement and the individual will slide up and down that continuum dependent upon the current situation and his or her skills for coping with that situation. Also psychological models do not present us with an absolute cut-off point for addiction at which we may place our level of concern, as the disease model seems to suggest. It is acknowledged that people may have problems at any level of consumption, and that these problems may be interpersonal, legal, financial, scholastic, work-related, psychological or physical. That is, anyone who is experiencing problems in relation to substance use may be a candidate for help, and we need not label this person an ‘alcoholic’ or an ‘addict’ in order to make him or her eligible for our attention. Also, none of the processes suggested by the theories is irreversible. This means that using psychological theories, we can come up with a whole range of possible goals and interventions. We do not have to advocate abstinence in every case; for some people a reduction in substance use will be sufficient, and for others it may be more pressing to teach methods of harm reduction. The psychological theories presented here give also indications as to what interventions may be developed.
Unlike biologists and psychologists who examine individual characteristics to explain drug use and addiction, those with a sociocultural bend study societal variables to explain drug use. The sociocultural approach generated various theories, each representing an area of inquiry that previous investigators concentrated on in attempts to explain antisocial behaviours and personalities in general. For instance, subcultural theory assumes that involvement in a particular social group with attitudes favourable to drug use is the key factor in fostering one’s own drug use, and that involvement in a group with negative attitudes toward drug use tends to discourage such use. Drug use is expected and encouraged in certain social circles and actively discouraged, even punished, in others’ (Goode 1999, p. 105). The labeling theory argues that the user views his or her initial experimentation with drugs as normal. However, once that behaviour has been brought to the attention of significant others, the user is labeled deviant. Eventually, the user internalizes the label as deviant (Covington 1987) and continues to use drugs because others expect this behaviour. These users may then avoid stigmatization by either maintaining conventional lifestyles and concealing their drug-taking behaviour or by affiliating more and more with an underground subculture. Another important theory of addiction, known as the selective interaction/socialization model is more or less based on the fact that potential drug users do not randomly ‘fall into’ social circles of users; they are attracted to certain individuals and circles – subcultural groups – because their own values and activities are compatible with those of current users. They are, in a sense, socialized ‘in advance’ for participation in certain groups, they choose and are chosen by certain groups because of that socialisation process, and, likewise, participation in those groups socializes them toward or away from the use of illicit drugs. There is something of a reciprocal or dialectical relationship here.
In view of the theories mentioned above, there is a major limitation of the sociocultural model of addiction. As Thombs (1994) points out, the concepts in this view are considered too abstract by some professionals. The concepts of social boundary markers, subcultures, and so on are sometimes seen as too intellectual, or perhaps useless because they cannot be readily measured or observed. Despite all this, it seems that the sociocultural model of addiction sheds light on the phenomenon of substance use and abuse. Goode (1999) explains how drug use is learned and reinforced within a group setting. Also, Goode (1999) emphasizes how future drug users interact with current users and learn appropriate definitions of the drug experience, which has a strong impact on their future experiences and behavior. However, the interaction and the subcultural perspectives do not address themselves to the question of why some people use and others do not. It seems, therefore, that the selective interaction/socialisation approach must be mobilized at this point. Personality factors must be combined with group and subcultural factors. Social background and parental, personality, behavioural and value characteristics predict which young people will gravitate toward one another – toward peer circles whose values and behaviour are compatible with use. Once someone is selectively ‘recruited’ into such a circle or group, his or her likelihood of use increases rapidly. The more consistent these values, and the more concentrated and intense the interaction, the greater the likelihood of use. Also, Goode (1999) stresses that youngsters do not magically and independently devise a solution to a psychological problem they may have, and rush out, looking for a chemical substance to alleviate that problem. Future users turn to drugs because they have friends who use and endorse use, and because they are relatively isolated from circles who do not use and who in fact actively discourage use.
However, despite what some theorists argue, Goode (1999) points out, ‘the validity of one theoretical perspective does not imply the falsity of another’. All three models are likely to play their part in any individual’s dependency, though one or two may be dominant for that person. Perhaps the most important thing to stress in conclusion is that addiction should not be regarded as a walled-off, stand alone ‘condition’. In attempting to answer the question, “Why drug use?” Goode (1999) advices that we need to be broad and eclectic in our approach rather than limited and dogmatic.
Chemical Dependency, the Individual and Society
Chemical dependency is a major public health problem that affects millions of people and places enormous financial and social burdens on society. It destroys families, damages the economy, victimizes communities, and places extraordinary demands on the education, criminal justice, and social service systems. Chemical dependency affects and costs the individual, the family, and the community in significant, measurable ways including loss of productivity and unemployability, impairment in physical and mental health, reduced quality of life, increased crime, increased violence, abuse and neglect of children, dependence on non-familial support systems for survival, and expenses for treatment. The physical, mental health and social consequences of alcohol and other drug use by women can seriously affect their lives and those of their families. Not only are women, especially young women, beginning to close the gap between female and male consumption of alcohol and other drugs, they suffer earlier and more serious consequences. Women become intoxicated and addicted more quickly than men and develop related diseases earlier. Sadly enough, children also must bear the burden of biological and environmental consequences of parental substance abuse.
References
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http://ehc.healthgate.com/getcontent.asp
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