The Biopsychosocial model of addiction is a multidimensional framework used to better understand the contributing factors of addiction (Levin, 1989). This model draws from the biological, psychological, and social theories – or the contributing factors of addiction. Biological factors concern the genetic predisposition of addiction as well as the impact of addiction on the body (Levin, 1989). Thoughts, behaviors and feelings are the associated factors that are of concern in various psychological theories regarding addiction (Fisher & Roget, 2009).
For example, social learning theory (Givazolias & Themeli, 2014), expectancy theory (Jones, Corbin, &Fromme, 2001) and psychoanalysis (Kaplan & Wogan, 1978), to name a few, are theories that provide a lens in which to examine the psychological factors of addiction. The influence of family, friends and other interpersonal relationships provide insight into the various ways social factors contribute to addiction (Fisher & Roget, 2009). Some models used to examine these social factors include family systems theory and cultural theory as well as other theories drawn from anthropology (Fisher & Roget, 2009). With this in mind, the purpose of this paper is to compare and contrast two specific theories – one psychological and one biological; provide evidence to support and refute each theory as well as to describe how each theory is used to influence best practices; and in addition, it will outline the rationale for implementing or not implementing these specific theories in practice.
Sigmund Freud, the founder of psychoanalytic theory, posits personality is composed of three parts: the id, the superego and the ego. Of these three components, the id is impulsive and childlike acting on cravings, urges and immediate satisfaction (Engler, 2009). In terms of a contemporary view of psychoanalytic theory applied to addiction, the id is the component of the personality that craves a particular substance or engages in addictive behavior as a means of dealing with upsetting emotions such as depression and anxiety (Thombs, 2006). In other words, the addictive behavior is used as a defense mechanism to mask the pain of the emotional upsets or as a means of self-medicating. Two major views of the self-medicating hypothesis emerging from psychoanalytic theory were developed by Khantzian (1977) and Duncan (1974). These researchers assert individuals with a history of depression and anxiety in their earlier years are more prone to become involved in addictive behaviors in their adult lives.
Contrary to the view of addiction as a self-medicating behavior, Goldsmith (1993) indicates this theory does not take into account the biological factors associated with addictive behaviors. Morgenstern and Leeds (1993) concur and indicate the psychoanalytic perspective to addiction does not take into account the multiple dimensions that contribute to addiction. Further, Matusow and Rosenblum (2013) posit a weakness of the psychoanalytic approach as not being able to produce empirical results.
Disease Model of Addiction Theory
Whereas the psychoanalytic view of addiction is seen as a coping mechanism or as a theory of self-medication, the disease model of addiction theory views addiction as a disease originating from biological, genetic, neurological and environmental factors that are beyond the control of the addict (Leshner, 1997). Under this model, addiction is viewed as a disease leading to behavioral symptoms that produce cravings (Morse, 2004). Likewise, Margolis and Zweben (2011) agree that addiction has a genetic predisposition, but assert however, that addicts do have control and are responsible for recovery through abstinence.
Applying the psychoanalytic approach to treat addiction involves many observations of the patient over an extended period of time in order to identify the root of depression and anxiety symptoms. Under this approach, therapy may include the free association method, in which individuals uncover subconscious issues bring them to their conscious mind. Another method is transference, in which patients transfer thoughts or fantasies of past relationships to their therapist (Kaplan & Wogan, 1978). Conversely, under the disease model of addiction, treatment consists of assisting patients in abstaining completely from addictive behaviors and actions in order to mitigate the associated physiological symptoms (Leshner, 1997).
Rationale for Theory Application in Practice
In comparing the psychoanalytic and the disease model perspectives, this author appreciates the advantages of using both frameworks within a private practice setting. On one hand the disease model may help alleviate the guilt associated with addiction, but may leave them feeling like they have no control over their genetic disposition to the disease. On the other hand, the psychoanalytic approach may be useful in uncovering subconscious feelings that may be contributing factors in developing addictive behaviors. Overall, this author prefers the biopsychosocial approach that considers the multidimensional nature of addiction.
- Duncan D.F . (1974). Drug abuse as a coping mechanism. American Journal of Psychiatry, 131(6), 724.
- Engler, B. (2009). Personality theories. Boston: Houghton Mifflin Harcourt Publishing.
- Fisher, G.L., & Roget, N.A. (2009). Encyclopedia of Substance Abuse Prevention, Treatment & Recovery. Thousand Oaks, CA: SAGE Publications, Inc.
- Givazolias, T., & Themeli, O. (2014). Social learning conceptualizations for substance abuse: Implications for therapeutic interventions. The European Journal of Counselling Psychology, 3(1), 69–88 doi:10.5964/ejcop.v3i1.23
- Jones, B. T., Corbin, W. and Fromme, K. (2001). A review of expectancy theory and alcohol consumption. Addiction, 96: 57–72. doi: 10.1046/j.1360-0443.2001.961575.x
- Kaplan, C.D., & Wogan, M. (1978). The psychoanalytic theory of addition: A reevaluation by use of a statistical model. The American Journal of Psychoanalysis, 38(4), 317-326.
- Khantzian EJ (1977). The Ego, the Self, and Opiate Addiction: Theoretical and Treatment Considerations. NIDA Research Monograph, 12, 101-117. http://www.nida.nih.gov/pdf/monographs/download12.html
- Leshner, A.I. (1997). Addiction is a brain disease, and it matters, Science, 3(278), 5335.
- Levin, J. D. (1989). Alcoholism: A bio-psychosocial approach. New York: Hemisphere.
- Margolis, R. D., & Zweben, J. E. (2011). Models and theories of addiction. In Treating
patients with alcohol and other drug problems: An integrated approach (2nd ed.) (pp. 27-58). Washington, DC, US: American Psychological Association. doi:10.1037/12312-002
- Morgenstern, J., & Leeds, J. (1993). Contemporary psychoanalytic theories of substance abuse: A disorder in search of a paradigm. Psychotherapy: Theory, Research, Practice, Training, 30(2), 194-206. doi:10.1037/0033-318.104.22.168
- Morse, S. J. (2004). Medicine and morals, craving and compulsion. Substance Use & Misuse 39(3). 437-460. doi:10.1081/JA-120029985
- Thombs, D. (2006). Introduction to Addictive Behaviors. New York: Guilford Press.