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Toward a Biopsychosocial Theory of Substance Abuse SpringerLink

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The negative impacts of alcohol and drug use are greater on Black and Hispanic Americans, although consumption patterns between Blacks, Hispanics, and Whites do not explain this difference (at least in relation to alcohol; ). Data are lacking for many ethnic groups regarding chronic pain, but Blacks and Asian Americans report higher levels of pain and lower pain tolerance compared to Caucasians, differences which may stem from racism, socioeconomic strain, and ineffective pain coping strategies . Other structural vulnerability factors such as poor access to health care are likely to contribute to the unequal impacts of SUD and chronic pain on minority groups . Further research is needed to gain a better understanding of how complex social and structural factors shape risk for chronic pain and SUD. As noted above, the biomedical paradigm is struggling to confront rising healthcare costs and poor, patient-reported outcomes . The BPS model, prided on person-centered care, can alleviate this financial and diagnostic burden, particularly as it relates to chronic pain, mental illness, and other functional disorders . Family involvement in treatment can heavily reduce stigma related to SUD and chronic pain, and this social engagement is correlated with lasting, positive treatment outcomes .


This is now a widely accepted model that not only helps people with their mental health, but it also helps treat those who struggle with the disease of addiction. By focusing on all of these factors, instead of just one, people have a greater chance of recovery as well as long-term sobriety.

What is the most popular model for the treatment of substance abuse?

As a point of illustration, Damasio’s somatic marker hypothesis provides a helpful perspective on integrating the neuropsychological domain of decision-making and human interaction with the social environment. The SMH proposes a mechanism where emotion guides or significantly influences behaviour, particularly decision-making. Somatic markers are acquired by experience and are under control of a neural “internal preference system is inherently biased to avoid pain, seek potential pleasure, and is probably pretuned for achieving these goals in social situations” . The brain responds to particular social cues that may provide instant pleasure, or regulate biological homeostasis, such as relief from withdrawal . Brain systems that moderate feeling, memory, cognition, and engage the individual with the world influence the decision to consume or not consume a drug, or participate in a specific behaviour or series of actions.

Another way of conceptualizing the division is factors that predispose an individual to develop chronic pain and those that emerge as a consequence of pain. As discussed below, there is a high degree of overlap between the psychosocial aspects of chronic pain and addiction, and it is not always easy to make the distinction between cause and consequence in SUD. As the name suggests, the biopsychosocial model proposes that healthcare professionals use biological, psychological, behavioral, and social lenses to understand health and disease. Psychiatrist George Engel has been credited with the formulation, and call for action, that propelled the understanding of disease and illness past that of basic Renaissance philosophy and into an understanding not solely based in biological factors .

Essay On Substance Addiction

The brain disease model further implies simplistic categorical ideas of responsibility, namely that addicted individuals are unable to exercise any degree of control over their substance use . This kind of “neuro-essentialism” (Racine, Bar-Ilan, and Illes 2005) may bring about unintentional consequences on a person’s sense of identity, responsibility, notions of agency and autonomy, illness, and treatment preference. As the addiction treatment field has evolved, it continues to move away from punitive dogmatic approaches to more client centered holistic approaches. Strengths based models of addiction treatment integrate a variety of influential components that enhance our understanding and ability to effectively treat the entire individual within his or her social, cultural, psychological, and biological contexts. MBSR and similar strategies that target aberrant learning have been shown to interrupt the progression of addiction to opioids . Mindfulness trainings reduce the intense neural reactivity to drug-cues, reduce cravings, and uncouple negative affective states from the previously induced, self-medicated state . Furthermore, by promoting gratitude for positive experiences and acceptance of negative physical and affective states, MBSR has been shown to reduce craving, downregulate sympathetic arousal, and heighten natural reward , essentially breaking the cycle of addiction.


One of the great struggles of the field is that we are excellent at getting people sober, but we are poor at keeping them sober. Do not live in environments that support recovery” (Polcin, Korcha, Bond, & Galloway, 2010). While there is no explanation of the contributors to the use of substances that progress into abuse and dependency, providers should tap into several disciplines to provide holistic care. The biopsychosocial model of addiction gathers biological, psychological, and social information to understand substance use, development, and progression. With this information, clinicians are better equipped to provide successful treatment and build effective multidisciplinary programs for overcoming substance dependence.

Toward a Biopsychosocial Theory of Substance Abuse

The complex behaviour contributes both positive and negative feedback, and thus affects how the complex behaviour emerges. Systems theory, therefore, balances reductionism and the intrinsic heterogeneity within systems. There are several processes that actively contribute to substance use with inputs and outputs on biological and psycho-social levels. One example is drug craving that may be experienced as strong, intense urges for immediate gratification that may impair rational thought about future planning . Factors such as drug availability within the environment can increase craving and consequently the vulnerability for relapse . Recent research has suggested that enriched environments produce long-term neural modifications that decrease neural sensitivity to morphine-induced reward . Accordingly, the social environment can increase the frequency of cravings, which may contribute to increased drug consumption, and thus increase the probability that affected individuals will participate in a series of habituated behaviours that facilitate using .

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Describe a system that classifies alcohol and other drugs, into four basic drug categories, which is based on the subjective mood-altering drugs effect. This course presents a model that integrates over forty years of scientific research on addiction into a practical and easy to understand model that can improve assessment, recovery education, and treatment planning. Be aware that there is no unified theory of addition, but that an integrated approach can help explain onset and maintenance of addictive behavior. As to similarities, both groups offer friendship, fellowship, mutual support, and human connection.

Intrapersonal Contributors to Drug Use

One area in particular in which these neuroethics notions of addiction may have significant impact is in the clinical setting. While making a decision is itself a mental act, a mental act or event does not cause behaviour alone, but is one part of the complex process between neuronal firing and action. Once an intention has been formed for example, to use substances one is aware of the intention, though intention itself does not sufficiently cause the individual to seek out or use drugs. From a neuroscience perspective, it is difficult to see such actions as completely free, particularly when explanations of natural phenomena are understood as causally ordered. The notion of free choice becomes particularly troublesome due to the conscious experience of acting freely.

  • Heroin is lipid soluble, which leads to fast penetration of the blood-brain barrier and high abuse potential .
  • Factors such as drug availability within the environment can increase craving and consequently the vulnerability for relapse .
  • We argue therefore for a biopsychosocial systems model of, and approach to, addiction in which psychological and sociological factors complement and are in a dynamic interplay with neurobiological and genetic factors.
  • An underlying feature of these interacting systems is the human subjective experience of free voluntary actions, which problematizes laws within the natural world that every event has a cause with causally sufficient explanations.

The contemporary model, adapted for addiction, reflects an interactive dynamic for understanding substance use problems specifically and addressing the complexity of addiction-related issues. The empirical foundation of this model is thus interdisciplinary, and both descriptive and applied. In this context, the focus of MI is on resolving ambivalence through change talk and enhancing the ability to cope with chronic pain by incorporating mindfulness and cognitive restructuring techniques . Another study found that infusing a biopsychosocial assessment of chronic pain with MI also had more favorable outcomes, including marital satisfaction, reductions in pain intensity, stability in positive mood, lower ratings of personal distress, and higher ratings of empathy . Future studies examining the efficacy of MI in treating comorbid SUD and chronic pain would be informative.

These dimensions can be broken down to match the three parts of the BPS framework. Dimensions one and two refer to biological concerns; dimensions three and four refer to psychological concerns; dimensions five and six refer to social concerns.

The video below provides an overview of how the ASAM dimensions are applied by professional addictions counselors. This holistic concept allows us to consider a range of factors that influence the development and maintenance of addictive behavior. Rush B, Urbanoski K, Bassani D, Castel S, Wild TC, Strike C, Kimberly D, Somers J. Prevalence of co-occurring substance use and other mental disorders in the Canadian population. Phelan J, Yang L, Cruz-Rojas R. Effects of attributing serious mental illnesses to genetic causes on orientations to treatment. This 3 hour course is designed to introduce clinicians to Terence Gorksi’s understanding of the Biopsychosocial Model of the nature of addictions.


These have proven helpful in recovery, especially for those who have few connections in their lives. So, various forms of psychotherapy are necessary to help learn how to identify negative thinking patterns related to addiction and replace them with new healthy thought patterns. Figure 9.3.6 – Photo by Jeremy Bishop on UnsplashSpiritual Dimension is very personal to people. You will hear about the importance of spirituality to people, whether it is religious or non-religious. It is very important to be respectful around all spiritual dimensions as it is very important to people. Think of it as the therapeutic imagination of what spirituality means to the individual and show respect to each person, so that they can have the freedom to find, explore, revisit or discover their own beliefs. The biological basis of addiction helps to explain why people need much more than good intentions or willpower to break their addictions.

What are the 5 Ps in the biopsychosocial model?

They conceptualized a way to look at clients and their problems, systematically and holistically taking into consideration the (1) Presenting problem, (2) Predisposing factors, (3) Precipitating factors, (4) Perpetuating factors, and (5) Protective factors.

Thus, people who experiment with drugs in the United States usually do so in highly marginalized social settings, which can contribute to the development of substance use disorders . We argue therefore for a biopsychosocial systems model of, and approach to, addiction in which psychological and sociological factors complement and are in a dynamic interplay with neurobiological and genetic factors. As Hyman has written, “neuroscience does not obviate the need for social and psychological level explanations intervening between the levels of cells, synapses, and circuits and that of ethical judgments” (p.8).

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