There are four conceptual models of addictive behavior as identified by Brickman and colleagues. These models are based on “beliefs about attributions of responsibility for acquiring the addictive problem and the responsibility for solving the addictive problem” (Miller, 2013).
My personal experience with addiction in relationship to my progression into recovery align with the compensatory model and integrate the four dimensions of SAMSHA’s definition of recovery as will be demonstarated. As I am studying and working in the everchanging field of addiction and recovery, new theories, research, and findings are published on a regular basis. My continuing education is a constant process of incorporating new information and using discernment with the new data. Additionally, best research strategies must be implemented.
Four Conceptual Models of Addictive Behavior
Brickman and colleagues have presented a useful analysis of personal responsibility. Their analysis reveals two fundamental questions: a) who is responsible for creating a problem?; b) who is responsible for solving it?. “These two questions generate four possibilities with respect to responsibility for personal problems including the moral model, the enlightenment model, the medical/disease model, and the compensatory model” (Addiction and Personal Responsibility: A Fundamental Conflict). The moral model constructs addiction as the result of a person’s weakness in character, suggesting that addiction is the result of bad decisions the addict makes due to poor moral strength. In addition, the enlightenment model proposes that the addict is culpable for developing the addiction, but not liable for solving it. The medical model holds the addict neither responsible for the addiction problem or the solution. Similar to the enlightenment model, the element of self-blame is eliminated. In comparison, the compensatory model poses that people are not responsible for the development of addiction but are responsible for their own recovery. Moreover, the compensatory model focuses on vigorous and balanced self-reliance, while encouraging the recognition of personal limitations, such as managing stress. There is no “magic bullet” for effectively treating persons with substance abuse problems. Different people respond to various approaches in diverse ways. This makes it critically important that individuals be matched appropriately with the treatment program or modality that is most likely to attack the problems resulting in their particular needs (Getting Ready to Test, 2017, p. 167).
Personal Perspective & Compensatory Model
The notion that addiction is a “brain-disease” has become widespread and rarely challenged. However, brain-disease model obscures the dimension of choice in addiction (Satel & Lilienfeld, 2014). People's understanding of their ability to control their own lives will greatly influence which types of recovery models are most suitable for them. My alignment with the compensatory model comes from my belief that I have an internal locus of control. This personality characteristic describes a person’s sense of control over their own life. This intrinsic self-perception of control over one’s own life should greatly influence which type of recovery model is most suitable for them. When people have an internal locus of control, they expect they will determine their own futures because of their own actions (Personal Responsibility and Locus of Control). After analyzing the compensatory model of addiction, there are multiple factors in the development of addictive behavior which include biological predisposition, early experiences, social and cultural variables, and the continued use of substances as a way to cope with stress (Miller, 2013).
An interpretation of the fundamental ideas of this model can be identified in these statements:
- 'I'm not responsible for creating the problem, but I am responsible for solving it.
- What do I need to solve the problem? (knowledge, skills).
- Someone else might say: “I respect you for your efforts. Let me know if you need any help”.
- Extreme, exaggerated versions of model - failing to recognize one's own limitations, grandiosity, stubbornly refusing help of any sort.
- Healthy recovery application: 'I sure wish I didn't have these problems. However, since I do, I'm going to figure out how to resolve them. I'll get some help if I need it” (Addiction and Personal Responsibility: A Fundamental Conflict).
Evidence suggests that biological, genetic, personality, psychological, cognitive, social, cultural, and environmental factors interact to produce the substance abuse disorder, and multiple factors must be addressed in prevention and treatment (Skewes & Gonzalez, 2013). Biological factors contributing to biological predisposition include evidence of heritability, genetic variations and genetic polymorphism. All of these variables may increase the risk of substance abuse. Children who are victims of abuse and show behaviors such as attention deficit/hyperactivity disorder and aggression can be at an increased risk of addiction. Social influences have shown to be a strong predictor of substance abuse if a person’s peer group participates in and endorses substance use. Consider a quote by Tony Robbins which states, “The quality of a person’s life is most often a direct reflection of the expectations of their peer group”. Expressly, if a person’s peer group condones, glorifies and glamorizes certain behavior, a person is more likely to act in congruence with those behaviors. Most drug use is social, and drugs are usually consumed in groups. In these situations, feelings of disinhibition and talkativeness generally generate and promote social bonding due to subsequent drug use ('The world drug problem: A status report', 2006). Drinking to fit in initiated my alcohol use for relief of social anxiety and low self-esteem. My own experience of struggling with alcohol addiction and the process in which I came into recovery are in congruence with the compensatory model. A treatment approach in support of a rooted belief that I was responsible for changing my addictive behavior helped guide me into living a new and purposeful life in recovery.
Compensatory Model & A Pathway Recovery
Multiple factors should be considered and addressed for prevention and treatment for a person to reach and maintain a recovered state. The individual is assumed to be capable of compensating for the addiction by taking an active and responsible role in the change process (Marlatt, 1988). Frequently the application of a coping skills program is teaching clients stress management techniques by way of a strategy knows as stress inoculation training (STI) (Theories of Counseling, Lofgren & Perez, 2017- need help citing correctly). Such training addresses one’s own recognition regarding personal limitations, such as managing stress, which was crucial for my success in abstaining from alcohol. STI consists of a combination of constructs. These theories consist of Socratic discovery-oriented inquiry, cognitive restructuring, problem solving, relaxation training, behavioral rehearsals, self-monitoring, self-reinforcement, and modifying environmental situations (Theories of Counseling by Lofgren & Perez, p. 312- need help citing correctly).
The daily work of recovery, whether or not it is abetted by medication, is a human process that is most effectively pursued in the idiom of purposeful action, meaning, choice, and consequence (Satel & Lilienfeld, 2014). My progress in recovery has been achieved by eliciting change in all aspects of my life. Such changes in my lifestyle have included a supportive social network, a new sense of physical and emotional well-being as well as a meaningful career, healthier daily activities, and a newfound stability at home. These changes are in direct correlation to the four major dimensions of SAMHSA’s definition of recovery.
In my life, recovery is the process of change through which I have improved my overall health and wellness. SAMHSA defines four major dimensions that support recovery: 1) health-overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being; 2) home-having a stable and safe place to live; 3) purpose-conducting meaningful daily activities and having the independence, income, and resources to participate in society; 4) community-having relationships and social networks that provide support, friendship, love, and hope” (Bradbury, 2019).
These four dimensions coincide and are integral parts of my notion of recovery. With strong faith in self-will, desire, and assumed ability to change my addictive behavior, the integration of change in all four dimensions was imperative. One approach to treating substance abuse from the social perspective involves changing the substance abuser’s environment and peer associations. The behavioral treatment approaches emphasize positive peer associations and pro-social lifestyles and activities. Self-help strategies similarly encourage drug0free activities and association with others in recovery (Getting Ready to Test, 2017, p. 160).
Treatment, Behavior Change, & Maintenance
Considerations for referring individuals to outpatient treatment programs are dependent on their motivation for treatment and ability to discontinue using drugs or alcohol (Getting Ready to Test, 2017, p.176). I chose to use outpatient treatment at NUWAY in Northeast Minneapolis as part of my recovery pathway because treatment is essential for those who become chemically dependent and are unable to control their use of alcohol (Getting Ready to Test, 2017, p. 151). When a person initially decides to enter a program of recovery, the primary goal should be to allow a person to attain advancement in overall physical and mental health ('The world drug problem: A status report', 2006). Once stabilization in my physical and mental health was met, change was met within the three additional dimensions of my recovery by incorporating behavior modification. Conceptualized by a sequence of changes, the change process helped me move from being unaware or unwilling to do anything about the problem to considering the possibility of change, then to becoming determined and prepared to make the change, and finally to taking action and sustaining or maintaining that change over time (Getting Ready to Test, 2017, p. 623).
Best Research Strategies for Addiction & Recovery
The best resource for credible information including data on addiction and recovery are peer reviewed articles within a library database. Most scholarly journals continue to use the gatekeeping (Gatekeeping, Collins English Dictionary, 2014). Gatekeeping is a process where submitted manuscripts are evaluated by scholars in the subject discipline in order to determine whether they are worthy to be published. This is a key distinction between a scholarly journal article and what you might find through the average Google search. On average, the peer review process does provide more confidence that the article is reliable than you would have from a website on the same topic (Badke, 2017). It’s important to be weary of Google searches because most results are published by treatments facilities as an advertisement in disguise. As part of this process, I consider epistemology (Epistomology. (n.d.) American Heritage® Dictionary of the English Language, Fifth Edition. (2011)). Scholars understand that the knowledge base will change over time and that some knowledge may even be suddenly disrupted by a radical new idea. Being a scholar means being confident in the discipline’s best understanding of itself to this point (Badke, 2017).
It is crucial when considering any psychoactive substance on a human, the psychomotor disturbances, physical consequences and overall dependence potential that may be attributed along with it. Substances are taken for a myriad of reasons, but not all drugs will be taken precisely as directed. By having a better understanding of how all substances will affect a person regardless of how they are taken, especially at a wider use scale, this then helps us to better understand the long-term physical and social consequences when introducing new drugs into society.
- Addiction and Personal Responsibility: A Fundamental Conflict. (n.d.). Retrieved from https://www.centersite.net/poc/view_doc.php?type=doc&id=48356&cn=1408-.
- Bradbury, Allison. (2019, May 17). Recovery and Recovery Support. Retrieved from http://www.samhsa.gov/find-help/recovery.
- Epistomology. (n.d.) American Heritage Dictionary of the English Language, Fifth Edition. (2011). Retrieved September 29, 2019 from http://thefreedictionary.com/Epistomology
- Gatekeeping. (n.d.) Collins English Dictionary – Complete and Unabridged, 12th Edition 2014. Retrieved September 29, 2019 from http://thefreedictionary.com/gatekeeping
- Getting Read to Test: A Review/Preparation Manual for Drug and Alcohol Credentialing Examinations (8th ed.). (2017). Apple Valley, MN: DLC Publishing. 573-591, 244-246
- Marlatt. (n.d.). Addictive Behaviors: Etiology and Treatment. Retrieved from https://www.annualreviews.org/doi/10.1146/annurev.ps.39.020188.001255.
- Personal Responsibility and Locus of Control. (n.d.). Retrieved from https://www.centersite.net/poc/view_doc.php?type=doc&id=48357&cn=1408-.
- Satel, S., & Lilienfeld, S. O. (2014). Addiction and the brain-disease fallacy. Frontiers in psychiatry, 4, 141. doi:10.3389/fpsyt.2013.00141
- Skewes, M. C., & Gonzalez, V. M. (2013). The Biopsychosocial Model of Addiction. Principles of Addiction, 61–70. doi: 10.1016/b978-0-12-398336-7.00006-1
- The world drug problem: A status report. (2006). World Drug Report World Drug Report 2004, 23-56. Doi:10.18356/9713659d-en
- William Badke. Research Strategies: Finding your Way Through the Information Fog. 6th edition. Bloomington, IN: iUniverse.com, 2017. ISBN: 978-1532018039