In this discussion, we will go over the difference between substance abuse and dependence, the 12-step model, and the DSM-5, and identify problems with the disease model of addiction.
Substance Abuse is marked by a negative impact on social and occupational life.
Substance Dependence is marked by the body’s tolerance.
What is Addiction?
NIDA defined addiction as “a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder because it involves functional changes to brain circuits involved in reward, stress, and self-control, and those changes may last a long time after a person has stopped taking drugs.”
Brain Disease Model of Addiction
Step 1: Desensitization of the reward circuits of the brain.
Step 2: Increased conditioned response
Step 3: Decline decision-making and self-regulation.
History of the Medical Model
Benjamin Rush was the “father of psychiatry.” He played an important role in pioneering addiction medicine early on. He was one of the most important figures of the temperance movement that leads to alcohol prohibition in the United States. He came up with the moral and physical thermometer.
This spurred the medication treatment for addiction. Interestingly, the medications used at the time contained ingredients, such as alcohol, marijuana, cocaine, and opium.
12 Steps of Alcoholics Anonymous (AA)
AA is the predominant treatment established in 1935. It popularized the disease concept of alcoholism. There are 12 steps in the program:
- Honesty
- Hope
- Faith
- Courage
- Integrity
- Willingness
- Humility
- Brotherly Love
- Justice
- Right action
- Spirituality
- Service
It is difficult to study the effectiveness of the AA program due to the anonymity part. Studies have reported between 6-75% efficacy.
Minnesota Model of Treatment
This model views addiction as a primary, progressive disease that cannot be cured, but the goal is total abstinence. It uses both professional staff and staff recovering from SUD.
Substance Abuse Disorder Treatment
There is a wide range of severity of symptoms, so there is not one treatment that is the best. Additionally, most people lack the motivation to receive treatment making it difficult to accurately measure the effectiveness of the treatment. Treatment must match severity.
DSM-5 for Substance Use Disorder
There are 11 total symptoms and the individual only needs two to meet the criteria for SUD.
- Taking larger amounts than intended (Impaired control)
- Persistent desire to regulate use but unsuccessful (impaired control)
- A lot of time is spent on getting the substance (impaired control)
- The individual has craving (impaired control)
- Failure to fulfill obligations (social impairment)
- Interpersonal problems (social impairment)
- Give up on important activities (social impairment)
- Abuse tends to happen in situations where it is physically hazardous (risky use)
- The recurrent problem caused or exacerbated by the substance
- Tolerance development (pharmacological)
- Withdrawal symptoms (pharmacological)
Oftentimes, the point of contact is in a general medical setting
Transtheoretical Model of Behavior Change (Motivational Interview)
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
Problems with the Disease/Medical Model
- Drug addiction vs non-substance-related addiction
- What % of the population becomes addicted?
- Treatment prognosis?
- Genetic predisposition