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 Centre for Addictionand Mental Health |
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An Integrated Biopsychosocial PerspectiveExcerpted from Chapter One: Theories of Addiction and Implications for Counselling in Alcohol & Drug Problems: A Practical Guide For CounsellorsFigure 1-1 (PDF) attempts to capture the many factors that influence substance use and to show how they interact. The model was developed for the World Health Organization (WHO, 1981). It identifies biological, personal and social factors and learning experiences, and shows how they may have immediate or more distant influences on a person’s disposition to use drugs. It also shows that social and individual factors can be influenced by the consequences of drug use. Other feedback mechanisms that can have positive or negative influences on future use, depending on individual users and their circumstances, are also identified. The model shows that drug actions and their effects may lead to biological responses that account for tolerance and drug-specific withdrawal symptoms. These responses may have either adverse or reinforcing properties. While withdrawal symptoms may initially be aversive, they can be relieved by taking more drugs, and this strengthens the drug-taking response. Repeated experiences of withdrawal can activate a classical conditioning process whereby previously neutral stimuli elicit withdrawal symptoms, or drug-like effects, and lead to further drug use. Over time, through a process of generalization, a variety of internal and external cues (e.g., anxiety, stress or social events) may be associated with withdrawal symptoms and drug effects. This process can lead to an extreme narrowing of a person’s repertoire of responses to cues, and a tendency to use drugs whenever these cues are present. The person often increases his or her involvement with other drug users, who facilitate access to drugs and otherwise support drug use. Conversely, involvements with people who might encourage reduced drug use and associated behaviours may become less frequent and significant. Some Implications for CounsellingThe model shown in Figure 1-1 (PDF) suggests that drug taking can be reduced by making the experience less rewarding and making abstinence or reduced use more rewarding. This could be achieved through a variety of biological, psychological and environmental interventions, some of which have been mentioned in this chapter. A useful summary of the objectives of such interventions was proposed by Daley and Marlatt (1992). These objectives are indicated in Table 1-1 together with the relevant clinical aids or procedures that have the strongest empirical support. Other chapters in this book describe many of the specific practices identified in Table 1-1. Further evidence for their effectiveness can be found in recent reports from Health Canada (1999, 2000, 2001a, 2001b & 2002), on the Treatment Improvement Protocols (TIPs) Web site ( www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.part.22441 ) maintained by the U.S. Center for Substance Abuse Treatment, and on the Web site of the U.S. National Institute on Drug Abuse (NIDA; www.nida.nih.gov/). However, more research is needed to determine the effectiveness of different treatments for different types of clients, especially for women and youth. Figure 1-1 Factors Affecting Drug Use and Abuse (PDF version only) Table 1-1 Objectives, Treatment Components and Empirically Supported Clinical Aids
Alcohol and Drug Problems: A Practical Guide For Counsellors
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Last updated: Dec 21, 2006 12:41 PM Published: Sep 05, 2008 7:13 PM ID#P25650 |