9.2 Theories of Substance Use / Addiction

There are many theories that hope to explain why individuals use and abuse substances.  Theories can also help with interventions, treatment, prevention, relapse and recovery.

We will be exploring substance use disorders / addiction through various theories. You may choose to explore other theories, there are links to multiple theories of substance use disorders in additional resources.

The concept of substance use disorders has evolved.  While a moral model is still prevalent in much of the population, there has been a shift in the medicalization of addressing substance use disorders.  The moral model is based on the belief that using substances is a moral failing, related only to individual issue and if you had better morals it wouldn’t be an issue.   Other theories include a biological theory, which suggests it may be the chemistry in our brain or our genetics that makes us susceptible to substance use.  There are theories of social dysfunction, psychology, trauma and early experiences as well as theories relating to society, culture and race.  There is no one theory that can explain substance use for every person with a substance use disorder.

Understanding theories is important as you will be exploring treatment, prevention and recovery, as well as harm reduction.  A theory can help explain a phenomenon like substance use.  You do not need to be an expert on theories; however, it is important to understand the theories and begin to explore your own beliefs about substance use and process addiction.  Exploring theories will help broaden your understanding, and through exploring theories you will have an opportunity to determine what connects for you.

In the next chapter we will look at the Biopsychosocial  Plus approach.

Moral theory

Where does a moral approach to substance use come from?  Moral judgments on substance abuse/addiction began when the view in victorian time that any weakness of moral fiber in self-restraint  would lead someone rapidly away from being a productive member of society, industry by way of the bottle, syringe or the pipe.  There are examples of the moral model in Canada, including prohibition and the Controlled Drug and Substances Act, as well as the Criminal Code of Canada.  The moral model suggests using a substance is a moral failing which will lead to a path of destruction.  It views people who use substances as having a choice to use substances and judges them for using the substances.

The moral model still exists today when you hear statements like “pull up your bootstraps,” or “get over it,” when talking about a substance use disorder.  It seeks to place blame on the person with the substance use disorder.  This can impact individuals who use substances, who may see themselves as having failed, especially when it comes to treatment and recovery. The following video may help you understand how some view substance use. Treatment methods generally have moved beyond a moral model.  For example, programs that offer a harm reduction approach are a direct challenge to the moral model, as they offer a lack of judgment and support people “where they are,” embracing the stages of change and allowing for engagement at each level of pre-contemplation, contemplation, preparation, action, and relapse. The field of Social Services is working to move beyond a moral model of substance use disorders.  You can help people make their own decisions (self-efficacy) and advocate for services to improve the lives of people who use substances and live with SUDs.

 Biological theory

Some researchers believe that substance use disorders are a biological phenomenon. The biological theory of substance use helps us understand how substances impact our brain and the changes that happen.  Please watch the following short video on how substances impact the brain.

Transcript

To Access the Video Transcript:
1. Click on “YouTube” on the bottom-right of the video. This will take you directly to the YouTube video.
2. Click on the More Actions icon (represented by three horizontal dots)
3. Click on “Open Transcript”

If you think about any activity you participate in, if it makes you feel good, chances are that when you participate your brain is releasing dopamine.  If you remember we learned dopamine is a neurotransmitter that impacts the reward centre of the brain.   Your brain typically releases dopamine when you participate in behaviours or activities that make you feel good.  This is released each time you repeat a behaviour.

When you take a substance, especially opiates, your brain releases dopamine.  Every time you take that substance, your brain, and the dopamine it produces are remembering that “feel good” feeling and reinforcing it.  For a person living with a substance use disorder, every time they use a substance it triggers adaptations in dopamine production.  Using a biological theory to explore how substances impact the brain can help with the development of treatment that focuses specifically on the brain.   Biology includes:  morphology, physiology, anatomy, behaviour, origin, and distribution.

Mental health also plays a role in substance use.  Many studies suggest and confirm those with mental health use substances to manage their day-to-day challenges due to their illness.  For example, numerous family studies, adoption studies, and twin studies suggest genetics plays a role.  Many of these studies however do not allow us to separate the effects of genetic and environmental influences.  This means that substance use disorders from a genetic perspective should not be considered simply a biological phenomenon.

Psychological Theories

Using psychology also helps us understand substance use disorders.  There are a variety of psychological approaches that help us understand behaviours, treatment, and recovery.  Psychological theory can look at behaviour.  For example, helpers may look at how and why the behaviour is maintained; they may also engage in understanding the behaviours that are happening while a person is under the influence of a substance (Open Educational Resource, n.d.).

Classical conditioning and operant conditioning are two types of learning models.  When we use classical conditioning in the field of substance use disorders, we examine the relationship between the substance use and its connection with the environment.  For example, let us examine smoking tobacco. Classical conditioning helps individuals understand their relationship with a substance and how they may crave a particular substance based on their environment.  For example, someone who smokes tobacco may feel a pleasant feeling every time they visit a particular store, as that is the store where they buy cigarettes from, and often smoke as soon as they leave the store.  There are numerous resources to help a person quit smoking based on classical conditioning.  These resources help individuals identify “triggers” or activators, they look at factors that can make someone feel like they need to use a substance, because of their relationship to the environment.  “Common triggers that bring-on cravings include drinking coffee or alcohol, relaxing after work or after a meal, talking on the phone, driving, feeling stressed or angry” Health Canada, 2021, para. 6 Using classical conditioning, you can examine activators and help an individual identify strategies to reduce the emotions associated with the activators.  These activators or cravings will reduce over time, the more a person is able to engage with the environment without using the substance.

Operant conditioning uses the concept of rewards and punishments.  If a person uses a substance, there are biological changes that happen.  For some it is a pleasant feeling, for others, it is unpleasant.  Not every person who uses a substance will develop a disorder; for some the pleasant feeling is just that, a pleasant feeling. For others the pleasant feeling takes over, and the reward becomes the focus.  This focus can then develop into a substance use disorder.  The Community Reinforcement Approach builds on operant conditioning.  Community Reinforcement Approach by the Canadian Centre on Substance Use and Addiction.

Psychological theories of substance use are varied and may help you explore how to best serve the individuals you will be working with.

Social Theories

We live in a complex world with many factors that influence our behaviours.  We learn from many areas around us.  This can be individual, family, peer and community. Substance use may be familial, a person may have watched a parent or caretaker use alcohol on special occasions or more frequently.  Perhaps you had a parent who smoked tobacco, and this may have played a role in whether you smoke.  These social connections that are critical for our development as babies, toddlers, youth and into adulthood play a role in what we do, how we act, and how we live.

Social connections are also important for our health.  Think back to the beginning days of the COVID-19 pandemic and how many people were negatively impacted by the social gathering restrictions.  For many people isolation increased their substance use / addiction.  Some people used technology to connect with family, friends, and even with their workplace.

Social connection is an important factor in wellness and subsequently whether a person uses substances.

Transcript

To Access the Video Transcript:
1. Click on “YouTube” on the bottom-right of the video. This will take you directly to the YouTube video.
2. Click on the More Actions icon (represented by three horizontal dots)
3. Click on “Open Transcript”

Social learning theory is intersectionality.  This theory is often used in counselling in supporting individuals with substance use disorders as it allows supporters to focus on individual, environmental, and societal factors. If you have been negatively impacted by one of these factors, are you susceptible to a substance use disorder?  The research indicates yes; remembering it is one risk factor and does not mean it WILL lead to a substance use disorder.  This theory is often used in counselling in supporting individuals with substance use disorders as it allows supporters to focus on individual, environmental, and societal factors.

The social factors that influence us are complex.  Many of the treatment models use a social-ecological approach, identifying factors like trauma, adverse childhood experiences, mental health, racism, as well as self-efficacy.  For further reading please review Open Educational Resource Chapter 5 by Patricia Stoddard Dare and Audrey Begun.  https://pressbooks.ulib.csuohio.edu/substancemisusepart1/part/module-5-social-context-physical-environment-models-of-substance-misuse/