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.
In this chapter we will be exploring substance use disorders as a biopsychosocial phenomenon and unpack biological, psychological and social theories of substance abuse. You may choose to explore other theories, there are links to multiple theories of substance use disorders in additional resources.
We will start by an overview on theories below. Watch Orientation to theories of substance use.
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 “using any drug is unacceptable, wrong, and even sinful. 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: “not everything that counts can be counted, and the healing that involves the making whole of a life involves not seeing different things but seeing everything differently”. When we understand these theories and use them together, this is called a biopsychosocial approach and western treatment models generally “implicates numerous biological, psychological and social factors as playing a part in the development of addiction. Consequently, it is considered that all three domains must be considered in treatment”.
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 a chance to determine what “makes sense” to you. Theories are also useful in service-provision, when working with individuals who live with a substance use disorder. This means the services you provide may rely on one theory or multiple theories. For example, Alcoholics Anonymous and Narcotics Anonymous use a spiritual model, which sees substance use and substance use disorders as a spiritual deficit and focus on bringing a spiritual component to treatment; “there is a power greater than us as individuals”.
Food For Thought
- Reflect on Chapter 1, intersectionality and substance use.
- How did you feel about substance use when we first began?
- How did you imagine those individuals living with a substance abuse disorder?
- Has your preconceived notion changed?
While there are many theories about substance use, this chapter should help you to understand why some people misuse substances. We will start with watching the video below which provides an exploration of some of the more prevalent theories of substance use.
- Review the various theories of addiction identified by ALLCEU Counselling (2012). What, if anything, is missing?
- Compare and contrast two theories.
- Pick the theories you most closely align with.
- Can any theory stand alone on its own? Why? Why not?
All these theories separately create a narrower view of substance use and influence how we treat substance use disorders. As our understanding of substance use and substance use disorders continues to evolve, using a perspective which includes an intersectional approach may help us to address some of the societal inequities that put people and communities at risk of substance use disorders. We must be cautious to acknowledge there is no panacea, nor any magic bullet. Substance use is a reality; and Wright suggests “if addiction is ‘always already’ part of the metaphysics of western culture, it can be hard to be analytical about specific effects at specific times”. This means that substance use is engrained in much of Canadian culture from celebrations to daily life and using one lens in one moment to explore substance use is not effective. Theories are one piece of a complicated puzzle.
- Council on Social Work Education. (2021). Orientation to theories of substance use. [Video]. Youtube. https://www.youtube.com/watch?v=qQdlvZc9leI&feature=emb_imp_woyt ↵
- Csiernik, R. (2016) Substance use and abuse, everything matters, (p. 52). Canadian Scholars. ↵
- Krentzman, A. R., Robinson, E. A., Moore, B. C., Kelly, J. F., Laudet, A. B., White, W. L., Zemore, S. E., Kurtz, E., & Strobbe, S. (2010). How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) work: Cross-disciplinary perspectives. Alcoholism Treatment Quarterly, 29(1), 75–84. https://doi.org/10.1080/07347324.2011.538318 ↵
- Al Ghaferi, H., Bond, C., & Matheson, C. (2016). Does the biopsychosocial-spiritual model of addiction apply in an Islamic context? A qualitative study of Jordanian addicts in treatment. Journal of Drug and Alcohol Dependence, 172(14), 1-22. http://dx.doi.org/10.1016/j.drugalcdep.2016.11.019 ↵
- Miller, W. R. (1999). Conceptualizing motivation and change: Enhancing motivation for change in substance abuse treatment. U.S. Dept. of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. http://www.ncbi.nlm.nih.gov/books/NBK64972/ ↵
- Alcoholics Anonymous World Services. (2018). The “God” word; agnostic and atheist members in A.A, (p. 5). AA Grapevine, Inc. https://www.aa.org/assets/en_US/p-86_theGodWord.pdf ↵
- ALLCEU Counselling. (2012, July 18). Theories of addiction. [Video]. YouTube. https://www.youtube.com/watch?v=sf2HtrfwiQE&feature=emb_imp_woyt ↵
- Wright, C. (2015). Consuming habits: Today’s subject of addiction. Subjectivity, 8, 93–101. https://doi.org/10.1057/sub.2015.6 ↵
- Ibid, p. 97. ↵