Throughout history, theorists have taken on the subject of addiction in different ways. There are those who’ve defended it as an inherited brain disease, a personality disorder or an environmental problem. However, in the late ‘70s, psychiatrist George L. Engel conceived the idea that addiction actually stems from a mix of biological, psychological and social factors. Thus, came the Biopsychosocial (BPS) Model of addiction.
Single-Causal Addiction Models
The BPS model is built upon the perceived shortcomings of earlier addiction models. BPS theorists believe that since these models are single-causal in nature, each narrowing in their interpretation of addiction, their corresponding recovery therapies are also limited. For a better understanding, here’s a look at each individual model of addiction:
Biological model of addiction: This model suggests an abnormality or deviation in the body’s normal function. One view under this model is that addiction is an inherited brain disease; another suggests that the disease starts out as a marginal chemical imbalance in the brain during early drinking or drugging. As the habit is prolonged, the imbalance worsens to the point that the addict has difficulty indulging in moderation. According to this model, addiction can only be managed through medication-aided abstinence.
However, this model is also driven by a fatalistic notion of addiction, even though there is no compelling evidence that the disease is inevitably heritable. There is also no evidence that addiction is unmanageable without medication. In fact, there is actually substantial proof that addicts can abstain without it.
Psychological model of addiction: This model centers on the idea of an “addictive personality,” which arises out of a person’s stressful thoughts and feelings. Its treatment focus is on addressing the perceived primary problem—the addict’s stress—rather than the addiction. This model is fixated on behavioral therapy, which may not work for every case.
Socio-cultural model of addiction: This model highlights culture and relationships with family and peers. It asserts, both in its interpretation and associated therapy, that the environment in which the addiction took place is the primary driver of addiction. This model involves lots of counseling with many groups of people, which can complicate the addict’s recovery process.
Another one of the biggest flaws of the models mentioned above is that each of the associated treatments do not encourage any sense of personal responsibility and accountability. They all blame various outside factors such as genetics, chemical imbalances, stressors and the environment, making the addict out to be a helpless victim.
The BPS Model of Addiction
The BPS model’s all-embracive approach tries to overcome the shortcomings of these past models. A BPS practitioner would assess all the available factors (biological, psychological and social) and the level to which each contribute to the addiction, and then decide how to best combine them into an individualized recovery plan for the patient.
For instance, say an individual with an alcohol-related liver problem seeks help. The problem could be traced back to previous trauma which led to excessive alcohol or drug abuse issues and ultimately to the liver damage. Under the BPS model, the patient will abstain from the substance, receive treatment for both the depression and the liver problem, and get his or her family relations monitored.
Compared to other single-causal models, BPS takes various factors into consideration for a more integrated approach to addiction treatment and creates a unique recovery path for each patient.
Criticisms of BPS Model
In its intent, the BPS model’s multi-sector approach is commendable because it offers the best way of matching patient needs to program techniques, thus achieving greater success in the field. The format also defies stereotyping because every patient’s route to addiction is seen as a unique experience. However, some argue that the all-inclusive approach it touts may actually be one of its primary flaws, spawning the following criticisms:
- It’s too broad.
Due to the wide array of factors it must consider, the BPS model does not necessarily provide a clear way of testing the interaction between each factor. This makes it difficult to address each in equal measure during therapy.
- It’s more psychology-bent.
Based on studies, it’s argued that the BPS model actually presents a bias towards psychological issues. It suggests an inordinate amount of time spent rehashing past traumatic events to find the primary causes of addiction, to the detriment of other factors.
- It neglects important issues.
The BPS model falls into the same trap as other models as it does not properly address issues of blame, accountability and rationalization, which are issues that have been associated with relapse.
- It looks over medication.
Downplaying biological factors may lead to downplaying of the real benefits of medication and less financing from medical insurance companies or government welfare for those who are truly in need of medication.
The BPS model posits that addiction does not have a one-size-fits-all solution. While it presents a valid point, to a number of experts in the addiction sphere, the BPS model is still unable to combine the various other theories nor address all known factors into a solid recovery program—one that has distinct guidelines and methodology. And until it’s able to do so, critics say it remains a work in progress.