The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry PMC

Individuals who are genetically predisposed for addiction enter the world with a greater risk of becoming addicted at some point in their lives. The biopsychosocial disease of gun violence is said to include far more than just the firearm, however. Other “aspects of the disease” include, literally, “high-risk youth; adults and elderly; […] and the environment.” Culture and attitudes can play roles in “’spreading’ the risk of the disease” as well. Therefore, it is claimed, these factors must also be “treated from [a] biopsychosocial perspective” (Hargarten et al. 2018, 1025–26).

biopsychosocial model of addiction

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These concerns are often exacerbated by experiences of disconnection, isolation, or emptiness, which can drive individuals to seek solace in substances or addictive behaviors. By addressing these underlying spiritual and existential issues, the Spiritual Model suggests that individuals can find healing and recovery from addiction. Research has consistently demonstrated the impact of social, cultural, and environmental factors on addiction. For example, studies have shown that individuals who grow up in households or communities with high rates of substance use are more likely to develop addiction themselves. Additionally, it has been found that substance use and addiction are more common among individuals who experience socio-economic disadvantage, social isolation, or discrimination. In terms of cognitive processes, research has shown that individuals with addiction often exhibit distorted thinking patterns, such as denial, rationalization, and minimization of their substance use or addictive behaviors.

  • A recent case study described a woman who was diagnosed with major depressive disorder and OUD, but later was identified as using opioids to self-medicate her underlying undiagnosed PTSD (67).
  • Learn more about how providers can use the biopsychosocial model to offer holistic care and how clients and patients can benefit from this approach.
  • This, in turn, implies that the problem is not a case of malingering, primarily psychological in nature, or under the patient’s direct control, and that, therefore, the patient is entitled to the sick role and its benefits.
  • In wayward BPSM discourse, however, people’s beliefs, etc., are treated as disease “risk factors” to be altered by medical and public health actors (Barron et al. 2021; Hargarten et al. 2018).
  • The Social Model posits that individuals are more likely to develop addiction when they are exposed to environments that promote substance use or addictive behaviors.

Heroin-Assisted Treatment: An Applied Case Example

A considerable amount of research has connected adverse childhood experiences (ACEs) to a dose-dependent increase in risk for drug abuse (70, 71). ACEs have been linked to age of opioid initiation, intravenous use of the drug, and lifetime overdose in a graded, dose-response manner (73). Potential mechanisms mediating this relationship could be environmental (e.g., poverty, parental criminal justice involvement) as well as biological (e.g., genetic heritability, altered neurodevelopment). Given the significant associations with childhood abuse and prescription opioid use, several authors have identified child maltreatment as an important social and environmental factor (path B) which should be considered in prevention and intervention efforts amidst the crisis (74, 75).

biopsychosocial model of addiction

A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health

  • More recent data points to loci within the HTR2A gene (encodes a serotonin receptor), casting some doubt on the previously identified candidate loci for impulsive personality traits (102).
  • We checked the data for normality of the residuals, homoscedasticity, multicollinearity, outliers and influence.
  • In some cases, the “diseases” are said to be caused by hypothetical factors (as in the case of schizophrenia), or to cause themselves (e.g., IBS, TMD).
  • Examples of acultural addicts include the medical professional who does not have to use illegal drug networks to abuse prescription medication, or the older, middle-class individual who “pill shops” from multiple doctors and procures drugs for misuse from pharmacies.

Social stigma also aids in the formation of oppositional values and beliefs that can promote unity among members of the drug culture. Few morbid conditions could be interpreted as being of the nature “one microbe, one illness”; rather, there are usually multiple interacting causes and contributing factors. Thus, obesity leads to both diabetes and arthritis; both obesity and arthritis limit exercise capacity, adversely affecting blood pressure and cholesterol levels; and all of the above, except perhaps arthritis, contribute to both stroke and coronary artery disease. Some of the effects (depression after a heart attack or stroke) can then become causal (greater likelihood of a second similar event).

  • Moreover, the larger social network of former users – all of whom are in various stages of recovery – encourage one another via modeling and reinforcement to take “personal inventory” and to identify the personal factors that play a causal role in their drug use.
  • The internal homunculus is a fallacy – it has no role in either the production or evaluation of behavior or its consequences.
  • Socrates was a nativist, as revealed by his insistence that it was human nature to select the virtuous option.
  • According to Engel, biological, psychological as well as social events are mutually interconnected and reciprocally influenced; a paradigmatic shift in the approach to the mind-body problem.

The clinical application of the biopsychosocial model.

Table 1 outlines the list of instruments that can be used to assess neuropsychological performance. I highly recommend this book, in fact it is something I think is a “must read” for everyone in SMART interested in a scientific approach to addictions. It is the best book on the biology of addictions I have seen, with a balance of scientific thoroughness presented in a style that makes it accessible by anyone. It is clear, funny, evocative, intellectually stimulating, and most important, provides a welcome alternative narrative to both the standard disease model, and the “it’s just a bad habit” psychological model. As current interventions are inadequately addressing the multidimensional and far-reaching nature of the opioid epidemic [5, 6], some scholars have suggested developing more tailored approaches to reach specific, underrepresented populations [7].

Despite these developments, the science is still in its early stages, and theories about how addiction emerges are neither universally accepted nor completely understood. Current ethical and legal debates in addiction draw upon new knowledge about the biological and neurological modification of the brain (Ashcroft, Campbell, and Capps 2007). All the informants received some degree of therapy and support from social services or specialised healthcare facilities during the years after inpatient SUD treatment in Tyrili. Three received opioid maintenance therapy (OMT) and were in contact with a GP or therapist. Eight had been in treatment for trauma, anxiety, depression, psychosis or insomnia, and three had or were waiting for treatment for ADHD. Also, four informants mentioned participation in activities and support groups run by NGOs, as described above.

It is a model based on Engel’s original biopsychosocial model (Engel 1977) for which he argued that to develop a scientific and comprehensive description of mental health, theories that promote biological reductionism should be dismissed in favour of those that adhere to general systems theory. The contemporary model, adapted for addiction, reflects an interactive dynamic for understanding substance use problems specifically and addressing the complexity of addiction-related issues. The empirical foundation of this model is thus interdisciplinary, and both descriptive and applied. The degrees in which self-control is exerted, free choice is realized and desired outcomes achieved are dependent on these complex interacting biopsychosocial systems. Many post-modern theorists such as Christman (2004) have challenged the original Kantian privileging and definition of autonomy.

Reciprocal Determinism as a Philosophical Model of Drug Addiction

The threats are based on emotional and moral attitudes towards the existence of the SIS and drug addicts generally, as opposed to empirical evidence (Des Jarlais, Arasteh, and Hagan 2008). While making a decision is itself a mental act, a mental act or event does not cause behaviour alone, but is one part of the complex process between neuronal firing and action. Once an intention has been formed for example, to use substances one is aware of the intention, though intention itself does not sufficiently cause the individual to seek out or use drugs. From a neuroscience perspective, it is difficult to see such actions as completely free, particularly when explanations of natural phenomena are understood as causally ordered.

The expert clinician considers explicitly, as a core skill, the achievement in the encounter of an emotional tone conducive to a therapeutic relationship. For that reason, all consultations might be judged on the basis of cordiality, optimism, genuineness, and good humor. By receiving a hostile patient with respect,55 it clarifies for the clinician that the patient’s emotions are the patient’s—and not the physician’s—and also sets the stage for the patient to reflect as well. Similarly, the physician must know how to recognize and when to express his or her own emotions, sometimes setting limits and boundaries in the interest of preserving a functional relationship. The same theory-shift that transformed biology also transformed neuroscience and cognitive psychology, enabling a coherent biopsychology.

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