Introduction
Severe and chronic substance use disorders leading to addiction by numerous people are as old as the human race itself. For instance, 33576 subjects out of 55561 involved in a 2005 study based on the 2001 National Household Survey of Drug Abuse in South Africa admitted to taking alcohol within the past year (Herman & Roberto, 2015). As presented by the authors, another study nine years later shows that 7% of the South African population meets the criteria for alcoholism or alcohol misuse.
2010 saw these numbers increase as 208 million people in the world exhibited alcohol use disorder, as suggested by the World Health Organization (Jahan & Burgess, 2022). In 2015, substance use disorder among people above the age of 12was 20.8 million in the United States alone (US Department of Health and Human Services, 2016). Consequently, substance abusers and misusers develop a dependence on the substances, but can be cured using different treatment plans.
Scenario
The scenario takes place at a counselling clinic serving a low socio-economic community affected by crime and substance abuse. Jane, a 23-year-old woman, sought advice while temporarily living with her boyfriend, Mark, whom she has been dating for over three years. Following her father’s death from cancer 21 months ago—a loss she described as devastating—they began using methamphetamine, initially on weekends, with use gradually increasing to every second day.
Jane’s father had been the main source of emotional and financial stability in the household, and his death deeply affected the family. Her mother, still struggling with unresolved grief and depression, began drinking heavily and eventually forced Jane to leave the family home. Jane and Mark both work in a restaurant with unstable income and high stress, often using substances to cope with difficult customers. Currently homeless and in debt of over R34,000 to a drug supplier, Jane is urgently seeking additional employment and fears being coerced into working off her debt if she cannot repay it.
In Jane’s context, explaining the biopsychosocial model of addiction, environmental factors that might play a role in her addiction, assessment of possible co-occurring disorders she might present, and offering her a treatment plan provides a practical base for delineating the theories above. The paper also outlines a plan for increasing awareness about the support available for addiction treatment at the clinic, as described in the case study.
The Biopsychosocial Model of Addiction
Model Description
Bearing the toll addiction takes on users, their families, societies, and the general public, it is clear why people would question one’s compulsive dependence on illicit substances despite the myriad of negative repercussions, while other people can control their intake. Through scientific research, the biopsychosocial model of addiction discredits the age-old belief that addiction stems from poor life choices. As the theory explains the reasons for addiction, it notes that anyone could suffer from the disorder irrespective of their moral fiber, virtue, or character (Skewes & Gonzalez, 2017). According to the theory, the American Medical Association declared addiction a disease in 1956, meaning it can be explained and addressed from a psychological and biological perspective (Skewes & Gonzalez, 2017).
However, since there is no genetic sequence accounting for all the differences in addiction experience or a single ‘addiction gene’, the biopsychosocial model offers a holistic, multidimensional conceptualization of addiction through its biological, psychological, and social components.
Biological Aspect
The model’s biological dimension, abbreviated as ‘bio’ in the acronym, shows that there is a genetic explanation for addiction (Becoña, 2018). As the author asserts, epigenetic, family, adoption, and twin studies provide evidence to support this claim. For instance, the Reward Deficiency Syndrome, as presented in Blum et al.’s (1996) study and discussed by Becoña (2018), shows how individuals born with hypodopaminergic functioning (underactive reward circuitry) are genetically predisposed to desire the rewarding effects of drugs. Moreover, deficiencies in any combination of neurochemicals involved in rewards, such as glutamate, endocannabinoids, serotonin, GABA, opioids, and dopamine, may lead to a predisposition to addiction (Becoña, 2018).
Psychological Aspect
In the psychological dimension (abbreviated as psycho in the acronym), factors such as the psychological effects of a person’s life experiences (like trauma) and psychological constructs (such as self-worth and self-esteem) contribute to the risk of addiction (Hunt, 2016). According to the author, mental health concerns (like depression and anxiety) and personality traits (such as impulsivity and sensation-seeking) are also predisposing factors in this category.
The explanation is that people with painful emotions are more inclined to seek the rewarding effects of drugs. For instance, trauma from adverse childhood experiences results in heightened stress hormones such as adrenaline and cortisol, leading to a dysregulated stress response. Such toxic stress can lead to anxiety, hypervigilance, and hyperarousal, increasing the chances of drug abuse for hormone regulation (Hunt, 2016). This shows how dependency could stem from psychological factors.
Social Aspect
Finally, the social dimension includes one’s social environment. In Wiss’s (2019) view, cultural beliefs, visibility, targeting practices, societal approval, expectancies, modeling, legality, accessibility, availability, and social norms all influence the addiction experience. For instance, impoverished communities are likely to have more availability of drugs and drug-related advertisements.
Also, people could learn to take drugs via observation through social modeling (Wiss, 2019). Social norms such as “everyone experiments a little with drugs in college,” as expressed by Wiss (2019), could also encourage drug abuse and lead to dependency. Therefore, an individual’s social context contributes to their addiction risk.
Altogether, the three components of the biopsychosocial model align with Blum et al.’s (2020, n.p) suggestion that “there are likely as many pathways to becoming an addict as there are addicts.” Therefore, drawing from this multifaceted theory mitigates the drawbacks that would arise from relying on a single perspective.
Application to the Case
Social Dimension
Using the biopsychosocial model in Jane’s case reveals some of the factors that might have contributed to her addiction to ‘tik’. The 23-year-old woman lives in a low socio-economic community with high crime and substance abuse prevalence. This means that social modeling could play a role in Jane’s addiction as she sees other people abuse drugs. Coming from an impoverished community (mentioned in the case study and seen through the job that she takes), she is also more likely to take drugs.
This social factor is closely tied to the psychological factor, as poverty can cause significant stress. Jane earns a meager income that cannot meet her needs, such as rent, since her mother kicked her out of their house. The money she earns is also not enough to satisfy her addiction to ‘tik’. As such, she is stressed from having meager finances, as worrying about how to afford basic needs like food and shelter leads to addiction, as explained under the psychological dimension of the biopsychosocial model.
Psychological Dimension
Moreover, the psychological perspective of the model manifests in Jane’s life in many ways. Jane has suffered trauma from her father’s death. From the case, it is evident that Jane’s father was her pillar, and she describes his roles as supporting, encouraging, providing, listening to, and advising her. He was also the one who held the house together. She also lost her brother and is in pain of losing a loved one as well as seeing her mum waste away from the pain of losing a husband and a son.
In addition, she is stressed because she owes her supplier R34,000. If she cannot find another well-paying job, she will likely end up working for her supplier to pay off her debt. As mentioned earlier, people with painful emotions are more inclined to seek the rewarding effects of drugs. This explains why Jane often seeks sensation, even on tough days at work.
Biological Dimension
Since there is no mention of a history of family addiction, it would be insensible to analyze Jane’s case using the biological perspective. Although her mother drinks excessively, it could not affect her, as she (Jane’s mother) only started drinking after the loss of her son. There is no mention of drinking for Jane’s father.
Environmental Factors of the Case
Environmental factors also affect addiction rates among populations. To begin with, Jane’s unstable home environment could be contributing to her addiction. As Jedrzejczak (2018) claims, traumatic events such as divorce, neglect, mental illnesses, criminal behavior, physical or sexual abuse, and violence at home lead to trauma that increases an individual’s chances of addiction.
According to an investigation published in the Addictive Behaviors journal, as reported by Jedrzejczak (2018), opiate users exhibit a 2.7 times higher chance of traumatic childhood, despite experiencing trauma as an adult. She lost herself to substance abuse when her father, who “held the home together,” as stated in the case, died. Her mother does not care about her, drinks excessively, and threw her out of the house. These traumatic events explain Jane’s addiction.
Furthermore, Jane’s friendships and social interactions contribute to her drug dependency. According to Jedrzejczak (2018), it can be tough for a person associating with people with drug or alcohol problems to discontinue usage. As the author notes, social interactions with drug problems increase one’s chances of displaying such problematic behavior.
In Jane’s case, her neighborhood has a high prevalence of substance abuse, increasing her chances of having social encounters involving drug-related issues. Her immediate family also abuses drugs. For instance, her boyfriend Mark uses ‘tik’ with her while her mother drinks excessively. These habits and behavior patterns of the people she interacts with result in peer pressure that makes it difficult for her to quit using ‘tik’.
Assessment of Possible Co-Occurring Disorders in the Case
Clinicians generally concur that addictions do not occur singly- they habitually show co-occurrence in certain problematic behaviors in the same individuals. According to Thege et al. (2016), disorders from addictions can be categorized into the following groups, as shown by studies over time:
Table 1 – Classification of Addiction-Related Disorders
An assessment of such problematic behaviors in Jane would require tools such as the Addiction Severity Index (ASI), Alcohol Use Disorder Identification Test, Mental Health Screening Form III, Columbia-Suicide Severity Rating Scale, Michigan Alcoholism Screening Test, The Stages of Change Readiness and Treatment Eagerness Scale, The University of Rhode Island Change and Assessment Scale, Structured Clinical Interview for DSM-V (SCID-5), Symptom Checklist-90-Revised, Psychiatric Research Interview for Substance and Mental Disorders (PRISM), Young Mania Rating Scale and the Angst Hypomania Check List.
With such tools, I should be able to accurately diagnose Jane. While using these tools, I will take into account Jane’s chronological history of mental illnesses and past symptoms of substance use disorders and how they were diagnosed and treated. Her present cultural barriers, skill deficits, limitations, supports, and strengths will also be necessary for accurate diagnosis and treatment. A detailed description of all these factors will explain Jane’s current biopsychosocial factors contributing to, aggravating, and justifying her functional status and symptomology. Such a thorough investigation will then enable me to assess her stage of change and readiness to participate in programs and enable me to make an informed decision on a proper treatment plan for Jane.
Treatment Plan and Obstacles to Recovery
In light of the information provided above, Jane’s treatment plan should consider the fact that she could have co-occurring disorders that create a complex web, hindering accurate assessment and effective treatment. Therefore, a thorough investigation into co-occurring disorders will inform the development of effective treatment plans. For instance, co-occurring symptoms will be treated alongside the main treatment plan. Other factors, such as a client’s sensitivity to sexual orientation, gender, and culture, must also be considered, as suggested by the Substance Abuse and Mental Health Services Administration (US) (2020). However, there can be no standard treatment plan for Jane’s co-occurring disorders until a clinician determines the results of her diagnosis.
Since Jane’s addiction is caused by psychological, social, and environmental factors, I would recommend cost-effective and efficient psychosocial treatment and education. Jane’s drug of choice (tik), being an opiate, I would start with the primary treatment option for opiate addiction- methadone maintenance. This is in line with the Institute of Medicine Committee on Opportunities in Drug Abuse Research (2021) suggestion that methadone maintenance is the basic treatment for opiate addiction.
There would be no need for pharmacotherapies as Jane has only been using ‘tik’ for close to two years. However, her treatment options would incorporate other tailored outpatient drug-free programs. These options are cost-effective and would be efficient in treating Jane.
Conclusion
People have always consumed chemical substances that produce temporary feelings of pleasure or euphoria since the world began, with the numbers increasing day by day, as seen in the statistics provided above. Reasons for substance abuse range from biological, social, psychological, and environmental factors as explained by the biopsychosocial model, with examples including genetics, mental health disorders, a history of trauma, and chronic stress. Nonetheless, with the proper assessment and treatment plans, patients can be cured, as seen in Jane’s case.
There is a need for a thorough investigation before treatment, as it reveals all the factors contributing to the problem. This would include informing the public through posters, advertisements, community days, and drives about treatment options such as pharmacotherapies for hardcore users, outpatient drug-free programs such as counseling services, and methadone maintenance. Through testimonies, the public will get informed about the vast array of treatment options that could be tailored to fit every client’s needs. This way, more people like Jane and Mark will be helped to deal with their addiction problems and avoid relapse. Addiction is everyone’s problem.
References
Becoña, E. (2018). Brain disease or biopsychosocial model in addiction? Remembering.
Blum, K., Baron, D., McLaughlin, T., & Gold, M. S. (2020). Molecular neurological correlates of endorphinergic/dopaminergic mechanisms in reward circuitry linked to endorphinergic deficiency syndrome (EDS). Journal of Neurological Sciences, 411(116733). Web.
Herman, M. A., & Roberto, M. (2015). The addicted brain: understanding the neurophysiological mechanisms of addictive disorders. Frontiers in Integrative Neuroscience, 9(18). Web.
Hunt, A. (2016). Expanding the biopsychosocial model: the active reinforcement model of addiction. Graduate Student Journal of Psychology, 15. Web.
Institute of Medicine (US) Committee on Opportunities in Drug Abuse Research. (2021). Pathways of addiction: opportunities in drug abuse research. National Academies Press. Web.
Jahan, A. R., & Burgess, D. M. (2022). Substance use disorder. StatPearls Publishing. Web.
Jedrzejczak, M. (2018). Family and environmental factors of drug addiction among young recruits. Military Medicine, 170(8). Web.
Skewes, M. C., & Gonzalez, V. M. (2017). The Biopsychosocial Model of Addiction. Principles of Addiction. Web.
Substance Abuse and Mental Health Services Administration (US). (2020). Substance use disorder treatment for people with co-occurring disorders. Treatment Improvement Protocol (TIP) Series, 42. Web.
The Vietnam veteran study. Psicothema, 30(3). Web.
Thege, B. K., Hodgins, D. C., & Wild, C. T. (2016). Co-occurring substance-related and behavioral addiction problems: A person-centered, lay epidemiology approach. Journal of Behavioral Addictions, 5(4). Web.
US Department of Health and Human Services. (2016). Facing addiction in America: the surgeon general’s report on alcohol, drugs, and health. Web.
Wiss, D. A. (2019). A biopsychosocial overview of the opioid crisis: considering nutrition and gastrointestinal health. Frontiers in Public Health, 7(193). Web.