Addiction

The word addiction can mean a lot of different things. Richard Rohr writes in Breathing Underwater: Spirituality and the Twelve Steps, "Our society itself shows all the signs of classic addiction. Alcoholics just have their powerless visible for all to see. The rest of us disguise it in different ways, and overcompensate for our more hidden and subtle addictions and attachments, especially our addiction to our way of thinking." Some might even relate this broad definition to our classic notion of sin. Some still think that depression is a decision we make, that addiction is a sin, that psychosis is demonic, and that all mental health problems can be resolved through prayer. However, a sound theological understanding of mental health is far from these things. When Jesus said in Matthew 5:3, "Blessed are the poor in spirit, for theirs in the kingdom in heaven," it is easy to see that he was referring to those who realize their own personal struggles to connect with God. You can read more about a theology of mental health here.

The distinction in what constitutes an addiction vs. an unhealthy habit has to do with the consequences. For instance, many of us really have to have that first cup of coffee in the morning, but that craving doesn't cause us any extensive problems in our lives. For the purposes of this article, we can think of an addiction as follows: Addiction is the repeated use of a pleasurable substance or a behavior despite the substantial harm it causes; there is a progressive deterioration of an individual's physical, mental, spiritual, and social status.

From a clinical perspective, we should note that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard reference for mental health professionals, uses the term Substance Use Disorder instead of addiction. Each specific substance carries a different diagnosis that is measured on a continuum from mild to severe. There are also different criteria for substance intoxication and substance withdrawal as their own diagnoses. In the case of polysubstance use (poly = more than one), which is not uncommon, each diagnosis is recorded separately. There is also separate diagnostic criteria for substance-induced mental disorders, which is important when thinking about co-occurring mental health conditions because the symptoms of intoxication and withdrawal can often imitate symptoms of other conditions like anxiety, depression, and psychosis. Assessment should always be conducted by a trained mental health professional when it comes to making any diagnosis.

Addiction can be understood in a lot of different ways, some of which are helpful, while some contribute to stigma. A holistic understanding borrows the best concepts from each of the models.

The Moral Model: Addiction is seen as a choice and the result of choices from a person's flawed character. It is seen as "sinful" and in need of spiritual intervention, the sign of a bankrupt spiritual life. Individuals with substance use issues are considered morally weak. This is generally the view that underpins our legal system, in which punishment is meted out. Clinical evidence shows that negative religious coping and punishment are not conducive to recovery. However, the advantages of this model is that it advocates for personal responsibility, encourages people to make good choices, appeals to those who have a worldview based on right and wrong, and can bring a positive spiritual component to counseling. The disadvantages are that it is judgment-based, embraces punishment, and it contributes to stigma and shame (which may keep people from treatment). It also minimizes the complex nature of addiction.

The Disease or Medical Model: Addiction is an illness that a person has. It is a chronic, long-term condition that cannot be cured, only managed. According to this view, abstinence is the only viable option, as any amount of use leads to loss of control. This is the view commonly held in the medical and mental health fields. The advantages are that it removes the societal and moral stigma and the shame component, it renders addiction a health issue and not only a legal issue, and it empowers individuals to seek help. It also provides a clear treatment goal (abstinence). This may also be a disadvantage since the same goal applies to mild and severe addiction. Other disadvantages are that it provides the addict with an excuse and removes personal responsibility while ignoring psychological variables.

The Socio-Cultural Model: Family, peer, and cultural influences play a primary role in substance abuse. This is a systemic approach. It isn't enough to look at the individual; one must examine the individual in relation to his or her environment. This is important because statistics show that people who belong to groups that are socially or culturally disadvantaged are more likely to experience substance abuse problems (look no further than the Native American population, for instance). This model combats the labeling of users as deviant, which exacerbates the problem. The advantages of this model are that it links inequality and drug use and focuses on prevention as a key factor in mitigating substance use while promoting societal responsibility for cultural norms. Some disadvantages are that this model risks placing all the blame on culture and promoting cultural stereotypes.

The Psychological Model: Addiction is seen as a coping mechanism for dealing with psychological stress. Addiction is a secondary problem that have underlying psychological causes. Such an understanding takes away the shame and stigma and addresses underlying reasons for substance abuse. Advantages to this model include improved accuracy in treatment protocols and learning healthy coping skills while treating underlying issues, which may reduce the chance of relapse and give hope for full recovery. The disadvantages are that it may encourage external blame instead of personal responsibility, as well as encourage clients to adopt a mindset of finding a reason to self-medicate.

The Biopsychosocial Model: Addiction has many factors including biological, psychological, and sociological together that influence or cause addiction. In this way there are many complex combination of causes that can lead to a pathway of addiction. In terms of advantages, this model is more holistic. It also promotes a multidimensional continuity of care approach to treatment and facilitates individualized and flexible treatment plans. The disadvantage is that it can complicate the recovery process by recommending too many changes - what are the priorities for treatment?

The Harm Reduction Model: Addiction is a complex phenomenon that encompasses a wide array of behaviors from severe abuse to milder forms. This model is useful because it looks to mitigate harm. For instance, heroin users may be helped by methadone clinics so that they don't look on the streets for dirty drugs. Other cities have also set up heroin clinics that provide users with clean needles. The advantage of this model is that it acknowledges that illicit drug use is part of our world and that the focus should be on minimizing its harmful effects, and it does not require total abstinence as the treatment goal. It is a totally non-judgmental approach that provides for a non-coercive delivery of resources to users, recognizing the realities of poverty, class, racism, social isolation, trauma, sex-based discrimination, and other social inequalities that affect both people's vulnerability to and capacity for effectively dealing with drug-related harm. The disadvantages are that this model may overemphasize external factors, that it does not require abstinence, and that it in some ways supports people's drug use.