Understanding the Biopsychosocial Model of Health

Going forward, these same principles can be used to guide the development of metacontingency-based interventions to aid recovery. The sponsor/coach/guide with a vested interest in sobriety is a critical component of any treatment intervention involving addiction. Indeed, this person is absolutely necessary for the establishment of a metacontingency in which the behavior of one individual determines the contingencies for another. A sponsor with a history of https://harmonica.ru/tabs/jane-says addiction (i.e., a peer) but also a history of long-term abstinence controls the contingencies that control the drug use of the individual just beginning recovery – this person models and reinforces abstinent-related behaviors while redirecting drug-centric behaviors to those that are conducive to recovery. Because both individuals are in long-term recovery – these behaviors both feedback and feed forward to maintain the abstinence of both individuals.


  • It has been criticized that treatment and the ongoing recovery process focuses on substance use only [6].
  • In contrast, network-level interventions that target the interactive processes between nodes take advantage of the positive feedback loops inherent to the system to produce effects that are greater than a simple summation of its individual parts.
  • The factors that increase an individual’s risk for addiction are numerous, yet they all find their place in the biopsychosocial model of addiction (Marlatt & Baer, 1988).
  • SUD and recovery should be understood using the same coherent approach—as an interplay between biological and psychological factors and social, political and cultural contexts.
  • Descartes was interested in how organisms interact with their environment, believing that nonhuman animals were nothing more than biological machines.

Consequently, absent or traumatically ruptured attachments are expected to impact the development of personal identity and affect regulation (Berner, Carlos, & Whipple, 2010; Fonagy et al., 2004; Speranza et al., 2017). Addiction can be understood from multiple perspectives and here we have focused on addiction http://journalisti.ru/?p=41807 through the lens of neurobiology and psychoanalysis. The neurobiological perspective provides a considerably structured and empirically-based approach, acknowledging that substance use leads to a series of neurochemical reactions in the brain that have structural and functional neuroadaptations.

biopsychosocial theory of addiction

2 Theories of Substance Use / Addiction

biopsychosocial theory of addiction

To solve the problem of addiction, reciprocal determinism demands metacontingencies, interlocking sets of contingencies between two or more individuals that produce an outcome greater than (or at least more efficiently than) that which can be obtained by any one individual (Glenn, 1988). In a metacontingency, the behavior established and https://www.crazy-frog.us/category/gardening/ maintained by one individual determines the contingencies for others. These interdependent contingencies thus control the behavior of both individuals and the broader social network. The term, metacontingency, was not used by either Skinner or Bandura, but it places operant contingencies squarely in the middle of a social context.

  • This ‘cannot classify’ category is important to the current discussion given the high index of early childhood adversity, rejection, neglect, and low support in their upbringing, that has been reported in substance-abusing populations (Kaltenbach, 2013; Suchman et al., 2012).
  • These practices borrowed from 12-step programs are just a few of the turn-key strategies that can be employed when developing new metacontingency- and network-based interventions for drug addiction.
  • As such, holistic treatment alternatives targeting these factors in both the child and the mother have been recommended (Neger & Prinz, 2015; Suchman, Mayes, Conti, Slade & Rounsaville, 2004).
  • The neurobiological perspective provides a considerably structured and empirically-based approach, acknowledging that substance use leads to a series of neurochemical reactions in the brain that have structural and functional neuroadaptations.
  • Therefore, when such a fragile core-ego is faced with the hedonic demands of the Id, it may give in to the demands, for example, by procuring and consuming psychoactive drugs, or engaging compulsively in gambling, sex, or binge-eating (Freud, S, 1915; Fonagy & Target, 2008).

Attachment Theory: Mental representations, reflective functioning, and addiction

Some of them had used substances for a couple of days, and others had more extended periods of use. Most of them started using substances at age 12–15, and heroin or amphetamines were their main substances, combined with cannabis, prescription drugs and alcohol. The NAOMI trial raised significant scientific, legal, ethical and political concerns, which included issues of patient safety, the controversial use of placebo control therapy, lack of equipoise, treatment discontinuation, and compassionate access to treatment (Oviedo-Joekes, Nosyk, Marsh, et al. 2009). Reflecting on these concerns, the authors stated “we [had] to be clear in our ethics applications and in our informed consent process with participants that HAT will not be available outside the context of the study” (p. 267). Although a full discussion is warranted pertaining to these challenges, these ethical concerns raised by Oviedo-Joekes et al. (2009) resonate with our present discussion.

  • Bandura’s theory was novel in arguing that (1) behavior, (2) the environment, and (3) personal factors internal to the individual (including biological characteristics and abilities), have reciprocal influences on one another – events that impact one of these components will also impact the others.
  • It is the external environment that contaminates this innate knowledge and leads us to misinterpret our reality.
  • The empirical foundation of this model is thus interdisciplinary, and both descriptive and applied.
  • The pathological component is significant, as it implies something physical in nature, with an organic cause and a behavioral consequence that is maladaptive to the health of the individual and to those affected by the individual’s behavior.
  • Central to this attachment-based integration of neuroscience and psychoanalysis are the mental representations of attachment or the internal working models of expectations and attributions about the mother, the child, and the dyadic relationship (Bowlby, 1988).
  • In this light, the addition of systems to the prototype biopsychosocial model allows for the inclusion of macrosocial systems as well as smaller components, such as cells and genes.

Social determinants of health

  • Following a behavior analytic tradition, Bandura argued the purpose of behavior was to produce a functional change in the external environment.
  • Finally, the individual in recovery is encouraged to “make amends” to those harmed, expanding the social network beyond the support group so that new metacontingencies can be established in novel environments.
  • Taken together, and according to incentive-learning principles (Bouton & Nelson, 1998), it is possible that before drug-related cues become meaningful enough to ‘incentivize’ drug use, they first need to be paired with the consequences of drug-use via repetition and reinforcement.
  • 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.

The models of relationship that have tended to appear in the medical literature, with a few notable exceptions,19 have perhaps focused too much on an analysis of power and too little on the underlying emotional climate of the clinical relationship. For this reason, we suggest a reformulation of some of the basic principles of the biopsychosocial model according to the emotional tone that engraves the relationship with such characteristics as caring, trustworthiness, and openness.49,50 Some principles of biopsychosocial-oriented clinical practice are outlined below. Engel’s perspective is contrasted with a so-called monistic or reductionistic view, in which all phenomena could be reduced to smaller parts and understood as molecular interactions. Nor did he endorse a holistic-energetic view, many of whose adherents espouse a biopsychosocial philosophy; these views hold that all physical phenomena are ephemeral and controllable by the manipulation of healing energies.

Psycho-Social Systems


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