The actions of an addict can be difficult for friends and family to comprehend. The destruction caused by this behavior is obvious yet the addict may seem almost oblivious to it. To say that individual is acting this way because they like it doesn’t make much sense; especially when the addiction takes away so much enjoyment from their life. People are not usually willing to undergo such extreme suffering just because they like something. There also will usually be times when such people feel desperate to escape their addiction but don’t feel able to. It is as if such individuals are driven by a powerful force beyond their control. The exact way that this compulsion works is a bit of a mystery but there are theories that may explain it.
A compulsion refers to a situation where an individual feels compelled to do something. They are not doing this action because they want to do it, but because they feel they have to. In many instances they will be unable to explain why. If an alcoholic is asked to justify their drinking they may struggle to give an honest answer. This does not mean they are being elusive, but rather that they do not understand and are unable to explain the compulsion that is driving them.
This model of addiction suggests that a compulsion arises because the individual has a disease. They are unwell in much the same way as the diabetic. They are not behaving this way because they are immoral or bad people. The addict has a chronic disease with little hope of a reprieve. It is possible for the individual live a normal life, if they remain abstinent from such abuse. There will always be the risk of relapse and this is why the addiction is never seen as cured. The reason why people develop such addictions may be due to a combination of genetic and environmental factors.
12 step groups favor the disease model of addiction. They view alcoholism, and other types of addiction, as incurable disorders which can be kept in check only by complete abstinence. The individual will always be an addict and the best they can hope for is a daily reprieve dependent on their commitment to recovery. This is why one of the most famous sayings associated with the group is, one day at a time.
Within the 12 step movement there is also a belief that addiction is a spiritual as well as a physical disease. Therefore a spiritual cure is also needed for recovery to be successful. The compulsion that drives the addiction is too powerful for the individual to beat alone. The only hope is that they can get strength from a power greater than themselves. Member can view this power as coming from God or something that comes from the rest of the group.
This model has had a significant impact on the approaches used in the treatment of addiction. However, it is not accepted universally. One of the main criticisms is that it is led to a view of the addict as a passive victim who is often in a losing battle. Those substance abusers who relapse, or don’t want to quit in the first place, can blame this on their disease. Cynics would argue that such a model of addiction disempowers the addict. Other models have been put forward to explain compulsive drug taking.
American psychologist William Glasser has developed choice theory and this is as an alternative way of looking at addiction. Here the individual is always seen as choosing their actions. Rather than having a disease, they are completely responsible for their addiction. Addiction arises because people develop ineffective strategies for achieving their basic life needs. If such people are able to develop more effective strategies it will allow them to easily move away from their addictive behavior. Choice theory has been criticized for ignoring the biological factors that are seen to drive addiction.
Recently there has been a lot of interest in incentive salience and how this drives compulsive behavior. It has led to the development of the incentive sensitization theory of addiction. These ideas have been popularized by Dr. Kent C. Berridge and Dr. Terry Robinson. It is a biological explanation for why these self-destructive compulsions occur.
If the brain develops an association between certain stimuli and reward it may lead to an addiction. In the case of addiction is believed to occur in four stages:
* Susceptible people may develop hypersensitization when exposed to an addictive substance. This tends to occur with repeated exposure. The effect of this is that this individual will get increased levels of pleasure from the substance in the future.
* Incentive salience develops because of hypersensitization. Now the brain associates this substance strongly with reward.
* This incentive salience ensures that the behavior is repeated again and again.
* Incentive salience develops into a conscious desire for the substance.
Incentive salience leads to actual changes in how the brain functions. It involves unconscious forces driving the addiction. This may explain why the addict may want to give up substance abuse, but they no longer feel able to. These changes to the brain can take many years to completely disappear. This is why the individual may still experience cravings even if they have been away from drugs for many years.
The incentive salience explanation of addiction provides some interesting ideas about how compulsive drug takes hold of the individual. More research will be needed to establish if this really is the force behind addiction.