Three Faces Of Addiction Require Integrated Research Effort

Chemical addictions result from a complex interaction among biological, psychological, and social variables. Recovery requires a broad spectrum of treatments applied to each of these levels. This complexity creates a unique challenge for researchers because no single branch of science is capable of describing all aspects of addiction. While the biological sciences are necessary to describe the complex neurological and neurochemical symptoms, the psychological sciences are needed to describe the patterns of cognition, affective responses, and behaviors that shape and maintain the addictive process. At the same time, the social sciences are necessary to understand the social dysfunction caused by the progressive biological and psychological symptoms. The picture is complicated by the fact that people get addicted to many different kinds of drugs, ranging from stimulants to depressants, from pain killers to hallucinogens. Each type of drug creates different biological damage and different psychological effects. Yet there seems to be some underlying mechanism or process linking all drug addictions. Is this process primarily biological, having its source in some common yet undiscovered biochemical process? Or is it primarily psychological, having its basis in a combination of genetically inherited personality temperaments interacting with patterns of learned behavior? Or might it be multicausal, with different patients exhibiting different pathways into the addiction? All of these are possibilities, but neither biological research nor psychological research in isolation from each other is capable of finding the answers. The search for the underlying addictive process and, ultimately, a treatment process that can reliably reverse it require a biopsychosocial approach. Unless both the impact of psychological processes on biological events and the impact of biological processes on psychological events are taken into account, the true dynamics of addiction may never be discovered. In the past, each discipline has conducted research in isolation from the others. Each discipline has developed its own theories, concepts, and language. Little effort has been made to learn about findings in other fields or to look at the complex interactions between the research outcomes emerging from different disciplines. Even when such attempts have been made, differences in language have made meaningful comparisons impossible. As a result, we have seen three distinct views of chemical addictions emerge from the three primary disciplines. There remains an as yet undiscovered, underlying truth that no single discipline can grasp without data from other related disciplines. The challenge of the 1990s is to create a unified model of chemical addictions that integrates biological, psychological, and social research. What might such a model look like? Do we have the template for such a model already before us? I believe we do. By integrating the known research from all three disciplines a pattern begins to emerge. The tool for integration is available in the form of a biopsychosocial grid. Such a grid might be partitioned across the top into three catagories - biological factors, psychological factors, and social factors. The vertical axis would contain five blocks where predisposing factors, early stage symptoms, middle stage symptoms, late stage symptoms, and, finally, the sequence of symptoms reversal in recovery could be appropriately noted under the initial three categories. A research grid such as this can help us design multidisciplinary research that will define the critical interrelationships among brain chemistry, psychological states, and social interactions. The result can be a powerful new diagnostic and treatment technology that can save lives by reducing relapse. Such a biopsychosocial research grid is a necessary first step toward advancing the state of the art of chemical dependency treatment. To illustrate the power of such a grid I will describe my current understanding of chemical addictions using the biopsychosocial perspective. There appear to be patterns of predisposing factors that create a biopsychosocial susceptibility to addiction. Some of these factors may be genetically inherited brain chemistry imbalances. Prenatal influences, such as alcohol and drug use during pregnancy, may also play a powerful role. There may also be psychological and social factors that combine with these biological factors to create a susceptibility to mild to severe addiction. When a susceptible individual begins using alcohol or other mood-altering drugs, he or she has a reinforcing experience. The drug use is biologically reinforcing in that it feels good physically. It is psychologically reinforcing because the physical effect alters personality in a way that meets psychological needs. It is socially reinforcing because it reduces social pressure and creates social reward. This reinforcing effect is short term and is followed by a long-term dysphoric effect created by biopsychosocial withdrawal. The dysphoria of biopsychosocial withdrawal creates an impetus to start using again. With heavy and regular use, the drugs create further brain dysfunction. This brain dysfunction causes disorganization of the personality. The chemical addict has difficulty thinking clearly, managing feelings and emotions, and regulating his or her behavior. The result is damage of the personality, and, as the personality becomes distorted by the chemical addiction, significant changes in relationships ensue. Work, family, and intimate problems begin to develop, and the entire life of the human being is affected. The damage does not occur all at once, but rather progresses in stages. In the preaddictive stage, a person who is biologically at risk for addiction begins regular use of alcohol or other drugs in response to social pressure. The resulting positive reinforcement begins altering the personality and values in such a way that more alcohol and drugs are sought. This results in a growing state of dependency that presents itself in the early stages. With continued use a middle stage of symptoms begins to appear, one marked by progressive loss of control. Finally, a marked deterioration in all areas becomes apparent in the chronic stages. Addicts either begin to recover, or they die. In recovery there are symptom reversals on all levels. The failure of specific symptoms to fully reverse themselves may lead to relapse. Given the pervasive nature of chemical addictions, it seems unlikely that a magic bullet will be found that will address all aspects of chemical addictions. What is more likely is that the biological, psychological, and social researchers and clinicians will begin working together to address the complex interactions among specific disturbances at each of these three levels. The challenge is to understand the true nature of chemical addictions and how addiction interacts with the human being on biological, psychological, and social levels. Terence T. Gorski is a counselor, lecturer, and consultant who specializes in the treatment of chemical dependence and relapse prevention. He is president of the Center for Applied Sciences in Hazel Crest, Ill.

Three Faces Of Addiction Require Integrated Research Effort

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