Firstly, a simple working definition of addiction:
Addiction describes an impaired ability to control substance use despite the problems arising
from the substance use.
There are five broad theories that contribute to an explanation of addiction, although no one
theory completely explains the problem. More importantly is the role that each theory plays in
recovery from addiction and not in its possible contribution to the cause of addiction.
THE ADDICTION IS A CHOICE THEORY
Substance use is always a choice but addiction is something else. No one would consciously
aspire to become an addict or alcoholic. The choice theory highlights the distinction between
drug use and drug addiction. Choice always plays a role in recovery from addiction, where a
conscious decision is always the starting point. Recovery never happens simply by osmosis or
wishful thinking.
Good addiction treatment aims to highlight the pros and cons between a return to active
addiction or a commitment to sobriety and recovery and should allow the addict to make an
informed decision about either of the two options.
THE ADDICTION AS A (BRAIN) DISEASE THEORY
This theory suggests that an as yet unidentified problem, possibly a dysfunction in the midbrain
reward mechanism, explains the characteristic hallmark of an addictive disorder – the impaired
control over using despite adverse consequences arising from the using. The theory does not
explain why addicts use (if that requires an explanation) but provides a postulated neuro-
biochemical explanation of the malevolent relationship addicts have with their substance use.
More importantly, disease model theory informs abstinence as the most sensible and rational
solution to the problem.
Good addiction treatment should provide the patient with a user friendly, clear understanding of
the nature of the disease that they are able to embrace.
THE ADDICTION IS A MALADAPTIVE WAY OF DEALING WITH PSYCHOLOGICAL DISTRESS
THEORY.
Everyone has a degree of psychological stress and distress. People cope in a variety of ways.
Substance use is one option.However when addicts use drugs to solve their psycho-emotional
distress, the problems either remain unresolved or deteriorate. While distress might explain
why people use drugs, it does not explain addiction, which is a behaviour that creates more
distress than it solves.
Good addiction treatment needs to identify the psychological stressors and put contingency
plans in place because if left unaddressed, these factors will eventually precipitate a relapse
but they should not be confused with the cause of addiction.
THE ADDICTION IS A FUNCTION OF UNSYMPATHETIC ENVIRONMENTAL CIRCUMSTANCES
THEORY
There is no given set of psycho-socio-economic circumstances that confidently predicts
addiction, although many factors will predict substance abuse. Addicts reside within the entire
socio-economic spectrum, from the indulged to the deprived, from the skilled to the
incompetent. Accepting the reality of one’s circumstances is the first step to changing them, if
that is what is required.
Good addiction treatment aims to help addicts make peace with their circumstances and then
either live within the constraints of their environment or make necessary changes.
THE ADDICTION AS A FUNCTION OF A SPIRITUAL MALAISE THEORY
This theory, which probably underpins 12 Step Recovery, says addicts are spiritually bereft
human beings. They have lost the plot and cannot make sense of the human predicament. They
see little purpose in ongoing human pain and suffering. Whether this is a cause or result of
addiction is difficult to say but the implication is that recovery requires a transcendent moment,
a “spiritual awakening” if it is to be successful.
Good addiction treatment programmes create a culture that inspires a new vision of life within
the patient – nothing less than a Damascene moment.
The over arching element of good addiction treatment is hope. Most clients, by the time they
reach a treatment programme, are feeling quite hopeless about their situation. They have tried
all manner of means to address the problem and have consistently failed. Many are resigned to
their destiny which locks them into their addiction. Inspiring a sense of hope that a sustainable
recovery is possible requires a degree of faith, and faith remains a belief that cannot easily be
proven.
RBM/2025