The Many Causes of Addiction and Bio-Psych-Social-Spiritual Model
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.
Many things influence the development of an addiction. While we do not yet know how these various influences combine to form an addiction, we do know there are two basic types. One type of influence is biological forces, such a person's genetics. The second type is environmental influences. This includes people's life experiences. Early life experiences, interpersonal relationships, and culture can heavily influence us. As we will soon see, there are many different explanations, or models, of addiction. The Bio-Psych-Social-Spiritual (BPSS) Model of addiction recognizes these different aspects of addiction are inter-related.
You may wonder, why do we need so many models? Addiction is unlike many medical diseases where we can point to a certain germ or defect that caused the disease. By understanding the cause of the disease, we can develop treatments or even a cure. In the same way, models of addiction have very practical applications. By understanding the causes of addiction, we can help someone recover from addiction by developing and testing these models. This leads to effective treatments.
Given the lack of certainty about what causes addiction, controversies emerge. People often debate the best and most effective approach to addiction treatment and recovery. The BPPS model of addiction accepts there are multiple causes and multiple solutions to addiction. Our position is that there is no one best approach. Given the infinite range of human diversity, it seems clear that each person must determine his or her own unique recipe for a successful recovery. Our goal is to introduce the various ingredients that may be useful in creating a personal recipe for recovery.
The term "model" implies an incomplete version. For instance, if I understand the theoretical reasons a ship floats and moves through the water in a certain way, I can build a model of a ship. It can look like a ship. It floats like a ship. It is even helpful for understanding how a ship works. The model helps me figure out how to fix problems on a full-size ship. Nonetheless, no matter how realistically I build my model ship, it will not exactly replicate a full-size ship. When we reduce a ship to model size, we can better understand ships in this smaller form. Other important details may be lost. The same is true for models of addictions and recovery.
Furthermore, models of different ship types (aircraft carrier, cruise ship, fishing boat) will certainly look and function much differently. Yet, they are each valid models of ships. We cannot say an aircraft carrier, cruise ship, or fishing boat, is "wrong." That would be silly. They are just different and serve different purposes. The same is true for models of recovery from addictions. It makes no more sense to argue which addiction model is best than it would to argue that a cruise ship is better than a fishing boat.
Therefore, each of the following explanations of addiction informs us about the many causes of addiction. Furthermore, they each propose a model for recovery based upon the presumed causes of addiction. Each model will necessarily leave out some aspects of recovery that might be highly relevant and beneficial to some people. It is up to each person to select, and to decide, which models are most relevant and beneficial. Different people will make different choices based upon their particular needs and circumstances. We want our models to guide and assist us, but not to trap us or limit us.
In the next section, we review the many possible causes of addiction. We derived this list of different treatment approaches from in the Handbook of Alcoholism Treatment Approaches: Effective Alternatives (Hester & Miller, 2003). The editors of this handbook were careful to include evidence-based practices. This means there is a sufficient amount of research evidence to support the effectiveness of that approach, at least with respect to alcoholism. We must base much of what we know on alcoholism research. There is less research about other specific types of addiction such as drug addiction, sex addiction, and gambling addiction. However, it is reasonable for us to assume that the research on alcoholism is at least somewhat applicable to other addictions.
In practice, it is possible to combine models or elements of models. These mergers regularly occur. As Miller and Hester (2003) point out, "Some evidence supports each of these perspectives. Each can likewise be shown to be limited in its ability to account for alcohol problems (pg. 8)." Combining models is good news for people seeking recovery. You do not have to choose the best or most correct model. You can select from many different models and combine them in a way that makes sense to you.