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.
The model of addiction that we have been discussing is the Bio-Psycho-Social-Spiritual (BPSS) model. It was previously just the Bio-Psycho-Social Model (without including "spiritual"). Many people feel it is unnecessary to separately mention spirituality. This is because moral and spiritual concepts are value laden and culture-specific. Thus, most clinicians understood that the socio-cultural (social) part of this model included spirituality. Nonetheless, spirituality is an important concept for many people. This is particularly true for people struggling to recover from severe or fatal disorders such as addiction. So, we feel it does merit specific mention.
In Western Judeo-Christian cultures such as the United States, spiritual models typically presume a God with supernatural powers. This God is seen as one who governs, guides, directs, or intervenes on behalf of human beings. Spiritual models assume addiction occurs because of a separation from God. Moral causes of addiction presume there is a "correct" morality based on a particular set of values. Deviation from those values results in addiction. It is important to note that moral codes reflect the value system of a particular culture. Therefore, the "correct" moral code will vary from one culture to the next.
Spiritual Model of Addiction and Recovery Implications
According to the spiritual model, a disconnection from God or a Higher Power causes addiction. This separation causes people's suffering because they fail to live according to God's will or direction. Therefore, recovery consists of establishing or re-establishing a connection with God or a Higher Power. The most prominent example of the spiritual approach is Alcoholics Anonymous (AA) and other 12-step groups. Participants practice 12-steps. These 12-steps help people restore their spiritual connection with a higher power. There are also "faith-based" approaches that arise from specific religious orientations. Prayer, meditation, and counseling with spiritual advisors are techniques associated with this model.
Questions for personal reflection from the spiritual model: How do I evaluate my life in terms of my relationship with God or a Higher Power? How do I evaluate my life in terms of my own ultimate values and beliefs? Am I living in accordance with what I believe is important? Do I devote enough time reflecting upon my values and beliefs?
Moral Model of Addiction and Recovery Implications
According to the moral model, a moral failure (a failure to do what is right) causes addiction. Therefore, recovery consists of strengthening one's will or motivation to behave in an upright manner. The moral model is prominent in traditional approaches to recovery. "He just needs to strengthen his willpower to resist temptation and get on with his life." The criminal justice system also approaches addiction from this perspective. Punishments for addiction related crimes (e.g., DUI, public intoxication) are intended to motivate people to behave better. Trying to persuade someone to behave better is also a technique associated with this model.
Moral Reconation Therapy (MRT) is an evidence-based addiction treatment aligned with this model, but MRT is not well known. Conation is an archaic psychological term referring to our capacity for conscious and deliberate decision-making. Moral Reconation Therapy works to raise the moral level of decision-making.
Questions for personal reflection from the moral model: Aren't there times when I need to exert more effort and willpower to stay on track? Should I use willpower to behave better make wiser choices? Are there times when I need to exert more effort to do the things I know will help me in my recovery efforts? I know if make the extra effort to exercise every day, I feel better. This improved my mood. It also reduced my cravings and made it easier for me to resist them.