STAGE 4. Selecting the theoretical approach

What steps should be completed?

Step 1: Select the theoretical approach or approaches on which the intervention will be based

THE MAIN THEORIES AND MODELS UNDERPINNING DRUG DEPENDENCE TREATMENTS

Biological theories and models

These situate the origin of addictions in biological factors, many of them genetic. These theories and models (approaches) explain drug dependence by the following factors:

• Certain endogenous biological deficits or disorders that, either directly or indirectly, would lead certain people to use substances to alleviate or ease some of the symptoms of these disorders ("self-medication hypothesis").
• Genetic predisposition, which would cause some people to be more susceptible drug dependence ("disease model").
• The pharmacological effect of the substance on the brain, acting on brain reward and neuroadaptation systems ("exposure model").

The psychosocial aspects are not particularly relevant to biological models (approaches), the use of pharmaceuticals constituting the central feature of addiction treatment, especially to manage the processes of detoxification and cessation, and treat certain symptoms associated with drug dependence (treatment of associated physical or mental comorbidity).

Psychological theories and models

Most of these theories and models (approaches) explain drug dependence by the following factors: particular personal characteristics or traits; social learning; and/or difficulty adapting to the social environment.

From the perspective of these models (approaches), substance abuse and dependence is understood to be either a mechanism to reduce the symptomatology of emotional conflicts or dysfunction, or as the result of maladaptive learning. These theories explain to a great extent the extensive development of treatments for behavioural addictions.

Sociocultural models

These consider drug addictions to be a result of the socialisation process in a particular society and culture. Consequently, responses to drug dependence include improving people's living conditions, creating an environment in which needs that are met by drug use can be satisfied through other less damaging behaviours.

Comprehensive theories and models (integrative)

In the past few years, there has been a fundamental change in the conceptualisation of drug addictions by addiction professionals and those responsible for policies in this matter, creating integrative models (approaches) that allow reductionist visions of the causes of addiction and therapeutic responses to them to be overcome.

These models (approaches) understand drug dependence to be the result of the interaction of the multiple factors (biological, psychological, cultural and social) present in previous approaches. The Biopsychosocial Model has been developed based on integrative theories and is widely used in the field of health in general. It underpins many of the current interventions to treat addictions. +