Note that a number of more specific versions of the BPSM have been proposed over the years (Bolton and Gillett 2019; Lindau et al. 2003; Wade and Halligan 2017). My focus will be on references to, and applications of, the general version of the BPSM described above. It was a physiologist who serendipitously discovered the importance of learned associations in biologically relevant responses. Ivan Pavlov, who was researching digestive processes in dogs, discovered that dogs would start salivating at previously neutral stimuli that were predictive of food presentation.

  • Meanwhile, however, genome-wide association studies in addiction have already provided important information.
  • In addition to having the potential to undermine research in the ways discussed above, it creates ethical problems.

Addiction Neuroethics in the Clinical Context

I argue that TMD has become the subject of unjustified claims and that these claims are at least partly products of the question-begging strand of wayward BPSM discourse. To keep the detail presented to a minimum, I have provided a full version of the TMD case study in the online Appendix, and offered an abridged version here. Let us begin by considering Engel’s discussion of schizophrenia, which occupies a prominent place in his article. Engel wants to argue that schizophrenia is a medical disease—that is, a problem falling under medicine’s purview—and that, if we carefully consider this disease’s properties (along with those of several other ailments) we will see that medicine ought to embrace his BPSM.

Sociodemographic variables and factors

biopsychosocial model of addiction

For many of these compounds, their intoxicating effects were an end to itself – people would take these drugs to achieve the presumably pleasurable states of inebriation they produced when consumed (Grilly, 2011). The Jekyll-and-Hyde-like dichotomy of drugs was thus apparent as early as 2500 years ago, with intoxicating agents seen as holding the potential for both personal and societal advancement, as well as personal and societal destruction. The use of drugs as inebriants predates even the earliest writings of human behavior – one need only read to the 9th chapter of Genesis to learn about Noah’s drunkenness. Anthropologists argue that humans first began consuming alcohol approximately 10,000 years ago after observing other animals selectively choosing fermented fruit over unfermented fruit when both were concurrently available. Our affinity for this inebriant was such that humans throughout most parts of the world had mastered the techniques of creating wine, beer, and distilled spirits 2000 years ago.

biopsychosocial model of addiction

Social determinants of health

Mind once was the place of mediation between person and situation, between the biological and the social. How these advances will impact the ethical relationship between our brains and our selves in addiction, is yet to be seen. Guiding an individual’s behaviour are brain processes, somatic mechanisms, the ethical rules and norms that govern society, and the nature of the interaction. The complex combination of biological, psycho-social and systemic factors may explain Sober House why it is so difficult for some individuals to refuse drugs in the face of increasingly negative consequences. An underlying feature of these interacting systems is the human subjective experience of free voluntary actions, which problematizes laws within the natural world that every event has a cause with causally sufficient explanations. In sum, we can see the question-begging variety of wayward BPSM discourse—and its power—at work in the TMD literature.

The biopsychosocial systems model is grounded in systems theory in which knowledge occurs at the intersection of the subjective and the objective, and not as an independent reality. This is a radical departure from the traditional positivist epistemology, which relies on empirical study and material proof (Bunge 1979; Heylighen, Cilliers, and Gerschenson 2007). Such new iterations of systems theory concentrate on the cognitive and social processes wherein the construction of subjective knowledge occurs. The dynamic within these relationships can contribute to or inhibit the emergence of a complex behaviour such as problematic substance use, while regulating both inputs and outputs from changing internal and external environments. The complex behaviour contributes both positive and negative feedback, and thus affects how the complex behaviour emerges. Systems theory, therefore, balances reductionism and the intrinsic heterogeneity within systems.

Clinical trials and guidelines

We provide arguments to support this view, discuss why apparently spontaneous remission does not negate it, and how seemingly compulsive behaviors can co-exist with the sensitivity to alternative reinforcement in addiction. Most importantly, we argue that the brain is the biological substrate from which both addiction and the capacity for behavior change arise, arguing for an intensified neuroscientific study of recovery. More broadly, we propose that these disagreements reveal the need for multidisciplinary research that integrates neuroscientific, behavioral, clinical, and sociocultural perspectives. For many people, the process includes stable periods and periods characterised by emotional, relational, and social pain and trouble [6]. Thus, recovery processes should be met with patience and adjusted and collaborative support. All the informants had received professional support and interventions following discharge from inpatient treatment in Tyrili, including mental health care in periods when substance use was a minor problem.

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