CEFS 691 Week 7 Theoretical Models and Approaches: Experiential Paper Example

Theoretical Models and Approaches: Explaining Recovery Stories Heard at AA and NA With Four Models of Addiction

Introduction

Models of addiction can seem abstract until they are set beside real lives. This paper applies four models, chosen from four of the course's categories, to stories I heard at the open AA and NA meetings I attended. Members shared these stories publicly, but out of respect for their anonymity I retell them in general terms and have changed details that might identify anyone. Capuzzi and Stauffer (2016) present multiple models of addiction because each captures part of a complex problem, and the stories show why no single model is enough. The course groups models of addiction into eight categories, and I chose one model from each of four of them, picking four that I could see clearly in the stories I heard, and I looked for stories that fit each model on its own terms rather than forcing them. Where a story could be read through more than one model, I chose the reading that best explained the details the member emphasized.

Part 1: Four Models and Four Stories

The Brain Disease Model

A woman in her thirties described how she began taking prescribed pain medication after surgery, felt calm and energized for the first time in years, and within months was taking far more than prescribed. She said that by the end she felt no pleasure from the pills, only relief from feeling sick, and that she kept using even after losing her job because "the craving was louder than anything else."

The brain disease model explains her story well. Volkow et al. (2016) describe how repeated drug use desensitizes reward circuits, dampening pleasure from ordinary activities, strengthens conditioned responses and stress reactivity, which drives craving, and weakens the brain regions involved in self-control. Her loss of pleasure, her use to avoid sickness and her inability to stop despite losing her job match each of those changes. The model also explains why she described her recovery as requiring medication and time for her brain to heal.

Social Learning Theory

A young man described growing up in a neighborhood where drinking and smoking marijuana began in middle school, where his older brother and friends all used, and where getting high was simply what weekends were for. He said his recovery began when a man in NA, who had grown up a few streets away, took him to meetings and showed him a different way to spend Friday nights.

Social learning theory fits this story closely. It holds that substance use is learned by observing others and through its rewards, and that recovery depends on new models and new reinforcement. Moos (2007) identifies abstinence-oriented role models and the building of self-efficacy as active ingredients of effective treatments, drawn from social learning theory. The young man learned to use from the people around him and learned to stay clean from a new role model, which is exactly the process the theory describes.

Family Systems Theory

A woman described a family in which her father drank every night, her mother covered for him, and she, as the oldest child, took care of her younger siblings. She began drinking heavily in her twenties and found that her own children were taking on the same roles she had once played. She said that recovery for her meant not only stopping drinking but also learning to stop managing everyone else.

Family systems theory explains her story by looking at the family rather than the individual. It sees substance use as part of patterns that the family organizes around and maintains, sometimes across generations. Copello et al. (2005) review family-focused interventions, including those that work with family members to engage a relative in treatment, those that involve families in the relative's treatment and those that address family members' own needs, and they note the harm substance misuse causes the whole family. Her story shows a family role passing down and a recovery that required changing her place in the system.

A Sociocultural Model: Social Control and Bonding

An older man described decades of heavy drinking that began after he retired and his wife died, when he no longer had coworkers, a schedule or anyone who expected him anywhere. He said that AA gave him "a reason to get up" and people who would notice if he did not show up.

A sociocultural model emphasizing social control and bonding explains his story. Moos (2007) draws on social control theory to argue that effective treatments strengthen bonds to family, work and community and provide monitoring and structure that discourage use. The man's drinking grew when his bonds and structure disappeared, and his recovery came through a fellowship that restored both.

Part 2: One Story Through Two Models

One member's story showed most clearly how two models can be true at once, each seeing something the other misses. A man in his fifties described drinking heavily for twenty years, getting sober in treatment, relapsing after eight months, and finally staying sober for nine years. His father and grandfather both drank heavily. His first sobriety, he said, was "white-knuckling it" alone; his relapse came after a family fight in which his wife said she did not trust him. His lasting recovery began when he returned to treatment, began taking medication to reduce cravings, and, with his wife and teenage son, went to family counseling and Al-Anon.

The brain disease model explains several parts of his story: the family history consistent with inherited vulnerability, the intensity of craving that made white-knuckled sobriety fragile, and the role of medication in reducing cravings during his lasting recovery (Volkow et al., 2016). But it says little about why the relapse came after a family fight, or why family counseling mattered. Family systems theory explains those parts. It sees his drinking as part of a family pattern, his relapse as a response to conflict within the system, and his lasting recovery as a change in the family as a whole, with his wife and son addressing their own hurt and roles (Copello et al., 2005). Each model, alone, gives an incomplete account.

The comparison has practical consequences. A counselor working only from the brain disease model might have focused on medication and relapse prevention and missed the family conflict that triggered his relapse. A counselor working only from family systems theory might have focused on the marriage and missed how strong his cravings were. His own account suggests that both were needed: medication quieted the craving enough for him to work on his relationships, and family counseling changed the conflict that had made sobriety feel impossible. For his counselor, the right question was not which model was correct but which parts of his story each one could help address.

Conclusion

Engel (1977) urged medicine to see illness as arising from biology, psychology and social life at once, and the stories here show how well that view suits addiction. The brain disease model explains craving and loss of control, social learning theory explains how use and recovery are learned, family systems theory explains patterns passed through generations, and sociocultural models explain the role of bonds and structure. For a counselor, the lesson is to assess each dimension and to choose interventions, from medication referral to family work to mutual-help involvement, that match the parts of a client's story that matter most. Miller and Rollnick (2013) add that whatever model a counselor uses, change comes most readily when the client's own reasons are drawn out. Scripture describes people as whole beings, body and soul, and calls for care of the whole person (English Standard Version Bible, 2001/2016, 1 Thessalonians 5:23). Integrated models of addiction help counselors offer that kind of care.

References

Capuzzi, D., & Stauffer, M. D. (2016). Foundations of addictions counseling (3rd ed.). Pearson.

Copello, A. G., Velleman, R. D. B., & Templeton, L. J. (2005). Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review, 24(4), 369-385. https://doi.org/10.1080/09595230500302356

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136. https://doi.org/10.1126/science.847460

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Moos, R. H. (2007). Theory-based active ingredients of effective treatments for substance use disorders. Drug and Alcohol Dependence, 88(2-3), 109-121. https://doi.org/10.1016/j.drugalcdep.2006.10.010

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. The New England Journal of Medicine, 374(4), 363-371. https://doi.org/10.1056/NEJMra1511480