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

Theoretical Models and Approaches: Genes, Cues, Pain and Place in Stories Heard at AA and NA, and One Relapse Seen Through Two Models

Introduction

At the AA and NA meetings I attended for this course, members told stories that seemed to answer the question of why they became addicted in very different ways. Some spoke of fathers and grandfathers who drank; some of a place or a time of day that still pulls at them; some of pain they could not bear sober; some of a neighborhood or a job where everyone used. Capuzzi and Stauffer (2016) present several families of models of addiction because no single explanation accounts for every person. This paper uses four of those categories to explain four stories, and then applies two models to one member's story of relapse. Every story has been altered and combined so that no member could be identified.

Part 1: Four Models and Four Stories

A Genetic Model

At a Saturday AA meeting, a man in his fifties said he was the fourth generation of his family to sit in a meeting. His great-grandfather died of drink, his grandfather was sober for twenty years before he died, and his father never stopped. He described feeling different from his friends with his first beer at fifteen: they got silly and stopped, while he felt normal for the first time and wanted more. He said that when his own son turned fifteen, he sat him down and told him the family history plainly.

A genetic model explains this story well because it accounts for the concentration of the disorder across generations and for the unusual first response he described. Verhulst et al. (2015) combined 12 twin studies and five adoption studies and put the share of variation in alcohol use disorder explained by genes at 0.49, with shared family environment explaining about 10% of the variance. Results were consistent across sexes, designs and assessment methods. Because adoption studies separate genes from upbringing, the estimate cannot be explained by family drinking habits alone. The model does not mean his addiction was inevitable, but it explains why he was more vulnerable than his friends to the same beer.

A Behavioral Model: Classical Conditioning and Cues

At a Tuesday NA meeting, a woman with about two years clean described what still happens when she drives past a particular convenience store. For years she bought her drugs in its parking lot, and even now her heart races, her mouth goes dry and she feels the craving rise before she has had a single thought about using. She has learned to take another route, and on the days she cannot, she calls her sponsor from the car.

A classical conditioning model fits her account because her reaction comes before any conscious decision. In this model, places, objects and people repeatedly paired with drug use become conditioned cues that trigger craving and physical arousal on their own. Carter and Tiffany (1999) meta-analyzed 41 cue-reactivity studies comparing responses to drug-related and neutral stimuli among people addicted to alcohol, nicotine, cocaine or heroin. Drug cues produced a large increase in self-reported craving, with an overall effect size of +0.92, along with smaller increases in heart rate and sweat gland activity and a drop in skin temperature. Her racing heart and craving at the store are the same pattern the studies measured.

A Psychodynamic Model: Self-Medication

At the noon NA meeting, a man spoke about the year his younger brother died. He had used pills recreationally before, but after the funeral he took them every day, because they were the only thing that let him feel nothing. He said he had never cried for his brother until his second month clean, and that the grief he had been avoiding for six years arrived all at once.

The self-medication hypothesis explains this story because it treats the drug as a solution to an unbearable feeling. Khantzian (1997) proposes that people discover that particular drugs relieve particular painful emotional states, and that this happens against a background of broader trouble managing feelings, self-worth, closeness to others and care of oneself. Opioids in particular, he argues, can calm intense feelings of rage, loss and emptiness. The member's account fits closely: use escalated after a loss, the pills were valued for numbing, and the grief returned when the drug was gone. The model also explains why early recovery can feel worse before it feels better.

A Sociocultural Model: Environment and Setting

At the step meeting, an older member who served in the Army said he used heroin daily during a deployment overseas, where it was cheap and everyone around him used. When he came home, he moved back to a small town where he knew no one who used, and he stopped. Years later, he became addicted to alcohol, not heroin, after a divorce, and he said that what puzzled him most was how easily he had quit the first time.

A sociocultural model, which explains drug use through availability, social norms and setting, accounts for the first part of his story. Robins (1993) reports the follow-up of enlisted men who served in Vietnam in 1970 and 1971, many of whom used narcotics there and many of whom became addicted. Readdiction after their return was surprisingly rare, and Robins argues that public and scientific views of heroin addiction have still not absorbed that finding. When the setting changed, from a war zone with cheap heroin and widespread use to a hometown without either, most men stopped. The member's later alcohol addiction shows the limits of the model, since a new stressor in a new setting produced a new problem.

Part 2: One Member's Story Through Two Models

At the candlelight NA meeting, a woman in her forties took a white keytag. She told the group that she had been clean for eight years, had sponsored others and had stopped going to meetings about a year before. Her mother became ill, she moved in to care for her, and she stopped seeing her friends from the program. She said she was proud that she could handle things on her own. One night, after a hard day at the hospital, a neighbor offered her a pill for her back pain, and she took it. Within a month she was using daily.

Through the Cognitive Behavioral Model of Relapse

Witkiewitz and Marlatt (2004) describe relapse as the outcome of dynamic interactions between background risks and the immediate situation. Her background risks included her history of opioid addiction and the loss of her support network when she stopped attending meetings. Her immediate risks were stress, physical pain, fatigue and an unexpected offer. In their model, these factors interact so that a small change, such as one offered pill on one exhausting night, can produce a sudden shift from abstinence to use. The model points a counselor toward practical steps: identifying high-risk situations, rebuilding coping skills for stress and pain, planning responses to offers and treating the first use as a lapse to learn from rather than proof of failure. Miller and Rollnick (2013) add that a counselor should evoke her own reasons for returning to recovery, rather than lecturing her about what went wrong.

Through the Twelve-Step Spiritual Model

The twelve-step model would read the same story differently. It would see the turning point not in the night of the pill but in the months before, when she stopped going to meetings and told herself she could handle things alone. In the language of NA's literature, recovery depends on continued surrender, honesty and connection with other addicts and a higher power, and isolation and self-reliance are warning signs (Narcotics Anonymous World Services, 2008). The model would point her back to meetings, a sponsor and the steps, and it would see her white keytag as an act of humility rather than defeat.

Comparing the Two Views

The two models agree that her relapse did not come from nowhere, but they emphasize different causes. The cognitive behavioral model focuses on skills, situations and the moment of choice, while the spiritual model focuses on pride, isolation and disconnection. A counselor can use both. The first offers concrete tools for the next hard night; the second explains why the tools were not used. Kelly et al. (2006), studying 227 outpatients over three years, found that continued mutual-help participation predicted later abstinence, which supports the spiritual model's emphasis on staying connected.

Implications for Counseling

This assignment showed me that the stories clients tell often fit more than one model, and that each model points toward different interventions. A client with a strong family history may benefit from psychoeducation about genetic risk; a client with powerful cue reactions needs a plan for triggers; a client numbing grief needs help with the grief; and a client returning to an old neighborhood needs attention to setting. Capuzzi and Stauffer (2016) encourage counselors to integrate models instead of choosing one, and the stories I heard support that advice. When I hear a client's story, I plan to ask what each model would notice before deciding what to do.

Conclusion

Four stories from AA and NA meetings illustrated four kinds of explanation: genes, conditioned cues, emotional pain and setting. One story of relapse after eight years showed that two models can describe the same events in complementary ways. Research on heritability, cue reactivity, self-medication, the Vietnam veterans and relapse helped explain what the members said. No model was sufficient alone, and the members' own stories were richer than any of them.

References

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

Carter, B. L., & Tiffany, S. T. (1999). Meta-analysis of cue-reactivity in addiction research. Addiction, 94(3), 327-340. https://doi.org/10.1046/j.1360-0443.1999.9433273.x

Kelly, J. F., Stout, R., Zywiak, W., & Schneider, R. (2006). A 3-year study of addiction mutual-help group participation following intensive outpatient treatment. Alcoholism: Clinical and Experimental Research, 30(8), 1381-1392. https://doi.org/10.1111/j.1530-0277.2006.00165.x

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231-244. https://doi.org/10.3109/10673229709030550

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

Narcotics Anonymous World Services. (2008). Narcotics Anonymous (6th ed.).

Robins, L. N. (1993). Vietnam veterans' rapid recovery from heroin addiction: A fluke or normal expectation? Addiction, 88(8), 1041-1054. https://doi.org/10.1111/j.1360-0443.1993.tb02123.x

Verhulst, B., Neale, M. C., & Kendler, K. S. (2015). The heritability of alcohol use disorders: A meta-analysis of twin and adoption studies. Psychological Medicine, 45(5), 1061-1072. https://doi.org/10.1017/S0033291714002165

Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist, 59(4), 224-235. https://doi.org/10.1037/0003-066X.59.4.224