1. CHAPTER 4: Theories of Substance Abuse Etiology
Substance Abuse Counseling: Theory and Practice
Fifth Edition
Patricia Stevens
Robert L. Smith
Prepared by:
Dr. Susan Rose, University of the Cumberlands

2. Overview of Chapter Understanding Theory Overview of ATOD Theories
Moral Theory
Disease Theory
Genetic Theories
Behavioral Theories
Sociocultural Theories
An Integrated Approach

3. Understanding Theory
Each major theory is examined through the aspects of:
Initiation: Why people begin to use drugs
Continuation: Why people continue to use or abuse drugs
Addiction: Why some people escalate to dependence on drugs and others do not
Recovery: Why some people quit using drugs and others do not
Relapse: Why some people remain clean and/or sober and others do not

4. Moral Theory
Belief that those who cannot “hold” their liquor have a lack of willpower and are morally corrupt.
Aspects of Use Addressed by the Moral Theory
Initiation
Moral deficiencies (Personal needs) under this theory include:
A means to cope with painful and threatening emotions
Childhood factors
Self-regulation (Under-regulation or mis-regulation)

5. Moral Theory Continuation Addiction
Aspects of Use Addressed by the Moral Theory cont.
Continuation
Perceived rewards perpetuate the continued use of the drug
Use masks the underlying physical or emotional problems
Addiction
Sign of addiction is the absence of choice the user has over the drug use

6. Moral Theory Aspects of Use Addressed by the Moral Theory cont.
Recovery
User must develop alternative rewards to replace the gratification of the drug experience
Relapse
Occurs when the needs and the lifestyle of the addict are not addressed when the drug use is ceased
Conclusion
Moral theory purports that addiction can be “cured”

7. Disease Theory Belief that alcoholics suffer from an illness.
Theory began with Alcoholics Anonymous (AA)
Jellinek chart (Figure 4.1, page 102)
Aspects of Use Addressed by the Disease Theory
Initiation
This theory does not address “why” an individual chooses to drink, however Jellinek’s Pre-Alcoholic Phase describes use as being socially motivated
This theory postulates that individuals with the disease of addiction do not know they have it until they start using.

8. Disease Theory Continuation Addiction
Aspects of Use Addressed by the Disease Theory cont.
Continuation
Prodomal Phase: Individual uses alcohol to relieve physical or emotional pain, tension from job or family, or other stress
Crucial Phase: Visible changes occur
Addiction
Chronic Phase: Total loss of control/Loss of a choice to drink

9. Disease Theory Aspects of Use Addressed by the Disease Theory cont.
Recovery
In this theory, an alcoholic or addict is never consider cured, only “in remission”, “recovering”, or a “nonpracticing” alcoholic or addict.
Recovery is focused on abstinence
Initial detoxification is followed by cognitive behavioral treatment
Relapse
Seen as failure, but also viewed as part of the recovery program
Conclusion
Having a disease removed the social stigma, making it easier for someone to seek treatment.

10. Genetic Theories
Studies demonstrated that genetic factors contributed between 50% - 60% of the variance of risk for alcoholism.
Dependence on illicit drugs estimates genetic heritability ranging from 45% - 79%
Aspects of Use Addressed by Genetic Theories
Initiation
More likely to be environmental and to co-occur with tobacco use
Other important factors:
History of parental drinking, smoking, or drug use
The degree of life stability
Personality traits

11. Genetic Theories Aspects of Use Addressed by Genetic Theories cont.
Continuation
May involve a combination of social and biological factors
Antisocial behavior is also linked with substance abuse
Addiction
A variety of genetically influenced factors create a predisposition toward alcoholism
Protective factors
Risk factors

12. Genetic Theories Aspects of Use Addressed by Genetic Theories cont.
Recovery
Addiction is a process.
Relapse
Heritability and molecular changes in individuals that lead to dependence, withdrawal and relapse:
Multiple neuronal pathways in the brain such as systems related to dopamine, serotonin, and opiate receptors
Can be induced by antagonists such as stress, environmental cues, and by the use of alcohol
High comorbidity rate with other psychiatric diagnoses
Concurrent use with other substances

13. Behavioral Theories Three modes of behavioral control:
Pavlovian approach
Goal-directed action
Habit
Aspects of Use Addressed by the Behavioral Theory
Initiation
Social Learning Theory: Substance abuse is a function of positive norms, expectations, and modeling from family members and peers
May occur when an individual’s coping abilities are overwhelmed

14. Behavioral Theories
Aspects of Use Addressed by the Behavioral Theory cont.
Continuation
Generally seen as dependent on a positive experience or other reward
Chemicals themselves can act as reinforcers, ie.: Self-medicate
Addiction
Maintained by habit
Maintained by reinforcement

15. Behavioral Theories
Aspects of Use Addressed by the Behavioral Theory cont.
Recovery
Involves a behavior change
Replace rewards gained by continued use
Break the habit
Relapse
Situational antecedents
Cognitive behavior processes
Triggers
Conclusion
Addiction and substance abuse are seen as the result of learning patterns.
In treatment, goals are easily formulated because behaviors are easily observed and measured.

16. Sociocultural Theories
Environmental support for heavy drinking is an important sociological variable contributing to alcoholism.
Attitudes toward alcohol consumption and abuse vary form culture to culture
Aspects of Use Addressed by the Disease Theory
Initiation
Social factors can contribute to the introduction of the first use of a drug.

17. Sociocultural Theories
Aspects of Use Addressed by the Disease Theory cont.
Continuation
Positive initial experience
Existence of a drug-using peer group
Pressure to conform/”fit-in”
System Maintained/System Maintaining
Addiction
Confluence of sociological and cultural factors contribute to the proliferation of addiction.
Example: Cultures where alcohol has been present for several centuries and is an accepted part of daily life tend to have a lower rate of alcoholism than cultures where alcohol is a fairly recent phenomenon.

18. Sociocultural Theories
Aspects of Use Addressed by the Disease Theory cont.
Recovery
While replacing pro-drug socialized peer activities with non-using peers is an important goal in recovery, social and cultural tolerance may be a limiting factor in maintaining recovery.
Relapse
If broader systems are not addressed, chances of relapse are increased.
Conclusion
Several components of culture and the environment affect the likelihood of substance abuse.

19. Sociocultural Theories
Factors that appear to protect youngsters:
Bonding
Goal-direction
Monitoring from family, peers, religion, etc.
Participating in rewarding activities and prosocial behaviors
Selecting and emulating individuals who model temperance or shun substance use
Increased self-confidence and coping skills.

20. An Integrated Approach
Researchers are beginning to view addiction as more than a one-dimensional process that be explained by one single theory.
Researchers are beginning to postulate a model that is an amalgamation of genetics, environment, and learned behavior.
Integral Quadrant Model
Interior
Exterior
Individual
Interior Individual
Exterior Individual
Collective
Interior Collective
Exterior Collective

21. Comparing Etiological Theories of Substance Abuse
Moral Theory
Disease Theory
Genetic Theory
Behavioral Theory
Sociocultural Theory

22. Discussion Is substance abuse an act caused by a weak moral character?
Is substance a disease?
Is substance abuse a result of heredity?
Is substance abuse a learned behavior?
Is substance abuse caused by environmental factors?