What are the three models of addiction

Deborah C. Escalante

Throughout history, we’ve understood addiction in many ways that are fundamentally different. For a long time, the perception of addiction as a moral failing was uncontested. However, the scientific literature universally refutes this concept and many new ideas have replaced it. Modern behavioral models of addiction provide great insight into what drives addiction and how we can treat it more successfully.

What are Some of the Behavioral Models of Addiction?

When it comes to the basic idea of what drives addiction, you have a theory. For instance, some theorize that the primary driving factor behind addiction is avoiding the severe discomfort of withdrawals. Others hypothesize that addiction is a purely medical phenomenon and that the reason some become addicted to a substance while others don’t is a matter of genetics and exposure.

Once a theory has more work behind it and can offer fuller, richer explanations for addictive behavior, it grows into a behavioral models of addiction.

Moral Model

While the moral model of addiction is outdated, many still uphold it and it features in many rehab clinics around America and the world. The basic foundation of this model is that addiction is a matter of moral weakness and that the cure to addiction is responsibility. Of course, no rigorous studies back up this idea and it’s essentially a relic.

Disease Model

Addiction is inarguably a disease, and the disease behavioral model of addiction elevates the elements of addiction that make it such. However, viewing addiction as nothing more than a disease is often problematic for understanding what drives people to addiction and how they can get better.

The only antidote to addiction that the disease model has to offer is abstinence, which doesn’t incorporate many of the effective, therapeutic treatments that are increasingly popular today.

Socio-Cultural Model

The sociocultural model of addiction takes a big-picture approach to the problem of addiction and identifies underlying, systemic causes of addiction. Discrimination, lack of opportunity, poor quality of life, and similar problems that are common in marginalized communities consistently explain the occurrence of drug addiction. Under this model, the idea is to treat addiction by tackling housing and economic inequality.

While further research may indicate that this theory is fundamentally correct, it’s not so applicable to individual rehabilitation.

Psycho-Dynamic Model

The Psycho-dynamic model of addiction looks into our traumas and mental illnesses as a cause of addiction. As such, it looks to therapy to understand and address the root of why addiction happens. Statistics on addiction bear this out, as childhood trauma and mental illness put someone at a much greater risk of drug addiction.

Learn More About Addiction

All of the modern models of addiction that replaced the moral model have gaps, but they each serve to explain a part of addiction. By applying these behavioral models, Dana Point Rehab Campus is better able to understand and treat addiction. Follow our blog to learn more about addiction and keep up on recent news.

 Throughout history, we have tried to understand the concept of drug use and why only certain people get addicted. There have been many theories that have been developed over time that provide us with explanations for drug use. Some of these theories were developed into models which help us define a problem or situation so we can understand it more easily. The models listed below are among the most influential in the development of drug treatment and policies. These models influence how we care for individuals who have issues with drugs. You may be able to relate better with some versus others. Main Models of Addiction

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Disease Model of Addiction

The most common model of addiction and one that most treatment places in the United States use are the disease model of addiction. The disease model of addiction believes that addiction is an illness and is a result of the impairment of healthy neurochemical and behavioral processes. This model assumes that addiction lies within the individual and that addiction is a disease. It says that addiction is either present or it’s not, and that addicted people cannot control their intake of any substance. They are powerless over stopping themselves.

The Moral Model of Addiction

The moral model of addiction states that addiction is a result of the person being weak and having defects of character. Those who believe in this model believe there is no biological basis for addiction. This model says if the person has greater moral strength or willpower they or could break an addiction. The moral model is widely applied to dependency on illegal substances, but no longer has any therapeutic value.

The Temperance Model of Addiction

The temperance model of addiction started back in the 19th century with prohibition. It states that there is no such thing as moderation and that abstinence is the only alternative. The core belief of this model is that the addictive and destructive power of the drug is strong and it is the drug itself that’s the problem.

The Genetic Model of Addiction

The genetic model of addiction believes there is a genetic predisposition to certain behaviors. It states that certain addictions run in the family. Research is continuing to be done to explore genetic influence, but there is strong evidence that genetic predisposition is often a factor in dependency.

The Opponent-Process Model of Addiction

This model states that for every psychological event there is an opposite psychological event. For instance, for every pleasurable experience, there is an unpleasurable experience. For example, someone takes heroin and feels a euphoric high from it, this is followed by an opponent process of experiencing withdrawal symptoms. Another example would be someone experiencing terror before jumping out of a plane, the opposite effect would be them experiencing pleasure when the parachute opens.

The Personality Model of Addiction

The personality model of addiction views substance abuse as having abnormalities in personality. It states that the person has an addictive personality, lacks impulse control, has low self-esteem, the inability to cope with stress, is egocentric, has manipulative traits, and has a need for control and power while feeling impotent and powerless. This model also believes that substantial restructuring of their personality is necessary for successful treatment.

The Social Education Model of Addiction

This model believes that addiction is a learned behavior that comes from cognitive processes, modeling influences, and genetic and behavioral influences. Theorists emphasize human-environment interactions as the key to shaping addiction behavior. They believe that imitating behavior one has observed as well as being influenced by role models is part of forming the behavior and treating it.

The Cultural Model of Addiction

The cultural model of addiction says that the influence of a person’s culture is a strong factor as to whether or not they fall prey to certain addictions. In some countries, alcohol is prohibited so therefore alcoholism is rare there. In the United States, gambling is common so gambling addictions have increased dramatically over the last two decades of the 20th century. Studies show that half of those with alcoholism are born into families with alcoholism. This suggests that genetic and familial influence play a vital role in the development of addiction and/or alcoholism.

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Help For Drug Addiction and Substance Abuse

Evoke Wellness treatment centers offer a safe and comfortable environment for medical detoxification. Our patients are treated extensively so that minimal discomfort is experienced during the detox process. We provide residential treatment in a structured environment and then provide you with aftercare support which is very important when being treated for addiction. Evoke Wellness is here to help you get on the road to long-term recovery.

A better understanding of the complex science of ‘addiction’ can improve responses to drug problems. This report contains a critical review of existing addiction theories and explores how these can be organised into an overarching structure to inform how we assess, prevent and treat addictive behaviours. This model is not limited to illicit drugs, but can also be applied to alcohol, tobacco and even non-pharmacological addictions, such as gambling or compulsive use of the Internet. Models of addiction delivers the message that understanding the biological basis of addiction, along with the broader social and psychological aspects of addictive behaviour, can lead to successful prevention and treatment responses.

Download the Brain Disease Model of Addiction Research Update.

Views and opinions on addiction have gone through many changes. Advances in neuroscience have helped us understand how drugs affect the brain, leading to the recognition that addiction is a chronic brain disorder that can be treated.1 The brain disease model of addiction is less stigmatizing than the view of addiction as a moral failing, and it brings hope that medications can be developed to address the disease.2 There is strong evidence supporting this paradigm, with neuroscientific research pointing to observable brain changes.2

The Brain Disease Model of Addiction Explained

The brain has many regions that are interconnected with one another, forming dynamic networks that are responsible for specific functions. Drugs can alter important brain areas that are necessary for healthy social interactions and life-sustaining functions, and can drive the compulsive drug use that marks addiction.1, 3, 4, 5

Addiction can be described as a repeating cycle with three stages. Each stage is associated with specific brain regions. The three-stages of addiction are:3, 4

  1. Binge/Intoxication: an individual uses an intoxicating substance and experiences its rewarding or pleasurable effects
  2. Withdrawal/Negative Affect: an individual experiences a negative emotional state in the absence of the substance
  3. Preoccupation/Anticipation: an individual seeks substance use again after a period of abstinence

The three stages are linked to each other, but they also involve different brain regions, circuits (or networks), and neurotransmitters; and result in specific kinds of changes in the brain. Brain areas affected by drug use include the basal ganglia, the extended amygdala, and the prefrontal cortex.1, 3, 4, 5

  • The basal ganglia control the rewarding effects of substance use and are also responsible for the formation of habitual substance taking. These areas form a key node of what is sometimes called the brain’s “reward circuit.” Drugs overstimulate this circuit, producing the euphoria of the drug high. But with repeated exposure, the circuit adapts to the presence of the drug, diminishing its sensitivity and making it hard to feel pleasure from anything besides the drug.
  • The extended amygdala is involved in stress and the feelings of unease, anxiety and irritability that typically accompany substance withdrawal. This circuit becomes increasingly sensitive with increased drug use. Over time, a person with substance use disorder uses drugs to get temporary relief from this discomfort rather than to get high.
  • The prefrontal cortex is involved in executive function (i.e., the ability to organize thoughts and activities, prioritize tasks, manage time, and make wise decisions), including exerting control over substance taking. This is also the last part of the brain to mature, making teens most vulnerable. Shifting balance between this circuit and the circuits of the basal ganglia and extended amygdala makes a person with a substance use disorder seek the drug compulsively with reduced impulse control.
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Figure 1. The Three Stages of the Addiction Cycle and the Brain Regions Associated with Them

Three stages of the addiction cycle


Source: Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health

In addition to the neurobiological changes, the brain disease model of addiction also notes that many genetic, environmental and social factors contribute to an individual’s vulnerability to begin using drugs, to continue using drugs and to undergo the progressive changes in the brain that characterize addiction. Factors that increase vulnerability to addiction include unaddressed trauma (sexual abuse, violence and adverse childhood experiences), family history of drug use, early exposure to drug use (adolescence is among the periods of greatest vulnerability to addiction), exposure to high-risk environments (typically, socially stressful situations with poor family and social supports, and environments in which there is easy access to drugs and permissive normative attitudes toward drug taking), and certain mental illnesses (e.g., mood disorders, attention deficit-hyperactivity disorder, psychoses and anxiety disorders).1, 3, 4, 18

Substance Use Disorder Treatment and Brain Research

The brain disease model of addiction has led to improvements in the understanding and treatment of substance use disorders. Identification of neural systems and structures that are changed by drug and alcohol use allow for development of different medication and non-medication-based treatments that target those vulnerable areas of the brain.3

Additional work on genetics (e.g., the study of genes) and epigenetics (e.g., the study of the impact of the environment on whether or not genes are expressed) have helped develop evidence of biomarkers (e.g., measures that capture what is happening in a cell at a given moment) that directly or indirectly affect the neurobiological processes that are involved in developing addictions.1, 6 Identifying biomarkers associated with drug- and alcohol-seeking behaviors will help to refine possible treatments and prevention of substance abuse.8, 9, 10

For example, scientists recently performed a genome-wide association study to try to identify genes that might put people at risk for problematic cannabis use. They identified a genetic locus on chromosome 8 that controls the levels of the gene CHRNA2 expressed in the brain. Low levels of expression of the gene CHRNA2 in the cerebellum are found to be associated with cannabis use disorder, including diagnosis at an earlier age. The findings suggest that under-expression of CHRNA2 in the cerebellum (and probably other brain regions) is involved in cannabis use disorders, and provides a potential target for future prevention strategies, therapies and medication.7, 11

Critiques of the Brain Disease Model of Addiction

One criticism of the brain disease model of addiction is that it does not reduce the moral stigma attached to addiction and may instead attach a new stigma by using the word disease.12 Critiques of this model also include that it may cause feelings of helplessness for those struggling with addiction, and it ignores other factors involved in developing and sustaining the negative behaviors of substance use disorders.12, 13, 14, 15, 16

However, research does not support these criticisms, and rather than disregarding psycho-social factors, the brain disease model attempts to explain how the environment and individual differences are a part of the development of addiction as a brain disease.1, 3


The brain disease model of addiction has contributed greatly to the current view of substance use disorders. Understanding the neurobiological changes that the brain undergoes has allowed for developments of novel intervention and prevention methods, while also providing overall stigma reduction. Continued advances in neuroscience research will serve to provide new and effective ways to combat the disease of substance use disorders.

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