Values, attitudes and models of drug use

There have been several models of drug use developed over time to try to understand why people use and become addicted or dependent on alcohol and other drugs.

In summary, these are:

The Psychodynamic Model

Psychodynamic theory originated with the father of psychiatry, Sigmund Freud, in the 1800s. It is still applied to treat drug addiction through psychological therapy. Fundamentally, this model says that everyone can trace their problems to their childhood, which influences how they cope with the issues that life throws at them as adults. In other words, using and misusing AOD can be seen as an unconscious response to childhood trauma.

This model forms the basis of treatment approaches with the aim of gaining insight into an individual’s unconscious motivations and how they can reduce anxiety and enhance their self-image, thereby reducing their unconscious need for drugs to fill a gap in their coping mechanisms.

This model also says that drug users turn to drugs as a soothing mechanism to reduce or remove unpleasant feelings associated with anxiety related to childhood trauma. Psychoanalytic theory proposes that people use defence mechanisms, such as denial, projection, regression, rationalisation, anger and avoidance, to cope with anxiety.

The Disease Model

The disease model of addiction makes the assertion that addiction is a brain disease characterised by abnormalities in an individual’s brain structure and functioning, which cause them to become addicted to drugs.

The disease model supposes that:

• Addiction either exists or it does not—it is not on a continuum
• Addiction is irreversible—it is incurable and can be treated only by lifelong abstinence
• Addicted individuals are unable to control their intake of a substance. Once an individual partakes of the substance, they are powerless to stop and are overtaken by cravings when they cannot have it.

The Pharmacological Model

The pharmacological model is founded on the conviction that the intrinsic power or attraction of a drug is able to completely overwhelm the individual’s will. Those who are in the grip of these powerful substances are considered victims of the drug and its effects on them, and the drugs alone are to blame for the individual’s circumstances.

The Social Learning Model

Before the 1960s, drug and alcohol dependence was understood in the context of an individual’s physical need for a substance and how they experienced withdrawal symptoms in its absence. In the 1970s, the social learning model introduced the concept that drug dependence is chemical, behavioural and social in nature.

Proponents of this theory reject the idea that individuals who use drugs are ill, immoral, criminal or vulnerable to the power of the substance. This model posits that drug-using behaviour is learned and reinforced by peers, parents, partners and/or the media. Drug use is not seen in the context of good or bad, and the ‘choice’ to use drugs is recognised as a process of weighing up the costs and benefits in terms of the drug, the user and their environment.

Watch

This video explains how models of addiction began to change as the study of social sciences arose in the mid-20th century: ‘Social Influences on Addiction - Investigating Addiction (3/6)’ by OpenLearn from The Open University on YouTube

The Biopsychosocial Model

The biopsychosocial model views an individual’s drug use as determined by interrelated factors that are biological, psychological/emotional and social/structural in origin. Emphasis has recently been placed on also tying in developmental and sociocultural factors.

This is a multidimensional and holistic model that underpins a variety of practice frameworks and approaches that concentrate on recognising and addressing the contributing factors of an individual’s or a group’s drug issues and on developing solutions that are adapted to the individual’s needs and the needs of groups and communities.

The biopsychosocial model and public health model are prevalent in drug treatment and prevention services in the current context of AOD services in Australia.

Watch

This video discusses the multifactorial approach to understanding addiction Factors for Drug Use and Drug Abuse’ by khanacademymedicine on YouTube

The Public Health Model

The public health model has framed the Australian approach to treating and preventing addiction since the mid-1980s. The National Campaign Against Drug Abuse came out of the National Drug Summit of 1985 and the later National Drug Strategy 1992–97 and 1998–03 and continues to inform treatment and prevention programs. The public health model uses an integrated approach that recognises three pivotal factors and their interrelationship:

• The individual – The user and their characteristics
• The agent – The drug and its characteristics and effects
• The environment – The context in which the drug is used

The public health model acknowledges there are many factors that interplay in the use and abuse of drugs and that people working in the public health and services sphere must approach the problem of drugs in the community from a number of angles.

The stages of change model identifies that every person is at a different stage of willingness to change. It says that practitioners in the AOD field must not make assumptions about their client’s readiness to make immediate or permanent changes to their behaviour. When a worker can identify where a client is in the change process, they can provide interventions tailored to the client’s stage of readiness for change.

The Five Stages of Change

Stage 1- Precontemplation
The client is not thinking sincerely about changing and can be defensive about their drug use. At this stage, they may not see that their drug use is problematic. The way they see it, the pluses of their using outweigh the minuses or negative consequences, so they are content to continue using.

Stage 2- Contemplation
The client ponders the prospect of quitting or decreasing their drug use but is unsure about taking the next step. They still enjoy taking drugs, but they are starting to experience negative consequences, such as personal, psychological, physical, legal, social or family problems.

Stage 3- Preparation
The client has tried to make changes to their using habits in the last 12 months. They have now recognised the negative consequences of continuing to use outweigh the pleasures brought by taking the drug, and they become more serious about the next steps to sobriety. The client understands they must make changes and that the time for change is on the horizon. However, some people will decide not to make any changes at this stage.

Stage 4- Action
The client will take active involvement in the steps required to start changing their using habits and may take huge strides towards meaningful changes in their behaviours. The client may try a variety of methods of giving up or reducing drug taking. During this part of the process, clients are at their biggest risk of relapse. Some clients may still feel ambivalent about change at this stage.

Stage 5- Maintenance
The client can avoid the temptation to go back to their past using behaviours. They have learned how to anticipate and manage their impulses to use and have learned new ways of coping that they can employ. At this stage, it is normal for clients to have minor setbacks, but these setbacks are not seen as failures.

Relapse

Most clients will experience a relapse when changing their using behaviours. Relapses provide important learning opportunities and can assist the client in strengthening their resolve to change. On the other hand, there are times when relapses might cause a client to give up on their attempt to change. The crux of recovering from relapse is for a client to evaluate their attempt so far, recognise their individual strengths and weaknesses, and then create strategies to improve their weaknesses, which they can use to address problems when they next happen.

Relapse is a key part of the action and maintenance stages. Many clients who do make changes to their behaviour decide for several reasons to resume their drug use or return to old patterns of behaviour. Researchers have identified that, in the stages of change model, relapse is the ‘rule’ rather than the ‘exception’.

How you feel about drug use and people who use drugs will influence the way in which you treat your clients in the AOD sector.

We all have what are called ‘unconscious biases’: thoughts and feelings that we do not even know we have, which influence the way we deal with people in our lives every day. These biases are reinforced by our environment and experiences, and they become the basis for a great deal of our patterns of behaviour towards people who are different from us.

It is important to examine your own attitudes towards AOD and people who are affected by them so that you can give the best possible service and assistance to your clients based on their actual needs rather than what you think they need.

Learn more about recognising and overcoming your unconscious bias: ‘How to Recognise and Overcome Your Unconscious Bias’ from The Guardian

Watch

In this Ted talk, the presenter discusses how our unconscious biases hold us back and how to address them: ‘How to Outsmart Your Own Unconscious Bias | Valerie Alexander | TEDxPasadena’ by TEDx Talks on YouTube

Australia’s long-standing commitment to harm minimisation considers the health, social and economic consequences of drug use on individuals, families and communities as a whole and is based on the following considerations:

• drug use occurs across a continuum, from occasional use to dependent use;
• a range of harms are associated with different types and paerns of drug use; and
• the response to these harms requires a multifaceted response.
  ~ National Drug Strategy 2017–2026

Harm minimisation strategies have been blended with the public health model of drug use to reduce the risks and harms of drug use and addiction, and improve health outcomes for users.

Harm minimisation strategies are based on the acknowledgement that is it not possible to eliminate addiction, abuse or misuse of drugs in the community and that certain drugs have inherent risks and harms associated with their misuse, abuse and addition. Instead, the goals of harm minimisation in the public health context are to identify and reduce the harms that are caused by drug addiction, abuse and misuse. Because these drug problems affect not only the individuals who use, but their families and community as a whole, harm minimisation provides assistance that will provide an overall improvement in public health.

Examples of harm minimisation strategies

• Diversion programs – One social harm that might come from using illicit drugs is ending up with a criminal record if a user is caught by the police for possession. Drug diversion programs give individuals who are charged with less serious drug offences—such as possessing a small amount or cannabis—education and/or treatment options. Diversion programs can help individuals avoid getting a criminal record and provide access to early intervention programs.
• Sobering-up services – These services give intoxicated individuals a safe environment in which to get care and sober up until the substances they took subside. They can be an alternative to police cells for individuals apprehended for being intoxicated.

While the goal of these services is to protect individuals as they sober up, they can also provide brief/early intervention services and referrals to other agencies for further help.

Watch

The cutting edge of addiction research is beginning to question everything previous generations have thought about addiction and drug use. Watch this video, keeping in mind what you learned about your unconscious biases: ‘Everything You Think You Know About Addiction Is Wrong | Johann Hari’ by TED on YouTube