Understanding Alcohol and Other Drug use

In this module, you will be given an introduction to the skills and knowledge required to work in an alcohol and other drugs (AOD) context. As the AOD field is ever-changing, it is vital that you keep yourself updated with key issues and frameworks, as well as understanding the various drugs usage and their impacts to ensure your confidence when working with AOD clients as a helping professional.

We will begin this module with an introduction to the historic, current, and emerging patterns of AOD use. You will then learn about the different impacts from AOD use and its harms, as well as the different models and theories to understand why people develop dependency for AOD.

Alcohol and other drugs have been around since the beginning of human history. Throughout time, they have been used to alter levels of consciousness and mood for various reasons such as religious purposes and medicinal purposes. For example, ancient tribal societies have made and used mind-altering drugs for healing and also used it for religious ceremonies to communicate with a divine principle (Stevens & Smith, 2014). Other drugs such as opium have been used for medicinal purposes in the past and back then it was considered much like how aspirin are today. There were also records that the Sumerians used alcohol and other drugs for recreational purposes (Fernandez & Libby, 2011).

Today, the use of both licit (i.e., legally sanctioned) and illicit (i.e., illegal) drugs are a common feature of modern-day life. For example, alcohol and tobacco form an important part of socialisation in many cultures around the world, and are easily accessible to almost everyone (Stevens & Smith, 2014). Due to the ease of accessibility to alcohol and other drugs, their consumption are very common in Australia. Each year, around 8 out of 10 Australians consume alcohol and 1 in 8 Australians have used at least one illegal substance in 2018, with cannabis being the most common drug used (around 10.4%; Department of Health, 2019).

Purposes of Alcohol and Other Drugs Use

With the high number of individuals using AOD in Australia, it is important to understand why your client chooses or chose to use alcohol and other drugs. By understanding the reason behind AOD use, it can help you to work with your client more effectively in developing a more appropriate treatment plan. There are a variety of reasons and situations why individuals start to use alcohol and other drugs, and you need to consider this in your client’s context and culture too. In some communities or cultures, it is acceptable to use AOD for certain purposes. For example, in some communities, people may consume alcohol for social and recreational purposes. In other communities or cultures, people may not be as accepting about AOD use. For example, the Muslim community does not condone any AOD use and practices AOD abstinence. In other words, whether the people in your community or rather, society, is accepting of AOD use is dependent on the community and culture you belong to.

According to the Department of Health (2004), Schaeffer’s model outlines five distinct patterns of AOD use and demonstrates that not all AOD use is problematic. People often do not fit into one single category and may be in different categories under different circumstances.

The various purposes for alcohol and drugs use are explained in detail below (adapted from Alcohol and Drug Foundation [ADF], 2017; Department of Health, 2004).

• Experimental use – An individual tries a substance once or twice out of curiosity or desire to experience new feelings or moods. This usually involves single or short-term use.
• Recreational/Social use – An individual chooses to use AOD for enjoyment, particularly to enhance a mood on specified social occasion. The majority of people use substances for this reason and rarely develop problems as a result.
• Situational use - AOD is used to cope with the demands of particular situations such as responding to peer group pressure, overcoming shyness in a social situation or coping with some form of stress. Some people might use it when performing specific tasks that requires special degrees of alertness and calm (e.g., shift work).
• Intensive use or 'bingeing' – An individual intentionally consumes a heavy amount of AOD over a short period of time, which may be hours, days or weeks. This is often related to individual’s need to achieve relief or to achieve high level of performance.
• Dependent use – An individual becomes dependent on AOD after prolonged or heavy use over time. They feel the need to take the substance consistently in order to feel normal and/or to avoid uncomfortable withdrawal symptoms. Typically, the individual who uses AOD experiences significant mental or physical distress when they discontinue AOD use.
• Therapeutic use – An individual takes a drug, such as a pharmaceutical, for medicinal purposes.

• Can Julian's alcohol use be described as purely recreational? How would you describe Roberto’s AOD use pattern?
• Are there any differences between Roberto and Julian’s pattern of AOD use? If so, what are the differences?
• Which of them seems to have a more severe AOD use? Why?

As mentioned earlier, there are a high number of individuals who use alcohol and other drugs in Australia for different purposes. Regardless of the reason of use, there is no doubt that the use of both licit and illicit substances incur significant costs on the individual who uses AOD such as health harms. However, the harm of alcohol and other drugs use can also damage the relationships between the individual and their family, friends, community, and the wider society (Fox et al., 2013). Below is an extract from the National Drug Strategy 2017 – 2026 (Department of Health, 2017) which list the different types of harms incurred by alcohol and other drugs use:

Health Impacts

According to the Australian Institute of Health and Welfare (AIHW; 2020a), “the non-medical use of pharmaceutical drugs is an ongoing public health problem in Australia”. This shows that the health burden of alcohol and other drug use is concerning, and the use of alcohol and other drugs has a significant impact on the individual and the people around them. The following are some health harms incurred by the use of alcohol and other drugs (Adapted from AIHW, 2020a):

• Drug-induced deaths: Drug-induced deaths are defined as those that can be directly attributable to drug use, as determined by toxicology and pathology reports.
• Deaths due to harmful alcohol consumption: The harmful consumption of alcohol can contribute to mortality in a number of different ways, and deaths can be directly attributable or partially attributable to harmful alcohol consumption.
  The most common cause of alcohol-induced death was alcoholic liver disease; while mental and behavioural conditions due to alcohol use, including alcohol addiction, is the most common contributor to alcohol-related deaths. Mental and behavioural disorders due to alcohol abuse also made up about 20% of alcohol-induced deaths in 2017 (ABS, 2018).
• Burden of disease: Burden of disease analysis is used to compare the impact of different diseases, conditions or injuries on a population. It combines the burden of living with ill health (non-fatal burden) with the burden of dying prematurely (fatal burden). This is measured through the calculation of disability-adjusted life years (DALY) – one DALY is one year of 'healthy life' lost due to illness and/or death.
  Tobacco, alcohol and illicit drug use contribute to increased chronic disease, injury, poisoning and premature death and are among the leading risk factors contributing to disease burden in Australia.
• Injury and hospitalisation: People who consumed alcohol in risky quantities (lifetime or single occasion risk) were far more likely to require medical attention or admission to hospital due to injuries sustained while drinking or due to intoxication. This was even higher among people aged 14 years or older who consumed 11 or more standard drinks at least monthly, with 4.9% requiring medical attention for their injuries (AIHW, 2020b).
• Overdose and non-medical use: Overdose and non-medical use of alcohol and other drugs are public health concerns that affect the community on many levels. Surveillance and monitoring of AOD overdose and non-medical use can help to form an evidence base in relation to trends and emerging patterns of harms (Moayeri et al., 2020).
• Mental health conditions: There is a strong association between illicit drug use and mental health issues. Over half of the participants of the 2020 Ecstasy and Related Drugs Reporting System (EDRS) reported mental health issues in the preceding 6 months. The primary issue of concern reported among this population of people who regularly use ecstasy and other stimulants was anxiety (69%) and depression (64%; Peacock et al., 2020).
• Pregnancy complications: Tobacco smoking in pregnancy is the most common preventable risk factor for pregnancy complications, and is associated with poorer perinatal outcomes, including low birthweight, being small for gestational age, pre-term birth, and perinatal death. Alcohol consumption during pregnancy is also associated with adverse impacts for the development of the foetal brain. Foetal alcohol spectrum disorder (FASD) is the term used to describe the effects of prenatal alcohol exposure including foetal alcohol syndrome (FAS).
• Injection-related harms: It was estimated that a very low proportion of the Australian general population aged 14 and over have injected drugs, either in their lifetime (1.5%) or in the past 12 months (0.3%; AIHW, 2020b).

Social Impacts

The use of alcohol and other drugs not only impacts the individual’s health, but also their family, community, and society’s wellbeing. The following are some social impacts from alcohol and other drugs use (Adapted from AIHW, 2020a):

• Risky behaviours and criminal activity: In addition to the illegality of drug use in Australia, alcohol and other drug use can also be related to crime in different ways. Under the influence of alcohol and other drugs, people may engage in risky or criminal activities such as driving a motor vehicle, offensive conduct, and verbal or physical violence. However, only a small amount of people who regularly use alcohol or illicit drugs report engaging in risky behaviours or criminal activity.
  Other than the individual who uses AOD, the community (e.g., illicit drug market) is often associated with a range of criminal activities, including property crime, fraud and violence. Engagement in criminal activity (beyond the illegal use of drugs) is more prevalent among populations of individual who uses AOD regularly by injection than it is among the general population.
• Driving under the influence of alcohol and other drugs: Driving a motor vehicle whilst under the influence of alcohol and other drugs significantly increases the risk of road accidents. According to data from the Australian Road Deaths Database, in 2018 there were 100 drivers and motorcycle riders who were killed with a blood alcohol concentration (BAC) above the legal limit (excluding Victoria and Western Australia).
• Family, domestic, and sexual violence: A recent study done in Australia revealed that domestic and family violence incidents is more likely to involve drugs compared to other kinds of violent incidents (Coomber et al., 2019).
• Emotional harms on family members: Parental drug use may affect their ability to provide adequate care for their child/ren. This may result in the neglect of the children’s emotional needs and are more likely to develop social, emotional, and behavioural problems compared to other children. They may also experience more emotional stress than other children. Further, individuals who use AOD may neglect their priorities with their loved ones and their loved ones may feel neglected and frustrated, which may lead to serious negative effects on these relationships.
• Illicit drug use within families: Parental drug use and conflict with parents are family factors that can increase the risk of drug use among younger people (Wilkins et al., 2019).
• Homicide: The Australian Institute of Criminology’s (AIC) National Homicide Monitoring Program (NHMP) showed that there were 196 homicide incidents recorded in Australia in 2017–18 (excluding the Australian Capital Territory) (Bricknell 2020b). The NHMP draws information on the use of alcohol and other drugs by homicide victims and offenders from different sources, with data on victims based on toxicology and offenders based on an assessment by the police.
  They found that 30% of the victims had consumed alcohol and 27% of victims had used illicit drugs. They also found that 25% of the offenders had consumed alcohol while 13% of offenders had used illicit drugs. 
• Victimisation: The Australian Bureau of Statistics Crime Victimisation survey, 2018–19, found that approximately 1 in 2 people aged 18 years and over who experienced physical assault (51.6%) or face-to-face threatened assault (49.3%) in the last 12 months believed that alcohol or any other substance contributed to their most recent incident.

Economic Impacts

There are both direct and indirect economic impacts from alcohol and drug use on the society. Direct impacts include the services and goods delivered to address the harmful effects of alcohol and other drugs. According to AIHW (2020), these impacts include:

• Household expenditure: In 2015-2016, the proportion of household expenditure on alcohol was 2.2%; tobacco products was 0.9%.
• Social costs (healthcare and law enforcement costs): The estimated social cost for tobacco use in 2015-2016 was $136.9 billion, and the costs are from the spending on tobacco by individual who uses AOD and value of life lost. In 2015 – 2016, the estimated social cost for cannabis use was $4.5 billion; more than half of this cost was spent on criminal justice system (e.g., imprisonment, administration of community supervision orders).

On the other hand, indirect impacts on the economy includes failure to deliver services as a consequence of alcohol and other drug use. In 2010, Dale and Levingston found that 1 in 10 workers were affected by a colleague’s alcohol use, e.g., got involved in an accident or close-call and decreased productivity to perform their own work. Below are more examples of the indirect economic impacts from AOD use:

• Decreased work productivity: Research has found that AOD use has cost Australian workplaces $6 billion annually due to lost productivity.
• Absence: Individual who uses AOD who and have developed drugs dependence are often on leave more frequently than other employees. In 2020, 2.7% of recent individuals who use AOD missed 1 day of work in the last 3 months due to their drug use (AIHW, 2020). Roche et al. (2016) also found that Australian workers took almost 11.5 million sick leaves due to their drug use.
• Work accidents: Under the influence of drugs, employees are unable to perform work in a safely manner and thus, leading to work accidents. As a result, employees might be absent from work in turn, AOD use has indirectly reduced the work productivity.

Common Terms Used in AOD Context

As mentioned earlier, the use of substances have different patterns and usually occur at different levels. In turn, these pattern of uses are often associated with different features and harms, which may be confusing for those new to the field of alcohol and other drugs. There are a range of terms and definitions that are used in this field to describe the various states and stages of substance use. We will be introducing some common term to describe the stages of substance use below:

Addiction

Addiction can be defined as “learned habits that, once established, become difficult to extinguish even in the face of dramatic, and at times, numerous negative consequences” (DiClemente, 2018, p. 4). DiClemente (2018) identified three critical dimensions required to identify an addiction:

• The development of a solidly established, problematic pattern of pleasurable and reinforcing behaviour
• The presence of physical and psychological components of the behaviour pattern that create dependence
• The interaction of these components in the life of the individual that make the behaviour resistant to change

Thus, addiction is a term used to describe the state whereby someone develops compulsive behaviors, both physically and psychologically, and unable to stop their repeated involvement with it despite the negative consequences. Other than AOD use, it can also be applied to activities such as gambling and eating – they are often called process addictions.

Dependency

This is a process whereby an individual becomes both physically and psychologically reliant to a substance due to regular exposure.

Physical dependence occurs when an individual’s body has developed physiological reliance on a substance and their body has gotten used to functioning with the substance in it. This often presented in the form of withdrawal symptoms – when the substance is no longer administered, physical cravings for the substance occur. Physical dependence can also occur in the form of tolerance symptoms whereby a greater amount of the same substance has to be administered to achieve the same initial effect.

Psychological dependence occurs when an individual experiences the need to use a substance to function. Alcohol and other drugs tend to stimulate pleasure in the brain and individuals usually become addicted to this positive feeling. As a result, this can influence an individual mentally and emotionally, and often lead to individuals “crave” for the same initial euphoric feeling.

Substance Use/Misuse/Abuse

Substance use can be defined as using any substances for non-medical purposes (i.e., inappropriate situations) and in high dosage, and often leads to health or social problems that impact the individuals and/or their community (McLellan, 2017). Despite the continuous occurrence of major problems related to health, work, social, or legal consequences associated with the substance use, the individual still continues to be involved with the substance.

As mentioned earlier, there are different stages and categories involving AOD use that leads to different harms and consequences to many around the individual who uses AOD. Even though not everyone who uses AOD for non-medical purposes will develop a dependency to it, there are a handful of individuals who develop issues such as addiction, dependency, and misusing substances. So, why does this happen? Why do some individuals get addicted or dependent on substances while others do not? Many theories and models have been proposed to explain why some individuals develop addictive behaviours and use substances for non-medical purposes. We will be exploring a few of the most common models to understand why people might develop a dependency to AOD in the later part of this section.

Relapse

It requires a lot of time for individuals who uses AOD to recover from AOD dependence. A relapse is part of the recovery journey from AOD dependence. A relapse occurs when “a person stops maintaining his or her goal of reducing or avoiding use of alcohol and other drugs and returns to previous levels of use.” (Alcohol and Drug Foundation, 2019). For example, an individual decided to avoid using tobacco has been successful for two months. However, due to stress from work, they started smoking tobacco again and later return to their previous pattern of tobacco use.

There are many reasons why an individual experiences relapse. It may be due to personal challenges, problems at work, or any ongoing psychological and emotional issues that the individual is facing. It can also be due to social economic problems, for example, financial hardship or rejection by social support networks.

Relapse is different from a lapse. A lapse is a temporary pause from the individual’s goal to reduce or cease substance intake and followed by a return to original goals. For example, a university student who set a goal of reducing alcohol intake by three beers a month may end up drinking a five bottles of beer at a friend’s party. However, they return to their goal the following day and aim to only take three bottles of beer a month.

The Power of Words

In an earlier unit, you learned that language is powerful and that it matters a lot when discussing AOD and individuals who use AOD. Hence, it is encouraged that we use person-centred language, especially helping professionals, when working with clients. This is so that we can focus on individuals, instead of their AOD use, to reduce the negative stereotypes surrounding AOD. Take some time and read through this practical guide developed by the Alcohol and Drug Foundation (2020) on how to use the right words to reduce stigma surrounding AOD use.

Throughout this module and beyond, we will be using AOD/substance use, instead of AOD/substance misuse/abuse; individual who uses drugs/AOD instead of drug user/abuser; developed dependency on drugs instead of drug addiction. We also use AOD and substance interchangeably and both terms have the same meaning: alcohol and other drugs. However, there may be occasions that we use these terms in alternative forms to help with explaining concepts in AOD context.

Throughout human history, many theories and models were proposed to help us understand why individuals use alcohol and other drug and why some become dependent on drugs but not others by explaining dependence on AOD. Over time, these have been refined to better reflect the most up-to-date development of AOD use. We will explore a few influential theoretical models below and use an ongoing case study to help you better understand each of the models.

The Moral Model

In the 1500s, the use of alcohol and tobacco was introduced in the Western countries. The widespread (mis)use of these substances resulted in a range of social problems and many perceive that substance use was “problematic” and “morally wrong” (Lassiter & Spivey, 2018). The moral model views AOD dependency as a moral personal weakness that involves a lack of willpower, and is often viewed as a threat to the society (Stevens & Smith, 2014). It believes that dependency is an individual’s refusal to abide by a set of ethical or moral conduct and viewed as behaviours chosen by the individual freely that is “at best irresponsible and at worst evil” (Thombs & Osborn, 2019, p. 23).

As the moral model considers addiction as a “sin” and a result of free choice, many politically conservative groups, religious groups, and legal system tend to punish the individual who uses AOD. Thus, these groups perceive the most appropriate ways to treat the individuals who use AOD are through legal sanctions such as imprisonment and fines. For example, the crackdown on Chinese opium smokers in the 1800s. A more recent example, in many countries drivers who are caught under alcohol and other drugs influence are not considered for treatment programs but instead receive court sentences as punishments (Fisher & Harrison, 2017).

However, this model has been shunned by alcohol and other drugs professionals as it puts forward the stigma surrounding addiction and substance use (White, 1991, cited in Fisher & Harrison, 2017). Majority of people who stood by this model view AOD use and addiction as a personal choice and responsibility and therefore they impose a moral judgement around it. As a result, individuals who initially wished to seek assistance have diminished motivation and are now more reluctant to do so as there is a stigma around the reasons they chose to use AOD (Fisher & Harrison, 2017).

The Disease Model

This model takes up the medical viewpoint and proposes addiction as a disease or illness that an individual has. It proposed that addiction is a disease that is progressive and chronic whereby the individual holds no control as long as the substance use continues. In other words, their addiction will continue to deteriorate with the continuous AOD (Thombs & Osborn, 2019). It also proposes that individuals who uses AOD can never be cured from addiction, though it can be readily treated through sustained abstinence such as self-help fellowships and treatment community.

In the 1940s, Jellinek proposed a disease model in relation to alcoholism, arguing that it is a disease caused by a physiological deficit in an individual, making the person permanently unable to tolerate the effects of alcohol (Stevens & Smith, 2014). Jellinek identified signs and symptoms and clustered them into stages of alcoholism, as well as progression of the disease, which form the basis of 12-step or Anon-type programs (e.g., Alcoholics Anonymous and Narcotics Anonymous; Stevens & Smith, 2014).

Under the disease model, treatment requires complete abstinence. Once an individual has accepted the reality of their addiction and ceased substance use, they are labelled as being in recovery, but are never ‘cured’ (e.g., “Once an alcoholic, always an alcoholic”; Thombs & Osborn, 2019). While Jellenik’s disease model was originally applied to alcohol dependency, it has now been generalised to other substances and many traditional substance use treatment models are based on this model (Capuzzi & Stauffer, 2020; Stevens & Smith, 2014).

The disease model offered an alternative to the moral theory, helping to remove the moral stigma attached to addiction and replacing it with an emphasis on treatment of an illness (Capuzzi & Stauffer, 2020). Disease theory helped to explain how some people experience the physiological effects of addiction such as dependence, tolerance, and withdrawal more than others, and how these mechanisms are caused by a biochemical abnormality in an individual which increases their likelihood of developing a dependency (DiClemente, 2018).

Capuzzi and Stauffer (2020) summarise the principles of the disease model:

• Addiction is a primary disease rather than being secondary to other conditions (e.g., depression).
• The disease is chronic, progressive, and incurable.
• If an individual has the disease, there is no treatment method that will enable them to use a substance again without reverting to problematic use – addicts must abstain.
• The idea that addiction is both chronic and incurable is the reason that addicts who are maintaining sobriety refer to themselves as ‘recovering’ rather than ‘recovered’.

While the disease model was well received by a range of professionals, many criticised it because research did not find that the progressive, irreversible progression of addiction through stages always occurs as predicted (Capuzzi & Stauffer, 2020). Additionally, many in the AOD field argued that the model did not address the complex interrelated factors that accompany dependency (Stevens & Smith, 2014). Finally, some professionals argued that the concept of addiction being a disease may also convey the impression to some individuals that they are powerless over their dependency and/or not responsible for the consequences of destructive addictive behaviours, which can be counteractive to treatment (Capuzzi & Stauffer, 2020).

Genetic and Neurobiological Theories

These theories suggest that some people may be genetically predisposed to develop drug dependency. For example, individuals usually begin substance use on an experimental basis. They then continue using because there is some reinforcement for doing so (e.g., a reduction of pain, experience of euphoria, social recognition, and/or acceptance, etc.). Some people may continue to use substances in a controlled or recreational manner with limited consequences while others progress to non-medical use and eventually develop a dependency. Why? Genetic and neurobiological theories propose that this is the result of a genetic predisposition to drug dependency (Fisher & Harrison, 2017).

There are various studies that found a link between genetic factors and substance use. For example, although genetic factors have not been established as a definitive cause of alcoholism, the statistical associations between genetic factors and alcohol use are very strong.

Capuzzi and Stauffer (2020) cited evidence that:

• Adopted children more closely resemble their biological parents than their adoptive parents when it comes to their use of alcohol.
• Alcoholism occurs more frequently in some families than others.
• Alcoholism rates are higher in identical twins (who share the same genetic make-up) compared to fraternal twins.
• Children of alcoholics can be as much as seven times more likely to be addicted than children of people who are not alcoholics.

Factors being considered by researchers in the genetic transmission of dependency on alcohol include neurobiological features such as an imbalance in the brain’s production of ‘feel good’ neurotransmitters or in the metabolism of ethanol, which is the key component of alcohol (Stevens & Smith, 2014). Other researchers explored genetic differences in temperament and personality traits which they argued may lead to certain individuals becoming more vulnerable in the face of challenging environmental circumstances, leading to AOD use (Stevens & Smith, 2014). Genetic predispositions such as these may explain why some individuals develop dependency on AOD while others in similar situations do not.

The Psycho-dynamic Model

This model proposes that substance use may be due to an unintentional response to some difficulties that an individual experienced in their childhood. This explanation is based on the theory that was put forward by Sigmund Freud, whereby the problems of whether we are able to cope with difficulties as adults are linked to our childhood experience. Many counselling approaches today are based on this theory which aim to seek understanding of people’s unconscious motivations and to enhance how they view themselves (Capuzzi & Stauffer, 2020).

Capuzzi and Stauffer (2020) also mentioned that dependency on AOD may be a symptom of the individual’s underlying psychopathology. This may be caused by their difficulty to regulate emotions and/or disturbed early attachment to primary caregivers. This model also believes that AOD use is often secondary to a primary psychological issue. In other words, alcohol and other drugs are used to temporarily relieve or numb emotional pain. For example, an individual suffering from depression might self-medicate with stimulants to relieve the enervating effects of depression or manage their anxiety by using benzodiazepines (Fisher & Harrison, 2017).

There is evidence to support this model, whereby childhood traumatic events are associated with mental health problems and substance use disorders. Wu et al. (2010) conducted a study among 402 adults who were receiving substance use disorder treatments. They revealed that almost all (95%) of the participants experienced one or more childhood traumatic events, and 65.9% of them experienced emotional abuse and neglect from their childhood. The authors also reported that the higher the number of childhood traumatic events experienced, the higher the risk of substance use disorders and mental health problems such as post-traumatic stress disorder.

Personality Traits

Some theorists suggest that certain individuals have certain personality traits that are linked to AOD dependency, whereby there is an “addictive personality type”. In other words, people developed the habit of AOD use to fulfil a purpose that is related to the individual’s personality profile (Eysenck, 1997, cited in Teesson et al., 2012). For example, dependency on alcohol has been associated with traits such as dependency, immaturity, impulsivity, high reactivity and emotionality, low frustration, and inability to express emotions (Capuzzi & Stauffer, 2020).

Social Learning Model

This model suggests that social processes such as modelling and cultural norms are important in the process of learning behaviours. According to the social learning model initially proposed by Albert Bandura, substance use is initiated by environmental stressors or modelling people around you with perceived status. It is important to note that the model acknowledges the influence of social context on an individuals’ learning behaviour, especially the influence from family and peers. For example, when a child observes that their parents use alcohol excessively in social situations, they will be more likely to perceive that AOD use for social situations are appropriate, and seeing it as a means to create social comfort and fun (Harrison & Fisher, 2017). Below is an extract from Wilson (1988) defining modelling, or, observational learning:

The social learning model also recognises the influence of cognitive processes such as coping, self-efficacy, and outcome expectancies. There are various research and literature that are currently focusing on how expectations of effects of drugs influence the pattern of AOD use and dependency on AOD. Russell (1976, cited in Wise & Koob, 2013) suggested that dependency on substance is not only chemical but also behavioural and social in nature.

In other words, this theory focuses more on the individual’s thoughts and feelings about the substance, as well as the experience under the substance’s influence. For example, youths may initiate substance use when around peers who have substance use history through observing and modelling their peers. This may be due to them believing that the substance use will have positive impacts such as allowing them to “fit in” better within the peer group and more fun to be with.

It has also been suggested that substance use occurs when an individual is overwhelmed by their coping capabilities and sees substance use as a learned coping mechanism. This is in response to severe stressors and in hope to relieve from them (Stevens & Smith, 2014).

Socio-Cultural Model

Different from the previous models, the socio-cultural model perceives substance use as an issue of society as a whole instead of focusing only on the individual. People tend to overestimate the influence of internal and psychological factors while underestimating the external and environmental factors, even among some helping professionals. Gladwell, 2000, cited in Lewis, Dana, & Blevins, 2015). Thus, this model highlights the importance of how society shapes substance use behaviours, such as cultural attitudes, peer pressures, family structures, economic factors, and more (Bobo & Husten, 2000). For example, Coffelt et al. (2006) found that parents’ alcohol use are associated with their children’s drinking behaviour, whereby when the adult’s alcohol problems increased, the likelihood of their adolescent child’s alcohol use increased.

The Biopsychosocial Model

After looking at the different models, it is apparent that there is no one single factor or model that is able to fully explain the causes and maintenance of substance use behaviour. All these factors, biological, psychological, learning, social context, all contributes to explaining why addiction occurs and maintains. Therefore, the interactions between these factors are presented in a different model – the biopsychosocial model – one of the most commonly used model to explain addiction today. This model was proposed by George Enel in 1977, a psychiatrist who suggested that there was a range of problems with using the biomedical model to explain substance use, which only focused on biochemical aspect of the body. With this model, substance use and the progression of its dependency can be explained in a way that the body and mind are connected within a social and cultural context (Skewes & Gonzalez, 2013). Below is a diagram of the model with the some example factors:

Reasons for AOD use

Psychological:

• Learning
• perceptions
• stress management strategies
• emotions

Social:

• Social support
• family background
• interpersonal relationships
• socio-economic status

Biological:

• Generic predisposition
• neurochemistry
• effects of medication

The biopsychosocial model is extremely useful in helping us to understand and assess AOD use and its dependency in a more thorough and individualised way. It allows any combination of these factors to contribute to the reason of AOD use and its dependency, rather than a single dominating factor. This way, a holistic and integrative approach is employed to identify and understand the determinants of AOD use (Stevens & Smith, 2014).

Additionally, his learning and conditioning experiences with both this father and peers involved the use of substances. Furthermore, he lives and works in an environment where substance abuse is considered ‘the norm’. All of these factors contribute to his substance abuse.

In this section, you learned the different patterns of substance use and its harms and impacts. We also went through various models that are being used to explain why people develop dependency, and help us understand why people maintain these behaviours despite the negative consequences. However, it is important to remember that not everyone who uses AOD develops a dependency. The different models can help us to understand the causes and factors of AOD use, which helps inform a more appropriate treatment/intervention plan for clients.

It is also important to remember that there is no one single reason that led to an individual to start using AOD. Therefore, as helping professionals, it is extremely crucial that you do not have a universal concept on the cause of behaviours but remain open-minded that different factors can interact with one another and consequently lead to AOD use.

In the next section of the module, you will learn about the different pharmacological properties of the different drugs. By having an understanding of the different drugs, you will be able to understand your client’s circumstances better and can assist you to develop a more appropriate treatment plan with your client.

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