Comprehensive Model of
Addiction
Richard Matthews
Comprehensive Model of Addiction Revised
Genetic
Predisposition
Chaotic
Environment
Abuses
Stress
Dissociation
Primary Addictions
Food & Sex
Bitter Root
Spiritual
Dis-ease
Distractions
TV & Fantasy
Shame
Psycho/Social Stressors
Progression
Stress
Stress
Obsession of
The Mind
Dissociation (Fog)
Facilitators
Apocalypse
Rituals
Chaos
Shame
Increased
Tolerance
Habituation
Anxiety
Fear
Guilt
Arousal
Phase
Negative Payoff
Core Beliefs
Reinforced
Release
Cruising
Acting Out
Using
Craving
Bodily
? Restless
Irritable
Discontent
The Comprehensive Model of Addiction applies for all addictions and can be
used to graphically display the Cycle of Addiction as well as the origins of
addiction.
This model based upon the disease model of Alcoholics Anonymous and the
bio/psycho/social/spiritual model requires some basic understanding of these
models.
Definition of Addiction
• WHO
• A Pathological Relationship with any Mood
Altering substance or experience.
• A life damaging relationship
• Two questions
• Can you control how much you use once you
start using?
• Can you control the stop and stay stopped?
Bio/Psycho/Social/Spiritual
• Biology = Family History, Genetics
• Psychological = Childhood Trauma
• Social = Poverty, Alienation, Despair, &
Disparity - PAD
• Spiritual = Values & Beliefs, a Relationship
to something greater than oneself.
Biology
•
•
•
•
Twin Studies
Family History of Addiction
Genetic Predisposition
Dopamine D2 receptor site deficiency
Psychology
•
•
•
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•
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Chaotic Childhood
Childhood Trauma
“Breach of the We” Unity Experience
Fritz Kunkel
Shame = there is something wrong with me
Egocentric i.e. Narcissism
Social
•
•
•
•
•
“Breach of We” = loss of at-one-ment
Feelings of Alienation
Not Belonging
A sense of being other than, othered
Further sense of Shame
Spiritual
• Loss of connectedness to the mother
• Loss of connection to something greater
than myself
• Unconditional Love replaced by conditional
Love
• Separateness
• No Atonement
Padd
•
•
•
•
•
Poverty
Alienation
Despair
Disparity
= More Shame
Codependency Definition
An attachment disorder resulting in an internal breach with the
authentic self producing a search for meaning and identity
externally from another. This search results in the sufferer
becoming dependant upon another for self-worth, meaning and
significance
A codependent’s dependency needs were unmet in childhood
and as a result they become dependant on another person,
object or experience. One could say that traditionally women
become codependent in their relationships with men while men
are codependent on their jobs for feelings of significance, selfworth and security.
Harm Reduction is a Response
Harm reduction is a non-anxiety driven
strategy with a clearly defined purpose and
goal. Harm reduction is an attempt to
minimizing the health consequences of the
behaviour until the person is in a position
where change becomes possible. Harm
reduction strategies usually result in
decreased isolation and increased exposure
to health care professionals thus facilitating
change.
Enabling Behaviour is a Reaction
• Any behaviour motivated by fear or anxiety
that attempts to protect another from non-life
threatening direct consequences of their
behaviour. Enabling behaviour is a short-term
anxiety driven solution that is non-purposive
and has no long-term goals attached to it.
Enabling behaviours arise from the enabler’s
emotional attachment to the person
exhibiting the maladaptive behavior. Enabling
behaviour is usually designed to reduce the
stress of the enabler.
Treatment
• Substance use must be understood as an
essential and integral part of the person. It is
not a pathological part that can be treated
outside of the whole person and removed.
Addiction must be understood as a
systemically holistic disease that affects the
body, mind, emotions and Soul. If treatment
of any aspect of the disease is omitted
treatment failure is likely.
Stages of Change
Precontemplation
Has no intention to take action within the next 6 months
Contemplation
Intends to take action within the next 6 months.
Preparation
Intends to take action within the next 30 days and has taken some behavioral
steps in this direction.
Action
Has changed overt behavior for less than 6 months
Maintenance
Has changed overt behavior for more than 6 months.
Relapse: Not failure, an opportunity for fine tuning
Stages Of Change 2
STAGES OF CHANGE
STAGES OF CHANGE AND WHAT CAN BE DONE
CLIENT’S STAGE
COUNSELLOR’S MOTIVATIONAL TASKS
Precontemplation
Raise doubt - increase client’s perception of risks and problems with
current behavior.
Contemplation
Tip the balance - evoke reasons to change, risks of not changing;
strengthen the client’s self-efficacy for change of current behavior.
Determination
(Preparation)
Assist the client to determine the best course of action to take in seeking
change.
Action
Assist the client to take steps toward change. Are there barriers?
Maintenance
Assist the client to identify and use strategies to prevent relapse.
Relapse
Assist the client to renew the processes of contemplation, determination,
and action, without becoming stuck or demoralized because of relapse.