3.1.2. After reading this article:
The chapter by Teesson et al. (2002) will have presented you with a clearly written initial orientation to addiction. The article introduced addiction at several different levels of explanation in what the authors term a ‘biopsy chosocial model’ (p. 47). Such an integrated model is at the heart of the approach taken in presenting the SD805 course. In retrospect, your personal viewpoint may now appear fragmented, with apparently disconnected topics or perhaps with a cluster of biased opinions. Teesson et al. should have persuaded you that the subject of addiction and drug dependence is complex, integrated, wide-ranging and far from well understood.
The first level of the ‘biopsy chosocial model’ explained drug dependence in terms of the biological effects on the brain and nervous system, and detailed the molecular and cellular sites of specific drug action (p. 34). The article concentrated on the two principal nerve systems in the brain that are affected by drug abuse. The first pathway is the ‘mesolimbic-frontocortical dopamine system’ (containing the mesolimbic and mesocortical dopamine pathways), which is central to processing neural information about meaningful stimuli and pleasure. The second pathway involves endogenous opioids that are involved in satiation and consummatory aspects of reward. The integrated function of both systems underlies pleasure and reward. Don't worry if these are unfamiliar concepts, as their importance will gradually unfold as you progress through the introductory articles. The second level of the model provided an introduction to the theme of genetics – a fundamental topic in addiction research, which is considered in greater depth in an article by Dick and Foroud (Dick D.M., Foroud T. (2003) Candidate genes for alcohol dependence: a review of genetic evidence from human studies. Alcohol Clin Exp Res. May; 27(5): 868–79.). The third level went on to discuss the classical psychological approaches to understanding drug dependence – behavioural models, cognitive theories, personality theories and models of rational choice. Here again, some of these topics will be explored in greater depth as the course progresses.
Teesson et al. conclude their article with a consideration of what they call ‘contextual factors’, i.e. social and environmental issues that are implicated in substance use, abuse and dependence. Contemporary research indicates that such factors cannot be ignored: the sociocultural background of a person will greatly affect their vulnerability to addictive behaviour and to possible subsequent treatment and therapy.
The ‘Summary’ on pp. 46–47 is a particularly good concise overview of research into addiction and addiction disorders. One important point emphasised by Teesson et al., that will recur frequently, is that there are clearly several levels of interrelated research – genetic, molecular, neuropharmacological, psychological and sociocultural – into how and why people become and remain addicted to psychoactive substances and activities. What is currently needed is an integrated approach to the subject area, drawing the various strands together into a more coherent theory of the nature of addiction. Many people who study addiction are unaware of the different areas and levels of enquiry and how they interrelate – bear these latter points in mind as you continue your studies.
Teesson asks the question (p. 38): ‘Do persons have a vulnerability towards one specific drug, or is there a more general vulnerability to a class of drugs or, indeed, to any psychoactive substance?’ Some of the issues underlying this question are taken up in the next article.
Click to view 'Dick and Foroud' article