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Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition

Models of addiction

by Poonam Bhandari, PhD, Jackie Dial, PhD

Category: Diagnosis and prevention

Definition: Addiction is a long-term relapsing disorder characterized by compulsive drug-taking behaviors.

Addiction Models

During much of the 20^th century, two models of addiction opposed each other. One model presented addiction as a character flaw, a moral inadequacy for which addicts are condemned for failing to control themselves. The other model considered addiction as a disease of the brain in which chronic behavioral choices produce neurobiological brain adaptations that preclude choice.

The first model of addiction, which could be called the moral model, suggests that addicts deserve censure because they have allowed themselves to slip into addiction.

The second model of addiction, which could be called the disease model, regards addiction as way of coping with life. Reasons for addiction vary by person, but behavior choices made often enough eventually cause changes in the brain. The addicted person can no longer control her engagement with the addicted substance and will feel compelled to consume the substance.

With new data the classical models have evolved. Rather than viewing addiction as compulsion induced by weakness or disease, some argue that addicts have reasons of their own to choose to use. The emphasis is no longer on the question of control or its lack. Today we attempt to understand why addicts choose behaviors that can lead to addiction because, if addiction is chosen, why can’t it be un-chosen?

Addiction and Choice

Although evidence suggests that addiction indeed disrupts neurological function in the brain, such changes need not preclude choice. Rats addicted to cocaine will eschew cocaine when offered alternatives, such as sugar, that seem more appealing; addicted rats have also chosen same-sex snuggling over cocaine. If the ability to choose were obliterated by addiction, such choices would not be possible. After all, the most commonly used drugs—cannabis, nicotine, and cocaine—came from plants that evolved chemical dissuasions to discourage consumption. Animals including humans who nevertheless consume those plants are likely to have internal protections that enable them to use the substances in a limited fashion without being sickened by them.

Elvin M. Jellinek: Alcoholism Is a Disease

Elvin M. Jellinek and his associates provided the basis for diagnosing the potential alcoholic in what became known as the Jellinek phases of alcoholism, or the Jellinek curve. Early warning signs of alcoholism include: sneaking and gulping drinks; worrying about consuming alcohol but not talking about drinking; and blacking out, forgetting what happened while consuming alcohol.

Jellinek was born in New York City on August 15, 1890. After his elementary and secondary education was completed, he became a student at three European universities: Berlin from 1908 to 1911, Grenoble in 1911, and Leipzig from 1911, until he received his master’s of education degree there in 1914. Twenty-one years later, Jellinek earned a doctorate in science at Leipzig.

Following college, from 1914 until 1919, Jellinek was employed as a biometric consultant and as a library and field researcher. In the field of human physiology Jellinek was a biometrician at the Government School for Nervous Children in Budapest, Hungary, a post he held from 1915 until 1920.

Beginning in 1941, Jellinek taught at Yale University as an associate professor of applied physiology, and he directed the Yale School of Alcohol Studies at the university’s Laboratory of Applied Physiology. At Yale, he subscribed to the principle that alcoholism is a disease and that the alcoholic is a sick person, that alcoholics can be helped and are worth helping, and that alcoholism is a public health problem and therefore a public responsibility.

Jellinek wrote two texts on alcohol and was generally considered an authority on that subject and on the science of biometrics, the statistical analysis of biological observation.

An interesting slant on addiction comes from an unexpected source: Observations of people after they use such psychedelics as LSD, peyote, or mushrooms. Back in 1952, when doctors in Saskatchewan gave LSD to a pair of alcoholics, both stopped drinking alcohol, at least temporarily. With that encouragement the doctors tested LSD on around 1,000 alcoholics from six hospitals. The patients they treated were entrenched addicts, their lives heavily impacted and their bodies gravely damaged; all had tried and failed conventional treatments, including AA, and their addictions appeared insurmountable. Remarkably, after treatment with LSD somewhere between half and 70 percent of this population either stopped or significantly curtailed their drinking. (The researchers emphasized that it was not only the psychedelic substances that promoted the changes but also contributions by surroundings and therapist.) After the turmoil of the ‘60s, research into psychedelics fell out of favor. As methodological procedures improved around the turn of this century, psychedelic research began a slow comeback.

After a Russian addiction researcher reported striking results after treating people addicted to alcohol or heroin with just one dose of ketamine, an anesthetic with strong hallucinogenic effects often used in veterinary medicine, researchers took notice. In 2012, results of a small, initial study of alcohol-dependent people treated with psilocybin reported that most participants had steep drinking declines that persisted through a nine-month follow-up. The same researcher had promising results after a much larger, double-blind, placebo-controlled trial. A 2014 pilot study of psilocybin for 15 tobacco smokers who had previously and unsuccessfully tried to quit reported 80 percent abstaining from smoking at six months after the trial’s end. Since nicotine dependence is considered fundamentally physiological, those results are particularly intriguing. Could it be that certain psychoactive drugs can modify addictive responses to other substances?

Summary

As a chronic disease, addiction is the culmination of biological, psychological, and social maladjustments. It is a complex disorder shaped by substance exposure, genetic susceptibility, and environmental influences. Whether someone is born ready to be addicted, or formulates practices that result in addiction, the result is the same.

It is difficult to get a clear picture of what goes on in the brains of living people, but until that changes what happens physiologically may not be as important as understanding what enables addicts to recover. And it is increasingly apparent that choice is an important component in addiction. If people choose behaviors that bring addiction, then perhaps they can choose behaviors that end addiction as well.

For More Information

Bleyer, Jennifer. “A Radical New Approach to Beating Addiction.” Psychology Today, published May 2, 2017. Web: https://www.psychologytoday.com/ca/articles/201705/radical-new-approach-beating-addiction?collection=1102202

Bogenschutz, Michael P., et al. “Clinical Interpretations of Patient Experience in a Trial of Psilocybin-Assisted Psychotherapy for Alcohol Use Disorder.” Frontiers in Pharmacology. 9:100 (2018).

Erickson, Carlton. The Science of Addiction: From Neurobiology to Treatment. New York: Norton, 2006. Print.

Nestler, Eric J. “Cellular Basis of Memory for Addiction.” Dialogues in Clinical Neuroscience 15.4 (2013): 431–43. MEDLINE Complete. Web. 30 Oct. 2015.

Parekh, Ranna, MD (reviewer). “What is Addiction?” American Psychiatric Association (2018). Web: https://www.psychiatry.org/patients-families/addiction/what-is-addiction

Pickard, Hanna, et al. “Alternative Models of Addiction.” Frontiers in Psychiatry 6:20 (2015).

Schaler, Jeffrey. Addiction Is a Choice. Peru: Carus, 2000. Print.

West, Robert, and Jamie Brown. Theory of Addiction. 2nd ed. Chichester: Wiley-Blackwell, 2014. Digital file.

Citation Types

Type

Format

MLA 9th

Bhandari, Poonam, and Jackie Dial. "Models Of Addiction." Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition, edited by Paul Moglia, Salem Press, 2018. Salem Online, online.salempress.com/articleDetails.do?articleName=Addictions2e_0199.

APA 7th

Bhandari, P., & Dial, J. (2018). Models of addiction. In P. Moglia (Ed.), Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Salem Press. online.salempress.com.

CMOS 17th

Bhandari, Poonam and Dial, Jackie. "Models Of Addiction." Edited by Paul Moglia. Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Hackensack: Salem Press, 2018. Accessed September 13, 2025. online.salempress.com.

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