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THEORETICAL MODELS AND APPROACHES
Benchmark Theoretical Models and Approaches
Author Note
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THEORETICAL MODELS AND APPROACHES
Benchmark Theoretical Models and Approaches
Part of understanding addiction is understanding that there is not one approach, modality,
or model that works for every client. Each client presents differently as they may come from
different cultural backgrounds, could have genetic predispositions, could have psychological
comorbidity, or come with their own physiological reasons. These factors should be taken under
consideration by a counselor prior to developing a treatment plan and deciding on a model. In
order to come to an educated decision of which model or approach to use, it is important for the
counselor to understand the models that exist. There are eight categories of models that have
been explored during this course work. The goal of this writing is to take four specific models
from the eight categories and summarize, explore biblical principles that relate, and identify the
alignment between the model and addiction. In this writing the four models explored will be the
Family Disease Model, Cognitive-Behavioral Model, Disease Concept Model, and Supracultural
Model. Each of these models falls under a different category of models including family models,
psychological models, disease models, and moral models.
“All models are wrong, but some are useful” – George E.P. Box (Box, 1976).
This quote seeks to aim as reminder that usefulness and application of a model is the important
focus rather than the insufferable search for a model that is correct in all cases.
Family Disease Modal
Family members originally were not considered during the early ages of addictions
counseling, and instead were solely focused on the addict themselves (Capuzzi & Stauffer,
2020). As addictions counseling developed, familial relationships were found to be incredibly
influential in the motivation of addicts remaining sober, so family models were developed in
response. The Family Systems Model looks specifically at the roles within families and how the
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interrelated (Capuzzi & Stauffer, 2020). As addicts begin to work through treatment or an addict
begins to show signs of desiring recovery some family members may notice a risk to the familial
functioning. Roles could likely shift within a family system as the addict shows signs of
recovery. The text provides the example of the role of caretaker that a family member may have
assumed being no-longer needed, therefore this family member may feel threatened (Capuzzi &
Stauffer, 2020). Roles shifting may induce anxiety, conflict, and resistance within the family
system. This model focuses on the family as a whole rather than just the addict as the family
system and the internal roles could be a risk factor to sobriety. It has been discovered that lack of
interaction and communication between clients and family members can increase the risk of
relapse (Matthew et al., 2018). The model promotes the involvement of the family within the
treatment in order to reduce risk factors. Additionally, this model focuses on increasing
protective factors for the addict and the family such as support, bonds, recognition, and problem-
solving skills.
Biblically the family unit is vital and it is encouraged to focus on familial functioning as
it glorifies God. Parents are encouraged to lead, protect, and value their children as they are a gift
from God Psalms 127:3 – 5 states:
“Children are a heritage from the LORD, offspring a reward from him. Like arrows in the
hands of a warrior are children born in one’s youth. Blessed is the man whose quiver is
full of them. They will not be put to shame when they contend with their opponents in
court.” (NIV).
Children are encouraged to honor their father and mother Exodus 20:12:
“Honor your father and your mother, so that you may live long in the land the LORD
your God is giving you.” (NIV).
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Man is commanded to manage their household as it is vital in his ability to care for God’s
church, 1 Timothy 3:5 states:
“For someone does not know how to manage his own household, how will he care for
God’s church?” (NIV).
This model focuses on the family unit as it is powerful and influential not only in one’s own life
but in the eyes of the LORD. Cultivating a strong and resilient family ensures a vigorous force
against the enemy.
Family disease model not only addresses the genetic and biological influences on an
addict, but targets the functioning of the family as a whole to ensure that risk of relapse is
reduced and protective factors are in place to encourage the overall health and synergy of the
family. Families are directly impacted by the impacts of addiction, and without consideration of
the family the addict is at greater risk due to possible resistance from the family. The importance
of interpersonal factors such as social support both positive and negative from family, friends,
and spouses/partners is not to downplayed (Capuzzi & Stauffer, 2020). Even the support of one
individual has been proven to influence better outcomes (Capuzzi & Stauffer, 2020).
Cognitive-Behavioral Model
Psychological models such as cognitive-behavioral model provide explanations for the
process and substance addictions. Psychological models aim to address and understand the
mechanisms of change such as learning processes, psychic drives, attachment, behaviors, and
cognitions as they can be the primary cause of addiction (Capuzzi & Stauffer, 2020).
Specifically, cognitive-behavioral model focuses on the cognitive and behavioral interactions as
reinforcers.
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Transformation of the mind biblically is to turn away from the world and flesh as it leads
one to death, but through transformation of the mind through God leads to eternal life. To have a
mind of the world and flesh is to be shackled, but through transformation we are set free.
Romans 8:6 states:
“For to set the mind on the flesh is death, but to set the mind on the Spirit is life and
peace” (NIV).
Understanding the ways of the world and sin met with trust and transformation by the Spirit one
is equipped with discernment to determine what is of God. Romans 12:2 states:
“Do not be conformed to this world, but be transformed by the renewal of your mind, that
by testing you may discern what is the will of God, what is good and acceptable and
perfect.” (NIV).
Discernment is not just had, it takes trial and trust in the Spirit. Through this process our
behaviors and emotions related to what is not good in the eyes of the LORD are altered.
Cognitive-behavioral model provides clients with the knowledge and understanding the mind
aiding in client’s developing discernment.
A dependent behavior such as using substances or alcohol is influenced by the degree of
reinforcement the addict perceives as occurring (Capuzzi & Stauffer, 2020). As this behavior and
reinforcement cycle continues it is met by the brain adapting to the presence of the substance use
leading to withdrawal symptoms. Cognitive-behavioral model is met with criticism if strictly
utilized due to the neurobiological reward system being difficult to control similar to compulsive
disorders (Capuzzi & Stauffer, 2020). However, cognitive-behavioral model is commonly
utilized to provide a model of understanding the cycle and the cognitive-behavioral
reinforcement of the addiction. Cognitive-behavioral models focus on the interconnected points
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of cognitions, behaviors, and emotions and it can be impactful in breaking negative thought
patterns.
Disease Concept Model
Shifting gears from the psychological models, the disease concept model does heavily
consider the neurobiological reward system. However, it is important to address that this model
is viewed as controversial, as it is claimed that it may increase stigma for people with addictions
(Barnett et al., 2017). Additionally, the disease concept model addresses that addiction is a
disease that chemically alters the body and suggests that an addict is ill at the genetic level
(Capuzzi & Stauffer, 2020). The birth of the American disease concept model of alcoholism in
the early 18th century was brought on by the writings of revolutionary armies (Capuzzi &
Stauffer, 2020). The model views addiction as a primary disease rather than secondary to another
condition.
Abstinence from substances that do not promote the health of the body is not a subject
that is ignored in the word of God. Rather, it is encouraged to abstain from such substances and
the sobriety of the mind is held in high-esteem, as our bodies are not our own and is in fact the
temple of the Holy Spirit. 1 Corinthians 6:19 – 20 directly states this:
“Or do you not know that your body is a temple of the Holy Spirit within you, whom you
have from God? You are not your own, for you were bought with a price. So glorify God
in your body.” (NIV).
Our bodies are to be treated as the vessel for the Holy Spirit to do work within us and around us,
therefore we are called to be weary of indulging in substances such as alcohol and drugs that dull
this ability. It is important to remember the significant symbolic weight and the gift from God
that wine is in the word of God, it also represents the life and sacrifice of Christ for our sins.
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However, excessive drinking and the dangers of drunkenness are incredibly cautioned.
Therefore, this model can reflect those dangers of drunkenness.
Although its birth can be tied back to the writings of the revolutionary war, E.M. Jellinek
is generally credited with introducing the model. Jellinek describes the progressive stages and
corresponding symptoms of the disease of alcoholism, but it has been generalized to addiction of
other substances as well (Capuzzi & Stauffer, 2020). The stages consist of prodromal, middle or
crucial, and chronic and were thought to be progressive and not reversible (Capuzzi & Stauffer,
2020). This model suggests that once an individual has the disease that it is chronic. The main
treatment factor of this model is abstinence.
Supracultural Model
Supracultrual model connects culture, social organization, and the use of alcohol. This
model examines the collective cultural attitude towards alcohol as it is thought to influence
alcoholism. These attitudes are categorized and are favored in order, abstinence, ritual use
connected with religious practices, convivial drinking in a social setting, and utilitarian drinking
with the fourth being seen as producing higher levels of alcoholism (Capuzzi & Stauffer, 2020).
Additionally, an important aspect of this model is the culture’s offering for alternatives to
alcohol use. Alternatives can reduce tension of alcohol use and substitute the means of
satisfaction (Capuzzi & Stauffer, 2020). Upward economic or social mobility is also emphasized
in this model as it will overwhelm or circumvent those who are not able to accomplish high-
levels of achievement in these areas. This is seen as another influence to high levels of alcohol
use. Cultures that merge high levels of achievement and lack of indulgence in children, and
negative attitudes toward dependent behavior in adults theorized by Bacon (1974) is to be
connected to high rates of alcoholism (Capuzzi & Stauffer, 2020).
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Suprscultual principles existent within Christianity appear to align with the supracultural
attitudes that are favored in relation to alcoholism. Within Christianity we are encouraged and
welcomed to rest as God did on the seventh day of creation, and this speaks to the high
achievement supracultural attitude mentioned previously. We are encouraged and invited to rest
along with God and so the Sabbath was made for man. Prior verses mentioned above speak to the
attitude that Christianity has towards alcohol. Wine is connected with religious practices and
celebration of life through Christ, however we are discouraged from over indulgence and
drunkenness unlike utilitarian use that suggests valuing alcohol for its potential benefits.
Supracultural models connect many of the principles that the ACA Code of Ethics
requires counselors to consider. Personal values and beliefs of our clients are of high importance
for counselors to consider, and simultaneously it is important to avoid imposing our own values
and beliefs onto our clients (American Counseling Association, 2014, A.4.b). Supracultural
models work to understand these values and beliefs in order to understand the risk level that our
clients are at for increased alcohol use or alcoholism. Working to reflect upon these risk factors
and the behaviors and condition of our client’s is impactful as it gives attention to those deep-
rooted influences that are present within our client’s experience.
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References
American Counseling Association. (2014). ACA code of ethics & standards of practice: As
approved by ACA governing council. American Counseling Association.
https://www.counseling.org/docs/default-source/default-document-library/ethics/2014-
aca-code-of-ethics.pdf?sfvrsn=55ab73d0_1
Barnett, A. I., Hall, W., Fry, C. L., Dilkes-Frayne, E., & Carter, A. (2017). Drug and alcohol
treatment providers’ views about the disease model of addiction and its impact on clinical
practice: A systematic review. Drug and Alcohol Review, 37(6), 697–720.
https://doi.org/10.1111/dar.12632
Capuzzi, D., & Stauffer, M. D. (2020). Foundations of addictions counseling (4th ed.). Pearson
Education.
Mathew, K. J., Regmi, B., & Lama, L. D. (2018). Role of family in addictive
disorders.LInternational Journal of Psychosocial Rehabilitation. Vol 22 (1) 65,L75.
The Holy Bible: ESV. (2001). American Bible Society.
