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THEORETICAL MODELS AND APPROACHES
Theoretical Models and Approaches Paper
Lyndsey G. Harris
Department of Clinical Mental Health Counseling, Liberty University
COUC691: Substance Abuse Counseling
Dr. Charlotte Crosland
June 20th, 2021
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THEORETICAL MODELS AND APPROACHES
Theoretical Models and Approaches Paper
Addiction, simply, is the dependence or “need” for a substance, act or activity and is
caused by a variety of causes. Just as there are a variety of substances, activities or acts that a
person may become addicted to, there is no one approach that is standard for the treatment of all
addiction. People are also different from one to another, which is also another reason to have
more than one approach. Based on research, this paper will cover The Moral Model, The
Psychological Model, The Family Model and The Disease Model. Within each of the models
presented in this paper there will be a brief overview, a provided example and reasoning for
support.
The Moral Model
Overview
Each culture has its own sense of moral beliefs, and this model is all about what the client
believes. As young children, many are taught the difference between right and wrong and
acceptable and unacceptable behavior, which is also the foundational principles of this model
(Capuzzi & Stauffer, 2020). It is noted that those who do well by using this model as a
therapeutic intervention that they end up believing that there is “something morally wrong with
people who use drugs heavily” (Capuzzi & Stauffer, 2020). This model explains how addiction is
a “consequence” of personal choice and those who engage in these behaviors can make other,
more appropriate choices (Capuzzi & Stauffer, 2020).
Example
One example of this model would be a former co-worker of mine from working
Emergency Medical Services (EMS). My co-worker was a paramedic, and as a paramedic, you
have access to the narcotics that are carried on each of our units. These narcotics must be
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THEORETICAL MODELS AND APPROACHES
accounted for and used only when the patient needs them. Over a period of months, this
employee started to display symptoms equivalent to opioid usage such as wearing long sleeves in
the summer, sleeping more than normal (even when transporting a patient to the hospital), crying
or being overly tearful and having erratic mood swings. The employee was never caught stealing
drugs from the units; however, she was caught with some of the same drugs that are carried on
the unit in her system after the supervisor mandated a drug test. This employee admitted that
what she had been doing was morally wrong and she had guilt from her actions. However, this
employee also stated that she had so much stress going on at home that she felt she “needed” to
do the drugs to not feel overwhelmed and have such depressive thoughts. Treatment was offered
to the employee after temporarily suspending her license and the employee is still in recovery.
Reasoning
The Moral Model is a good example for this situation because this employee realized her
wrongs and now sees a problem with engaging in drugs at all. This employee knew that she had
to make the right decision if she ever wanted to work as a paramedic again and therefore, she had
to make the hard decision, however the right decision to continue to make an effort every day to
continue to work on her recovery. In the months leading up to this employee’s termination, there
were several employees and our supervisors who used several motivational interviewing
techniques to talk to this employee. Some of the techniques that we used with her were reflective
and active listening, engaging with her in conversation, not making her feel that she was “crazy”,
rather that she was heard and seen. However, the most useful motivational interviewing
technique that we utilized with her was planning, which strengthened her “own motivation and
commitment to change” (Miller & Rollnick, 2013).
The Psychological Model
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THEORETICAL MODELS AND APPROACHES
Overview
The psychological model explains that there are 5 things that a person who has become
addicted to a substance needed to change to recover: attachment, behaviors, cognitions, learning
processes or psychic drives (Capuzzi & Stauffer, 2020). The cognitive-behavioral model uses
cognitive and behavioral motivations and reinforcements to add in the recovery process (Capuzzi
& Stauffer, 2020). One study by (Myers et al.,2019) examines the effect of substance abuse
history and academic success correlate together. In this study, they note that personality traits of
everyone are imperative to look at their success and are determined by their “behavior, thoughts,
and feelings” which “can be seen as relatively stable in different situations and overtime” (Myers
et al., 2019).
Example
One example of this is a woman whose story I heard in a Narcotics Anonymous Meeting
(N.A). This woman who had tried to numb her pain of losing her husband with drugs and
alcohol. She stated that after a while of drinking, she was able to quit, however, she could not
fully stop taking the drugs alone. Anytime that she did stop taking the drugs for a few days, she
stated that she could work herself through the withdraw symptoms, even if that meant going to
the hospital for additional treatment, however, she couldn’t stop the negative automatic thoughts
she conceived about herself each time she stopped. Her family and friends made snarky
comments about her physical appearance and how they never thought she would never make
anything of herself again. They were less than supportive, and this woman decided she needed
more professional help outside of the NA group.
Reasoning
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THEORETICAL MODELS AND APPROACHES
A cognitive-behavioral psychological approach would probably work best for this client
because it sounds as though she has a lot of thoughts and emotions to work through. In CBT type
of interventions, the intervention begins with the therapist walking you through automatic
negative thoughts and emotional regulations and then arriving at changing behaviors as a result.
The goals of focusing on the cognitive-behavioral aspect of healing are “to identify and change
faulty information processing and to modify beliefs that support psychological dysfunction to
ones that are more adaptive” (Murdock, 2017).
The Family Model
Overview
Family members are just as important to the recovery process of an addict as the addict
themselves. Our text mentions how early on, family members were not included in the therapy
process, however, it was found that family members could be influential in motivating the addict
(Capuzzi & Stauffer, 2020). There are three models of the family model: behavioral model,
family systems model, and family disease model. The family systems model focuses on how
some family members may feel threatened if the addict starts to act more responsible because
they would then need them less (Capuzzi & Stauffer, 2020).
Example
A prime example of the family systems model would be my aunt as the addict and my
grandmother. My aunt has been on and off drugs for most of my life. She is in her upper thirties
and began using drugs because of two failed and abusive marriages. After the second marriage,
my aunt and her two kids moved in with my grandmother (her mother). My aunt was injured and
was given pain medication, which she later became addicted too. Over the years, I have watched
my grandmother beg for my aunt to “get it together”, and how this has now turned into a
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THEORETICAL MODELS AND APPROACHES
dependence relationship. My family and I agree that my grandmother does too much for my aunt
and often enables the addiction. As a result, my grandmother has agreed to and has been
attending Al-non meetings for a few months now to gain support for this problem in her life.
Reasoning
The family systems model is an important model for a counselor to consider because
family members are probably the most important influence and opinion of the addict. Research
states that “substance misuse behaviour within a family context adds a powerful perceptive to
our understanding of these baffling behavioral disorders” (Steinglass, 2009). In this article, the
author goes on to give another reason for family members to be involved in the recovery of the
addict, saying, “many of the more exciting approaches to substance misuse treatment incorporate
techniques that bear striking resemblances to techniques that have been used with equal success
by family therapists” (Steinglass, 2009).
The Disease Model
Overview
According to the Disease Model, addiction is viewed as “a primary disease rather than
being secondary to another condition (Capuzzi & Stauffer, 2020). One study by Hall used
animals that would self-administer drugs to themselves to see the behaviors and research
addiction as a disease (Hall et al., 2015). It was noticed in the study that dopamine signaled a key
role in the brains reward’s system as they noticed the animals working harder to obtain the drugs,
showing greater tolerance overtime, must like a human does (Hall et al., 2015). The researchers
used this evidence to argue that addiction is a disease (Hall et al., 2015).
Example
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THEORETICAL MODELS AND APPROACHES
One example that comes to my mind would be watching the TV show called Intervention
(Benz & Branton, 2021) where individuals who are addicted to substances demonstrate the
disease model due to their dependence on the drug or substance. Many of the individuals who are
on the show are dependent upon these drugs and will work harder and hard, pulling themselves
away from their families and their lives just to get a “fix” of a substance. This show uses real life
examples of addicts who are addicted to several different substances and give them the option to
get better through going to a recovery program or denying the option to get better.
Reasoning
The disease model is an important model to remember because many of the individuals
who are addicted to a substance do not understand how to quit. These individuals need help
realizing that the bigger issue that is underneath their addiction is a mental illness. Such
individuals often use a substance to cover up their pain that they may be feeling from their
mental illness and therefore the substance becomes a disease. Counselors and lay helpers alike
should understand that a substance is the primary disease that should be addressed first.
Conclusion
Knowing the models that could help those who are addicted to one or more substances
will benefit helpers in understanding how to best help the individual. Counselors should do their
research and study these models prior to using them with clients. Understanding that an addict
has a “need” for a substance and that they do not just do it for fun or attention will help the
helper provide empathy to the client.
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THEORETICAL MODELS AND APPROACHES
References
Benz,G. & Branton, M., P.P. (Executive Producer). 2005-2021 Intervention A&E United States.
Capuzzi, D., & Stauffer, M. D. (2020). Foundations of addictions counseling (4th ed.). New
York, NY: Pearson. ISBN: 9780135166932.
Hall, W., Carter, A., & Forlini, C. (2015). The brain disease model of addiction: Is it supported
by the evidence and has it delivered on its promises? The Lancet Psychiatry, 2(1), 105–
110. https://doi.org/10.1016/S2215-0366(14)00126-6
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd
ed.). New York, NY: Guilford. ISBN: 9781609182274.
Murdock, N., 2017. Theories of Counselling and Psychotherapy: A case approach. 4th ed.
United States of America: Pearson Education.
Myers, C. D. (2019). The Big Five Inventory, Substance Abuse History, and Academic Success
among Students Majoring in Substance Abuse Counseling (Order No. 27545965). Available
from ProQuest Central; ProQuest Dissertations & Theses Global; Social Science Premium
Collection. (2386383544). http://ezproxy.liberty.edu/login?qurl=https%3A%2F
%2Fwww.proquest.com%2Fdissertations-theses%2Fbig-five-inventory-substance-abuse-
history%2Fdocview%2F2386383544%2Fse-2%3Faccountid%3D12085
Steinglass, P. (2009). Systemic-motivational therapy for substance abuse disorders: An
integrative model. Journal of Family Therapy, 31(2), 155–174.
https://doi.org/10.1111/j.1467-6427.2009.00460.
