Models and Theories of Mental Health and Addictive Disorders
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Counseling CEUs and Specialty Certificates
Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery

Earn counseling CEUs for this course

Objectives
~ Explore why the mental health counselor needs to understand addictive behaviors
~ Learn the scientific and theoretical basis of models of addiction and mental distress from multiple disciplines
~ Develop criteria for assessing models and theories
~ Explore the appropriate application of models
~ Learn how to access addiction and mental health related literature from multiple disciplines

Why is this important to the Counselor
~ Prevalence (proportion of cases in the population) and incidence (number of new cases) of addiction is increasing
~ New understanding/awareness of behavioral addictions
~ Improved knowledge of clinicians across disciplines to diagnose
~ Enables the clinician to provide more ethical and comprehensive treatment to the client by understanding
~ The influence of drugs and certain behaviors on brain chemistry which could
~ Lead to the development of additional MH, Legal, health, social, economic or addiction problems
~ Negatively impact MH treatment progress
~ Less than % of people who try to stop an addiction succeed for more than days
~ Patients often interpret a systemic failure (what we don’t know or understand) as a personal failure leading to low self esteem, depression, guilt, shame
Criteria for Assessing Models and Theories
~ Does it explain the development of the condition in some people and not others (Predictive validity and reliability)~
~ Can this explanation be applied across people and situations (Generalizability)~
~ Can it be used to develop effective prevention and intervention strategies~
~ Does it explain the use of seemingly destructive behaviors~
~ Are there other unaccounted for factors which may influence development or recovery~

What are the Theories of Addiction
~ Biological/Disease Model
~ Moral/Spiritual Model
~ Behavioral Model
~ Environmental/Social Learning Model
~ Sociocultural Model
~ Enviro-Bio-Psychosocial Model
~ And many, many more….
Case Studies
~ John year old male reports no problems with addictive behaviors until years ago. Has had recurrent bouts of depression since he was .
~ Susan year old female began experimenting with drugs in high school. Currently does not meet criteria for any addictive or mood-related disorder.
~ Ralph is a year old male. Prior to this episode, reports no history of mental health or addiction issues. Recently had rotator cuff surgery and was on pain killers for days. Meets criteria for opiate dependence and generalized anxiety disorder.
~ Sally has a long history of major depressive disorder. She reports that after a recent surgery she was given Vicodin which she found made her feel much happier and more relaxed.
~ Julian is a year old male. Reports beginning recreational use of substances at . Currently meets criteria for generalized anxiety, marijuana dependence
Biological/Disease Theories
~ Include
~ Genetic predisposition
~ Brain dysfunction
~ Theory
~ Addiction and mental health issues are primarily a brain disorder
~ In mental health, neurochemical imbalances cause the mental disorder
~ In addiction, the brain is disordered causing “cravings” for behaviors or substances to balance or rebalance the system
~ Example: Craving for dopamine and norepinepherine releasing activities supports survival by motivating certain behaviors

Biological/Disease Theory
~ Addiction and mental health issues are diseases with symptoms and is incurable and progressive.
~ Strengths
~ As a disease it provides hope of being treatable
~ Removes societal stigma
~ Relieves feelings of guilt and shame
~ Limitations
~ Removes much of the responsibility from the individual
~ May provide “excuses” for relapse or avoid treatment
~ Assumes recovery upon achievement of abstinence
Biological/Disease Theory
~ Evidence
~ Serotonin and norepinephrine have both been implicated in the development of depression and anxiety.
~ Dopamine imbalances have been implicated in schizophrenia
~ The dopamine pathway is involved in motivation and reward processes
~ The prefrontal cortex is implicated in regulation of behavior
~ There are differences in that structure in people with addictions.
Biological/Disease Theory
~ Intergenerational, twin and adoption studies have shown some correlation with trends in type and frequency of addiction
~ Question: What else might cause mental health or addictive issues intergenerationally besides genes~
~ Adoption studies have shown that children from addicted parents are more likely to develop addictions, even if adopted.
~ Twin studies have shown that in identical twins, if one develops an addiction, there is a greater concordance toward addiction than fraternal twins
http://pubs.niaaa.nih.gov/publications/aa.htm
Biological/Disease Theory
~ Limitations
~ Fails to account for
~ Social/environmental influences
~ Higher-order cognitive processes
~ Most of the research for this theory has been done in non-human species.
~ No consistently useful interventions(SSRIs or MATs) have emerged from his theory, with the exception of certain nicotine replacement drugs
Biological/Disease Theory
~ Implications for prevention and treatment
~ Recognizes that changes within the brain are present in the majority of persons with symptoms of addictions or co-occurring disorders
~ Pharmacological interventions
~ Nutritional and health interventions to rebalance or restore functioning within the brain
~ Cognitive interventions to reduce distress which increases “stress” neurochemicals and improve mood which increases “reward” neurochemicals.
Biological/Disease Theory
~ Interventions cont…
~ Attainment of complete abstinence
~ Self-help support groups
Moral Model
~ Addiction and mood disorders are caused by a lack of will power or moral degradation (gluttony, sloth)
~ Willpower, motivation and determination to live by spiritual/moral principles are sufficient for recovery
~ Strengths
~ Emphasizes personal responsibility for choices and recovery
~ Limitations
~ Does not account for biological, environmental or social factors

Moral Model
~ Treatment Implications
~ Values clarification
~ Cognitive therapy
Behavioral Theory
~ Theory
~ Addictions and mental health issues are learned
~ Through direct experience
~ Social learning
~ Vicarious learning
~ Types of Reinforcements and Punishments
~ Reinforcement of negative thinking styles
~ Reinforcement of “helpless” behavior
~ Reinforcement of pleasurable or escape behavior (esp. when pleasure is lacking)
~ Lack of effective responses to deal with threats/stressors
~ Lack of reinforcers in the environment
Behavioral Theory
~ Theory
~ Learning is influenced by
~ Biology (what is rewarding and punishing)
~ Cognitions (cognitive behavioral)
~ Past learning
~ Situational antecedents
~ Reinforcement contingencies
~ Strength
~ Frequency
Behavioral Theory
~ Strengths
~ Behaviors are easily observed
~ Increases awareness of “triggers” or antecedents for behaviors
~ Treatment goals are easily defined for changing the behavior by modifying the triggers and consequences of behavior.
~ Limitations
~ May not encourage the involvement of the family and larger social system
~ Pressures (reinforcement contingencies) implemented by the family to maintain current behaviors are not directly addressed
Behavioral Theory
~ Treatment and Prevention Implications
~ Rewards encouraged are nondestructive, but often fail to have the reinforcement strength of the addictive behavior.
~ Enhance triggers and reinforcement frequency and intensity for alternate behaviors
~ Identify and reduce reinforcing properties of undesired behaviors
~ Reduce punishing properties of the new behaviors.

Socio-Cultural Theories
~ Theory
~ Environmental and social pressures contribute to the development of addiction and mental health issues including unemployment, single parenting, poverty and the attitudes of family, peers and society.
Environmental/Social Learning
~ Emotionally
~ Stress
~ Lack of education about coping skills
~ Physically
~ Nutrition
~ Safety
~ Health

 

~ Socially
~ Peer pressure
~ Observational learning
~ Spiritually
~ Absence of hope
~ Absence of love/compassion
~ Environmentally
~ Advertising
~ Laws
Socio-Cultural Theories
~ Strengths
~ Views issues within the context of the larger environment
~ Acknowledges the impact of social and environmental pressures in the development of mental health and addictive issues
Socio-Cultural Theories
~ Limitations
~ Largely ignores biological and genetic aspects of mental health and addiction
~ Does consistently explain why, in similar cultural environments, one person develops issues while another does not.
~ Treatment
~ The social environment of the person must be changed to improve family functioning and enhance cultural sensitivity
~ Unhelpful behaviors need to be replaced with helpful behaviors and triggers for those behaviors
EnviroBioPsychoSocial Model
~ Theory
~ Mood and addictive behaviors often result from an interaction of multiple factors producing dysphoric moods
~ Environmental influences
~ Triggers
~ Social Pressures
~ Biological influences
~ Brain changes (homeostasis)
~ Genetic predispositions
~ Nutritional
~ Sleep
~ Pain
~ Medication side effects
EnviroBioPsychoSocial Model
~ Theory
~ Psychological influences
~ Addictive behavior produces positive feeling states and/or numbing in response to dysphoric states.
~ Lack of effective coping skills  mood or addictive disorders
~ Motivation for escape
~ Social
~ Social learning/modeling from peers, family, culture attitudes and behaviors
~ Which behaviors are rewarded by social system
~ Environmental Influences
~ Availability
~ Triggers

Remember…Assessing Models and Theories
~ Does it explain the development of the condition in some people and not others (Predictive validity and reliability)~
~ Can this explanation be applied across people and situations (Generalizability)~
~ Can it be used to develop effective prevention and intervention strategies~
~ Does it explain the use of seemingly destructive behaviors~
~ Are there other unaccounted for factors which may influence development or recovery~

Summary
~ There are a variety of theories of the development of addiction and mental health issues
~ Research has indicated that people with addictions, like those with mental health issues have differences in brain structure or the amount or ratio of neurochemicals available.
~ No singular theory can reliably explain/predict why some people develop addiction or mental health issues and others do not.
~ Research has indicated that biology, environment, culture, social relationships and cognitions are all involved in the development and maintenance of mental health and/or addictive issues
~ It is unknown which factors are causative and which occur as the result of pre-existing issues.
~ Treatment involves assessing the envirobiopsychsocial condition of the individual and defining what will help him or her manage the presenting symptoms.

Excellent Resources for FREE Literature
~ National Institute of Health’s National Library of Medicine (ncbi…gov)
~ Open Access Journals (doaj.org)
~ British Medical Journal (bmj.com)
~ NIMH Publications (nimh.nih.gov)
~ NIDA Publications (drugabuse.gov)
~ SAMHSA (samhsa.gov)

Also see
~ Addiction Counselor Certification Session ( videos) PPT “Session ”
~ Models of Addiction: Moral and Medical (Youtube)
~ Models of Addiction and Co-Occurring Disorders (Youtube)
~ SocioEcological Theories of Addiction (Youtube)
~ Models and Theories of Co-Occurring Disorders Behavioral, Developmental, Learning (Vimeo)