Biopsychosocial Assessment
Biopsychosocial Assessment
ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS
For this Discussion, review the Learning Resources attached below. Create a fictional case study of a client with an addiction disorder that affects at least two life domains. Provide the following information: Biopsychosocial Assessment
- Age of the client
- Type of addiction and what is the source of the addiction (e.g., cocaine, alcohol, nicotine)
- Describe the client’s ethnicity
- Describe the client’s relationships
- Describe the client’s current health
- Describe the client’s social life
- Describe the client’s psychological well being.
Please remember that you are presenting a case study as though you are a counselor sharing this case in clinical supervision
Acomponentsmodelofaddictionwithinabiopsychosocialframework.pdf
ApplyinganEcologicalFrameworktoUnderstandingDrugAddictionandRecovery.pdf
Assessmentofspiritualityanditsrelevancetoaddictiontreatment.pdf
CURRENT OPINION PIECE
A ‘components’ model of addiction within a biopsychosocial framework
MARK GRIFFITHS
International Gaming Research Unit, Psychology Division, Nottingham Trent University, Nottingham,
UK
Abstract There is now a growing movement that views a number of behaviours as potentially addictive including many that do not involve the ingestion of a drug (such as gambling, sex, exercise, videogame playing and Internet use). This paper argues that all addictions consist of a number of distinct common components (salience, mood modification, tolerance, withdrawal, conflict and relapse). The paper argues that addictions are a part of a biopsychosocial process and evidence is growing that excessive behaviours of all types do seem to have many commonalities. It is argued that an eclectic approach to the studying of addictive behaviour appears to be the most pragmatic way forward in the field. Such commonalities may have implications not only for treatment of such behaviours but also for how the general public perceive such behaviours.
Introduction
Certain individuals use certain substances in certain ways, thought at certain times to be
unacceptable by certain other individuals for reasons both certain and uncertain.
(Burglass, & Shaffer, 1984, p. 19)
Conceptualizing addiction has been a matter of great debate for decades. Although the
opening quote is not recent, it still holds true despite the enormous amount of research into
addictive behaviours. Any conceptualization of addiction has implications for several
groups of people (e.g. addicts, their families, researchers, practitioners, policy makers, etc.).
Obviously, the needs of these groups may not be equally well served by certain models, and
in some cases there will be absolute incompatibility. Any framework for the conceptualiza-
tion of addiction must allow for the bottom-up development and integration of theory by
each of these groups – that is, it must be flexible, accountable, integrative and reflexive.
For many people the concept of addiction involves taking of drugs (e.g. Rachlin, 1990;
Walker, 1989). Therefore it is perhaps unsurprising that most official definitions
Correspondence: Mark Griffiths, International Gaming Research Unit, Psychology Division, Nottingham Trent University,
Burton Street, Nottingham NG1 4BU, UK. Tel: +44 115 8485528. Fax: +44 115 9486826. E-mail: mark.griffiths@ntu.ac.uk
Journal of Substance Use, August 2005; 10(4): 191–197
ISSN 1465-9891 print/ISSN 1475-9942 online # 2005 Taylor & Francis Group Ltd
DOI: 10.1080/14659890500114359
Biopsychosocial Assessment
concentrate on drug ingestion. Despite such definitions, there is now a growing movement
(e.g. Miller, 1980; Orford, 2001; Shaffer et al., 2004) which views a number of behaviours
as potentially addictive including many behaviours which do not involve the ingestion of
a drug. These include behaviours as diverse as gambling (Griffiths, 1995), overeating
(Orford, 2001), sex (Carnes, 1983), exercise (Terry, Szabo, & Griffiths, 2004), videogame
playing (Griffiths, 2002), love (Peele, & Brodsky, 1975), Internet use (Griffiths, 2000) and
work (Griffiths, 2005). Such diversity has led to new all-encompassing definitions of what
constitutes addictive behaviour. One such definition is that of Marlatt, Baer, Donovan,
and Kivlahan (1988, p. 224), who define addictive behaviour as:
…a repetitive habit pattern that increases the risk of disease and/or associated personal
and social problems. Addictive behaviours are often experienced subjectively as ‘loss of
control’ – the behaviour contrives to occur despite volitional attempts to abstain or
moderate use. These habit patterns are typically characterized by immediate gratification
(short term reward), often coupled with delayed deleterious effects (long term costs).
Attempts to change an addictive behaviour (via treatment or self initiation) are typically
marked with high relapse rates.
In addition, it has been argued that addiction is most usefully described as a process
(Krivanek, 1988), with involvement in addictive behaviour being placed upon a spectrum
of severity of use and abuse (McMurran, 1994). The boundaries of this formulation are
flexible enough to include both substance and non-substance behaviours and to account for
the inclusion of a wide variety of influencing factors. However, on an ethical level, the
emphasis on the ‘subjective experience’ of loss-of-control means that the above definition
does not locate the problem entirely within the individual concerned, but nor does it
preclude our attribution of some responsibility to that individual.
It is also important to acknowledge that the meanings of ‘addiction’, as the word is
understood in both daily and academic usage, are contextual, and socially constructed
(Howitt, 1991; Irvine, 1995; Truan, 1993). We must ask whether the term ‘addiction’
actually identifies a distinct phenomenon – something beyond problematic behaviour –
whether socially constructed or physiologically based. If so, what are the principal features
of this phenomenon? If we argue that it is hypothetically possible to be addicted to
anything, it is still necessary to account for the fact that many people become addicted to
alcohol but very few to gardening. Implicit within our understanding of the term ‘addiction’
is some measure of the negative consequences that must be experienced in order to justify
the use of this word in its academic or clinical context. It seems reasonable at this stage to
suggest that a combination of the kinds of rewards (physiological and psychological) and
environment (physical, social and cultural) associated with any particular behaviour will
have a major effect on determining the likelihood of an excessive level of involvement in any
particular activity.
The way of determining whether non-chemical (i.e. behavioural) addictions are addictive
in a non-metaphorical sense is to compare them against clinical criteria for other
established drug-ingested addictions. This method of making behavioural excesses more
clinically identifiable has been proposed for behavioural addictions such as ‘television
addiction’ (McIlwraith, Jacobvitz, Kubey, & Alexander, 1991) and ‘amusement machine
addiction’ (Griffiths, 1991, 1992). Further to this, authors such as Brown (1993) and
Griffiths (1996) have postulated that addictions consist of a number of common
components. Griffiths’s (1996) components of addiction (modified from Brown, 1993)
192 M. Griffiths
are salience, mood modification, tolerance, withdrawal, conflict and relapse. These are
described in more detail below with some relevant examples.
Salience
This refers to when the particular activity becomes the most important activity in the
person’s life and dominates their thinking (preoccupations and cognitive distortions),
feelings (cravings) and behaviour (deterioration of socialized behaviour). For instance, even
if the person is not actually engaged in the behaviour they will be thinking about the next
time they will be. Three separate quotes from Griffiths’s (1995) studies of slot machine
addicts highlight the concept of salience in gambling:
If I wasn’t actually gambling I was spending the rest of my time working out clever little
schemes to obtain money to feed my habit. These two activities literally took up all my
time (Extract 1, p. 253).
Gamble, gamble, gamble your life away…you might as well have put it down the
drain. You’ve got to face the truth that you’re having a love affair, and it’s with a
machine whose lights flash, takes your money and kills your soul (Extract 2, p. 253).
During four or five years of compulsive gambling I think I missed about six or seven
days of playing fruit machines – keeping in mind that about four or five of those days
were Christmas days where it was impossible to gain access to a gambling machine…As
you have probably gathered, I ate, slept and breathed gambling machines…I couldn’t
even find time to spend with the people I loved…The machines were more important
than anything or anyone else. All I can remember is living in a trance for four years…as if
I’d been drunk the whole time (Extract 3, p. 253).
It should also be noted that some addictive behaviours such as smoking (nicotine) and drinking
(alcohol) are activities that can be engaged in concurrently with other activities and therefore do
not tend to dominate an addict’s thoughts or lead to total preoccupation. For instance, a
smoker can carry around their cigarettes and still engage in other day-to-day activities.
However, if that person was in a situation that they were unable to smoke for a long period
(such as a 24-hour plane flight), smoking would be the single most important thing in that
person’s life and would totally dominate their thoughts and behaviour. This is what could be
termed ‘reverse salience’ with the addictive activity becoming the most important thing in that
person’s life when they are prevented from engaging in the behaviour.
Mood modification
This refers to the subjective experience that people report as a consequence of engaging in
the particular activity (i.e. they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a
tranquillizing and/or destressing feel of ‘escape’ or ‘numbing’). What is interesting is that a
person’s drug or activity of choice can have the capacity to achieve different mood-
modifying effects at different times. For instance, a nicotine addict may use cigarettes first
thing in the morning to get the arousing ‘nicotine rush’ they need to get going for the day.
By the end of the day they may not be using nicotine for its stimulant qualities, but may in
fact be using nicotine as a way of destressing and relaxing. It could be argued that in these
situations, psychology to some extent overrides physiology because of expectation effects.
‘Components’ model of addiction 193
In essence, many addicts use substances and behaviours as a way of producing a reliable
and consistent shift in their mood state as a coping strategy to ‘self-medicate’ and make
themselves feel better in the process. Such mood-modifying experiences are also common
in many behavioural addictions such as gambling. These have included both subjective self-
reports from interviews and questionnaires (Dickerson, & Adcock, 1987; Griffiths, 1990)
and objective experimental studies that have measured heart rate as an indicator of arousal
(Griffiths, 1993; Leary, & Dickerson, 1985).
Tolerance
This refers to the process whereby increasing amounts of the particular activity are required
to achieve the former effects. The classic example of tolerance is a heroin addict’s need to
increase the size of their ‘fix’ to get the type of feeling (e.g. an intense ‘rush’) they once got
from much smaller doses. In gambling, tolerance may involve the gambler gradually having
to increase the size of the bet to experience a mood-modifying effect that was initially
obtained by a much smaller bet. It may also involve spending longer and longer periods
gambling. Tolerance is well established in psychoactive substance addictions and there is
growing evidence in the field of behavioural addictions.
For instance, Griffiths (1993) appeared to show that tolerance could be observed in an
experimental situation involving gamblers. He found that both regular and non-regular slot
machine gamblers’ heart rates increased significantly during the playing period by
approximately 22 beats per minute. However, the interesting finding was that after playing
slot machines, regular gamblers’ heart rates started to decrease at once, whereas non-
regular gamblers’ heart rates did not change significantly. In terms of an addictive model of
gambling, both regular and non-regular gamblers get a ‘high’ physiologically when playing,
but the non-regular gamblers stay ‘higher’ for longer, meaning they do not have to gamble
as fast or as often to induce the arousal peaks. Regular gamblers, in contrast, could be seen
as becoming more tolerant to the gambling ‘highs’, meaning they have to gamble either
faster or more often to experience the initially desired effect. It was argued by Griffiths
(1993) that the study could be viewed as the first to show an objective measure of tolerance
in gambling.
Withdrawal symptoms
These refer to the unpleasant feeling states and/or physical effects which occur when the
particular activity is discontinued or suddenly reduced. Such withdrawal effects may be
psychological (e.g. extreme moodiness and irritability) or more physiological (e.g. nausea,
sweats, headaches, insomnia and other stress-related reactions). Withdrawal effects are well
documented in drug addictions (Orford, 2001) and there is growing evidence that
behavioural addictions such as pathological gambling also feature withdrawal symptoms
(Griffiths, 2004). For instance, Rosenthal and Lesieur (1992) found that at least 65% of
pathological gamblers reported at least one physical side-effect during withdrawal including
insomnia, headaches, upset stomach, loss of appetite, physical weakness, heart racing,
muscle aches, breathing difficulty and/or chills. Their results were also compared to the
withdrawal effects from a substance-dependent control group. They concluded that
pathological gamblers experienced more physical withdrawal effects when attempting to
stop than the substance-dependent group.
194 M. Griffiths
Conflict
This refers to conflicts between the addict and those around them (interpersonal conflict)
or from within the individual themselves (intrapsychic conflict) which are concerned with
the particular activity. Continual choosing of short-term pleasure and relief leads to
disregard of adverse consequences and long-term damage which in turn increases the
apparent need for the addictive activity as a coping strategy. The conflict in the addict’s life
means that they end up compromising their (1) personal relationships (partner, children,
relatives, friends, etc.), (2) working or educational lives (depending on what age they are)
and (3) other social and recreational activities. Intrapsychic conflict may also be
experienced in the form of addicts knowing that they are engaged heavily in the behaviour
and want to cut down or stop – but find they are unable to do so, experiencing a subjective
loss of control.
Relapse
This refers to the tendency for repeated reversions to earlier patterns of the particular
activity to recur and for even the most extreme patterns typical of the height of the
addiction to be quickly restored after many years of abstinence or control. The classic
example of relapse behaviour is in smokers who often give up for a period of time only to
return to full-time smoking after a few cigarettes. However, such relapses are common in all
addictions including behavioural addictions such as gambling (Griffiths, 2002).
Griffiths (2002) has argued that all these components need to be present for a behaviour
to be operationally defined as addictive. It is clear that some individuals engage in
behaviours that have addictive elements without it necessarily being a full-blown addiction.
For instance, if someone has no negative withdrawal effects after stopping their excessive
behaviour, are they really addicted? If the excessive behaviour does not conflict with
anything else in that person’s life, can it be said to be an addiction? The difference between
an excessive healthy enthusiasm and an addiction is that healthy enthusiasms add to life
whereas addictions take away from it.
Addictions always result from an interaction and interplay between many factors
including the person’s biological and/or genetic predisposition, their psychological
constitution (e.g. personality factors, unconscious motivations, attitudes, expectations
and beliefs, etc.), their social environment (i.e. situational characteristics) and the nature of
the activity itself (i.e. structural characteristics) (Griffiths, 1999). These many factors
highlight the interconnected processes and integration between individual differences (i.e.
personal vulnerability factors), situational characteristics, structural characteristics and the
resulting addictive behaviour. Each of these three general sets of influences (i.e. individual,
structural and situational) can be subdivided much further depending on the type of
addiction.
It is clear that many research paradigms are insular and inadequate in explaining
addiction. Addiction is a multifaceted behaviour that is strongly influenced by contextual
factors that cannot be encompassed by any single theoretical perspective. These factors
include variations in behavioural involvement and motivation across different demographic
groups, structural characteristics of activities/substances and the developmental or
temporal nature of addictive behaviour. Research and clinical interventions are best served
by a biopsychosocial approach that incorporates the best strands of contemporary
psychology, biology and sociology.
‘Components’ model of addiction 195
Griffiths and Larkin have suggested there are core components of what a successful
theory of addictions should contain (Griffiths, & Larkin, 2004; Larkin, & Griffiths, 1998).
A successful theory must (1) synthesize pharmacological, cultural, situational and
personality factors, (2) account for the varying nature of addiction across cultures,
individuals and time, (3) account for commonalities between all addictions and (4) be
faithful to lived human experience.
Larkin and Griffiths (1998; Griffiths, & Larkin, 2004) have also argued the case for a
complex systems model of addiction: ‘complex’ for obvious reasons, and ‘systems’ after
Davies (1992, p. 163), who argued that alternative explanations for excessive behaviour
require:
…the development of a ‘system’ within which drug use is conceived of as an activity
carried out for positive reasons, by people who make individual decisions about their
substance use, and who may take drugs competently as well as incompetently.
Gambino and Shaffer (1979) have emphasized the difficulties of reintegrating research and
practice in the area of addiction. On the basis of Polkinghorne’s (1992) observations on the
nature of such divisions, a more flexible theoretical approach, such as the complex systems
model, ought to go some way toward bridging the epistemological gap.
The complex systems model corresponds well to the biopsychosocial approach to
addiction (e.g. Marlatt et al., 1988; McMurran, 1994). It may also be considered to be a
descendant of previous multifactorial approaches to the addiction process (e.g. Wanberg, &
Horn, 1983; Zinberg, 1984). Obviously, from the perspective of the complex systems
model, it is possible to consider the interaction of both the common and the unique
elements of any specific individual’s situation. This includes psychological, physiological,
social and cultural factors that may be particular to any individual. It also allows for
consideration of the pharmacological properties of specific substances, or the reinforcing
properties of certain kinds of gaming machines (see Griffiths, 1995). It is important,
therefore, to point out that this is not a return to siting the property of ‘addictiveness’ as
located within particular substances (or within particular activities). However, it is
necessary to be aware of effects that may be common to certain kinds of substances or
activities, but not to others.
Hopefully, what this paper has demonstrated is that addictions are a part of a
biopsychosocial process and not just restricted to drug-ingested behaviours. Evidence is
growing that excessive behaviours of all types do seem to have many commonalities and this
may reflect a common aetiology of addictive behaviour. Such commonalities may have
implications not only for treatment of such behaviours but also for how the general public
perceive such behaviours.
References
Brown, R. I. F. (1993). Some contributions of the study of gambling to the study of other addictions. In
W. R. Eadington, & J. Cornelius (Eds), Gambling behavior and problem gambling. Reno, NV: University of
Nevada Press.
Burglass, M. E., & Shaffer, H. J. (1984). Diagnosis in the addictions I: Conceptual problems. Addictive Behaviors,
3, 19–34.
Carnes, P. (1983). Out of the shadows: Understanding sexual addiction. Minneapolis, MN: CompCare.
Davies, J. B. (1992). The myth of addiction: An application of the psychological theory of attribution to illicit drug use.
Reading, MA: Harwood Academic.
196 M. Griffiths
Dickerson, M., & Adcock, S. (1987). Mood, arousal and cognitions in persistent gambling: Preliminary
investigation of a theoretical model. Journal of Gambling Behavior, 3, 3–15.
Gambino, B., & Shaffer, H. J. (1979). Addiction paradigms II: Theory, research and practice. Journal of Psychedelic
Drugs, 11, 299–304.
Griffiths, M. D. (1990). The acquisition, development and maintenance of fruit machine gambling in adolescents.
Journal of Gambling Studies, 6, 193–204.
Griffiths, M. D. (1991). Amusement machine playing in childhood and adolescence: A comparative analysis of
video games and fruit machines. Journal of Adolescence, 14, 53–73.
Griffiths, M. D. (1992). Pinball wizard: The case of a pinball machine addict. Psychological Reports, 71, 160–162.
Griffiths, M. D. (1993). Tolerance in gambling: An objective measure using the psychophysiological analysis of
male fruit machine gamblers. Addictive Behaviors, 18, 365–372.
Griffiths, M. D. (1995). Adolescent gambling. London: Routledge.
Griffiths, M. D. (1996). Nicotine, tobacco and addiction. Nature, 384, 18.
Griffiths, M. D. (1999). Gambling technologies: Prospects for problem gambling. Journal of Gambling Studies, 15,
265–283.
Griffiths, M. D. (2000). Internet addiction – time to be taken seriously? Addiction Research, 8, 413–418.
Griffiths, M. D. (2002). Gambling and gaming addictions in adolescence. Leicester: British Psychological Society/
Blackwell.
Griffiths, M. D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British
Medical Journal, 329, 1055–1056.
Griffiths, M. D. (2005). Workaholism is still a useful construct. Addiction Research and Theory, 13, 97–100.
Griffiths, M. D., & Larkin, M. (2004). Conceptualizing addiction: The case for a ‘complex systems’ account.
Addiction Research and Theory, 12, 99–102.
Howitt, D. (1991). Concerning psychology. Milton Keynes: Open University Press.
Irvine, J. M. (1995). Reinventing perversion: Sex addiction and cultural anxieties. Journal of the History of Sexuality,
5, 429–450.
Krivanek, J. (1988). Addictions. London: Allen & Unwin.
Larkin, M., & Griffiths, M. D. (1998). Response to Shaffer (1996): The case for ‘complex systems’
conceptualizations of addiction. Journal of Gambling Studies, 14, 73–82.
Leary, K., & Dickerson, M. G. (1985). Levels of arousal in high and low frequency gamblers. Behaviour Research
and Therapy, 23, 635–640.
Marlatt, G. A., Baer, J. S., Donovan, D. M., & Kivlahan, D. R. (1988). Addictive behaviors: Etiology and
treatment. Annual Review of Psychology, 39, 223–252.
McIlwraith, R., Jacobvitz, R. S., Kubey, R., & Alexander, A. (1991). Television addiction: Theories and data
behind the ubiquitous metaphor. American Behavioral Scientist, 35, 104–121.
McMurran, M. (1994). The psychology of addiction. London: Taylor & Francis.
Miller, W. R. (1980). The addictive behaviors. Oxford: Pergamon Press.
Orford, J. (2001). Excessive appetites: A psychological view of the addictions, 2nd edn. Chichester: Wiley.
Peele, S., & Brodsky, A. (1975). Love and addiction. New York: Taplinger.
Polkinghorne, D. E. (1992). Postmodern epistemology of practice. In S. Kvale (Ed.), Psychology and
postmodernism. London: Sage.
Rachlin, H. (1990). Why do people gamble and keep gambling despite heavy losses? Psychological Science, 1,
294–297.
Rosenthal, R., & Lesieur, H. (1992). Self-reported withdrawal symptoms and pathological gambling. American
Journal of the Addictions, 1, 150–154.
Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A. N., & Stanton, M. V. (2004). Towards a
syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 1–8.
Terry, A., Szabo, A., & Griffiths, M. (2004). The Exercise Addiction Inventory: a new brief screening tool.
Addiction Research and Theory, 12, 489–499.
Truan, F. (1993). Addiction as a social construction: A postempirical view. Journal of Psychology, 127, 489–499.
Walker, M. B. (1989). Some problems with the concept of ‘gambling addiction’: Should theories of addiction be
generalized to include excessive gambling? Journal of Gambling Behavior, 5, 179–200.
Wanberg, K. W., & Horn, J. L. (1983). Assessment of alcohol-use with multi-dimensional concepts and measures.
American Psychologist, 38, 1055–1069.
Zinberg, N. E. (1984). Drug, set, setting: The basis for controlled intoxicant use. New Haven, CT: Yale University
Press.
‘Components’ model of addiction 197
0 comments