Understanding Addiction: Models, Diagnosis, and Etiology
Core models and the disease concept
Candidates must compare the moral, medical (disease), biopsychosocial, and learning/behavioral models of addiction. The disease model - chronic, progressive, relapsing, treatable, not a moral failing - underlies most treatment systems; the biopsychosocial model adds genetics, trauma, environment, and coping skills. Neurobiologically, drugs hijack the mesolimbic dopamine pathway, producing reinforcement, tolerance, withdrawal, and sensitized craving.
Diagnosis: DSM-5 substance use disorder
DSM-5 merged abuse and dependence into one SUD with 11 criteria grouped as impaired control (4), social impairment (3), risky use (2), and pharmacological (2: tolerance, withdrawal). Two or more within 12 months = SUD: 2–3 mild, 4–5 moderate, 6–11 severe. Craving counts as a criterion; legal problems count as only one.
Traps
- Treating tolerance and withdrawal as proof of addiction - they are only 2 of 11 and occur with prescribed medication.
- Confusing physical dependence with addiction, or requiring a person to hit "rock bottom" before treatment.
- Assuming someone must be motivated before you engage them; engagement builds motivation.
- Ignoring co-occurring disorders. The standard is integrated, concurrent treatment, not sequential.
Rule of thumb / worked example
Count criteria, then grade: 2–3 mild, 4–5 moderate, 6+ severe. A client reporting using more than intended, craving, tolerance, withdrawal, and continued use despite marital conflict meets five criteria - moderate SUD, not "dependence" and not automatically severe.