Biopsychosocial Concept

Biopsychosocial Conceptualization of the Evolution of a Substance Use Disorder

1. We have endogenous systems in our brain that influence our behavior by creating a natural rewarding experience in response to certain stimuli such as food, sex and social interactions.
2. Exogenous substances can also activate these reward systems.
3. Some people with biological, psychological, and/or social susceptibility find that they are particularly receptive to the rewarding effects of these substances and use them in high doses over an extended period of time.
4. The body adapts to the chronic, high dose use of these substances in ways that diminish response to natural rewards and enhance sensitivity to the exogenous substance as well as stress. A dysphoric system may also be recruited that paradoxically contributes to continued substance use. For alcohol, sedatives, and opioids a physical dependence may also be created. These three developments lock the person into the continued substance use – a process called “addiction.”
5. These changes lead the person to make a psychological adaptation (“cognitive distortions”), the style of which depends on the person’s personality. This adaptation reinforces the biological locking-in process. If the person has separate psychological or social issues, these can intensify the locking-in process.

Treatment Approaches That Follow From This Conceptualization

1. Remove the exogenous substance or replace it with a less problematic alternative.
2. Allow time for the brain to return to as normal a state as possible. Use medications if available to expedite this process.
3. Intervene psychologically to help reverse the addiction-perpetuating psychological adaptations. Educate the patient about the disorder. Address other psychiatric issues if present, including using medications as appropriate.
4. Address addiction-perpetuating social adaptations that may lead to relapse.

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