Psychologists Brent Slife and Richard Williams (1995) pointed out that if you asked six psychologists why your neighbor was rude to you this morning, you’d likely get six different answers.
The field of addiction is a case study of the struggle Slife and Williams described. A handful of addiction psychologists have proposed that we need to integrate the sprawling variety of theoretical and practice models in the field. Integration is necessary, they argue, to provide guidelines for theory development, research, and practice.
The Confusing State of Addiction Psychology
If you were to survey the literature on addiction and its treatment—more than 60 journals and countless books—you’d find many ways of making sense of the problem. This literature tells us that addiction is a disease, self-medication for an underlying condition, a counterfeit search for spirituality, a maladaptive coping skill, a result of faulty thinking, rational consumer behavior, a consequence of family dysfunction, or some other explanation.
After examining 24 separate theories of addiction, psychologist Robert West (2006) concluded, “There was little sense of progress in our understanding [of addiction]; little sense that we are engaging in ‘incremental science’” (p. 1). Theorists were at the same table, but they were playing solitaire. Rather than confront conflicting evidence, they ignored research that did not fit with their favorite idea. The result was that there was no agreed upon framework to guide theory, research, and practice.
Mainstream scientific psychologists typically interpret addiction as the effect of the drug on the person. But social scientists, especially in Europe, make sense of addiction through their postmodern epistemologies. They propose that addiction is a social construction. Anthropologists, for example, became interested in the subject beginning in 2001. They believe that how we define and treat addiction is a paradigm of our 21st century way of making sense of health care, such as privileging brain science, using technologies, and pathologizing users.
Therapy follows from theory, so it’s not surprising that treatment programs are as varied as the theories. Psychologists Reid Hester and William Miller (2003) famously examined 99 therapies for addiction. As expected from such a confusing situation, treatment outcomes were less than inspiring. Curiously, only a handful of experts have publically stated the obvious. Heyman (2009) remarked, “If addiction has not been properly defined, then it is likely that these [treatment] efforts are not accomplishing as much as they could” (p. vii). Ballinger, Matano, and Amantea (2008) concluded that the variety of treatments has resulted in a “lack of consensual outcome criteria for successful treatment, as well as the personal preferences of clinicians” (p. 180). Bickel and Potenza (2006) put it succinctly: “Why is addiction so difficult to treat” (p. 8)?
Integration as a Way of Bringing Order
Integrating the different approaches is complicated, if for no other reason than different perspectives operate on different assumptions. If addiction is a disease, for example, then voluntary control is undermined. On the other hand, if addiction is self-medication, then drug users make a choice to use the drug.
West suggested that individual addiction experts are reticent about integration because it demands veering into territory that they have little training in. It is not the case that addiction psychologists are merely being irresponsible. It’s a problem of our time. We have so much information today that each of us is forced to become a specialist. Integrating behavioral economics, for example, into a coherent theory demands having some understanding of the complicated mathematical equations of economics as they describe consumer behavior. Similarly, integrating neuroscientific studies is daunting if the theorist has little training in neuroscience. Imagine integrating not merely two or three theories but 24-plus models.
Yet complexity does not absolve us from the task. West has done the most sophisticated work thus far integrating theories. He proposed a theory of addiction, which, he argued, “synthesizes” the 24 theories he examined. We can call his idea motivational dominance. West assumed that “the human mind has evolved to be inherently unstable” (p. 167). Stability comes from continual adjustments from various influences on motivation: plans, responses, impulses/inhibitory forces, motives, and evaluations. The benefit is, of course, that the mind is highly adaptable to fluid circumstances. The problem of addiction is that it provides an abnormal motivation for drug using; that is, most of the influences that have evolved to keep the mind balanced are subordinated to the addictive motivation. West admitted his work is preliminary, and he made some progress in a second edition of his work with Jamie Brown (West & Brown, 2013), but much more work remains.
Still, motivational dominance does not make sense of many models, such as those that propose addiction is a social construction or individual accounts that focus on boredom, loneliness, and loss of community.
A more promising route to integration is by using personal meaning as the organizing construct. One benefit is that a meaning approach has its roots in existential psychology. As May and Yalom (2000) stated, existential psychology is not a school of psychology, in the manner of behaviorism or cognitive psychology. Rather, it arises from a way of making sense of the human condition, known as existentialism. This is why we can have existential psychology, existential philosophy, existential theology, and existential art, but no one has ever heard of behaviorist theology or cognitive art. Meaning is thus an overarching construct, unconstrained by the assumptions of any school of psychology.
Another benefit, as Wong (2012) reminded us, is that a foundational principle of existential (and humanistic) psychology is its openness to different perspectives. The problem of reducing a phenomenon to any one perspective is obviated because a meaning approach is inherently integrative. It recognizes that we derive meaning from our biology, behavior, cognitions, affect, and relationships. A meaning approach “is holistic by virtue of its focus on meaning and conceptualizing humans as biopsychosocial spiritual beings” (p. 628).
Addiction and Meaning
The meaning construct is, as far as I know, the only framework that allows us to make sense of addiction research from mainstream psychology, the social sciences, and individual accounts.
Through the lens of meaning, addiction is a response to living a life that lacks personal meaning. This description accepts that addictive drug use affects the brain. It accepts that some people at some times use drugs to self-medicate. It accepts that habit influences drug use. It accepts that the social stigma of addiction has a role in developing and maintaining the problem. What it proposes, however, is that if we want to understand addiction as it actually is, we have to recognize that it operates beyond neural adaptation, self-medication, maladaptive coping skill, consumer behavior, cultural interpretation, and other current models.
If addiction is a response to a meaningless life, then the solution is obvious. Those suffering from addiction have to get a life. For someone actively pursuing a meaningful life, addiction serves no purpose. The blessing of this approach is that even those burdened with ongoing medical, financial, and family hardships as a result of drug use can still flourish in recovery.
References
Ballinger, B., Matano, R. B., & Amantea, A. C. (2008). A perspective on alcoholism: The case of Charles. In K. J. Schneider (Ed.), Existential-integrative psychotherapy: Guideposts to the core of practice (pp. 177–185). New York, NY: Routledge.
Bickel, W. K., & Potenza, M. N. (2006). The forest and the trees: Addiction as a complex self-organizing system. In W. R. Miller & K. M. Carroll (Eds.), Rethinking substance abuse: What the science shows and what we should do about it (pp. 8–24). New York, NY: Guilford.
Hester, R. K., & Miller, W. R. (2003). Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.). New York: Allyn and Bacon.
Heyman, G. M. (2009). Addiction: A disorder of choice. Cambridge, MA: Harvard.
May, R., & Yalom, I. (2000). Existential psychotherapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (6th ed., pp. 273-302). Itasca, IL: F. E. Peacock.
Slife, B. D., & Williams, R. N. (1995). What’s behind the research? Discovering hidden assumptions in the behavioral sciences. Thousand Oaks, CA: Sage.
West, R. J. (2006). Theory of addiction. Oxford, UK: Blackwell.
West, R., & Brown, J. (2013). Theory of addiction (2nd ed.). Oxford, UK: Blackwell.
Wong, P. T. P. (2012). From logotherapy to meaning-centered counseling and therapy. In P. T. P. Wong (Ed.), The human quest for meaning: Theory, research, and applications (2nd ed., pp. 619–647). New York: Routledge.