Addiction Treatment Theories

Models and Theory Behind Addiction Treatments

Addiction can be tackled in a multitude of ways. Psychological therapies attempt to treat addiction b addressing the emotional and mental factors related to addiction. We will discuss three main models behind addiction treatment theory: the Theory of Reasoned Action, the Theory of Planned Behaviour and the six stages of change model, developed by Prochaska.

Theory of Reasoned Action

The Theory of Reasoned Action (TRA) from Fishbein and Ajzen (1975) suggests that a person's attitude and subjective norms toward a particular way of behaving influence that individual's intention to act that way. The intention is thought to be the main driver towards carrying out a specific behaviour.

People's attitude towards a particular behaviour can include their personal beliefs and opinions, plus the possible outcomes of behaving that way. If the outcome may be negative and paired with results that may go against social norms, then it can be predicted that this person will have no intent to behave this way.

This can also be said for positive attitudes and socially accepted behaviour about things that can become addictive.

Personal attitudes could change from focusing on the positive aspects of drug use, e.g., pleasure, to the negative aspects, e.g., loss of control, money, or friends. People often weigh the pros and cons of their addiction, and if the good outweighs the bad, they will most likely continue their behaviours.

Theory of Planned Behaviour

Ajzen's (1985, 1991) theory of planned behaviour (TPB) added a third aspect beyond attitude and subjective norms, known as perceived control of behaviour.

TPB still states that central to behaviour is intention. When applied to addiction, intention refers to a person's choice to give up their addiction, and any intentions can predict behaviour. TPB attempts to explain how we can change behaviours over which we have control (intentional behaviours).

According to TPB, intention arises from three critical influences:

• Personal attitudes (a person's view of their addiction).
• Subjective norms (the person's beliefs about whether their friends and family approve of their addictive behaviour).
• Perceived behavioural control (how much a person believes they have control over their behaviour, based on their willpower, ability and resources, also known as 'self-efficacy').

Fig. 2 - The theory of planned behaviour states intention arises from personal attitudes, subjective norms, and perceived behavioural control.

Prochaska's Six-Stage Model of Addiction Treatment

Prochaska and DiClemente (1983) developed a model after recognising the multiple and variable ways people overcome smoking addiction.The model recognises that overcoming addiction is not a linear process but an ever-changing solution. One may return to earlier stages several times before finally giving up the addiction.The model also recognises that the benefits of specific treatments vary depending on a person's stage of the model.The stages are as follows:

1. The Pre-contemplation Stage - When the individual shows no intention of changing. Friends and family, however, are concerned and want to talk about it.
2. The Contemplation Stage - When the individual is aware of their problematic behaviour but doesn't want to change. They're encouraged to discuss the pros and cons.
3. The Preparation Stage - When the individual is willing to change slightly and prepares to change, accepting their addiction is an issue and they are encouraged to change.
4. The Action Stage - When the individual takes direct action to make bigger changes, given help and support.
5. The Maintenance Stage - When the individual maintains their behaviour to keep these changes in place, with continued support.
6. The Relapse Stage - When the individual regresses and engages with addictive behaviours again.

Fig. 3 - Stages of addiction treatment can be challenging to navigate.

Evaluation of Theories Used in Addiction Treatment

Some evaluations can be made of these theories on addiction treatment:

• Research Support (TPB): Hagger et al. (2011) tested the TPB for alcohol-related addictions. They found that personal attitudes, subjective norms, and perceived behavioural control influence an addict's intention to quit their addiction. Both intention and perceived behavioural control also affected the number of units an addict consumed after one and three months. This intention led to attempts to quit the addictive behaviour.

• Dynamic: Prochaska's model emphasises the dynamic nature of addiction and abstinence, which is a realistic view. Part of this is that the model recognises that relapse is a part of recovery. However, the arbitrary nature of this model means that it is unreliable.

• Methodological problems: TPB is based on logic, reasoning, decision-making, and choice. As a result, it has difficulty accounting for less rational factors influencing addiction intentions and behaviours, such as emotions and cognitive bias. Many research studies on TPB use self-report and are therefore susceptible to social desirability bias.

• They do not explain addiction: Both Prochaska's model and TPB explain how we can end addictions but not why people become addicted in the first place.

Drug Addiction Treatment Theories

The theories of reasoned action, planned behaviour and the six-stage addiction model can help explain how to treat drug addiction. In theory, drug addiction treatment is most effective when combinations of drug therapy and cognitive or behavioural therapies (such as aversion therapy or CBT) are used.

Drug therapy helps combat the physical symptoms of treating substance addiction. Psychological therapies can help explore the individual's attitude and beliefs about subjective norms and then create changes to intentions and behaviour.

Support from a professional can be helpful when someone is at the preparation, action, maintenance or relapse stage of the six-stage model of drug addiction.

Attachment Theory and Addiction Treatment

Attachment theory links to addiction treatment in that having an insecure or avoidant attachment type is a risk factor for developing an addiction, even with suggestions of attachment type and common substance use, such as heroin use frequently used by those with fearful-avoidant attachments.

This suggestion comes from a review of Schindler's (2019) research on the links between attachment type and substance use. The researcher suggested that having an insecure attachment type can complicate addiction treatments. This is due to difficulty building a trusting relationship with a professional/therapist and maintaining support during addiction treatment.