Models of addiction and types of interventions: An integrative look

Background: Use of psychoactive substances and problem gambling create serious harm to individuals who engage in these practices and to society as a whole (World Health Organization, 2002). The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) regularly monitors drug-related problems and interventions, as well as the efficiency of interventions. The scope and methodology of monitoring, however, depends on the conceptualization of “addiction.” Methods: The relevant literature was screened for models and theories relating to “addiction,” resulting in a systematic overview of the concepts and related approaches (EMCDDA, 2013). Using this as a background, different approaches for interventions and their theoretical bases are discussed. Results: Models of addiction follow two approaches. Most of these focus on the individual addict, involving constructs such as emotions, drive states, habits, choice, and goal-oriented processes, or else taking a more integrative or change-oriented view. Others are population-based models, including social network, economic, communication, and organizational system models. While substanceand non-substance-related addictions differ in a number of respects, they share key elements: a repeated powerful motivation to engage in a particular behavior, acquired through enacting the behavior, despite the experience or risk of significant harm. Nine different types of intervention to combat addiction found in the literature involve attempts to change one or more of three factors that interact to underpin behavior: capability, opportunity, and motivation (the “COM-B” model). The models of addiction reviewed may serve as a basis for such interventions. Illicit psychoactive drug use, excessive alcohol consumption, tobacco use, and problem gambling create serious harm to individuals who engage in these practices and to society as a whole (World Health Organization, 2002). While not all substance-related harm arises from addiction, it clearly plays a major role. It is also apparent that today the concept of addiction seems not to be limited to illicit psychoactive drugs or indeed pharmacological agents. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has published two years ago an overview on models of addiction (2013), which aims to provide a clearer understanding of the nature of addiction. This in turn allows identification of factors that contribute to the development and maintenance of addiction. Interventions can target these factors in order to prevent, reduce, or stop addiction. Monitoring responses to drug problems should assess and follow up these different aspects to provide a full picture of responses towards drug problems in a society. Based on the aforementioned overview, this paper reviews the main models specific to addiction, as well as more general ones that were used, starting from a comprehensive mapping of the concept in scientific literature. What constitutes a “model” is interpreted here quite broadly and includes general theoretical approaches and specific theories. Following the review of models, an integrative approach is used to describe the core elements of these models and to give an overview on general approaches used in prevention and treatment derived from them. While social responses to drugs and drug use include measures of supply reduction as well as demand reduction, the concept of “addiction” is discussed here mainly from a health perspective.