The Meaning of Addiction - 3. Theories of Addiction - Adaptation Theories

Written by Stanton Peele

Adaptation Theories

Social Learning and Adaptation

Conventional conditioning models cannot make sense of drug behavior because they circumvent the psychological, environmental, and social nexus of which drug use is a part. One branch of conditioning theory, social-learning theory (Bandura 1977), has opened itself to the subjective elements of reinforcement. For example, Bandura described how a psychotic who continued his delusional behavior in order to ward off invisible terrors was acting in line with a reinforcement schedule that was efficacious despite its existing solely in the individual's mind. The essential insight that reinforcers gain meaning only from a given human context enables us to understand (1) why different people react differently to the same drugs, (2) how people can modify these reactions through their own efforts, and (3) how people's relationships with their environments determine drug reactions rather than vice versa.

Social-learning theorists have been especially active in alcoholism, where they have analyzed how alcoholics' expectations and beliefs about what alcohol will do for them influence the rewards and behaviors associated with drinking (Marlatt 1978; Wilson 1981). Yet it has also been social-learning theorists who have launched the alcohol-dependence syndrome and who seem to feel subjective interpretation is far less important than the pharmacological effects of alcohol in causing drinking problems (Hodgson et al. 1978, 1979). This lacuna in their theorizing is most noticeable in the inability of modem social-learning theorists to make sense out of cultural variations in drinking styles and experiences (Shaw 1979). Whereas McClelland et al. (1972) offered an experiential bridge between individual and cultural conceptions about alcohol (see chapter 5), behaviorists have regularly rejected this kind of synthesis in favor of direct observations and objective measurements of alcoholic behavior (embodied by Mendelson and Mello 1979b).

In another area of social-learning theory, Leventhal and Cleary (1980) proposed "that the smoker is regulating emotional states and that nicotine levels are being regulated because certain emotional states have been conditioned to them in a variety of settings" (p. 391). In this way they hoped to "provide a mechanism for integrating and sustaining the combination of external stimulus cues, internal stimulus cues, and a variety of reactions including subjective emotional experience . . . with smoking" (p. 393). In other words, any number of levels of factors, from past experience to current setting to idiosyncratic thoughts, can influence the person's associations with smoking and subsequent behavior. In creating a conditioning model as complex as this one in order to account for behavior, however, the authors may have been putting the cart before the horse. Instead of conceiving of cognition and experience as components of conditioning, it seems easier to say that addiction involves cognitive and emotional regulation to which past conditioning contributes. In this view, addiction is an effort by an individual to adapt to internal and external needs, an effort in which a drug's effects (or some other experience) serve a desired function.

Social-Psychological Adaptation

Studies that have questioned users about their reasons for continued drug-taking or that have explored the situations of street users have revealed crucial, self-aware purposes for drug use and a reliance on drug effects as an effort to adapt to internal needs and external pressures. Theoretical developments based on these investigations have focused on the psychodynamics of drug reliance. Such theories describe drug use in terms of its ability to resolve ego deficiencies or other psychological deficits—brought on, for example, by lack of maternal love (Rado 1933). In recent years theorizing of this sort has become broader: less wedded to specific child-rearing deficits, more accepting of a range of psychological functions for drug use, and including other substances besides narcotics (cf. Greaves 1974; Kaplan and Wieder 1974; Khantzian 1975; Krystal and Raskin 1970; Wurmser 1978).

These approaches developed in response to the clearcut finding that very few of those exposed to a drug, even over extended periods, came to rely on it as a life-organizing principle. What they failed to explain adequately is the great variability of reliance on drugs and addiction in the same individuals over situations and life span. If a given personality structure led to the need for an specific kind of drug, why then did the same people wean themselves from the drug? Why did others with comparable personalities not become wedded to the same substances? What was obvious in the case of narcotic addiction was its strong association with certain social groups and lifestyles (Gay et al. 1973; Rubington 1967). Efforts to incorporate this level of social reality led to higher-order theories that went beyond purely psychological dynamics to combine social and psychological factors in drug use (Ausubel 1961; Chein et al. 1964; McClelland et al. 1972; Winick 1962; Zinberg 1981).

Such social-psychological theories addressed the function of drug use in adolescent and postadolescent life stages as a way of preserving childhood and avoiding adult conflicts (Chein et al. 1964; Winick 1962). They also dealt with the availability of drugs in certain cultures and the predisposing social pressures toward their use (Ausubel 1961; Gay et al. 1973). Finally they presented the impact of social ritual on the meaning and style of use that a person in a given setting adopted (Becker 1963; Zinberg et al. 1977). What ultimately limited these theories was their lack of a formulation of the nature of addiction. While nearly all of them minimized the role of physiological adjustments in the craving and response to withdrawal that signify addiction (Ausubel 1961; Chein et al. 1964; Zinberg 1984), they provided little in the way of basic mechanisms to account for the dynamics of addiction.

As a result, the social-psychological literature exists in almost total isolation from the pharmacological and learning literature on addiction. Because they do not confront laboratory-based models directly, social-psychological theorists are forced to rely on biological concepts that their own data and ideas contradict (as illustrated by the discussion, in chapter 1, of Zinberg et al. 1978). This exaggerated deference to pharmacological constructs makes these theorists reluctant to incorporate a cultural dimension as a basic element in addiction or to explore the meaning of nonsubstance addictions—surprisingly so, given that their own emphasis on the socially and psychologically adaptive functions of drugs would seem to apply equally well to other involvements. What may curtail the social and psychological analysis of addiction most is the inappropriate meekness and limited scientific aspirations of those best suited to extend the boundaries of addiction theory in this direction. Such meekness certainly does not characterize modern conditioning and biological theorizing.

The Requirements of a Successful Theory of Addiction

A successful addiction model must synthesize pharmacological, experiential, cultural, situational, and personality components in a fluid and seamless description of addictive motivation. It must account for why a drug is more addictive in one society than another, addictive for one individual and not another, and addictive for the same individual at one time and not another (Peele 1980). The model must make sense out of the essentially similar behavior that takes place with all compulsive involvements. In addition, the model must adequately describe the cycle of increasing yet dysfunctional reliance on an involvement until the involvement overwhelms other reinforcements available to the individual.

Finally, in assaying these already formidable tasks, a satisfactory model must be faithful to lived human experience. Psychodynamic theories of addiction are strongest in their rich explorations of the internal, experiential space of their subject matter. Likewise, disease theories—while seriously misrepresenting the nature and constancy of addictive behavior and feelings—are based on actual human experiences that must be explained. This last requirement may seem the most difficult of all. One may wonder whether models built on social-psychological and experiential dynamics make any sense when confronted with the behavior of laboratory animals or newly born infants.