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  • Writer's pictureHans Reihling, Ph.D., LMFT

Debunking Addiction Medicine: Towards Holistic Recovery From Substance Misuse

Tired of relying on outdated, limited medical models of addiction? It's time to discover the full picture and unlock your path to recovery. Addiction affects individuals on numerous levels, but traditional models only focus on physical dependence and withdrawal symptoms. But addiction is a complex and multi-dimensional problem that requires a comprehensive approach to effectively address and treat. Holistic treatment includes the psychological, social, and cultural factors that contribute to addiction. In this post, I aim to provide a more comprehensive understanding of addiction by exploring the limitations of medical models and incorporating the latest research in neuroscience, psychology, and anthropology for a broader audience.



The Negative Reinforcement Model


The negative reinforcement model of addiction is centered on the idea that individuals continue to use drugs or alcohol to avoid unpleasant withdrawal symptoms. This model emphasizes the importance of addressing physical dependence in addiction treatment, such as managing withdrawal symptoms through medications, tapering or substitution drugs. This can be life saving in the case of life-threatening alcohol withdrawal, but it's not treating the root causes of addiction.


While addressing physical dependence is crucial, it is not enough to fully understand and treat addiction. Research has shown that addiction involves changes in the brain that can result in decreased self-control and increased cravings. Social and cultural factors such as stress, trauma, and exposure to addictive behaviors also play a significant role in addiction's development and maintenance.


The Positive Reinforcement Model


Beyond the pleasure hijack

The Positive Reinforcement Model highlights the impact of the brain's reward circuit on addiction. This model suggests that repeated drug or alcohol use hijacks and overstimulates the reward circuit, leading to changes in the brain and compensation by inhibiting the pleasure response in the nucleus accumbens. This results in a need for more stimulation to feel pleasure, leading to less enjoyment from other rewarding activities. However, the root cause of repeated substance use is often the desire to cope with trauma and a lack of adequate social support.


Many people engage in repeated drug and alcohol use as a means of coping with difficult emotions and experiences due to a lack of other forms of support. Over time, medicating emotional pain with substances makes the brain become numb to the their pleasurable effects. This results in urges for more frequent and higher doses, creating a cycle of repeated use. Addressing the underlying trauma and building safe social connections is crucial in breaking this cycle and finding lasting healing and recovery.


More than dopamine

The Positive Reinforcement Model also emphasizes the role of craving in addiction. Dopamine, a neurotransmitter responsible for feelings of pleasure, is not just about liking, but also about craving. When a reward is unexpected, dopamine is released, leading to an increase in craving. With addiction, the liking may decline but the wanting increases.


This dopamine release takes place within a larger context and is influenced by individual biology and the cultural and social environment. It is not the sole cause of addiction, but rather a key player in a network of brain and socio-cultural processes that contribute to addictive behavior. Social expectations and availability shape reward-seeking behavior and dopamine release associated with addiction. For example, cultural norms about masculinity can impact a man's vulnerability to addiction.


Prefrontal Cortex revisited

The Positive Reinforcement Model also highlights the role of the prefrontal cortex (PC) in self-control. The PC, referred to as the CEO of the brain, is responsible for inhibiting behavior suggested by the reward circuit. Chronic substance use weakens the PC's ability to self-control, leading to increased substance use without support.


Strengthening the prefrontal cortex is crucial in addiction recovery. Sharing personal stories of recovery and building connections within a supportive community can help individuals build a stronger sense of self and increase self-efficacy. These relationships provide a sense of belonging and self-worth, further enhancing self-control. By incorporating meaning-making through storytelling and relationships, you can tap into their innate capability to create a narrative for your life, which can serve as a source of strength in overcoming addiction. This approach to addiction recovery highlights the power of human connection and the significance of the stories we tell ourselves in shaping our experiences.

Where to go from here?


In conclusion, both the Negative and Positive Reinforcement Models have their limitations and strengths in explaining addiction in medicine. However, the Positive Reinforcement Model provides a more comprehensive understanding of addiction, highlighting the brain's reward circuit, craving, and the role of self-control in addiction. The model can easily be upgraded to include the impact of psychological, social, and cultural factors on addiction. Understanding these processes in a holistic way can aid in the development of effective recovery.

Addiction is a complex and multi-dimensional process that cannot be fully understood through limited medical models in addiction medicine. By incorporating the latest research in neuroscience, psychology, and anthropology, we can take a holistic approach to addiction recovery that truly addresses the root causes and provides lasting healing.


One of the most powerful aspects of this holistic approach is the emphasis on human connection and the significance of the stories we tell ourselves. By tapping into our innate human capability to connect with others and give life meaning, we can find the strength to overcome adversity. This is the beauty of a holistic approach to addiction recovery, and the power of the stories we tell ourselves in shaping our experiences. If you're considering getting help, I would be honored to be a part of your journey and help turn your vision into a reality. So, don't wait any longer, let's work together to make a difference today!

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