A Biopsychosocial Approach to Addiction: A Case Study of Henry

Drug and Gambling Addictions

This case study involves a 27-year-old lawyer named Henry. Henry recreationally uses cocaine with his friends, typically two or three nights a week, Henry also bets on the horses and recently lost £3000. Henry came from a wealthy family; his parents are professional people and did not spend a lot of time with Henry or his siblings. They were raised by the house nanny and attended a prestigious boarding school. Henrys’ recent health check did not identify any health concerns. This essay will begin by briefly explain addictive behaviours substance abuse and gambling disorder then, discuss the biopsychosocial model of addictive behaviour which will try and understand the biological (physical health, genetic vulnerabilities, drug and gambling effects), psychological (coping skills, social skills, self-esteem, mental health) and social factors (peers, family circumstances, family relationships) The cognitive behavioural therapy intervention will be applied to the case study to identify understand and support Henry to develop the skills and motivation needed to address his addictive behaviours, also discuss the strengths and weakness of cognitive behavioural therapy.

The addictive behaviours in the case study are frequent cocaine use and gambling. Zou et al (2017) claims that substance addiction is a neuropsychiatric disorder (concerned with cognitive and behaviour disorders) which is characterised by impulses to continue using the drug despite the negative consequences. The prevalence of cocaine uses in Wales and England in 2018 -2019 was reported to be 2.9%, the highest since 2008-2009 gov. UK (2019). Zou et al (2017) claims gambling is a pathological disorder (to behave in an extreme and unacceptable way). The gambling related burden of harm was 3.0more than drug addiction, gambling is the only non-substance disorder in the addictions and related disorders WHO (2017). Research found there are similarities between problem substance use and gambling addictions Petry et al (2014). Research shows that clinical interventions are more effective when a biopsychosocial model is applied according to Griffiths (2009). The American Psychiatric Association (APA) (2013) claim that addiction is a complex condition, a brain disease that is manifested by compulsive behaviour or activity despite harmful consequence. The APA designed a diagnosis criteria DSM-5 to clinically diagnose individuals with addictive disorders and claim that an individual must show at least four symptoms of the addictive behaviour or disorder to make a mental disorder diagnosis along with the biological, psychological and social factors (biopsychosocial approach) that may contribute to the addictive behaviour or disorder.

Biopsychosocial model

The biopsychosocial model is a holistic approach that treats each person as an individual. Dr George Engel (1977) proposed the biopsychosocial model of addictive behaviour considers that the biological, psychological and social determinants play an important role in understanding and treating addictive behaviours. Applying the biopsychological model to the case study we identify the biological influences, psychological effects and the social influences on Henrys addictive behaviours Engel (1977).

The biological approach into addictive behaviours focuses on genetic vulnerabilities (can influence who we are) and the neurobiological effects of frequent substance use and gambling disorder (how the brain perceives the addictive behaviour). The biological approach will be applied to the case study as part of the biopsychosocial model to better understand the biological determinants of Henrys addictive behaviours according to Morrison (2016). Muller (2013) claims genetic vulnerabilities (family history) could increase the risk of addictive behaviour. It may be that one or both of Henry’s parents have addictive behaviours, such as alcohol consumption to relieve stress of work or has developed through social interaction with work colleagues; it maybe Henry’s parents are addicted to work. These biological factors will need to be identified to better understand Henry’s frequent substance use and gambling disorder. Miller (2013) claims that genetic vulnerabilities could have an increased tendency toward addictive behaviours in general. Frequent substance use and gambling disorder has a biological effect on the brain. Henrys addictive behaviour activates the brain reward pathway which is instinctively involved in how the effect of how the addictive behaviour is perceived by Henrys brain. The rewarding effect of cocaine and gambling has activated the circuitry system of the mesocorticolimbic dopamine systemin the brain and increases the dopamine (neurotransmitter) which is produced in the ventral tegmental area (VTA), then travels to the amygdala (responsible for emotions) along the synapse to the nucleus accumbens (controls motor functions) to the prefrontal cortex (focus, attention and planning), then travels to hippocampus (formation of memories). When Henry indulges in his addictive behaviours (stimulus) the VTA releases the dopamine along these pathways to the prefrontal cortex initiating a pleasurable perceived benefit, making it more likely that Henry will continue to use cocaine and gamble, Potenza (2013).

Psychological determinants can play an important role in the development of addictive behaviours in the case study. Firstly, Henrys personality type could be determinant of his addictive behaviour. Personality is what makes individuals different from one another. All individuals behave in a distinctive way and demonstrate traits that are continuous whatever the situation and, is associated with addictive behaviours and contribute to decisions about lifestyle choices, according to Raynor et al (2019). There are many personality types and McCrae et al (2019) put forward a five-factor model which identified five principal factors of personality. Applying the five-factor personality test to the case study could identify the personality traits of Henry in order to understand his addictive behaviours. 1)Openness (more likely to be more open to opportunities; 2) Conscientiousness (how they are perceived by peers, work to the best of their abilities; 3) extroversion (outgoing, seeks and adventure and sociable); 4) agreeableness (follower); 5) neuroticism (tendency toward unstable emotions). Henry would appear to score high as neuroticism, low agreeableness and low conscientiousness according to his behaviour in the case study which means Henry would be more likely to develop addictive behaviours according to McCrae et al (2019). Genevieve et al (2019) examine the links between the five-factor personality determinants of addictive behaviour and the comorbidity between these behaviours. The study involved 3,785 participants of whom were twins and siblings, they completed five factor inventories and psychiatric interviews. Genevieve et al (2019) suggests the personality traits of low conscientious, high neuroticism and low agreeableness linked with addictive behaviours. Henry had limited interaction with his parents and seem to spend most of his adolescent years or with his nanny away at boarding school. Henry may have felt rejected and undervalued by his parents which could have had an impact on Henrys self-esteem feeling a lack of self-worth, which could have an impact on Henrys coping skills. A controlled study was carried out in Stockholm to identify a possible link between dysfunctional parenting and development of addictive behaviours. A convenience sample was 81 heroin addicts and 81 healthy subjects, and the data showed there was a link between dysfunctional parenting (rejection or over protectiveness) and the development of addictive behaviours, Anderson et al (2003).

Biological Determinants

Sociological determinants of addictive behaviour that can be applied to the case study are firstly, the socio-economic status (SES) of Henry. Henry comes from an affluent family background and is a lawyer, so the financial cost of using cocaine and gambling with huge losses has no negative consequences for Henry at present, however, could escalate out of control. Henry may have financial support from his parents as that this may be how they show their love for him, hence money has no value to Henry. Patrick et al (2012) carried out a study which examined the correlation of these three factors, income, wealth, parental education and SES and addictive behaviour during young adult hood. The data was collected from the national panel study of income dynamics and found based on the three factors of family SES that young adults with high SES were most prone to addictive behaviours. Secondly, Henry applies these addictive behaviours recreationally when socialising with his peers, this could possibly be peer pressure. Henry identifies himself with his peer group and is more to behave and adopt the peer groups perceived norms (typical behaviour) as Henry may excluded and not part of the group, according to Savolainen (2019). Andrew et al (2002) claim peer influence can contribute to young adult substance use. Lastly, Henrys family relationship and circumstances have an impact on the case study. Henry and his siblings were raised by the house nanny, when he was not attending boarding school in fact not raised by his parents, therefore Henry was denied the parental nurturing from his parents, who should be the most influential people in his life and according to Malinaro (2014) parental nurturing which expresses affection, empathy, closeness was linked with low scores of addictive behaviours.

Cognitive behavioural therapy (CBT) is a psychotherapy therapy approach which will be applied to the case study to identify and better understand the dysfunctional thoughts and feelings Henry has towards his addictive behaviours. In order to identify and understand the causes of Henrys substance and gambling addiction, he will need to consult with a counsellor over a period, Carroll et al (2017). Henrys therapist will aim to identify Various psychological and sociological factors associated with Henrys addictive behaviours, Henry lives in affluent area of London, and frequent use of cocaine when socialising with his friends, which is an expensive addiction (external cues). These external cues may be identified as factors to the gambling addiction to maintain the lifestyle henry is accustomed to. Also, the parental pressure to be equally as successful combined with the stress of his professional life (internal cues) using cocaine on nights out suggest an escapism from day-to-day pressures. The therapy sessions can be either on an individual basis or in group sessions and will last between 30 to 60 minutes The therapist will firstly need to help Henry realise his behaviour is addictive then, identify strategies to increase Henrys motivation to engage in therapy and manage the addictive behaviours to increase self-efficacy (self-regulation) change how Henry thinks about his addictive behaviours and develop coping strategies and apply them to situations that would trigger the addictive behaviours, Sudhir, p (2018).  CBT strengths are that they not only help Henry overcome the addictive behaviours but aids to Henry to develop new skills and strategies which can be applied for Henry to recover. There are also weaknesses to CBT theory, Henry must want to change his attitude to the behaviours for CBT to be beneficial and the co-morbidity of addictive behaviours can interfere with Henrys response to treatment, Sudhir, P (208).