The Process of the Development of the Addictive Career. Young People and Addictive Behaviour

Discuss the process of the development of the addictive career, making reference to theoretical perspectives presented in the course.

Introduction

The term addiction is commonly alluded in the day-to-day conversations between individuals (example, I am a chocolate addict); yet, not much thought is given on what the construct actually means (McMurran, 1994; Shaffer, 2017). As a matter of fact, the word ‘addiction’ is quiet difficult to interpret because everyone has different meanings and connotations to it depending on the believes and knowledge that each individual has as well as, the context that it is used in (Moss & Dyer, 2010; Thombs & Osborn, 2013). In spite of this, a common understanding of the term amongst researchers is that addiction is a type of chronic disorder that transpires when an individual develops some sort of habit that is beyond his conscious control and that is persistently repeated, regardless of the negative consequences that the habit may have on the individual himself or on others (Henderson, 2000; Ross & Kincaid, 2010; West & Brown, 2013; Ryan, 2014; Bedell, 2015; Diclemente, 2018).

However, such an open understanding of the term took time to get established. Back in the days, addictive behaviours where only considered as being substance-related disorders, in fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) used to define it as being compulsive drug use, which are characterized by withdrawal symptoms (West & Brown, 2013; Potenza, 2014). Nowadays, the term has evolved and professionals understand that addiction is not just substance related. The DSM-5 extended the definition from ‘Substance-related disorders’ by adding ‘… and Addictive disorders’ to the original meaning (American Psychiatric Association, 2013; Potenza, 2014; Pinna et al., 2015). The definition has transitioned and behaviours like, gambling and internet use, are now also taken into consideration as being behavioural addictions because they share various elements (Moss & Dyer, 2010; Clark, 2011; Shaffer, 2017). These kind of behaviours where not even thought of as being addictive behaviours, considering how normal certain activities may seem, like for instance shopping and sex addictions (Hartney, 2019b). It should also be noted that, everyone and anyone could become a victim of addiction (Henderson, 2000; Moss & Dyer, 2010).

Phases of the Addictive Career

Addiction does not just happen overnight, but rather is a process that takes time to develop (Moss & Dyer, 2010; Hartney, 2019a). It is supposedly being said that the best way to formulate and understand addiction is by utilizing a career approach; similarly, to the one adopted to criminal behaviour (Clark, 2006). Through this approach, addictive behaviours occur along points on a continuum; which is not necessarily always a linear process. This is because an individual who is at stage one of the career, does not automatically mean that the individual will also engage in stage four (Clark, 2011). An addictive career has four stages, these being; onset, escalation, commitment and desistance (Clark, 2006; Clark, 2011). These stages represent the beginning (i.e. onset) and the end (i.e. desistance) of the addictive career, as well as the career length in between (Clark, 2011).

Onset. While adolescents are transitioning into becoming independent, young adults they are at a crucial phase in which they like to experiment with new behaviours (Wolfe, Jaffe & Crooks, 2006; Qidwai, Ishaque, Shah, & Rahim, 2010). For instance, more often than not adolescents experience using drugs or alcohol consumption for the first time during this phase so as, to impress and fit in with their peers (Albert, Chein, & Steinberg, 2013). Such experimentation could potentially lead to the beginning of the adolescent’s addictive career (NIDA, 2018). Nonetheless, it does not mean that every adolescent that consumes drugs or alcohol on an occasional basis, like during the weekends, ends up being a substance or alcohol addict (Clark, 2011). In fact, the American Academy of Child and Adolescent Psychiatry (AACAP) mentions how certain adolescents will just experiment and then stop, if not entirely at least limit their consumption to infrequent basis, without having any significant troubles (Leipholtz, n.d.). Additionally, Clark (2011), continues to elaborate that “use may remain experimental … and the individual may fail to progress along the continuum” (p. 61). Thus, will not lead an addictive career.

However, there are a few adolescents that end up developing an addiction, especially if they have been experimenting with such behaviours from a very early stage in their life (Leipholtz, n.d.). When young people whom are relatively still young in age develop an addictive career, it is referred to as early-onset. According to The European School Survey Project on Alcohol and other Drugs (ESPAD, 2015), results showed that the highest type of early-onset behaviours are that of; alcohol consumption (47%) and cigarettes (23%), amongst the students that took part aged thirteen or younger.

Escalation. Following the phase of onset, is escalation. During this stage addiction increasingly progresses to a point where the behaviour or substance dependence becomes very hard to control, excessive and prodigious (Coombs, 2004; Ahmed, 2011). The individual’s mind and body is still not entirely hooked to the addiction, however continuous use of the substance or behaviour will lead to that path (Leipholtz, n.d.). At this stage, adolescents start acknowledging the negative repercussions that such addictions can have on their life like for instance, excessive consumption of alcohol leads to reckless driving and thus could potentially end up having their license suspended (Moss & Dyer, 2010; Clark et al., 2018). In cases where this happens, adolescents can deviate from repeating that particular behaviour. Besides that, such behaviours can also have positive effects on adolescents’ life like for instance, decreasing stress or pain (Leipholtz, n.d.; McMurran, 1994; Taughinbaugh, 2013). If that’s the case, adolescents are more likely to keep using or administering such behaviours, leading them to the next stage in the criminal career.

Commitment. Next comes the phase of commitment. This is the stage where addiction becomes totally uncontrollable up to a point where individuals cannot even manage to control their lives and behaviours anymore (Clark, 2011; Leipholtz, n.d.). The addicted person might start to believe that without the substance or addictive behaviour, he/she is not able to function properly or, that such addictions are a part of who they are (Henderson, 2000; Moss & Dyer, 2010; West & Brown, 2013). Also, individuals become rather preoccupied with the addiction throughout this phase, in the sense that, they start spending significant time engaging with such activities or behaviours up to a point where they even start neglecting both others around them and their routine activities, like going to work and school (Freimuth, 2008; Clark, 2011; Sussman, 2017).

Desistance. Lastly, comes the end of the addictive career. In this final phase, individuals try to potentially give up their addiction, or at least limit the activities or behaviours to a more controllable level (Frisher & Beckett, 2006; Weaver, 2019). At this point, individuals seek the necessary help from professionals as it is rather impossible for the individual to stop the addiction alone, thus requiring professional guidance (Clark, 2011; Leipholtz, n.d.). If adolescents attempt to immediately stop consuming alcohol, for example, they could end up with serious withdrawal symptoms or worse, even end up dead (Maisto, Connors, & Dearing, 2007). Hence, it is crucial that they take it seriously and seek the professional help they require.

The Four Models of Addiction and Potential Interventions

The four models of addiction have a crucial role in the addictive career. Each model represents the likelihood for an individual to become an addict, in light of the respective aforementioned phases in the addictive career as well as, presents potential interventions that can be adopted.

Disease and Choice Model. First model is the Disease and Choice Model. In light of this model, addiction is seen as being a chronic disorder that is caused by some sort of brain dysfunction, rather than being a temporary situationally activity or behaviour (Dunnington, 2011). This model portrays addict individuals as being the victims, who are blameless for their actions. Considering that they are ‘sick’, addicts are unable to think rationally about the choices they make (Schaler, 2000; Racine, Sattler, & Escande, 2017). Their choices of whether or not to engage in substance or addictive behaviours depends on the outcomes of such activities, for instance, if the pleasure outweighs the consequences than these individuals carry on with the activity, without thinking about any future repercussions the action might have (Heyman, 2009; Clark, 2011). Hence, their choice is completely voluntarily and they choose to engage in such behaviours daily out of their own free will. Furthermore, according to this model, addicts need medical treatment in order to be ‘cured’ from their disease (i.e. addiction) (Racine et al., 2017). A potential intervention could be raising awareness amongst adolescents about the fact that addiction is not a disease imposed on individuals, but rather individuals choose to engage themselves with addictive behaviours or activities. This way, adolescents became aware that they could opt-out from engaging in an addiction; since it is not a disease afflicted on them, they have a choice (Loverde, 2010)!

Biological Construct. Second model views addiction as a Biological Construct, in which addiction is seen as an inevitable biological source (Clark, 2011). There are two biological explanations which attempt to explain addiction, being; genetic characteristics and neuroadaptation (West, 2002). The former relates to the genetic disposition that individuals have. Several studies in the area, specifically twins, adoption and family studies, show that an individual’s risk of becoming an addict is proportionate to the genetic relationship of an addicted relative (Bevilacqua & Goldman, 2009; Ducci & Goldman, 2012). Consequently, in light of this explanation, adolescents are unable to desist from the addictive career because of their inherited genes- it is their path (Goldberg, 2010; Lewis, 2015). The latter, relates to the changes that occur in the brain following the use of drug administration (West, 2002; Seger, 2010; Mons & Beracochea, 2016). Example, adolescents that have previously engaged with alcohol consumption have developed drinking patterns in their brain. The next time they consume alcohol they would need to drink more than the last time in order to feel its effect, considering that they have increased their tolerance levels (ENA, 2013). Since the adolescents brain has adapted to alcohol use, they might experience feelings of longings, i.e. cravings, for alcohol thus leading them to future consumption (Waal & Morland, 1999). Failure to consume in the future will lead to withdrawal symptoms (West, 2002). Consequently, this model suggests that the addiction will only get worse as it keeps progressing; from onset to commitment, and then desistance (withdrawal). Lastly, such a model implies treatment as means of intervention; however, it also suggests that developing a neurodevelopmental perspective when implementing policies (especially focusing on vulnerable adolescents) might help in early intervention (Potenza, 2013).

Psychological Construct. Although closely associated with the above model, the psychological construct focuses more on the person-behaviour-environment interaction, rather than internalized processes alone (Clark, 2011). A set of theories in this area are the personality theories, amongst others; which focus on individuals as having an ‘addictive personality’, thus the reason why they are more prone to becoming addicts lies in their personality traits (West, 2002). Addictive personality individuals, specifically those who are; psychoticism, neuroticisms and extraversions, engage in addictive behaviours or activities regardless of knowing and understanding what the consequences are. For instance, studies show that since neuroticism personality type individuals suffer from emotional liability, like mood swings and extreme anxiety, they are more likely to engage in a substance related addiction, as it helps ease and control their feelings and moods (Sher, Trull, Bartholow, & Vieth, 1999; West, 2002). However, it is not concluded that personality traits alone lead to an addictive career as the environment has an important role as well (Clark, 2011). Learning theories allude that adolescents mimic the behaviours of those around them, especially their guardians. If, adolescents are exposed to an environment in which their parents have an addiction, they are more likely to become addicts themselves (Bates, 2019). That being so, according to this model, adolescents have no other choice but to lead an addictive career. A potential intervention could be encouraging treatment for those adolescents suffering from a personality disorder (such as OSD), like counselling sessions or therapy, so as to teach adolescents the appropriate ways of how to handle their feelings and mood swings without any form of substance-use and thus, hopefully avoid addiction.

[...]