From a psychological perspective, there are two prominent models that form the basis of understanding how substance use develops and how it is initiated and stopped. A model that describes how substance use develops is called, the biopsychosocial model, developed by psychiatrist George Engel (1977) and a model that describes how substance use is initiated and stopped is called, the Stages of Change model (Prochaska & DiClemente, 1984).
The biopsychosocial model proposes that biological, psychological and social factors are interconnected and contribute to substance use (Engel, 1977). Some biological factors that may contribute to substance use include a possible genetic predisposition to use due to parents who used substances, initiation of use at adolescence and being a male. Difficulties managing stress and also social factors such as having a friendship network that use substances can also contribute to the increased likelihood of drugs and / or alcohol.
The Stages of Change model suggests that individuals move through six stages of change: Pre-contemplation, contemplation, preparation, action, maintenance, and termination (Prochaska & DiClemente, 1984). The Stages of Change model can be used to explain one’s initiation and cessation of substance use. The model recognises that relapse can happen at any stage and is common when an individual is attempting to reduce or cease substance use (Werch & DiClemente, 1994).
Assessment of substance use disorders typically involves an initial clinical interview with a psychologist and the completion of a questionnaire such as the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) (WHO Assist Working Group, 2002). The ASSIST was specifically developed by the World Health Organization (WHO) to assess for substance use. The ASSIST consists of eight questions related to the use of tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, inhalants, sedatives, hallucinogens, opioids and other drugs. A risk score of low risk, moderate risk or high risk is given for each substance. The risk score determines the level of recommended intervention.
Treatment of substance use disorders typically involves a combination of Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) techniques to build motivation for change, teach strategies to clients to cope with their cravings, help clients to identify the association between their thoughts and behaviours and work on relapse prevention.
Please connect with a mental health professional if you or someone you care about experiences substance use issues. Cause Effect Psychologists are trained to assist individuals with alcohol or substance use issues who are local to the Redlands area.
Written by: Amit Singh – Cause Effect Psychologist (July 2020)
Engel, G.L. (1977). The need for a new medical model. Science, 196, 129–136.
Prochaska, J.O. and DiClemente, C.C. (1984) The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy. Dow Jones Irwin, Homewood, IL.
Werch, C. E., & DiClemente, C. C. (1994). A multi-component stage model for matching drug prevention strategies and messages to youth stage of use. Health Education Research, 9(1), 37-46.
WHO ASSIST Working Group (2002). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction, 97 (9): 1183-1194.