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About the EMCDDA TD ISS N -X M IS The European Monitoring Centre for Drugs and Drug Addiction D o S2 (EcEosMtmaCbplrDiesDhhAeend) s iiisnv e o1 ni9ne9f oo3rf m athanedti o Ebnua rosoenpd ed airnun g LUiss nbaioonnnd,’ s di tdr uiesgc tehanedt rdcaielcintsiteordan l aisngo euEnruccreioe pso.ef . -13-014-EN dels of addic N 0000-00314-9264 The EMCDDA collects, analyses and disseminates factual, objective, -N tion 00 reliable and comparable information on drugs and drug addiction. In doing so, it provides its audiences with an evidence-based picture of the drug phenomenon at European level. The EMCDDA’s Insights are volumes conveying the findings of study and research on topical issues in the drugs field. EMCDDA E M INSIGHTS C D D Price (excluding VAT) in Luxembourg: EUR 15 A I N S I ISBN 978-92-9168-652-0 G Models of addiction H T S 14 14 How to obtain EU publications Free publications: • via EU Bookshop (http://bookshop.europa.eu); • at the European Union’s representations or delegations. You can obtain their contact details on the Internet (http://ec.europa.eu) or by sending a fax to +352 2929-42758. Priced publications: • via EU Bookshop (http://www.bookshop.europa.eu). Priced subscriptions (e.g. annual series of the Official Journal of the European Union and reports of cases before the Court of Justice of the European Union): • via one of the sales agents of the Publications Office of the European Union (http://publications.europa.eu/others/agents/index_en.htm). EMCDDA INSIGHTS Models of addiction 14 Author Robert West Legal notice This publication of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is protected by copyright. The EMCDDA accepts no responsibility or liability for any consequences arising from the use of the data contained in this document. The contents of this publication do not necessarily reflect the official opinions of the EMCDDA’s partners, any EU Member State or any agency or institution of the European Union. Information on the European Union is available on the Internet. It can be accessed through the Europa server (http://europa.eu). Europe Direct is a service to help you find answers to your questions about the European Union. Freephone number (*): 00 800 6 7 8 9 10 11 (*) Certain mobile telephone operators do not allow access to 00 800 numbers or these calls may be billed. Cataloguing data can be found at the end of this publication. Luxembourg: Publications Office of the European Union, 2013 ISBN: 978-92-9168-652-0 doi: 10.2810/99994 © European Monitoring Centre for Drugs and Drug Addiction, 2013 Reproduction of this publication is authorised provided the source is acknowledged. Printed in Spain Printed on white chlorine-free PaPer Cais do Sodré, 1249-289 Lisbon, Portugal Tel. (351) 211 21 02 00 • Fax (351) 218 13 17 11 [email protected] • www.emcdda.europa.eu Contents Foreword 5 Acknowledgements 9 Executive summary 11 Chapter 1: Background, scope and aims 17 Chapter 2: Defining addiction 21 Chapter 3: Summarising theories and models of addiction—methods 29 Chapter 4: Modelling in the individual 33 Chapter 5: Modelling populations 79 Chapter 6: Towards a comprehensive theory of addiction 87 Chapter 7: Implications of theory for assessment and measurement of addiction and related constructs 105 Chapter 8: Implications of the comprehensive theory for intervention strategies 115 Chapter 9: Implications for policy and practice 127 References 135 3 Foreword It is a great pleasure to introduce this EMCDDA Insights publication on models and theories of addiction. Addiction continues to be one of the key concepts in the scientific and policy debate around drug use and interventions, and lies at the very heart of the responsibilities of this agency. The diverse approaches presented here have been developed by different academic disciplines and are a reminder of the fact that addiction is a multifaceted problem. Without doubt, both understanding it and developing interventions to combat it will benefit from a broad perspective—one that goes beyond the ‘brain disease’ model or purely sociological or economic approach. With a view to encouraging debate, as well as a common understanding of this complex concept, this report presents a compendium of models of addiction placed within an integrated framework. The EMCDDA commissioned this report in order to increase understanding of the nature of addiction, highlighting the lessons that alcohol, tobacco and non-pharmacological addictions can provide for understanding addiction to illicit drugs, and vice versa. The addiction concept is central to our work, and the various models and theories are presented here against a background of recent debates in the scientific community. While it is clear that drug problems are correlated with a range of factors, addiction is undoubtedly a central factor. It is also apparent that in many ways addiction is a phenomenon that is not limited to illicit psychoactive substances, indeed, pharmacological agents. This discussion does not stop at substance-based problems and includes phenomena such as gambling or compulsive use of the Internet. We note that a number of European countries have established centres of addiction that potentially cover the full range of addictive behaviours. One important conclusion is, therefore, that it is both possible and desirable to undertake a broader analysis of addictive behaviours than is currently practised. For those in the business of drug research and monitoring, it raises some central questions, such as whether we should continue to monitor addictive use by substance or at a more general level. Importantly, this report progresses from a presentation of addiction theories to an exploration of their consequences for interventions. Utilising an integrative framework, it is proposed that combating addiction requires an analysis of the capabilities, opportunities and motivations needed for change in an individual or target population, followed by a selection of appropriate responses from a range of 5 Models of addiction interventions. Making use of this approach not only provides the reader with the possibility of keeping an overview on the perspectives taken by the existing different models of addiction, but also allows for the selection of policy and practice interventions based on the behavioural targets, and which in the long run, should enable the development of more effective response strategies. Wolfgang Götz Director, EMCDDA 6