Addictions: a holistic approach to a complex problem

Drinking, like other cases of substance abuse, does not have a simple cause; reasons for alcohol-seeking and drinking are, therefore, many-fold. A number of triggers and stressors have been identified in the literature, including cultural, socio-economical (Hirschovits-Gertz, 2011; Peele, 2011; White, 2004), biological (Liang, 2010; Schmid, 2009) and psychological precipitating factors (Johnson, 2011; Gullestad, 2001). The BioPsychoSocial Model is a contemporary framework which takes into account a variety of factors when considering causes of psychological and physical disorders, and is often used to formulate and plan treatments for addiction disorders (Borrel-Carrio, 2004).

We are social creatures... a bit too social perhaps? Or is it just an illusion?

Participation in social activities involving drinking may be required by our environment in the form of social expectations, assigned gender roles, peer pressure, social gatherings, or even team-building activities at work. Social cultures differ significantly with respect to drinking. Cultural differences may be explained by local customs, mentality and even local climate. In some countries drinking is culturally valued and may become almost unavoidable in social situations; on the other hand, women in particular cultures are supposed to abstain from alcohol due to their understanding of femininity and gender roles. Being unable to engage in expected social behaviours may lead to social isolation thus possibly internal psychological problems; however, to stay in a group, one may be required to indulge oneself in unhealthy drinking behaviour even against one's own will (Kelman, 1958). On the other hand, socialising brings positive emotions and a feeling of belongingness which may improve mood, work productivity and overall stress resilience. The effects of social drinking thus need to be assessed in each case individually by taking into account developmental, social, personality and genetic issues. Nevertheless, when drinking habits start dominating one's lifestyle and decisions, going out and social events often turn into drinking reinforcement which may considerably hurt already vulnerable individuals. Moreover, when one accepts drinking too eagerly, it may also well be that one feels lonely, uncomfortable or depressed. This ¨over-socialization¨ when actively participating in all kinds of social gatherings and over-drinking only seems social at the first glance; paradoxically, one may often find behind this social game a lack of social skills, a dependent personality or a lack of social support.

Biological factors affecting drinking habits

When discussing biological factors of alcohol-seeking and alcoholism, genetic predisposition (Diaz-Ansaldua, 2011; Schmid, 2009), influence of certain organic disorders such as traumatic brain injury (Book, 2002; DeLongis, 1988; Grant, 1995), Fatal Alcohol Syndrome (AAP, 2000) as well as biological aspects of psychosocial stress (Nash, 1988; Sadava, 1993; Spencer, 1990; Wand, 1991) come to mind. However, in reality, one may rarely refer to biological factors in isolation; even genetic structures are being continuously modified by our environment (for details, see literature about the so-called genes-environment interaction; Murgatroyd, 2011). Also, any predisposition does not necessarily lead to actual consequences before a sufficient amount of triggers accumulate and reach a certain threshold. For instance, stressful life events may result in various physical and psychological disorders and behavioural changes. In the absence of such stressors, however, one may avoid following one's ¨biological destiny¨ by choosing healthy lifestyles or being raised in favourable environments (Schwarzer, 2002; see also literature about the so-called ¨nature-nurture¨ debate).

Psychosocial triggers

As psychological factors are concerned, one may identify developmental issues such as attachment patterns in early stages of life (Gullestad, 2001), family relationships (Newman, 2009) and personal characteristics (Gil, 2005; Johnson, 2011) which all contribute to the development of attitudes and their dynamics. It is difficult, however, to clearly differentiate between psychological and biological factors, as both seem to matter and may reinforce each other. Children of alcoholics, for instance, are found to be more eager to accept drinking behaviours (Newlin, 1999); they are, however, also significantly more predisposed to alcohol abuse due to biological and environmental reasons (Murgatroyd, 2011). Furthermore, emotional stress coping is often the case when engaging in drinking activities, which means that psychosocial stress serves as a precipitating factor (Garland, 2011; Gil, 2005).

Putting it all together

Choosing drinking as a coping mechanism is not necessarily a conscious personal decision and is often a consequence of psychological problems. Loneliness, for instance, may lead to anxiety or depression (Kushner, 2000) which in its turn may make one choose alcohol bringing temporary relief (Austenfeld, 2004; Gil, 2005; Zaleski, 1998). Choosing drinking for coping and stress relief may sometimes be personality-driven; more often though one turns to drinking due to a combination of various biological and psychosocial factors (Brady, 1999). No single factor can explain this phenomenon; thus, it becomes crucial to assess clients holistically when diagnosing and treating substance abuse disorders.


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