EXPLICATORY MODELS
If we look at the literature, diverse explicatory models which try to explain the Dual Diagnosis Phenomenon have been developed. Thus, we can find:
Addiction Disease Model
It considers the addiction as an independent entity and not as the consequence of another disorder.
The main characteristic of addiction disorders is the lack of control on the substance’s use and their concern to obtain it, in spite of the negative consequences that result from its use.
It considers that this lack of control has a biological and genetic basis.
This idea is contrary to the psychoanalytic model, which believes that the addiction is either the symptom of a psychopathology, of a psychological conflict or of underlying unacceptable emotions.
This model led to the development of an addiction treatment independent to the psychiatric one.
Self-medication hypothesis
The specific pharmacological effects of the drugs abused are used by individuals who are susceptible of self-medicating the symptoms of their mental disorders.
The choice of drug does not constitute a random process but rather a specific drug is
used to provide a specific self-medication.
This theory, however, does not contemplate the following factors:
- biological and genetic factors.
- sociocultural factors.
Biopsychosocial model
It takes into account a multiple factors cause when dealing with the use of substances,
which includes:
GENETICAL PREDISPOSITION
PSYCHOLOGICAL FACTORS ---------------------- > Reciprocal
SOCIO-CULTURAL FACTORS Interaction
1. The genetic factor which entails the lack of control constitutes a representative element of the addiction’s disease model.
2. The psychological factor which leads to the consumption as a way of running away from unpleasant feelings supports the self-medication hypothesis.
3. The socio-cultural factor implied in the availability of the substance either for cultural reasons, or the easy access because of social validity depending on each demographical group.
This model enables us to explain:
1. The diversity of patients with addiction disorders, many of which present pre-existing, co-existing or secondary psychiatric disorders to the substance’s use.
2. The variety in the prevalence of addiction disorders in different populations.
This model also suggest that the population abusing toxic substances are not
homogenous but rather a constellation of heterogeneous subpopulations,
among them we can find dual diagnosis patients, where we can distinguish
different original circumstances leading to the consumption:
I. Disorders due to the use of substances, secondary to a psychiatric disorder.
II. Disorders due to a primary substance’s use
The byopsychosocial model is compatible with the integral approach of dual diagnosis.
- Context
- Definitions
- Characteristics and associated circumstances
- Origin of the disorder and clinical predominance
- Explicatory Models
- Operational hypothesis: Crossed vulnerability
- Complementary Hypothesis