A person accepts and prefers suffering from problems and the stigma of the addiction. From this perspective, one who is in conformity with the social structure and other people in the community is not at risk of drug dependence, but it is the strategy of isolation-seeking people in competitive situations in which they have no chance of success.
Self-control theory, proposed following the social strain theory in explaining abusive behaviors, including drug use, believes that individuals behave normally based on their own benefits and interests, and socialization and education to restrict these benefits by creating self-control are essential Based on this theory, the drug use originates from the dialectic between the dominant culture especially the drug subcultures of and the evolutionary course of individual identity.
Drug use is a personal decision, but dominant drug subcultures and the status of an individual related them have a greater effect on the behavior. Individual decisions to adopt or reject different aspects of dominant subcultures lead to the development of old subcultures into new sub-cultures These relationships learn the way of using drug and different views that consider drug a pleasurable element Nowadays, the idea is markedly expanding that one-dimensional models are not able to explain all the realities of addiction and drug abuse phenomenon 68 , and newer theories try to explain various biological, psychological, and sociological aspects of this phenomenon and the interaction among these dimensions in a complex image using a holistic approach and multidimensional models 68 - Some of these models have focused on finding common physical, psychological, and social characteristics between drug addiction and other addictive behaviors such as gambling, sex, internet, computer games, eating, and shopping 70 - By integrating physical, psychological, and social factors affecting drug use 73 , 74 or by presenting combination of at least two different models dual model 75 , 76 or several different theoretical approaches, some models have tried to explain why and how the various factors inhibit drug use or trigger the onset of drug use and its continuation 77 , and finally addiction Theorists who have used the theory systems to explain the phenomenon of addiction 78 - 81 have tried to explain the interaction among the components of addiction and explain how a change created by other components is compensated, eliminated, or reinforced 8.
While these theories have a holistic approach to addiction, they do not evaluate drug use as an independent phenomenon but also as a cause for other factors, which may not be in other equilibrium conditions.
Not only the content but also the form and methodological approach of these theories and models to the phenomenon of addiction have had a determining influence on our perception of the concept of addiction and the response to it. Thus addiction theories can be criticized and analyzed in different aspects:. The focus of these studies is on the individual or on the group or on both of them Another class is epidemiological studies with an ecological approach. These studies are conducted to understand the effect of context, for example, the health of individuals and population groups through responses such as selection, distribution, interaction, and conformity Other studies have also investigated the influence of contextual macro factors on the formation of individual behavior Accordingly, the types of bias and fallacy can occur in the process of designing and analyzing these studies and influence the theory resulting from it.
Although some studies have focused on the anthropology of drug use in some particular tribes or subcultures or groups and social classes with particular specifications 85 , 86 , less attention has been paid to this issue that how and in which social and economic conditions, communities at macro-level are prone to drug use and the addiction. It seems that one of the reasons for reductionism of the phenomenon of addiction to the individual level to be the methodology of the studies, which these theories have been developed based on them, so theories resulting from the result of these studies failed to explain this phenomenon since:.
Thus by relying on the findings of a study conducted on an individual level or group level, one cannot predict its characteristics and the study should be conducted both on the individuals and the groups consisting of those individuals.
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A mistake occurs when we want to induct from micro levels such as molecules, genes, cells, tissues, and organs to macro levels such as individuals, groups, or generations or the reverse of this path and generalize our findings at one level to other levels Many of addiction theories have been presented based on the study on drug addicted people.
Some drug use theories were based on the study of addicted people, while only a part of drug users reaches to addiction stage. What is crucial in this regard is the individual physical, psychological and social factors affecting the drug users with a very diverse combination. Individual studies not only ignore the group effects on the phenomenon studied, but also do not examine the fact that these individuals belong to which groups and classes with varying characteristics of the studied population.
In such a situation, the correlation observed among the individuals within a group and the variables studied can be different and more diverse compared to that among the groups. For example, when the effect of group pressure on drug use in adolescents is examined, if the target group is not stratified properly or possible inflectional factors such as education level of parents or socio-economic status of the family based on variables such as family size are controlled, our conclusion will guide us to a non-generalizable theory.
In addition, both of these independent individual- and group variables the level of education and the average education of community or the group to which he belongs are influenced by the contextual and macro variables affecting the education process and they are not considered in usual studies. In other words, two persons with similar levels of education living in two communities with a different average of education might show different proneness for drug use under the effect of these group and contextual variables.
Hence, without conducting multi-level extensive studies in a variety of social areas, it is impossible to specify the status of the education variable in the theoretical and explanatory model of the addiction. With this methodology, it is not possible to generalize the results to explain the use of drug in all communities or populations in different situations since the relationships of variables can vary when people are studied in general and when they are grouped in specific categories, thus it is wrong to think that the presence of relationship at one level of a population group can be deducted from other levels of that population.
As stated above, it should be noted that when the addiction study is performed at the group or subculture level using independent group variables, that group itself is influenced by macro and contextual variables and may directly affect the person. Therefore, if a theory aims to be developed based on the characteristics of a specific group or subculture in a community, it can be generalized to other people in that community when are compared with similar groups or subcultures in different contexts.
Therefore, any theory can only explain the onset and the continuation of drug use of a part of users of various drugs and generalizing it to all users is a fallacy. At the same time, it should be noted that the cultural context of the community, where the study group is living plays a key role. Therefore, we need to conduct cross-cultural studies in order to present a generalizable theory It should be noted that the study of specific groups of the population is subjected to specification bias.
Thus when we examine the drug use and addiction in groups such as marginalized groups or refugees, we should note that a variable such as poverty in the sense of deprivation of a variety of resources will directly influence drug use and the conditions of marginalized groups and or refugees. Hence, determining the relationship between the variable of poverty and the drug use will be crucial to explaining the relationship of these groups with drug use.
This fallacy is common at the individual level. The root of the fallacy is cross-level bias and it can be the result of an atomistic fallacy. It occurs when the observation stops at the individual level and the group effects are not considered and specification bias occurs when the occurrence of this bias is highly probable in the statistical analysis at the individual level Hence, in a study on drug users, when it is seen that micro crimes caused by drug use or drug-seeking behaviors are more in drug users, we cannot conclude that in communities where these crimes are more common, drug use is also necessarily more common and thus we cannot consider the roots of drug use and committing a crime as the same in theory developed based on this information.
In addition, the independent variables paving the way to commit a crime in some drug users should be identified and included in the theoretical model, otherwise, the results of a limited study will be generalized to users of a variety of drugs. The fallacy may also occur when the results of the addiction study conducted on people belonging to specific social groups, age, job, and ethnic groups or subcultures are generalized to other populations and even the entire community of people. This evidence cannot be the base for a holistic theory since people belonging to the studied groups may be exposed to different contextual and integral variables.
It seems that some of the theories using environmental variables to explain the phenomenon of addiction suffer from the ecological fallacy since they create a causal relationship between group characteristics and drug use at the individual level by generalizing the characteristics of a group to individual members of the group, including those using drugs. However, that group characteristic in spite of statistical correlation may be due to a common contextual factor, which has been ignored.
Therefore, based on an epidemiological study, if we realize that drug use is associated with some psychological states, we are not allowed to claim in the theoretical model that anyone who is in a mental state considered in this epidemiological study is necessarily at higher risk for addiction unless we conduct adequate studies at the individual level to assess the etiology effect of that psychological state on the addiction.
When measures of individual characteristics refer to contextual conditions such as social class and education , they can reflect the characteristics of the group to which he belongs. Special time conditions are neglected when the mean figures hide the differences among the individuals. In contrast, the lack of individual measures can suppress the occurrence of relationships found at the group level.
Multi-Level Approach to Theories of Addiction: A Critical Review
For example, in the subculture theory of drug use, both behaviors inconsistent with the governing values in the community and drug use can be attributed to psychological factors such as personality , which separately make a person and the conditions in which the person is located either direct or indirect prone to drug use.
It is possible that both of these conditions to be influenced by the contextual and macro variables. However, a person with minimum socio-economic resources can possess a completely different destiny. As stated, group variables may impose more effects on person state. In the same example, if a person belongs to a minority group, he may experience higher deprivation.
However, the degree of deprivation in a minority for example, a religious, racial or ethnic minority varies from one country to another. Thus the demographic conditions age or gender or the literacy or job capability of a person belonging to a minority group can change its proneness to use drugs as they affect his socio-economic factors such as his socialization level.
Similarly, the study group might make its members prone to drug use due to conditions, which are not necessarily related to drug use. For example, if access to drugs or similar risk factors is high due to the poor performance of the police in marginalized areas, people living in those neighborhoods will be normally more prone to drug use. Accordingly, the effect of various types of common stressors in these neighborhoods or the type of relationships and the social network governing on neighborhoods with specific conditions can be examined.
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As the effect of physical, psychosocial, and social factors is not only applied directly, but in the form of causal network, it is necessary to pay attention to the role and dynamics of the relationship between a variety of factors at the onset of drug use, continuation of use, drug dependence, drug addiction, and the occurrence of a variety of addictive behaviors, and ignoring them will lead to the presentation of reductionism theoretical models.
Generally, it can be stated that the factors influencing the onset of drug use are different for those who are influenced by persistent drug use, drug addiction, and outcomes of drug use and we cannot explain all of them in a theory limited to a number of individual or social variables. In practice, the correlation of relationships is larger when the study subjects are population groups when they are studied at the individual level since the groups containing humans have higher homogeneity and covariance than when individuals are randomly selected.
In addition, valid studies try to eliminate the extraneous variations as much as possible to explain a larger share of variations by studying the variables Drugs were directly used for pleasure or for the relief of physical and psychological sufferings in the past, but different population groups are nowadays using drugs for completely different reasons. Hence, a single theory used to explain drug use by a young woman to lose weight to gain social acceptability cannot be used to explain the use of stimulants to focus more on studying for university exams or getting more energy to work harder or getting deeper feelings during an artistic activity or get into a trance to gain spiritual experience in a group ritual.
When these people are studied together in a target group, the statistical results will be very misleading. The use pattern can also be another determining factor in our theoretical model since the tendency to use different drugs hard-soft can result in different socio-economic analyses with different outcomes, which influence other variables. For example, one uses injectable heroin is more likely to suffer from unemployment, social exclusion, and a variety of physical and psychological harms than one who uses marijuana sporadically for fun.
Thus it is necessary to obtain knowledge on the use pattern of people included in the theoretical model as drug users. It will help us develop multiple theories for different drugs and drug users. Another effective factor, which has not been considered in the addiction theorizing is the effect of the prevalence of drug use in terms of the acceptability of drug use in general or a specific drug in the study population. It means that when the use of a drug is more common in a community or even a country for example, a coca leaf in South American countries or a marijuana in many Western or Khat in Arab countries , no longer only people with special characteristics show a tendency for drug use to consider these characteristics as base of explanatory model of drug use.
People often use different types of drugs in communities with different socio-economic conditions. Thus socio-economic variables influence the type of drug used by individuals within a community Therefore, various theories can be presented to explain the use of different types of drug in different communities. In contrast, it can be expected that, as we see in high-risk behaviors, making people prone to HIV 91 , when the use of drug in general or a specific drug is unaccepted or had low prevalence in a given community for example, the use of alcohol in Islamic countries , the odds ratio of drug use will be higher in people who are prone to show a risky behavior.
The beliefs of various communities and groups in viewing drug use normal or abnormal and the status of drug use or its non-use in the social capital of people belonging to these groups and communities can also influence the characteristics of groups and people prone or tend to use drugs or do not reject it. Thus if only their individual proneness is considered to be the etiology of drug use, and the influence of sociological and epidemiological factors is ignored, the theory will not present proper explanation and it will remain limited to the population studied.
Hence, the effects of factors such as the criminalization or decriminalization of drug use in different countries on the level of drug use can be added to this equation. Thus it is more likely that, in a community where drug use has been criminalized based on the laws and even penalties have been specified it, those people use drugs who have a higher tendency to break the law or risky behaviors compared to a community, larger number of people are prone to use drugs due to toleration to use drugs. Consequently, mono-level theoretical models based on epidemiological information and even demographic information since women have a lower tendency to break the law in all communities will certainly have significant differences in these two communities.
It should be noted that in order to specify the prevalence of addiction in a population, it is not proper to categorize people into addicted and non-addicted people. The more accurate approach is that the addiction should be specified in people and the addiction status should be assessed in a community based on the fact that people are addicted in varying degrees and severity 8.
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Theories based on this viewpoint clarify how environmental and social factors directly related to the person facilitate drug use and addictive behaviors or prevent it. Although the role of dynamism governing intra-group relationships in the phenomenon of addiction has been considered by these theories, especially social learning theory, this approach does not focus on the effect of macro socio-economic contextual factors on the psychological state and its related behaviors. To gain a holistic and accurate understanding of the multi-dimensional bio-psycho-social and multilevel individual and social phenomena of drug use and addiction requires multidimensional studies in individual, group, contextual, and macro dimensions.
Thus the theories developed based on these studies will be able to predict the influence of change in the types of factors on the addiction and drug use, and they will be used as a base for the design of interventions, which will guide us towards realistic goals. Theorizing with this approach requires a multidisciplinary and cross-disciplinary view, which avoids the reduction of this phenomenon to one of the level or dimensions and does not deprive itself of any data. Analysis of such big data has not been common in addiction studies and its theoretical modeling and its products will certainly reveal many unknown dimensions of human in addition to the addiction.
Challenging the brain disease model of addiction: European launch of the addiction theory network
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