Addiction and psychopathology: a multidimensional approach to clinical practice

The etiology of addiction has a long history of clinical and scientific interest, which is characterized by differences in conceptual approach, conflicting data and public controversy. There have been numerous attempts to describe the antecedents and consequences of addiction in theoretical models and by classifying addicts on the basis of personal, pathological and environmental characteristics (Lettieri, Sayers, & Pearson, 1980). Despite these considerable efforts, the insights that emerged from theory and empirical research have not led to a clear understanding of the etiology and the course of addiction. Perhaps evenly important, the limited clinical applicability of theory and research has led practitioners in the addiction field to rely on their private theories about the nature of addiction and the significance of co-existent problems in the treatment of addiction. Complicating the issue, addiction is subject to considerable moral debate, which includes opposing views on the types of drugs that are considered acceptable, the acceptability of drug use in general, law enforcement strategies, and treatment methods. Perhaps the most important trend that emerges from the past decades of model-development and research in the addiction field, is that scientist of various disciplines now agree that addiction is a heterogeneous concept in terms of its antecedents, concomitants, and consequences. Simply acknowledging the multifaceted complexity of addiction however, does itself not necessarily lead to a better understanding of the phenomenon, nor does it provide a guidance for clinical decisions. To expand our views on addiction, it has become extremely important to examine the interactions between the various components of the full addiction complex in detaiL Of particular importance is the question whether addiction constitutes a complex of highly interdependent problem areas that together form one underlying "addiction-dimension", or whether separate dimensions exist that are relatively independent from each other. Perhaps the most intriguing issue in this question is the relationship between substance abuse and psychopathology, as psychiatric disorders are often assumed to antedate and precipitate the onset and continuation of substance abuse. Clearly, the issue of dimensionality and the specific role of psychopathology in addiction is not only important from a theoretical point of view, but also bears relevance to the treatment of addiction. While the unidimensional concept of the full addiction complex would argue for a treatment approach that primarily focuses on reduction of the actual substance use, under the assumption that this will more or less automatically lead to reduction of addiction-related problems in other areas, the multidimensional concept of addiction would argue for focused attention on each of the specific problem areas, including psychiatric symptomatology, independently. This introductory chapter describes the context and perspective of the dissertation. First, the major models and research findings in the general field of addiction are briefly summarized as background of the study. Second, issues associated with dimensionality conceptualizations of addiction are discussed. Third, the relationship between psychopathology and addiction is examined. Fourth, the significance of psychopathology in the treatment of addiction is discussed. At the end of the chapter, the methodology and research questions on which this dissertation is based are described.

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