Substance Use Blog Series: Bio-Psycho-Social-Spiritual Model of Substance Use and Recovery
Today’s Substance Use blog post is about the bio-psycho-social-spiritual model of substance use. This might sound complicated, but bear with us. All this model really stands for is seeing your substance use challenge as the multifaceted thing it is. This model recognizes that there are many influences behind problematic substance use, and likewise, there are many areas of healing that can be addressed beyond simply limiting your substance use.
Addressing the complexity of your substance use in practical ways can lead to a more sustainable recovery.
To make this as simple as possible, we are going to briefly go through each facet individually, describing how each facet can influence substance use, and how its needs can be addressed and nurtured.
Biological – The Body
The biological facet of problematic substance use mainly refers to how physical dependency and cravings develop. As a substance is used more and more, and as our brain gets used to the substance supplying pleasure and rewards, cravings and dependency develop and we gradually lose control over its use. Substance dependency is quite complex and this post is not meant to encapsulate the whole process, but rather give an overview. If the following explanation is confusing and/or you are a visual learner, you can watch the video provided instead.
In the brain, pleasure involves the release of the neurotransmitter dopamine in the nucleus accumbens, which is referred to as the brain’s pleasure center by neuroscientists. All drugs cause a powerful surge of dopamine in the nucleus accumbens. Addictive drugs provide a shortcut to the brain’s reward system by flooding the nucleus accumbens with dopamine. The part of our brain responsible for memory (the hippocampus) remembers this rapid sense of satisfaction, and the part responsible for stress regulation (the amygdala) becomes conditioned with its response to the drug.
Basically, we get used to unnatural levels of pleasure and it becomes physically difficult to address stress in other ways that don’t provide as much pleasure.
Over time, the brain adapts to the substance’s interaction with these parts of the brain, and its pleasurable effects level out and do not have the same flooding effect. The pleasure associated with the substance subsides, but the memory of the desired effect persists in the form of cravings and in severe cases, physical dependency (Harvard Health).
Physical wellness
The previous description stated how biological cravings affect problematic substance use. This is an important part of the picture. If you are seeking help for substance use, you have recognized that your substance use has become excessive. Since biological dependency can develop in relation to substances, it is important to care for your body and biological well-being while decreasing use or abstaining.
Caring for your body during recovery involves addressing and maintaining the following areas:
• Medical care
• Exercise
• Nutrition
• Sleep practices
• Recreation
• Hygiene practices
Caring for your physical well-being while experiencing withdrawal after detox is a topic that warrants specific attention, and we will be describing that in more detail in a future post. These suggestions are meant for ongoing and everyday nurturance of your physical health. Everybody has different methods of care that work best for them and that offer the most meaning. At the bottom of this post, we have included a blank worksheet for you to fill out in a way that suits your own needs and preferences.
Psychological – The Mind
There are many psychological factors associated with problematic substance use. It is also virtually impossible to separate these 4 facets from each other, which is why the model exists. The point is to show how intertwined different aspects of functioning are.
Psychological processes are especially difficult to separate from physical, because all emotional processes have a physiological basis, and all behaviours that are not purely reflex have an emotional component.
Cravings are sometimes described as physical and psychological. Physical cravings fit into the category of what I just described and refers to the brain and body’s physical dependency on a substance. Cravings have another component however, which can be an emotional or mental attachment to a substance (Florida Alcohol And Drug Rehab). This kind of attachment can develop in response to a number of psychological factors. For example, a substance could be used in response to the grief or loss of something meaningful in your life, internal beliefs you developed from your family environment, trauma, or feelings of alienation.
Beyond physical desire or dependency of a substance, there are other needs that a substance is fulfilling. In our post about Alcohol and COVID-19 we talked about the replacement technique which aims to determine and meet needs underlying problematic substance use. It is also possible that you will encounter new psychological struggles during recovery such as anxiety when not using the substance you have become accustomed to. Finding ways to cope with this anxiety or other struggles that may arise is another important facet of recovery. Here we outlined grounding techniques for coping with cravings when tied to stress. Anxiety is often a part of this, so it may be a helpful tool.
Psychological wellness
Here are some examples of ways to nurture your psychological wellness on an ongoing basis.
• Seek counselling
• Reflect on the connection between your thoughts, feelings, and actions
• Use positive self-talk
• Nurture the psychological needs underlying substance use
• State affirmations
• Write a letter or journal to express thoughts and feelings
• Remind yourself of your value
• Honour your feelings; find ways to contain them safely.
Social – The External
Social and societal influences greatly impact mental health, and therefore also affect substance use. Community and belonging is closely tied to mental wellbeing as well as recovery.
The way a culture interacts with a substance can have a massive impact on personal interaction and outcomes.
We can quickly illustrate this point by using alcohol as an example. In a study run by the National Institute of Alcohol Abuse and Alcoholism (NIAAA), over 40% of American college students reported binge drinking at least once in the previous two weeks. This culture of binge drinking can have serious and lasting effects such as association with assaults, injuries, and future alcoholism (Addiction Center). These stats are specific to college drinking culture, but many other cultures have a much different relationship to alcohol. For example, according to the world health Organization’s (WHO) Global Status Report on Alcohol and Health, Italy has an extremely low rate of alcoholism compared to other European counties and the United States (Neirenberg, 2015). The drinking age in Italy is 16, which is lower than many other countries, but the country’s culture of moderation significantly impacts the way people have learned to interact with alcohol. In fact, one of the most successful addiction treatment facilities in the world (named San Patrignano) incorporates wine making into its treatment program and allows residents one glass of wine per day (Kelly-Linden).
Intersectionality and Marginalization
Levels of marginalization within society also have a significant effect on substance use factors. Intersectionality is a framework for understanding how one’s identity is affected by different levels of social oppression and marginalization, and it is a helpful framework while discussing this topic.
Kimberlé Crenshaw defined intersectionality as “a metaphor for understanding the ways multiple forms of inequality or disadvantage sometimes compound themselves and create obstacles that are often not understood in conventional ways of thinking.”
Mental health is not experienced within ourselves as if in a vacuum. The contexts we live in and communities we are included in or excluded from massively impact our health, self-concept, and access to services. Stigma towards those who use substances has been found to have a significant impact on level of substance use [1], and marginalization of substance users from mainstream society plays a role in hindering recovery [2]. We have written several topics on stigma already that further flesh out this topic which can be found here, here, and here. This video describes intersectionality in more depth.
Social wellness – Positive Supports
Just like exclusion can play a role in perpetuating substance use, inclusion and community plays a huge role in recovery and general wellbeing. Nurturing your social wellness can include:
- Spending time with those who respect your recovery goals
- Advocating politically for your communities
- Cooking with others; doing crafts together
- Volunteering and helping others
- Participating in cultural ceremonies and sharing
- Support groups
- Recreational groups
- Interacting with your support system
Spiritual – The Spirit
Many people include spirituality as part of their wellbeing, and many do not. If you do not, feel free to disregard this section. There are countless ways that individuals and communities can interpret substance use from a spiritual standpoint and we do not pretend to even scratch the surface of all the possible ways in this post. But, we can offer some brief examples. One common perspective comes from the 12 steps that originated in Alcoholics Anonymous but are used in relation to many kinds of substances. Some of the steps refer to recognizing a higher power and surrendering ultimate control over urges to use substances. This stance can be very meaningful to some folks by connecting them to a power outside of themselves that provides guidance and love. The 12 steps originated within Christianity but are adaptable to many faiths. There are also shamanic approaches to recovery and treating substance use which help connect an individual with the universe and/or spirits as a way of offering support and guidance within the struggle of problematic substance use (Winkleman, 2018). Shamanism is practiced among some Indigenous communities, among others. Spirituality is very tied to the social facet of this model in that communal spirituality can be very powerful as a healing tool.
Spirituality can exist separately from religion. Religion refers to a set of organized beliefs and practices shared by a community and involves a sense of spirituality. When apart from religion, spirituality is an individual practice that has to do with peace, purpose, and life meaning (Reach Out). According to Dialectical-behaviour-therapy (DBT) this can be accomplished by existing in the space between the reasoning mind and emotion mind, and listening to what is called “Wise mind.” This can be another way to seek spiritual guidance without engaging in religious thought (Mindfulness Muse).
This is a guided visualization-meditation that uses this concept.
Spiritual wellness
Some examples of nurturing your spiritual wellness include:
• Connecting with nature
• Experiencing gratefulness
• Meditation
• Smudging
• Prayer
• Talking to a higher power
• Reading & writing poetry
• Journaling
• Attending places of worship
We provided some suggestions for activities to nurture all these facets of health, but ultimately you know what works best for you and everybody is unique. We have provided a blank sheet that includes all of these sections for you to fill out yourself and reflect on ways to approach your substance use in a holistic way. Access it here: BPSS Resource Worksheet
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[1] Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review, 24(2), 143-155.
[2] Maté, G. (2008). In the realm of hungry ghosts: Close encounters with addiction. Toronto: Knopf Canada.
