


































GSJP Volume 16 final


Graduate Student Journal of  Psychology
2015, Vol. 16

Copyright 2015 by the Department of  Counseling and Clinical Psychology
Teachers College, Columbia University

25

Expanding the Biopsychosocial Model: 
The Active Reinforcement Model of  Addiction

Annie Hunt
University of  Denver

7KH�FRQWHPSRUDU\�XQGHUVWDQGLQJ�RI �DGGLFWLRQ�LV�H[SDQGLQJ�UDSLGO\�DV�UHVHDUFK�DFURVV�VSHFLDO�ÀHOGV�LQIRUPV�WUHDW-
ment and intervention techniques.  Current prevention efforts work from the well-accepted biopsychosocial model 
and are aimed at identifying the underlying causes of  addiction and attempting to block them from manifesting, 
primarily through educational methods.  However, once an addiction has already emerged, intervention and treat-
ment efforts should operate from a more comprehensive conceptualization of  addiction that takes into account 
more than just underlying factors – these efforts must address how these factors are currently operating and rein-
forcing one another.  The active reinforcement model proposed in this paper addresses the mechanisms of  action 
that govern the relationships among three primary elements of  addiction: a) impaired neurological mechanisms; b) 
unmet psychological needs; and c) dysfunctional behavior. This model serves as a more comprehensive conceptu-
alization of  addiction as it accounts for each of  the present factors and places them in an interdependent context.  
Thus, while the biopsychosocial model effectively addresses the underlying causes of  addiction, the proposed active 
reinforcement model addresses the mechanisms of  existing addictions in a more comprehensive manner.  A better 
description of  the relationship between each element provides a deeper understanding of  the full phenomenon of  
addiction, and may therefore be more effective in generating successful treatment outcomes than previous models.  

Introduction to Addiction
 Medical, psychological, and social understandings 
of  addiction have evolved rapidly over the past century, 
and contemporary addiction research and treatment 
is becoming increasingly interdisciplinary.  Addiction 
VWXGLHV�� LQLWLDOO\�EDVHG�LQ�WKH�ÀHOG�RI �SKDUPDFRORJ\��
now incorporate psychological, neurobiological, ge-
netic, environmental, social, and spiritual consider-
ations.  Furthermore, addiction is being studied in 
schools of  social work, public health, medicine, and 
psychology.  Addiction has thus become a multi-dis-
ciplinary construct that necessitates a wide range of  
understanding from contemporary practitioners, and 
as this understanding expands, the professional obli-
gation to maintain a consistent and regulated standard 
RI � SUDFWLFH� EHFRPHV� VLJQLÀFDQWO\�PRUH� FKDOOHQJLQJ���
� 6WDQGDUGL]HG� FOLQLFDO� SUDFWLFHV� LQ� WKH� ÀHOG� RI �
addiction are developed, tested, and disseminated 
through clinical research, and the myriad factors in-
ÁXHQFLQJ�WKLV�ÀHOG�SUHVHQW�DQ�LQWHUHVWLQJ�FKDOOHQJH�IRU�
researchers who must take them into consideration 
when designing and implementing studies. These 
studies are the mechanism for generating empirically 
EDVHG�ÀQGLQJV��ZKLFK�DUH� WKH�QHFHVVDU\�SUHUHTXLVLWH�
in allowing new considerations to be incorporated 
into standardized treatment options.  In order to in-

crease evidence-based treatment options in response 
to the expanding conceptualization of  addiction, 
RQH�PXVW� ÀUVW� EHJLQ�ZLWK� D� FOHDU� XQGHUVWDQGLQJ� RI �
WKH�FXUUHQW� VWDWH�RI � WKH�ÀHOG�� DQG� WKHQ�SURSRVH�DU-
eas for further academic consideration and research.  
The starting point for this process is the Diagnostic 
and Statistical Manual of  Mental Disorders (DSM), 
RULJLQDOO\�SXEOLVKHG�LQ�������ZKLFK�VLJQLÀFDQWO\�LQÁX-
ences treatment options, research, insurance policies, 
public opinion, and social stigma.  While the DSM 
DFNQRZOHGJHV� WKDW� WKH� GLDJQRVWLF� FODVVLÀFDWLRQ� SUR-
cess is a challenging one, and that there are no strict 
boundaries dividing one disorder from the others or 
from no mental disorder at all, it does offer a profes-
sional consensus about the categorization and iden-
WLÀFDWLRQ�RI �PHQWDO�GLVRUGHUV�DW�WKH�WLPH�RI �LWV�SXE-
lication (DSM-5; American Psychiatric Association, 
2013).  Thus, it provides a reliable tool for establish-
ing standards of  diagnoses, terminology, and criteria 
IRU�FODVVLÀFDWLRQ�ZKLOH�DW�WKH�VDPH�WLPH�HPSKDVL]LQJ�
WKH� LPSRUWDQFH� RI � ÁH[LELOLW\�� DSSURSULDWH� WUDLQLQJ��
and cultural sensitivity during clinical application.
 Addiction terminology.  Chemical and behav-
ioral addictions have long been recognized as serious 
and prevalent psychological problems throughout 
history, so it is interesting that the most recent version 
RI � WKH�'60³WKH� )LIWK�(GLWLRQ�� SXEOLVKHG� LQ�0D\�
����³GRHV�QRW�DFWXDOO\�LQFOXGH�WKH�WHUP�́ DGGLFWLRQµ�
(APA, 2013). The category used in the DSM-5 to de-

Annie Hunt is doctoral student at the University of  Denver. Cor-
respondence concerning this article should be addressed to: an-
niehunt1@gmail.com



26

scribe the phenomenon colloquially referred to as 
chemical or substance addiction is titled “Substance 
Use Disorder,” and it combines the former catego-
ries of  substance abuse and substance dependence 
(from the DSM-IV) into a single disorder that is to be 
measured on a scale from mild to severe (APA, 2013).  
Neither did the previous edition, the Fourth Edition, 
Text Revision, published in 2000 by the American Psy-
chological Association, include the term “addiction,” 
as the term ‘dependence’ won out over ‘addiction’ 
by one vote during the last revision process (DSM-
IV-TR, APA, 2000; O’Brien, Volkow, & Li, 2006).  
� 6SHFLÀF� DQG� DFFXUDWH� WHUPLQRORJ\� SOD\V� DQ� LP-
portant role in the conceptualization of  this phenom-
enon.  According to the National Institute on Drug 
Abuse (NIDA), the term “dependence” indicates a 
physiological need or dependency on a substance. 
This is evidenced by a biological adaptation to the 
substance in which the body requires more of  it to 
achieve an effect (the phenomenon of  tolerance) and 
also manifests physical indicators if  use is sudden-
ly stopped (the phenomenon of  withdrawal; NIDA, 
2012).  Physical dependence, however, can occur with 
continued use of  many different substances, includ-
ing those taken as prescribed, and does not necessarily 
include the psychological or behavioral consequenc-
es that characterize an “addiction” or “disorder.”  

 The term “disorder,” according to 
the APA (2012), includes the following:

1. A behavioral or psychological syndrome or 
pattern that occurs in an individual
��� 7KDW�UHÁHFWV�DQ�XQGHUO\LQJ�SV\FKRELRORJLFDO�
dysfunction
3. The consequences of  which are clinically 
VLJQLÀFDQW�GLVWUHVV�RU�GLVDELOLW\
4. Must not be merely an expectable response 
to common stressors and losses or a culturally 
sanctioned response to a particular event
5. That is not primarily a result of  social devi-
DQFH�RU�FRQÁLFWV�ZLWK�VRFLHW\�

Thus, “disorder” indicates the presence of  behavioral 
and psychological symptoms, but fails to clearly ar-
ticulate the aspect of  compulsory repetition that the 
terms “dependence” or “addiction” include in their 

GHÀQLWLRQV�
 Finally, the term “addiction,” according to the 
National Institute on Drug Abuse, indicates com-
pulsive use of  a substance despite harmful con-
VHTXHQFHV�� VXFK� DV� IDLOXUH� WR� IXOÀOO� VRFLDO�� ZRUN�� RU�
family responsibilities, and an inability to stop using 
the substance of  one’s own accord (2013).  Addition-
ally, according to the APA website, addiction falls 
under the category of  “Mental Health Disorders/
,VVXHV�µ� DQG� LV� GHÀQHG� DV� ´D� FKURQLF� EUDLQ� GLVHDVH�
that causes compulsive substance use despite harm-
ful consequences” (APA, 2012).  Arguably, the most 
FRPSUHKHQVLYH� DQG� VSHFLÀF� GHÀQLWLRQ� RI � DGGLFWLRQ�
comes from the American Society of  Addiction 
0HGLFLQH��$6$0���������ZKR�GHÀQH�DQ�DGGLFWLRQ�DV�

a primary, chronic disease of  brain reward, moti-
vation, memory and related circuitry . . . [which] 
LV�UHÁHFWHG�LQ�DQ�LQGLYLGXDO�SDWKRORJLFDOO\�SXUVX-
ing reward and/or relief  by substance use and 
other behaviors.  Addiction is characterized by 
inability to consistently abstain, impairment in 
behavioral control, craving, diminished recogni-
WLRQ� RI � VLJQLÀFDQW� SUREOHPV� ZLWK� RQH·V� EHKDY-
iors and interpersonal relationships, and a dys-
functional emotional response (ASAM, 2010).

It is interesting to compare the terms to identify dif-
ferences as well as overlaps. According to the above 
GHÀQLWLRQV�� GHSHQGHQFH� RQ� D� VXEVWDQFH� GRHV� QRW�
necessarily constitute an addiction, and an addiction 
does not necessarily involve physiological depen-
dence (NIDA, 2012).  Furthermore, a disorder does 
not necessarily constitute an addiction. These terms 
therefore cannot be used interchangeably, as they 
each indicate the presence of  different symptoms.  
 It should be noted, however, that the DSM-5 
does use the category of  “Addictive Disorders” to 
describe pathological gambling as a behavioral addic-
tion (APA, 2013).  This is the only condition listed 
in this category, despite general clinical recognition 
of  other non-chemical, behavioral addictions such 
as sex addiction, internet addiction, compulsive tan-
ning, and compulsive shoplifting (e.g., Grant, Po-
tenza, Weinstein, & Gorelick, 2010).  Neither the 
1,'$� GHÀQLWLRQ� RI � GLVRUGHU� QRU� WKH� $3$� GHÀQL-

HUNT



27

tion of  addiction include non-chemical addictions, 
despite the widespread social, medical, and cultural 
call for recognition and treatment of  these partic-
XODU� SUREOHPV� �*ULIÀWKV�� ������ :DQJ� HW� DO��� ������
 This paper argues that one of  the most critical 
aspects of  active addiction treatment is addressing 
the phenomenon of  being unable to stop certain 
substance use or behaviors solely of  one’s own vo-
lition – namely, the compulsive aspect of  the condi-
tion regardless of  known negative consequences. As 
of  the most current edition, the DSM still does not 
FRPSUHKHQVLYHO\�DUWLFXODWH� WKH�SUHVHQFH�DQG�VLJQLÀ-
cance of  this symptom.  The continued exclusion of  
this component indicates that at this point in time, 
FRQWHPSRUDU\�UHVHDUFK�KDV�VWLOO�QRW�VXIÀFLHQWO\�SLQ-
pointed what exactly this phenomenon is, what it 
involves, how it operates, and how to address it.  It 
is this phenomenon that the proposed active rein-
forcement model attempts to describe, validate, and 
address by drawing together parts of  prior concep-
tualizations and constructing a more comprehensive 
model.  This paper argues that once an addiction is 
manifest, it is actively reinforced by the relationships 
between three essential factors: a) impaired neuro-
logical mechanisms; b) unmet psychological needs; 
and c) dysfunctional behavior, the combination of  
which results in the compulsive aspect of  the phe-
nomenon.  Understanding the relationship between 
these factors and how they actively reinforce addic-
tion would offer a starting point for developing in-
terventions aimed at disrupting these relationships.  
 Previous conceptualizations of  addiction.  
Addiction has previously been conceptualized using 
different models, with the most historically prom-
inent being the “adaptive” and the “disease” mod-
els.  The adaptive model preceded the disease model, 
DQG�VXJJHVWHG�WKDW�DGGLFWLRQV�GHYHORS�ZKHQ�VSHFLÀF�
psychological needs – such as acceptance, autonomy, 
FRPSHWHQFH�� RU� FRQÀGHQFH�²� DUH� QRW�PHW�� WKLV�ZDV�
also termed “integration failure” (Alexander, 1990).  
The adaptive model argues that addictions develop 
WR�PHHW�WKHVH�VSHFLÀF�SV\FKRORJLFDO�QHHGV��DQG�WKDW�
the addictive behavior provides a sense of  support, 
reassurance, or meaning that individuals feel is miss-
ing in their lives.  The disease model, also sometimes 

called the medical model, posited that addiction is 
neither an issue of  failed willpower nor the result of  
conscious repeated habitual behavior, but is rather a 
chronic, progressive medical illness characterized by 
abnormalities or defects in brain functioning (Shee-
han & Owen, 1999).  Silkworth (1939) was one of  
the pioneers of  this model, originally applying it to 
alcohol dependence.  In the primary text of  the Al-
coholics Anonymous program, he described alcohol-
ism as an unusual or distorted behavioral response 
to alcohol consumption, and described problematic 
chronic drinking as a manifestation of  a “physical 
allergy” to alcohol (Alcoholics Anonymous, 2001).  
Sheehan and Owen (1999) argue that the disease 
model represents a more comprehensive explanation 
of  addiction through its depiction of  neurological 
GHÀFLWV� DQG� DEQRUPDO� EHKDYLRUDO� UHVSRQVHV�� �7KHVH�
models offered initial foundations for the develop-
ment of  addiction studies and treatment, and they 
remained prominent until the emergence of  George 
Engel’s “biopsychosocial model” (Engel, 1978).
 Current conceptualization of  addiction.  The 
biopsychosocial model, which is used to describe 
many different mental disorders, is arguably the most 
prominent construct used to conceptualize addiction 
today (Alonso, 2004).  This model built upon the dis-
ease model by accepting that addiction involves ab-
normalities in brain functioning, but then expanded 
that model by integrating the subjective psychological 
experiences of  individuals into the conceptualization 
of  illness.  It suggests that an understanding of  the 
patient’s subjective experience is critical in devel-
oping accurate diagnoses and successful treatment 
options (Borrel-Carrio, Suchman, & Epstein, 2004).  
The biopsychosocial model thus seeks to explain suf-
fering, disease, and illness as generated by multiple 
causes, including social, biological, and psychological 
factors.  This inclusion of  subjective psychological 
components into the disease model expands the con-
cept of  addiction to include individual experiences, 
perceptions, stressors, and perspectives as mediat-
ing factors in the expression of  clinical illnesses and 
medical problems.  Thus, this model helps to bridge 
WKH�JDS�EHWZHHQ�WKH�PHGLFDO�DQG�SV\FKRORJLFDO�ÀHOGV��
DQG� LV� H[WHQVLYHO\� DFFHSWHG� LQ� WKH� ÀHOG� RI � DGGLF-

ACTIVE REINFORCEMENT MODEL OF ADDICTION



28

tion studies and psychology today (Alonso, 2004). 
 Drawing from the above-mentioned previous 
DQG� FRQWHPSRUDU\� GHÀQLWLRQV� RI � DGGLFWLRQ�� WKUHH�
FRUH�HOHPHQWV�RI �DGGLFWLRQ�FDQ�EH�LGHQWLÀHG�²�XQPHW�
psychological needs, impaired neurological mech-
anisms, and problematic behaviors.  However, the 
DGDSWLYH� DQG�GLVHDVH�PRGHOV�GR�QRW� VXIÀFLHQWO\�GH-
scribe the relationships involved in the phenomenon 
of  addiction because they suggest simple linear cau-
sality between either coping and problematic behav-
iors or disease and problematic behaviors. This paper 
argues that the previous conceptualizations of  addic-
tion, including the biopsychosocial model, do identify 
WKH�FRUH�HOHPHQWV�RI �DGGLFWLRQ��EXW�IDLO�WR�VXIÀFLHQWO\�
demonstrate the reciprocal relationships among them.  
Emerging research reveals evidence that unmet psy-
chological needs, impaired neurological mechanisms, 
and problematic behaviors can act as both causes 
and effects in the construct of  addiction (Castel-
lani, Wedgeworth, Wootton, & Rugle, 1997; Grant, 
Brewer, & Potenza, 2006; Hyman & Malenka, 2001).  
 While the biopsychosocial model offers a more 
substantive argument for acknowledging the presence 
of  combined psychological and biological/pharma-
cological factors in the development of  addiction, and 
SDUWLDOO\�LGHQWLÀHV�VRPH�RI �WKH�UHODWLRQVKLSV�LQYROYHG�
among these factors, it does not offer a comprehen-
sive conceptualization of  all of  the relationships be-
tween these factors that contribute to active addiction 
and compulsive behaviors.  It states that these differ-
ent factors play a role in impacting outcomes, and that 
there is a relationship between biological/psycholog-
ical elements and external functioning, but it makes 
XVH�RI �DQ�HFOHFWLF�DSSURDFK�WKDW�GRHV�QRW�VSHFLÀFDOO\�
or explicitly describe how that relationship functions 
and impacts addiction (Ghaemi, 2009).  Furthermore, 
it fails to establish the impact that psychological fac-
tors have on neurobiological factors, the impact that 
neurobiological factors have on psychological fac-
tors, and the reverse impact that dysfunctional be-
haviors may have upon psychological and biological 
IXQFWLRQLQJ³DQ�LPSRUWDQW�QHZ�UHODWLRQVKLS�WKDW�KDV�
been demonstrated in emerging research (Hyman 
& Malenka, 2001).  This paper will propose a new 
model that includes the critical elements of  addic-
tion and places them in an interdependent context 

that offers a more comprehensive understanding of  
how addictions function.  It will also defend each 
RI �WKHVH�UHODWLRQVKLSV�ZLWK�UHFHQW�UHVHDUFK�ÀQGLQJV�
 Proposed “Active Reinforcement Model of  
Addiction.”  Current research consistently indicates 
the presence of  neurological, psychological, and ex-
ternal/behavioral components in the overall concep-
tualization of  addiction, though each element may 
have varying degrees of  intensity and causality (i.e., 
one element may be more powerful or have more 
LQÁXHQFH� WKDQ� RWKHUV�� GHSHQGLQJ� RQ� WKH� LQGLYLGXDO��
Grant, Brewer, & Potenza, 2006).  This paper argues 
that there is a cause-effect relationship between all 
three elements, meaning that each element both in-
ÁXHQFHV�DQG�LV�UHLQIRUFHG�E\�WKH�RWKHU�WZR�HOHPHQWV���
In light of  this knowledge, a new model, entitled the 
“Active Reinforcement Model of  Addiction” (Fig-
ure 1), is proposed.  From this conceptualization, 
the critical principle that emerges is not the impor-
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ÀQGLQJ� DQ�XQGHUO\LQJ� UHDVRQ� IRU�ZK\� WKH� DGGLFWLRQ�
emerged.  Rather, the focus is shifted to the impor-
tance of  acknowledging how all three coexist and 
reinforce one another in an interdependent context 
once an addiction has become active.  From there, 
an altered focus for treatment and interventions can 
be proposed, again shifting the focus of  treatment 
techniques from why to how addictions function.  
 Prevention efforts generally focus on the ques-
tion of  why addictions develop and use education, 
risk protection techniques, and resilience training 
based on the proposed answers to this question, 
though there still is no consensus on exactly what 
FDXVHV�DGGLFWLRQ��6$0+6$����������7KH�ÀHOG�LV�IXOO�
of  varying hypotheses and theories that attempt to 
explain addiction’s underlying causes in order to cre-
ate successful prevention efforts and education pro-
grams aimed at stopping addiction before it starts.  
This paper, however, is not focused on prevention 
efforts, but rather proposes use of  a different model 
to guide treatment of  active addictions. Prevention 
efforts are distinctive from treatment efforts, ac-
cording to the American Society of  Addiction Med-
icine, though they may both be used concurrently in 
certain circumstances (ASAM, 2005).  Treatment, 
according to ASAM, is aimed at helping individ-

HUNT



29

ACTIVE REINFORCEMENT MODEL OF ADDICTION  11 
�

Treatment, according to ASAM, is aimed at helping individuals currently suffering from an 

addiction.  Once addiction symptoms (according to either the DSM or APA criteria) are 

manifest, prevention models should be substituted for a working understanding of how the 

addiction is actively functioning.  While research on preventive measures is valuable and will 

continue to hold its place in the field, this paper argues that addiction treatment and intervention 

should be based on a more comprehensive conceptual model of how addictions are actively 

sustained.   

 
Figure 1: Active Reinforcement Model of Addiction.  This figure illustrates the critical 
relationships that reinforce active addiction. 
 

As demonstrated by the figure above, the phenomenon of addiction is sustained by the 

presence of and relationship among three elements: a) impaired neurological mechanisms; b) 

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uals currently suffering from an addiction.  Once 
addiction symptoms (according to either the DSM 
or APA criteria) are manifest, prevention models 
should be substituted for a working understanding 
of  how the addiction is actively functioning.  While 
research on preventive measures is valuable and 
ZLOO� FRQWLQXH� WR� KROG� LWV� SODFH� LQ� WKH� ÀHOG�� WKLV� SD-
per argues that addiction treatment and intervention 
should be based on a more comprehensive concep-
tual model of  how addictions are actively sustained.  

� $V�LOOXVWUDWHG�E\�WKH�ÀJXUH�DERYH��WKH�SKHQRPH-
non of  addiction is sustained by the presence of  and 
relationship among three elements: a) impaired neu-
rological mechanisms; b) unmet psychological needs; 
and c) dysfunctional behavior.  This model serves 
as a comprehensive conceptualization of  addiction 
that incorporates the main elements of  addiction and 
places them in an interdependent context.  It helps to 
organize the concept of  active addiction into a struc-
WXUHG�PHFKDQLVP�GHÀQHG�E\�UHLQIRUFLQJ�UHODWLRQVKLSV��
which may allow studies and interventions to specif-
ically focus on particular sections or relationships in 
the model.  At the same time, it also offers a full de-
piction of  the phenomenon, which may help to re-
mind practitioners that each element and relationship 
must be attended to in treatment.  This paper will de-
scribe how many existing theories and interventions 
ÀW�GLUHFWO\�LQWR�WKH�DFWLYH�UHLQIRUFHPHQW�PRGHO��DQG�
will explain how each encompasses one or some of  
the six relationships described: a ȹ (causing) b, a ȹ 
c, b ȹ a, b ȹ c, c ȹ�b, and c ȹ�a.  Any element, 

standing alone or impacting only one of  the other 
elements, does not necessarily lead to the emergence 
of  an addiction.  This model theorizes that all rela-
tionships must be present to some degree in order to 
constitute an active addiction.  This paper will begin 
to justify this theory by examining the current work-
LQJ�GHÀQLWLRQ�RI �ZKDW� WKH� WHUP�´DGGLFWLRQµ�PHDQV�
 'HÀQLWLRQ�RI �$GGLFWLRQ��D��E�	�F�
All people engage in self-regulatory behaviors in re-
sponse to their biological, psychological, social, and 
spiritual wants and needs (Bandura, Adams, & Bey-
er, 1977).  Many people use substances or engage in 
risky behaviors to meet these needs, and these do not 
always develop into disruptive or chronic patterns of  
use.  The crossover from substance use or occasional 
dysfunctional behavior to the full manifestation of  
DGGLFWLRQ�LV�DPELJXRXV�DQG�GLIÀFXOW�WR�GHÀQH���2QH�
must consider the motivations for, frequency and 
intensity of, and consequences of  the substance 
use or dysfunctional behavior in order to deter-
mine whether it can be considered problematic (c).  
 As noted previously, the DSM acknowledges that 
there are no absolute boundaries in diagnoses, and the 
VDPH�ÁH[LELOLW\�PXVW�EH�XWLOL]HG�ZKHQ�DWWHPSWLQJ�WR�
GHÀQH�DGGLFWLRQ��$3$����������'HVSLWH�WKH�FKDOOHQJH�
the phenomenon of  addiction poses, it is still critical 
WR�GHYHORS�D�JHQHUDOO\�DFFHSWHG�ZRUNLQJ�GHÀQLWLRQ�VR�
that researchers and clinicians can work toward stan-
GDUGL]LQJ�WKH�ÀHOG��GHYHORSLQJ�EHVW�SUDFWLFHV��DQG�UHJ-
ulating the associated treatment options for addiction. 
 The American Society of  Addiction Medicine’s 
GHÀQLWLRQ� RI � DGGLFWLRQ�� SUHYLRXVO\� TXRWHG� LQ� WKLV�
paper, clearly supports the concept of  a biological 
element in the reinforcement model of  addiction, 
suggesting that neurological dysfunction (a) directly 
causes problematic psychological (b) and behavioral 
(c) manifestations (a ȹ b, a ȹ�c).  It also indicates that 
the behavior (c) in turn can affect psychological and 
emotional components (b) of  the individual’s life (c 
ȹ�E����,Q�WKH�ORQJHU�GHÀQLWLRQ��$6$0�JRHV�RQ�WR�H[-
plain that brain “morphology, connectivity, and func-
tioning are still in the process of  maturation during 
development and young adulthood, and early expo-
VXUH�WR�VXEVWDQFH�XVH�LV�DQRWKHU�VLJQLÀFDQW�IDFWRU�LQ�
the development of  addiction” (ASAM, 2011).  This 
suggests that dysfunctional behaviors such as chem-

Figure 1: $FWLYH�5HLQIRUFHPHQW�0RGHO�RI �$GGLFWLRQ���7KLV�ÀJXUH�
illustrates the critical relationships that reinforce active addiction.

ACTIVE REINFORCEMENT MODEL OF ADDICTION



30

ical abuse (c) also impact brain development (a) in a 
phenomenon known as “neuroadaptation” (c ȹ a; 
$6$0����������,W�LV�ZRUWKZKLOH�WR�QRWH�WKDW�WKLV�GHÀ-
nition includes both “substance use and other behav-
LRUVµ�LQ�LWV�GHÀQLWLRQ��DQG�WKDW�WKH�LQFOXVLRQ�RI �ERWK�
chemical and non-chemical addictions is a critical ele-
ment to the reinforcement model, as will be discussed 
ODWHU���7KXV��$6$0·V�GHÀQLWLRQ�RI �DGGLFWLRQ�ÀWV�LQWR�
the proposed model, and supports some of  the rela-
tionships it describes (a ȹ b, aȹ c, c ȹ a, c ȹ b).
� $QRWKHU� ZLGHO\�UHFRJQL]HG� GHÀQLWLRQ�
of  addiction came from the former pres-
ident of  the American Society of  Addic-
tion Medicine, Dr. Michael Miller, who stated:

At its core, addiction isn’t just a social problem 
or a moral problem or a criminal problem.  It’s 
a brain problem whose behaviors manifest in 
all these other areas . . . [the] disease is about 
brains, not drugs.  It is about underlying neurol-
ogy, not outward actions. (Smith, 2011, p. 901)  

This statement also directly supports the reinforce-
PHQW�PRGHO��DQG�GHPRQVWUDWHV�WKH�VLJQLÀFDQFH�RI �QHX-
rophysiology in affecting the full conceptualization of  
addiction (a ȹ�b, a ȹ c).  Goodman (1990) proposed 
D� VLPLODUO\� ZHOO�DFFHSWHG� GHÀQLWLRQ� RI � DGGLFWLRQ�

$GGLFWLRQ�PD\�EH�GHÀQHG�DV�D�SURFHVV�ZKHUHE\�
a behavior that can function to produce pleasure 
and provide relief  from internal discomfort, [and] 
is employed as a pattern characterized by (1) re-
current failure to control the behavior (powerless-
ness) and (2) continuation of  the behavior despite 
severe negative consequences (unmanageability).

7KLV� GHÀQLWLRQ� KLJKOLJKWV� WKH� EHKDYLRUDO� HOHPHQW�
LQFOXGHG� LQ� WKH� UHLQIRUFHPHQW� PRGHO�� DQG� GHÀQHV�
what is meant by “dysfunctional” behavior (c) and 
psychological causes and consequences (b).  While 
LW� GRHV� QRW� VSHFLÀFDOO\� PHQWLRQ� QRQ�FKHPLFDO� EH-
haviors, it does not explicitly exclude them, and as 
such they too can be incorporated into this con-
FHSWXDOL]DWLRQ�� � )XUWKHUPRUH�� WKLV� GHÀQLWLRQ� DG-
dresses the impact that these behaviors have on 
SV\FKRORJLFDO� IXQFWLRQLQJ�� DQG� VXSSRUWV� DQG� ÀWV�
into the reinforcement model (b ȹ c, c ȹ b).
Smith and Seymour (2004) included the additional ele-
ment of  “compulsive use or engagement in the behav-

LRUµ�WR�WKLV�GHÀQLWLRQ��ZKLFK�VXJJHVWV�DQ�XQGHUO\LQJ�
biological urge (a ȹ c). Moreover, they suggested that 
addictive behaviors (c) are used to gain either psychic 
(mood-related), recreational (social or activity-relat-
ed), or instrumental achievement (performance-relat-
ed) rewards (b).  This also directly ties into the rein-
forcement model in that it explains the relationship 
that dysfunctional behaviors can have on psychologi-
cal functioning and the attainment of  needs (c ȹ b).
 Application of  the term “addiction” to both 
chemical and behavioral disorders.  One critical 
theoretical consideration that supports the reinforce-
ment model is the inclusion of  non-chemical or be-
havioral dependencies (c) in the broader conceptual-
ization of  addiction.  Chemical dependencies alone 
are not necessarily considered dysfunctional, as many 
medical patients develop dependencies even when 
they take their medications as prescribed.  These de-
pendencies do not necessarily result in a compulsive 
or disruptive pursuit of  chronic use.  Dependencies 
become dysfunctional only once they develop causal 
relationships with psychological and biological pro-
cesses (c ȹ b, c ȹ a).  Additionally, certain behaviors, 
such as gambling, hand-washing, or exercising, are 
QRW� FRQVLGHUHG� G\VIXQFWLRQDO� RQ� WKHLU� RZQ³WKHVH�
behaviors only become dysfunctional when they dis-
rupt psychological and biological processes (c ȹ b, 
c ȹ a), resulting in a non-chemical addiction.  For 
example, hand-washing is a normal human behavior, 
but if  it becomes a psychological obsession and an 
individual feels compelled to do it repetitively, then 
it has developed into an addiction (c ȹ a, c ȹ b).  
 Traditionally, the clinical terms “addiction” and 
“addictive behavior” have been applied exclusive-
ly to substance abuse and dependency, but there is 
growing empirical evidence of  a related category of  
“non-chemical” addictive behaviors, “including gam-
bling, eating disorders, and sexual behavior,” that 
have recently been included in the conceptualization 
of  addiction (Donovan & Marlatt, 2005, p. 4).  There 
are easily recognizable external patterns that are sim-
ilar between chemical and behavioral addictions, in-
cluding tolerance, withdrawal, repeated unsuccessful 
DWWHPSWV�WR�VWRS��DQG�VLJQLÀFDQW�LPSDLUPHQW�LQ�DUHDV�
of  life functioning.  However, the emerging recog-
QLWLRQ� RI � ELRORJ\·V� LQÁXHQFH� RQ� DGGLFWLRQ� KDV� HQ-

HUNT



31

couraged researchers to explore whether behavioral 
addictions and substance addictions recruit similar 
biological processes (a ȹ c, c ȹ a; Grant, Brewer, 
& Potenza, 2006).  Brain science and neural imag-
ing have begun to validate food and sex addictions, 
compulsive shopping and gambling, and eating dis-
orders, among others, as “process,” “non-chemical,” 
or “behavioral” addictions that can be included in 
the new, broader category of  addiction disorders.  
 Emerging research indicates that dysfunctional 
behaviors can be powerful determinants of  psycho-
logical functioning (c ȹ b) and can also cause neuro-
adaptation (c ȹ�a; Lubman, Yucel, & Pantelis, 2004; 
Hyman & Malenka, 2001).  It has also been demon-
strated that dysfunctional behavior can be the direct 
UHVXOW�RI �EUDLQ�GHÀFLWV�RU�PDODGDSWLYH�SV\FKRORJLFDO�
states (a ȹ�c, b ȹ�F���*UDQW�HW�DO�����������7KHVH�ÀQG-
ings support the incorporation of  non-chemical ad-
dictions into the reinforcement model, as they follow 
the same relationship patterns of  chemical addictions.  
This recognition greatly enhances the argument for 
the reinforcement model of  addiction, as it helps to il-
luminate the interconnectedness of  both internal and 
external factors involved in this phenomenon, regard-
less of  the involvement of  substances and chemicals. 
� 7KH������'60�UHYLVLRQV� UHÁHFW� WKLV� LQFUHDVLQJ�
awareness of  the role of  non-chemical dysfunctional 
behaviors in the construct of  addictions through their 
inclusion of  “Gambling Disorder” (APA, 2012).  This 
movement to include a non-chemical addictive disor-
der demonstrates that researchers and practitioners 
are migrating toward the general understanding that 
both chemicals as well as behaviors can impact neuro-
adaptation within the brain’s reward system (c ȹ a).  
Smith (2012) reinforced this by stating that addiction 
disrupts the areas of  the brain responsible for regu-
lating cognitive, emotional, and social behaviors, and 
Marks suggested that “syndromes of  behavioral ad-
diction share [similar neurological] features with those 
of  substance abuse . . . [including] obsessive-com-
pulsive disorder, compulsive spending (including 
gambling), overeating, hypersexuality, kleptomania, 
and perhaps trichotillomania, tics, and the Tourette 
syndrome” (c ȹ a, c ȹ b;  Marks, 1990, p. 1389).
� $V� VXSSRUWHG� E\� WKHVH� ÀQGLQJV�� ERWK� FKHPLFDO�
and behavioral dependencies can be included in the 

reinforcement conceptualization of  addiction.  The 
emerging understanding of  the ability of  external be-
KDYLRUV�WR�LQÁXHQFH�EUDLQ�FKHPLVWU\��DV�ZHOO�DV�WKH�UHF-
ognition that brain chemistry affects external behav-
iors, demonstrates that these two factors are mutually 
LQÁXHQWLDO��Dȹ c, c ȹ a).  Thus, including problematic 
and dysfunctional behaviors that do not include chem-
icals greatly supports the active reinforcement model, 
and further illuminates the extent to which external 
IDFWRUV� LQÁXHQFH� LQWHUQDO� SURFHVVHV� DQG� YLFH� YHUVD�

Three Core Components and Six Core 
Relationships

 The psychological and behavioral components of  
addiction have been well established in contemporary 
research, so an extensive discussion of  these elements 
is not necessary in this paper and they will be only 
EULHÁ\�PHQWLRQHG�EHORZ���5HVHDUFK�RQ�WKH�QHXURELR-
logical components, however, is the more recent and 
emerging area that will be discussed in more detail. 

3V\FKRORJLFDO�&RPSRQHQWV�RI �$GGLFWLRQ��E�ȹ 
a, bȹF�
 The active reinforcement model indicates a dis-
tinct relationship between psychological components 
(b), such as stressors, the effects of  environmental 
LQÁXHQFHV�� WKRXJKWV�� DQG� HPRWLRQV�� XSRQ� ERWK� WKH�
brain as well as behavior (b ȹ a, b ȹ c).  There are 
numerous studies that support the causal relationship 
between unmet psychological needs and dysfunction-
al behaviors, as well as the impact of  psychological 
stress on brain chemistry and neurological function-
ing (b ȹ c, b ȹ a) (Castellani et al., 1997; Whang, 
Lee, & Chang, 2003; Young, Boyd, & Hubbel, 2000; 
Sinha, 2001).  These two relationships in the rein-
forcement model of  addiction are well established, 
and a detailed discussion of  these two mechanisms 
can be easily found in contemporary literature and is 
thus beyond the scope of  this paper.  One particularly 
good explanation of  these relationships can be found 
in Franken (2003), who explains the relationship 
between psychological urges and their impact upon 
neurological functioning and addictive behaviors.

ACTIVE REINFORCEMENT MODEL OF ADDICTION



32

%HKDYLRUDO�&RPSRQHQWV�RI �$GGLFWLRQ��F�ȹ a, c 
ȹ�E�
 As previously mentioned, dysfunctional or risky 
behaviors alone do not comprise addiction.  Dys-
functional behavioral or chemical dependencies only 
become addictions when they develop relationships 
with the psychological and neurobiological elements 
of  the active reinforcement model.  This means that 
when a behavior or chemical use becomes a method 
of  psychological coping to deal with stress, or when 
the individual feels compelled to engage in this be-
havior due to pressing internal impulses, the full rela-
tionship of  these factors manifests as an active addic-
tion (c ȹ a, c ȹ b).  There are numerous studies that 
demonstrate the wide range of  addictive behaviors, 
including both non-chemical and chemical depen-
dencies, and a discussion of  all of  the behavioral ele-
ments associated with addiction is beyond the scope 
of  this paper.  For a more detailed discussion of  these 
relationships, see Smith (2012), Smith and Seymour 
(2004), Marks (1990), or Hyman and Malenka (2001). 

1HXURELRORJLFDO�&RPSRQHQWV�RI �$GGLFWLRQ��D�
ȹ b, a ȹ�F�
� :KLOH�WKH�FXUUHQW�GHÀQLWLRQV�RI �DGGLFWLRQ�H[SODLQ�
VRPH�RI �WKH�QHXURORJLFDO�DQG�SV\FKRORJLFDO�LQÁXHQF-
es on behavior (aȹ c, bȹ c), it is critical to also incor-
porate recent research that indicates that behaviors 
LQÁXHQFH�QHXURORJLFDO�DQG�SV\FKRORJLFDO�IXQFWLRQLQJ�
(c ȹ a, c ȹ b).  This research indicates that behav-
iors can contribute to neuroadaptation and psycho-
logical problems (Lubman, Yucel & Pantelis, 2004).  
An individual may not necessarily have an underlying 
QHXURORJLFDO�GHÀFLW�WR�EHJLQ�ZLWK��EXW�FRXOG�GHYHORS�
one as a result of  engaging in dysfunctional behavior 
or encountering psychological stressors (Lubman et 
al. 2004).  Thus, neurobiology is not necessarily the 
primary causative factor of  this phenomenon.  The 
active reinforcement model effectively demonstrates 
ERWK�WKH�VLJQLÀFDQFH�DV�ZHOO�DV�WKH�UHODWLRQVKLS�RI �QHX-
robiology to the overall conceptualization of  addic-
tion, instead of  placing it as the primary causal factor.
 The active reinforcement model indicates that 
QHXURELRORJ\� ERWK� LQÁXHQFHV� DQG�PHGLDWHV� WKH� UH-
lationship between dysfunctional behaviors and psy-

chological issues, and in combination with these fac-
tors it can generate chemical or behavioral addictions.  
Neuroimaging and neuropsychological studies have 
revealed clear differences in brain function between 
chronically addicted and non-addicted individuals, 
suggesting that addiction is indeed associated with al-
terations in brain functioning and neuropsychological 
changes (Lubman, Yucel, & Patelis, 2004; a ȹ c, c 
ȹ a).  The research they describe has been primari-
ly focused on the brain’s reward pathways, which in-
volve dopamine and serotonin receptors.  Dopamine 
and serotonin are neurotransmitters released by the 
brain as a result of  certain actions and behaviors, and 
they are associated with the experience of  pleasure 
and reinforcement and can function as ‘rewards’ in 
the brain.  Hyman and Malenka (2001) report that 
the chemicals released as a direct result of  engage-
ment in addictive behaviors are both rewarding, or 
interpreted as intrinsically positive by the brain, as 
well as reinforcing, meaning that the behaviors in-
volved with these rewards tend to be repeated (c 
ȹ a, a ȹ c).  Thus, substances and behaviors that 
produce these neurotransmitters can become very 
SRZHUIXO� UHLQIRUFHUV� WKDW� LQÁXHQFH� IXWXUH� EHKDYLRU�
and can result in inhibitory dysregulation (Hyman & 
Malenka, 2001).  This means that individuals either 
develop lowered inhibitions against risky behavior 
or experience urges so strong that they overwhelm 
typical inhibitions (c ȹ a; Lubman et al., 2004).

Tolerance.  Neurochemical changes in response to 
addiction often manifest in the development of  tol-
HUDQFH��GHÀQHG�DV�D�GHFUHDVH�LQ�WKH�HIIHFW�RI �DQ�DG-
dictive substance that often results in more frequent 
or intense engagement in addictive behavior (a ȹ c).  
Individuals who develop these altered brain states 
PD\�GHPRQVWUDWH�WROHUDQFH�DV�́ UHZDUG�GHÀFLHQF\�V\Q-
drome, a hypothesized hypo-dopaminergenic state 
involving multiple genes and environmental stimuli 
that puts an individual at high risk for multiple addic-
tive, impulsive, and compulsive behaviors” (a ȹ c; 
Grant et al., 2006, p. 925).  This hypo-dopaminergen-
ic state is one of  the proposed mechanisms of  brain 
chemistry in addiction.   Lower levels of  dopamine 
(or decreased activation of  dopamine circuits and 
receptors) may result in an individual’s increased at-

HUNT



33

WHPSWV�WR�FRPSHQVDWH�IRU�WKHVH�GHÀFLWV�WKURXJK�SDU-
ticular chemicals or behaviors (a ȹ c).  Higher lev-
els of  tolerance can promote increased and frequent 
use, which may then result in dependence (c ȹ a).
Sensitization. Another result of  chronic addiction is 
sensitization. This occurs through enhanced reward 
responses in the brain resulting from repeated ad-
ministration of  a substance or engagement in an ad-
dictive behavior (c ȹ�a; Hyman & Malenka, 2001).  
Individuals who develop more sensitive brain states 
may experience a higher level of  euphoria after en-
gaging in behaviors that release dopamine or sero-
tonin.  Due to the experience of  more substantial 
´UHZDUGV�µ� WKH\�PD\� KDYH� JUHDWHU� GLIÀFXOW\� LQ� FRQ-
trolling impulses to engage in and continue addictive 
behavior (c ȹ a, a ȹ c).  With chronic use of  or 
engagement in these behaviors, adaptations at genet-
ic, molecular, and cellular levels occur within distinct 
brain regions that counter acute drug effects in an 
attempt to maintain internal homeostasis (c ȹ a). 
When intake of  the substance ceases, these neuroad-
aptations initially persist and act unopposed, result-
ing in a characteristic rebound syndrome, or “with-
drawal” (Lubman et al., 2004).  Hyman and Malenka 
(2001) note that this response can develop beyond 
just a physical or psychological liking of  one’s addic-
tive behavior into the experience of  intense urges or 
“wanting.”  It is at that point that physical depen-
dence can cross over to compulsive desire and pur-
suit as neurological systems become hypersensitive, 
ZKLFK�VLJQLÀFDQWO\�LQFUHDVHV�WKH�LQFHQWLYH�WR�VHHN�RXW�
these stimuli (a ȹ c, c ȹ a; Hyman & Malenka, 2001).

Disrupting the Relationships between the Ac-
tive Elements of  Addiction
 As discussed, the active reinforcement model 
of  addiction demonstrates six relationships between 
WKUHH�SULPDU\�HOHPHQWV�RI �DGGLFWLRQ��ELRORJLFDO�GHÀ-
cits (a), unmet psychological needs (b), and dysfunc-
tional behaviors (c); these relationships are described 
as a ȹ b, a ȹ c, b ȹ a, b ȹ c, c ȹ a, and c ȹ 
b.  Any of  these elements in isolation do not nec-
essarily indicate an addiction, and as such cannot be 
considered primary causal factors of  this phenome-
non.  For example, an individual can engage in dys-
functional or risky behavior without it affecting their 

psychological or biological functioning. Similarly, 
one may experience stress from unmet psychological 
needs but never turn to dysfunctional behavior as a 
coping mechanism, or may suffer from neurological 
GHÀFLWV�ZLWKRXW� WKH�DGGLWLRQDO�H[SHULHQFH�RI �XQPHW�
psychological needs or attempting to compensate for 
WKHVH�GHÀFLWV�EHKDYLRUDOO\���5DWKHU��LW�LV�WKH�UHODWLRQ-
ships among these factors – not the factors them-
selves – that indicate an active addiction.  Therefore, 
this model suggests that addiction treatment research 
should be devoted to disrupting these mechanisms 
and developing interventions to block the relation-
ships between the factors that combine to sustain ad-
diction (indicated by the sign X).  A comprehensive 
treatment plan must therefore involve interventions 
to disrupt these relationships (a X b, a X c, b X a, b X 
c, c X a, c X b).  Addressing and resolving one element 
can reduce the severity of  the addictive behavior, but 
this paper argues that attention to all three factors and 
their respective relationships with one another is vi-
tal to successful, comprehensive addiction treatment.

7UHDWPHQW�RI �%LRORJLFDO�)DFWRUV��D�;�E��D�;�F�
 Emergency care.�7KH�YHU\�ÀUVW� VWHS� LQ�DGGLF-
tion treatment is to focus on the most urgent needs 
of  the client (Wallace, 2005).  This typically involves 
meeting essential physiological requirements and en-
suring that basic physical functioning is supported 
and maintained, as many clients cannot take action 
LQ�DGGUHVVLQJ�SUREOHP�EHKDYLRUV�LI �WKH\�DUH�QRW�ÀUVW�
stabilized (Wallace, 2005).  Regardless of  whether cli-
ents enter addiction treatment voluntarily or not, they 
can initially present in a state of  shock, trauma, se-
vere emotional disturbance, despair, depression, and 
other varying states of  instability, and at that stage 
they may not be capable of  identifying or attend-
ing to their basic needs.  Thus, prior to any psycho-
logical interventions, the client must be placed in a 
safe, calm environment without easy access to their 
addictive drug or behavior, and they must be thor-
oughly screened for any pressing physiological prob-
lems that can be immediately addressed (a X b, a X 
c).  This includes any kind of  treatment of  overdose 
symptoms, medicine for management of  withdrawal 
V\PSWRPV� GXULQJ� GHWR[LÀFDWLRQ�� DGPLQLVWUDWLRQ� RI �
essential nutrients or electrolytes for severe cases of  

ACTIVE REINFORCEMENT MODEL OF ADDICTION



34

eating disorders, and other related medical treatment.  
 Pharmacological treatment.  The use of  pre-
VFULSWLRQ�GUXJV� WR� WUHDW� QHXURELRORJLFDO� GHÀFLWV� LV� D�
critical component of  addiction treatment.  This 
has become the subject of  extensive research as the 
conceptualization of  addiction as a brain disease be-
comes more prevalent.  While a full discussion of  the 
pharmacological component of  addiction treatment 
is beyond the scope of  this paper, it is worth noting 
that the emerging trends of  successful prescription 
drug use in the treatment of  addiction often involve 
drugs associated with supporting or enhancing the 
serotonin or dopamine pathways of  the brain (Grant 
HW� DO��� ������� �$OOHYLDWLQJ� WKHVH� QHXURORJLFDO� GHÀFLWV�
can directly promote psychological health and re-
duce engagement in dysfunctional behaviors as cop-
ing mechanisms (a X b, a X c; Grant et al., 2006). 

7UHDWPHQW�RI �3V\FKRORJLFDO�)DFWRUV��E�;�D��E�;�
F�
 Interdisciplinary approaches to addiction studies 
have allowed for more comprehensive incorporation 
of  the psychological aspects of  addiction.  There 
have been several widely recognized movements 
WKDW� KDYH� GHÀQHG� DQG� LQÁXHQFHG� WKH� ÀHOG� DV� LW� UH-
lates to addiction treatment, and while there are many 
different orientations to psychological counseling, 
one of  the primary approaches – cognitive behav-
ioral therapy – will be discussed here as an exam-
ple of  a psychological treatment that can be directly 
incorporated into the active reinforcement model. 
 The cognitive-behavioral orientation is one of  
the main approaches used in addiction treatment to-
day, and it purports that that human thoughts and 
behavior are driven by the conditioning and rein-
forcement that people experience throughout their 
lives (b ȹ c).  Dysfunctional thoughts and behav-
ior, such as behavioral and chemical addictions, are 
considered to be the result of  the development of  
inaccurate and unhealthy life schemas, which are 
the mental framework used to organize informa-
tion about the self  and the external world (b ȹ c) 
(Alford & Beck, 1997).  The goals of  cognitive-be-
havioral therapy are therefore to focus on individual 
problematic behaviors and thoughts, identify their or-
LJLQV�DQG�LQÁXHQFHV��DQG�FKDOOHQJH�DQG�FKDQJH�WKHP�

as needed to promote healthier psychological func-
tioning and recovery (b X c).  Cognitive-behavioral 
therapy, or CBT, developed out of  this psychological 
orientation and is prominent in addiction treatment 
programs today.  It is a highly standardized therapeu-
tic process that utilizes such techniques as identify-
ing individual goals, focusing on present problems, 
exposure therapy, cognitive restructuring, behavior 
change, and psychoeducation (b X c).  Thus, while 
there are many approaches to the treatment of  the 
psychological factors of  addiction, CBT is one exam-
ple of  a well-established practice that is compatible 
with and supports the active reinforcement model.

7UHDWPHQW�RI �%HKDYLRUDO�)DFWRUV��F�;�D��F�;�E�
� $� ÀQDO� FULWLFDO� FRPSRQHQW� RI � WKH� DFWLYH� UHLQ-
forcement model is the existence and relationship 
of  dysfunctional behaviors and their impact on both 
psychological functioning and neurology.  The most 
prominent treatment approach is the promotion and 
facilitation of  abstinence or sobriety from dysfunc-
tional behaviors or chemical dependencies as a way 
WR�GLVUXSW� WKH�ÀQDO� UHODWLRQVKLSV� LQ� WKLV�PRGHO� �F�;�
a, c X b).  Other approaches, such as the harm-re-
duction model, emphasize the importance of  mod-
eration, self-regulation, honest and open self-report-
ing of  engagement in problematic behaviors, and 
RWKHU� PHDVXUHV� WR� VLJQLÀFDQWO\� UHGXFH� HQJDJHPHQW�
in disordered behavior (Marlatt & Tapert, 1993).  
One critical aspect of  intervention efforts aimed at 
treatment of  behavioral factors is the consideration 
of  replacement behaviors that may be utilized in the 
absence of  the typical addictive behavior, and the 
importance of  providing the client with adaptive 
rather than harmful substitutes for these behaviors 
(Shaffer et al., 2004).  Treatment of  behavioral fac-
tors also involves a combination of  the techniques 
used to treat the neurological and psychological as-
pects of  addiction, and each of  the interventions 
described above also work to disrupt the relation-
ships between dysfunctional behaviors and psycho-
logical or neurological mechanisms (c X a, c X b).
  

Conclusion

 The working conceptualization of  addiction 

HUNT



35

continues to develop as emerging research across 
PXOWLGLVFLSOLQDU\� ÀHOGV� LQIRUPV� WUHDWPHQW� DQG� LQ-
tervention techniques.  While prevention efforts are 
often aimed at identifying the underlying causes of  
addiction, intervention and treatment should oper-
ate from a more comprehensive conceptualization 
of  addiction that is focused on the mechanisms of  
action among three primary elements: a) impaired 
neurological mechanisms; b) unmet psychological 
needs; and c) dysfunctional behavior.  This paper ar-
gues that all three must be present and involved in 
an active relationship with one another for an active 
addiction to be manifest.  Thus, the proposed active 
reinforcement model serves as a more comprehen-
sive conceptualization of  addiction that accounts for 
and incorporates all of  the elements of  addiction 
and places them in an interdependent context that 
may be more effective in generating successful ad-
diction treatment outcomes than previous models.  
 The next steps in validating the proposed model 
are to evaluate it using research studies and psycho-
metric evaluations.  One of  the most critical aspects 
of  this model is its comprehensive incorporation of  
multiple concepts of  addiction, and demonstrating 
its effectiveness empirically could start with an evalu-
ation of  each of  these elements and the six relation-
ships described by the active reinforcement model.  
Demonstrating the validity of  these individual rela-
tionships empirically and introducing intervention 
efforts intended to disrupt them would support the 
relevance of  this model and demonstrate the need 
for continued exploration of  this conceptualization 
of  addiction.  Once the individual relationships have 
been empirically validated, a treatment approach that 
addresses all components should be implemented, 
evaluated, and compared to models that operate from 
a less comprehensive conceptualization of  addiction.
 In conclusion, the active reinforcement model 
serves as a more comprehensive conceptualization 
of  addiction as it accounts for multiple interrelated 
factors.  While the currently accepted biopsychoso-
cial model effectively addresses the underlying caus-
es of  addiction, the proposed active reinforcement 
model addresses the mechanisms of  existing addic-
tions in a more comprehensive manner.  A better de-
scription of  the relationship between each element 

provides a deeper understanding of  the full phenom-
enon of  addiction, and may therefore be more ef-
fective in generating successful treatment outcomes.  

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