The theory proposed in this paper is based on motivation and addresses some of the concerns regarding stage-based theories such as the trans-theoretical theory of motivation. The various tenets of motivation that are attributed to change are propounded in the initial sections as described below. Motivation is a key to change. The incentive sensitization theory of addiction explains addiction from a motivational perspective with respect to mental processes. Arguably, a motivational change process would therefore be an ideal recovery mechanism. Due to the complexity and multidimensional nature of change involving human behavior, this theory calls for a multifaceted approach that does not necessarily involve discrete stages. There are many forces that are both internal and external to the individual that must be addressed as a means to recovery. An addict should familiarize not only with the condition he/she is in, but also with individual capability to deal with change.
In the subsequent section, the role of the external forces presented as integral to an addict attempting to recover from the condition. Since individual effort alone may not sufficiently drive motivation, addicts should seek to be in harmony with societal expectations and view them positively, clinical assistance and mental therapy as well as support groups including immediate family members and chemical dependent groups. A concurrent influence from these forces and an individual’s internal forces can lead to recovery more conveniently. Whereas an addict may be experiencing setbacks from the internal perspective for reasons such as low self-efficacy and learned helplessness, external forces are likely to enhance internal strengths and enhance the change process. Chemical dependent groups, for instance, provide sufficient peer support should perceive that the wider society is unduly discriminating. Motivation therefore provides a comprehensive platform for behavior change.
The perennial problem of addiction has resonated through history and therefore has multiple theories attempting to address its nature and treatment. Despite this fact, there are concerns regarding the individual theories that have been directed towards changing addictive behavior. The predominant trans-theoretical model of change (TTM) is a particular example. TTM is undermined by the fact that human functioning is too complex and multidimensional to be categorized into discrete stages. Major pitfalls that have been pointed out regarding this theory include the argument that the TTM violates the defining properties of a genuine stage-based theory in three aspects namely: one, the theory has overlapping qualitative properties between the precontemplation and contemplation stages; two, addicts do not all begin from the same stage and three, the theory allows for looping within the stages yet genuine stage theories do not have reversibility (Lenio, 2006). Other theories of change applicable to addiction also have their unique limitations.
This paper proposes a multifaceted motivational theory of change. The proposed theory considers important tenets both internally and externally with respect to the individual. This follows research findings that motivation can be viewed as both intrinsic and extrinsic (Benabou & Tirole, 2003). Accordingly, an addict is under concurrent influence of factors from both the internal and external environment. The theory therefore incorporates complex components that are internally attributed to an individual including self-efficacy. Due to this multidimensional approach, the theory draws from major competing as well as evolving theories of change regarding addiction inclusive of the TTM, the moral model, the medical model, spiritual model and sociocultural model (Miller & Chair, 1999). The fundamental argument of the proposed theory is that motivation is a key to change and therefore addicts are likely to change their behavior given a multifaceted motivational approach to change.
Why motivation is the key to change
Motivation is a widely applicable concept. Although there are multiple broad definitions of motivation, in this context it involves recognizing a problem, searching for a way to change it, and then beginning and sticking with that change strategy (Dupery, 2004). In another pertinent definition, Benabou and Tirole (2003) refers to motivation as being purposeful, intentional, being positive, and is directed towards the best interests of the self. From these definitions, it can be observed that motivation almost comprehensively addresses issues that relate to a change process. In order to recover from the problematic condition of addiction, an individual is inclined to experience or have sufficient motivation to do so.
Learned helplessness is a mainstay drawback to recovery from addiction. According to Dupery (2004), this phenomenon has a direct impact on motivation and is often the reason as to why many addicts regress. It reduces motivation to continue the process of recovery. It is necessary to maintain motivation by believing that by doing things differently, one will be able to change behavior. Since motivation is both intrinsic and extrinsic, it can be viewed as a heuristic approach to change that will necessarily not incorporate discrete stages. An understanding of the addict’s situation, knowing the ways that can lead him or her away from the situation and pursuing realistic objectives and goals with the right mix of internal and external forces all incline to the concept of motivation.
Key assumptions of the model
The following key assumptions relating to the nature of motivation are adopted into this model (Center for Substance Abuse Treatment, 1999):
- Motivation is a key to change
- It is multifaceted
- It is dynamic and fluctuating
- It is influenced by social interactions
- Motivation can be modified
This theory of change advocates for an in-depth understanding of addiction, develop internal drives to counter the problem and seek or indulge with the external environment in a way that enhances recovery. The key elements of the theory are presented in the ensuing sections in more detail.
Understanding addiction and incentive sensitization
An understanding of addiction is very essential to recovery. Patients may be driven to act on their condition or be able to consider various options to address their addiction if they have sufficient knowledge of the nature of addiction. Even more important is the proposition that such individuals should have at their fingertips adequate information relating to the specific context of addiction. Robinson and Berridge (2008) argued that an understanding of incentive sensitization, for instance, would be a boost to an addict attempting to recover. The theory of incentive sensitization provides an insight into addiction that is important to this theory as regards understanding addiction.
It is expected that the brain is in one way or another having a direct link with addiction. According to the theory of incentive sensitization, repeated exposure to potentially addictive drugs can cause a persistent change in the brain as a consequence of development of a strong association between stimuli (addictive drugs for instance) and reward. Reward in this case can be seen to be the pleasure that follows the addictive behavior. Robinson and Berridge (2000) noted a number of key features of the incentive sensitization theory. They argued that potentially addictive drugs are likely to produce persistent adaptations in the neural systems. Specifically, the affected brain systems are those associated with the process of incentive motivation and reward. Consequently, these adaptations render the affected brain systems hypersensitive to the stimuli. Although less detailed here, this explanation of addiction is critical to establishing the nature of the problem to be addressed.
Self efficacy and confidence enhancement
It is expected that many factors influence an individual’s level of confidence in their attempts to deal with the conditions that facilitate substance abuse. Miller and Chair (1999) observed that while some may be overly confident in some situations, others may feel hopeless under the same condition. The implication of this for recovery is that the ability to abstain from addictive substances is contingent not only to specific individuals, but also to the situation. Therefore an understanding of self-efficacy is critical to recovery from addiction. Lindenberg (2008) noted that the perceptions that individuals hold about their ability are important determinants of behavior change.
Accordingly, addicts should thrive to establish a beneficial range of their self-efficacy within given circumstances. There are quite a number of methods and tools that can be used to evaluate self-efficacy. One such tool is the self-efficacy questionnaire (Miller & Chair, 1999). Addicts may choose to self-administer this questionnaire or seek help from a health practitioner. The relevance of self-efficacy to this theory is that its knowledge will help an individual to set realistic and perceivable targets based on the circumstances and the individual’s level of confidence. From this perspective, the perception and drive of the individual on the change process will appear more realistic as opposed to viewing the process as a single pipelined system of activities aimed at achieving the same goal stage-wise. Motivation would be derived from the little individual achievements that may be realized. External consultation and assistance may be necessary to complement the above individual initiatives.
The role of external forces
External forces are a crucial part of the change of behavior of addicts. They include societal expectations and approval as well as clinical and therapeutic assistance. The society defines the norms and standards for all. Through an understanding of addiction, addicts will be able to perceive the existence of a gap between their current practice and the societal standards. It is therefore important to benchmark one’s own standards with societal standards and work towards striking a balance between them. The expectations and promise of approval emphasized by the society are often important motivators (Dupery, 2004). Addicts should view such pressures not as being unnecessary, but as a source of motivation change.
In the contemporary world, the role of clinical assistance as well as mental therapy is an integral practice in behavior change. The neurological explanation for addiction implies that ample clinical consideration is necessary for effective behavior change. Whereas support for addicts is commonplace in the contemporary society, the role of immediate relations and groups that are objectively constructed, notably chemical dependent groups have been proven useful (Dupery, 2004). The group approach to chemical dependents promotes mediated peer support that is highly motivational. Unlike the extreme clinical approaches, Dupery (2004) observed that the use of chemical dependent groups in the treatment of addiction does not only encourage autonomy, but promotes commitment towards recovery. In the case of mediated recovery, the use of reinforcement is highly encouraged under this theory. This may be applicable for individual small targets in an attempt to encourage the realization of similar progress in other aspects. Similarly, patients should seek the support of immediate family members where possible. Lack of such support may deter the process of change and frustrate any attempts of progress.
Accordingly, the role of external forces is essential to the change process. An addict should have a positive attitude towards the social pressures that call for change from addiction to acceptable norm standards. An individual may not be able to recover or achieve reasonable progress in isolation for various reasons among them may be low self-efficacy. External forces should be considered under such circumstances since they are equally strong motivators. It is important that addicts are accorded the necessary support to avoid regression.
Conclusion
The paper proposes a heuristic theory of change that is based on motivation. It is difficult to address human behavior through discrete stages due to its complexity and multidimensional nature. Motivation is a key element to change. Motivation allows for an understanding of individual conditions, setting reasonable targets and using internal and external forces to affect the best possible mechanism to achieve these targets. This theory of change requires individuals to understand the nature of addiction as well as their ability to alter behavior. These aspects of the theory are linked to internal motivational forces. The role of external forces has also been underscored in the theory. The patient should develop a positive perception of the society’s expectations and view it as support rather than as a form of discrimination. Addicts also need the support of their immediate family and friends, clinical assistance as well as mental therapy and peer group support. Accordingly, the theory views the change process as multidimensional and complex such that it cannot be approached from a stage-wise perspective, but contingent upon internal and external conditions.
References
Lenio, A. J. (2006) Analysis of the Trans-theoretical Model of Behavior Change. Journal of Student Research. Retrieved 7 May 2013 from http://www2.uwstout.edu/content/rs/2006/14Lenio.pdf
Benabou, R. & Tirole, J. (2003). Intrinsic and Extrinsic Motivation. Review of Economic Studies, 70 (N.I) 489-520
Miller, R. W. & Chair, P. C. (1999) Enhancing Motivation for Change in Substance Abuse Treatment. Treatment Improvement protocol Series, 35.Retrieved 8 May 2013 from http://radar.boisestate.edu/pdfs/TIP35.pdf
Dupery, R. (2004) Basis for Motivation and Change. New Jersey: Trafford Publishing.
Lindenberg, S. (2008) Intrinsic Motivation in a New Light. Kyklos, 54 (2-3): 317-342. Retrieved 7 May 2013 from http://onlinelibrary.wiley.com/doi/10.1111/1467-6435.00156/pdf
Robinson, E. T. & Berridge, C. K. (2008). The Incentive Sensitization Theory of Addiction: Some Current Issues. Philosophical Transactions of the Royal Society, (363) 3137-3146. Retrieved 7 6 May 2013 from http://rstb.royalsocietypublishing.org/content/363/1507/3137.full.pdf
