Iranian Journal of Psychiatry and Behavioral Sciences

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Multi-Level Approach to Theories of Addiction: A Critical Review

Seyed Ali Shafiee 1 , * , Emran Razaghi 2 , ** and Abou Ali Vedadhir 3
Authors Information
1 Department of Neurosciences and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Anthropology, Faculty of Social Sciences, University of Tehran, Tehran, Iran
Corresponding Authors:
Article information
  • Iranian Journal of Psychiatry and Behavioral Sciences: 13 (2); e88881
  • Published Online: May 15, 2019
  • Article Type: Review Article
  • Received: January 7, 2019
  • Revised: January 25, 2019
  • Accepted: January 30, 2019
  • DOI: 10.5812/ijpbs.88881

To Cite: Shafiee S A, Razaghi E, Vedadhir A A. Multi-Level Approach to Theories of Addiction: A Critical Review, Iran J Psychiatry Behav Sci. Online ahead of Print ; 13(2):e88881. doi: 10.5812/ijpbs.88881.

Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. What Are the Theory and Theoretical Model?
3. Theories and Theoretical Models of Drug Use and Addiction
4. Types of Drug Use and Addiction Classifications and Models
5. Discussion
6. Conclusions
  • 1. Weiner B. Human motivation: Metaphors, theories, and research. United States of America: Sage; 1996.
  • 2. National Academy of Sciences (US). Working group on teaching evolution. Teaching about evolution and the nature of science. Joseph Henry Press; 1998.
  • 3. Schafersman SD. An introduction to science: Scientific thinking and the scientific method. Miami: Miami University; 1997, [cited 1997 Jan]. Available from:
  • 4. Frigg RA. Models in science. The Stanford encyclopedia of philosophy. Metaphysics Research Lab: Stanford University; 2018, [cited Jun 25]. Available from:
  • 5. Rogers K. Scientific modeling. Encyclopedia Britannica. 2018, [cited May 30]. Available from:
  • 6. Reeves S, Albert M, Kuper A, Hodges BD. Why use theories in qualitative research? BMJ. 2008;337. a949. doi: 10.1136/bmj.a949. [PubMed: 18687730].
  • 7. Lettieri DJ, Sayers M, Pearson HW. Theories on drug abuse: Selected contemporary perspective. US Department of Health; 1980.
  • 8. West R. Models of addiction. Luxembourg: Publications Office of the European Union; 2013.
  • 9. Goode E. Drugs in American society. New York: Knopf; 1989.
  • 10. Ouzir M, Errami M. Etiological theories of addiction: A comprehensive update on neurobiological, genetic and behavioural vulnerability. Pharmacol Biochem Behav. 2016;148:59-68. doi: 10.1016/j.pbb.2016.06.005. [PubMed: 27306332].
  • 11. Panlilio LV, Goldberg SR. Self-administration of drugs in animals and humans as a model and an investigative tool. Addiction. 2007;102(12):1863-70. doi: 10.1111/j.1360-0443.2007.02011.x. [PubMed: 18031422]. [PubMed Central: PMC2695138].
  • 12. Koob GF. The neurobiology of addiction: A neuroadaptational view relevant for diagnosis. Addiction. 2006;101 Suppl 1:23-30. doi: 10.1111/j.1360-0443.2006.01586.x. [PubMed: 16930158].
  • 13. Ahmed SH. The science of making drug-addicted animals. Neuroscience. 2012;211:107-25. doi: 10.1016/j.neuroscience.2011.08.014. [PubMed: 21864653].
  • 14. Leshner AI. Addiction is a brain disease, and it matters. Science. 1997;278(5335):45-7. doi: 10.1126/science.278.5335.45. [PubMed: 9311924].
  • 15. Feltenstein MW, See RE. The neurocircuitry of addiction: An overview. Br J Pharmacol. 2008;154(2):261-74. doi: 10.1038/bjp.2008.51. [PubMed: 18311189]. [PubMed Central: PMC2442446].
  • 16. Hyman SE, Malenka RC, Nestler EJ. Neural mechanisms of addiction: The role of reward-related learning and memory. Annu Rev Neurosci. 2006;29:565-98. doi: 10.1146/annurev.neuro.29.051605.113009. [PubMed: 16776597].
  • 17. Volkow ND, Li TK. Drug addiction: The neurobiology of behaviour gone awry. Nat Rev Neurosci. 2004;5(12):963-70. doi: 10.1038/nrn1539. [PubMed: 15550951].
  • 18. Piazza PV, Deroche-Gamonet V. A multistep general theory of transition to addiction. Psychopharmacology (Berl). 2013;229(3):387-413. doi: 10.1007/s00213-013-3224-4. [PubMed: 23963530]. [PubMed Central: PMC3767888].
  • 19. Volkow ND, Wang GJ, Fowler JS, Tomasi D, Baler R. Neuroimaging of addiction. In: Seeman P, Madras B, editors. Imaging of the human brain in health and disease. Academic Press; 2014. p. 1-26. doi: 10.1016/b978-0-12-418677-4.00001-4.
  • 20. Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011;12(11):652-69. doi: 10.1038/nrn3119. [PubMed: 22011681]. [PubMed Central: PMC3462342].
  • 21. Badiani A. Is a 'general' theory of addiction possible? A commentary on: A multistep general theory of transition to addiction. Psychopharmacology (Berl). 2014;231(19):3923-7. doi: 10.1007/s00213-014-3627-x. [PubMed: 24888430].
  • 22. Katz N, Mazer NA. The impact of opioids on the endocrine system. Clin J Pain. 2009;25(2):170-5. doi: 10.1097/AJP.0b013e3181850df6. [PubMed: 19333165].
  • 23. Jones DC, Miller GW. The effects of environmental neurotoxicants on the dopaminergic system: A possible role in drug addiction. Biochem Pharmacol. 2008;76(5):569-81. doi: 10.1016/j.bcp.2008.05.010. [PubMed: 18555207].
  • 24. Dafny N, Pellis NR. Evidence that opiate addiction is in part an immune response. Destruction of the immune system by irradiation-altered opiate withdrawal. Neuropharmacology. 1986;25(8):815-8. doi: 10.1016/0028-3908(86)90003-1. [PubMed: 3774111].
  • 25. Cui C, Shurtleff D, Harris RA. Neuroimmune mechanisms of alcohol and drug addiction. Int Rev Neurobiol. 2014;118:1-12. doi: 10.1016/B978-0-12-801284-0.00001-4. [PubMed: 25175859]. [PubMed Central: PMC4804710].
  • 26. Brewer JA, Potenza MN. The neurobiology and genetics of impulse control disorders: Relationships to drug addictions. Biochem Pharmacol. 2008;75(1):63-75. doi: 10.1016/j.bcp.2007.06.043. [PubMed: 17719013]. [PubMed Central: PMC2222549].
  • 27. Dole VP, Nyswander ME. Heroin addiction--A metabolic disease. Arch Intern Med. 1967;120(1):19-24. doi: 10.1001/archinte.120.1.19. [PubMed: 6028693].
  • 28. Adan A. A chronobiological approach to addiction. J Substance Use. 2012;18(3):171-83. doi: 10.3109/14659891.2011.632060.
  • 29. Jonas DF, Jonas AD. A bioanthropological overview of addiction. Perspect Biol Med. 1977;20(3):345-54. doi: 10.1353/pbm.1977.0054. [PubMed: 558580].
  • 30. Nesse RM. An evolutionary perspective on substance abuse. Ethol Sociobiol. 1994;15(5-6):339-48. doi: 10.1016/0162-3095(94)90007-8.
  • 31. Prescott JW. Somatosensory affectional deprivation (SAD) theory of drug and alcohol use. NIDA Res Monogr. 1980;30:286-96. [PubMed: 6256634].
  • 32. Hicks BM, Iacono WG, McGue M. Index of the transmissible common liability to addiction: Heritability and prospective associations with substance abuse and related outcomes. Drug Alcohol Depend. 2012;123 Suppl 1:S18-23. doi: 10.1016/j.drugalcdep.2011.12.017. [PubMed: 22245078]. [PubMed Central: PMC3330176].
  • 33. Venniro M, Zhang M, Caprioli D, Hoots JK, Golden SA, Heins C, et al. Volitional social interaction prevents drug addiction in rat models. Nat Neurosci. 2018;21(11):1520-9. doi: 10.1038/s41593-018-0246-6. [PubMed: 30323276].
  • 34. Heilig M, Epstein DH, Nader MA, Shaham Y. Time to connect: bringing social context into addiction neuroscience. Nat Rev Neurosci. 2016;17(9):592-9. doi: 10.1038/nrn.2016.67. [PubMed: 27277868]. [PubMed Central: PMC5523661].
  • 35. Levy N. Addiction is not a brain disease (and it matters). Frontiers Psychiatr. 2013;4. doi: 10.3389/fpsyt.2013.00024.
  • 36. Reinarman C, Granfi Eld R. Addiction is not just a brain disease: Critical studies of addiction. In: Granfield R, Reinarman C, editors. Expanding addiction: Critical essays. Routledge; 2014.
  • 37. Satel S, Lilienfeld SO. Addiction and the brain-disease fallacy. Front Psychiatry. 2013;4:141. doi: 10.3389/fpsyt.2013.00141. [PubMed: 24624096]. [PubMed Central: PMC3939769].
  • 38. Stewart J, de Wit H, Eikelboom R. Role of unconditioned and conditioned drug effects in the self-administration of opiates and stimulants. Psychol Rev. 1984;91(2):251-68. doi: 10.1037//0033-295X.91.2.251. [PubMed: 6571424].
  • 39. McAuliffe WE, Gordon RA. Reinforcement and the combination of effects: Summary of a theory of opiate addiction. In: Lettieri DJ, editor. Theories on drug abuse: Selected contemporary perspectives. 30. NIDA Res Monogr; 1980. p. 137-41.
  • 40. Susan Nolen-Hoeksema RL. Atkinson and Hilgard's introduction to psychology. 15th ed. Wadsworth Cengage Learning; 2009.
  • 41. Ellis AW, Young AW. Human cognitive neuropsychology: A textbook with readings. London: Psychology Press; 2013. doi: 10.4324/9780203727041.
  • 42. Petraitis J, Flay BR, Miller TQ. Reviewing theories of adolescent substance use: Organizing pieces in the puzzle. Psychol Bull. 1995;117(1):67-86. doi: 10.1037//0033-2909.117.1.67. [PubMed: 7870864].
  • 43. Edwards S. Reinforcement principles for addiction medicine; from recreational drug use to psychiatric disorder. Prog Brain Res. 2016;223:63-76. doi: 10.1016/bs.pbr.2015.07.005. [PubMed: 26806771].
  • 44. Miller WR, Brown JM. Self-regulation as a conceptual basis for the prevention and treatment of addictive behaviours. Self Control Addict Behav. 1991:3-79.
  • 45. Diaz RM, Fruhauf AG. The origins and development of self-regulation: A developmental model on the risk for addictive behaviours. Self Control Addict Behav. 1991:83-106.
  • 46. Hester R, Lubman DI, Yucel M. The role of executive control in human drug addiction. Curr Top Behav Neurosci. 2010;3:301-18. doi: 10.1007/7854_2009_28. [PubMed: 21161758].
  • 47. Bickel WK, Jarmolowicz DP, Mueller ET, Gatchalian KM, McClure SM. Are executive function and impulsivity antipodes? A conceptual reconstruction with special reference to addiction. Psychopharmacology (Berl). 2012;221(3):361-87. doi: 10.1007/s00213-012-2689-x. [PubMed: 22441659]. [PubMed Central: PMC4035182].
  • 48. Ausubel DP. What every well-informed person should know about drug addiction. Chicago: Burnham Inc Pub; 1980.
  • 49. Wurmser L. Drug use as a protective system. NIDA Res Monogr. 1980;30:71-4. [PubMed: 6779198].
  • 50. Greaves G. Toward an existential theory of drug dependence. J Nerv Ment Dis. 1974;159(4):263-74. doi: 10.1097/00005053-197410000-00005. [PubMed: 4473050].
  • 51. Jessor R. Problem behavior and psychosocial development: A longitudinal study of youth. New York: Academic Press; 1977.
  • 52. Jessor R, Jessor SL. Toward a social-psychological perspective on the prevention of alcohol abuse. Normative approaches to the prevention of alcohol abuse and alcoholism. Res Monogr. 1980;3:27-46.
  • 53. Simpson B, Harrell A. Rational choice theories. The blackwell encyclopedia of sociology; 2007. doi: 10.1002/9781405165518.wbeosr023.
  • 54. Bickel WK, Marsch LA. Toward a behavioral economic understanding of drug dependence: Delay discounting processes. Addiction. 2001;96(1):73-86. doi: 10.1080/09652140020016978. [PubMed: 11177521].
  • 55. Durkheim E. Suicide: A study in sociology. London: Routledge; 1897.
  • 56. Merton RK. Social structure and anomie. Am Sociol Rev. 1938;3(5):672. doi: 10.2307/2084686.
  • 57. Cloward RA, Ohlin LE. Delinquency and opportunity. Oxon: Routledge; 1960. p. 150-9.
  • 58. Alexander BK. The globalization of addiction. Addict Res. 2009;8(6):501-26. doi: 10.3109/16066350008998987.
  • 59. Hirschi T. Causes of delinquency. University of California Press; 1969.
  • 60. Gottfredson MR. A general theory of crime. Stanford University Press; 1990.
  • 61. Johnson BD. Toward a theory of drug subcultures. NIDA Res Monogr. 1980;30:110-9. [PubMed: 6779165].
  • 62. Golub A, Johnson BD, Dunlap E. Subcultural evolution and illicit drug use. Addict Res Theory. 2005;13(3):217-29. doi: 10.1080/16066350500053497. [PubMed: 23805068]. [PubMed Central: PMC3690817].
  • 63. Barkan SE. Social problems: Continuity and change. Flat world knowledge. Incorporated; 2013.
  • 64. Keene J, James D, Willner P. Social influences on individual drug USE: Three distinct sub-cultures among agency non-attenders. Addict Res. 2009;6(1):43-62. doi: 10.3109/16066359809008843.
  • 65. Sussman SY. The social psychology of drug abuse. Buckingham, GB: Open University Press; 2001.
  • 66. Burgess EW. The city. Chicago: University of Chicago Press; 1925.
  • 67. Shaw CR. Juvenile delinquency and urban areas. Chicago: University of Press; 1942.
  • 68. Du Plessis G. Toward an integral model of addiction: By means of integral methodological pluralism as a meta theoretical and integrative conceptual framework. J Integral Theory Pract. 2012;7(3):1-24.
  • 69. Amodia DS, Cano C, Eliason MJ. An integral approach to substance abuse. J Psychoactive Drugs. 2005;37(4):363-71. doi: 10.1080/02791072.2005.10399809. [PubMed: 16480163].
  • 70. Griffiths M. A ‘components’ model of addiction within a biopsychosocial framework. J Sub Use. 2009;10(4):191-7. doi: 10.1080/14659890500114359.
  • 71. Donovan DM. Assessment of addictive behaviours. Guilford Press; 1988.
  • 72. Shaffer HJ, LaPlante DA, LaBrie RA, Kidman RC, Donato AN, Stanton MV. Toward a syndrome model of addiction: Multiple expressions, common etiology. Harv Rev Psychiatry. 2004;12(6):367-74. doi: 10.1080/10673220490905705. [PubMed: 15764471].
  • 73. Skewes MC, Gonzalez VM. The biopsychosocial model of addiction. In: Miller PM, editor. Principles of addiction: Comprehensive addictive behaviors and disorders. Academic Press; 2013. p. 61-9. doi: 10.1016/b978-0-12-398336-7.00006-1.
  • 74. DiClemente CC, Prochaska JO. Toward a comprehensive, transtheoretical model of change: Stages of change and addictive behaviors. In: Miller WR, Heather N, editors. Applied clinical psychology. Treating addictive behaviors. New York, NY, US: Plenum Press; 1998. p. 3-24. doi: 10.1007/978-1-4899-1934-2_1.
  • 75. Vandermeeren R, Hebbrecht M. [The dual process model of addiction. Towards an integrated model?]. Tijdschr Psychiatr. 2012;54(8):731-40. Dutch. [PubMed: 22893538].
  • 76. Assailly JP. An integrated model of addiction: When will we integrate biological and affective processes? J Psychol Psychother. 2014;5(1). doi: 10.4172/2161-0487.1000166.
  • 77. Glantz MD, Pickens RW. Vulnerability to drug abuse. Washington, DC, US: American Psychological Association; 1992. doi: 10.1037/10107-000.
  • 78. Emshoff JR, Cuskey WR, Cort RW. Environmental interaction theory: A systems approach to the prevention and control of drug addiction. Contemp Drug Probs. 1975;4:57.
  • 79. Ahn AC, Tewari M, Poon CS, Phillips RS. The clinical applications of a systems approach. PLoS Med. 2006;3(7). e209. doi: 10.1371/journal.pmed.0030209. [PubMed: 16683861]. [PubMed Central: PMC1459481].
  • 80. Chambers RA, Bickel WK, Potenza MN. A scale-free systems theory of motivation and addiction. Neurosci Biobehav Rev. 2007;31(7):1017-45. doi: 10.1016/j.neubiorev.2007.04.005. [PubMed: 17574673]. [PubMed Central: PMC2150750].
  • 81. Borland R, Young D, Coghill K, Zhang JY. The tobacco use management system: Analyzing tobacco control from a systems perspective. Am J Public Health. 2010;100(7):1229-36. doi: 10.2105/AJPH.2009.165910. [PubMed: 20466970]. [PubMed Central: PMC2882395].
  • 82. Anderson NB. Solving the puzzle of socioeconomic status and health: The need for integrated, multilevel, interdisciplinary research. Ann N Y Acad Sci. 1999;896:302-12. doi: 10.1111/j.1749-6632.1999.tb08125.x. [PubMed: 10681906].
  • 83. Susser M. The logic in ecological: I. The logic of analysis. Am J Public Health. 1994;84(5):825-9. doi: 10.2105/AJPH.84.5.825. [PubMed: 8179056]. [PubMed Central: PMC1615050].
  • 84. Von Korff M, Koepsell T, Curry S, Diehr P. Multi-level analysis in epidemiologic research on health behaviors and outcomes. Am J Epidemiol. 1992;135(10):1077-82. doi: 10.1093/oxfordjournals.aje.a116207. [PubMed: 1632420].
  • 85. Room R. Stigma, social inequality and alcohol and drug use. Drug Alcohol Rev. 2005;24(2):143-55. doi: 10.1080/09595230500102434. [PubMed: 16076584].
  • 86. Singer M. Anthropology and addiction: An historical review. Addiction. 2012;107(10):1747-55. doi: 10.1111/j.1360-0443.2012.03879.x. [PubMed: 22962955].
  • 87. Currie CZ. Social determinants of health and well-being among young people. Copenhagen: WHO Regional Office for Europe; 2012.
  • 88. Fletcher A, Bonell C, Hargreaves J. School effects on young people's drug use: A systematic review of intervention and observational studies. J Adolesc Health. 2008;42(3):209-20. doi: 10.1016/j.jadohealth.2007.09.020. [PubMed: 18295128].
  • 89. Berry JW. Cross-cultural psychology: Research and applications. Cambridge University Press; 2002.
  • 90. Smart RG, Murray GF. Narcotic drug abuse in 152 countries: Social and economic conditions as predictors. Int J Addict. 1985;20(5):737-49. doi: 10.3109/10826088509044293. [PubMed: 3876293].
  • 91. Koopman JS, Longini IM, Jacquez JA, Simon CP, Ostrow DG, Martin WR, et al. Assessing risk factors for transmission of infection. Am J Epidemiol. 1991;133(12):1199-209. doi: 10.1093/oxfordjournals.aje.a115832. [PubMed: 2063828].
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