In inherent limitation of the medical model is ignoring the fact that a pathological dependence implies that a relationship, one that is emotional and psychological in nature, has formed with the substance or activity (i.e. alcohol/drugs, gambling, porn, sex and love addictions). By neglecting essential emotional aspects there is an implied presumption that addiction is primarily, if not, solely a medical condition and can be fined only terms that are observable, objective and measurable, i.e. behavioral, bodily or physiological. The emotional, psychological and relationship aspects are invisible and subjective in nature, therefore considered to be invalid, barely worth considering. It appears that physical pain takes precedence over emotional pain as well. For example, by defining withdrawal solely as a physiological process, medical issues and physical pain or discomfort), we lose sight of emotional withdrawal the crash after the high wears off which can be as painful, last longer and be more far-reaching. Pathological dependence is a pathological relationship, one in which there is continuous and increasing emotional involvement, and an irresistible attachment develops, as well loss of control. The relationship is with a substance or activity that induces an extraordinary mind and mood altering effect in the form of a rush or high, escape and relief.
The Pathological Relationship
Certainly the term pathological to describe this relationship is apt in a number of ways, beginning with the underlying obsession and desperation that drives the relationship. Tantamount to having a secret love affair, this relationship is carried on behind a cloak of denial and deception, and is separate from the rest of the addict's life. This relationship immediately becomes the primary relationship, more powerful than any other. There is a loss of control, an inability stop thinking about or pursuing the means of relief. While the relationship with the substance or activity provides much needed relief, immediately yet temporarily, it feeds the addiction by further starving the addict emotionally as no real nourishment is provided. Actually the addict is worse off than before he consumed the substance because he is feeling worse than he did before when sober. During the course of this relationship, the addict is becoming increasingly isolated from the rest of the world, from other people and relationships, the level of (pre-existing) pain increases over time. There are a number of other harmful physical effects considering the toxic effects of the substances and increased stress that comes with mounting problems associated with this relationship.
Etiology and Pre-disposing Conditions
What happens when relationships fail to provide adequate emotional nourishment? What happens when we don't receive the affection, attention, acknowledgement and appreciation we require; when we are not heard and understood; when we don't feel loved or special or connected? There is pain and this pain builds over time, as deprivation continues from previous relationships to current ones. Depending on the level or severity of pain (frustration, hunger, dysphoria, anguish, shame, emptiness), there will be a need to relieve that pain. At some point, desperation sets in. Until external means of relief are discovered, internal defense mechanisms such as denial, delusion and deception are relied upon to cope and function When the mind and mood altering effects of external means of relief, drugs/alcohol, gambling, porn, sex, the most common ones, are discovered, the means most easily accessible and provide the most relief in the most pleasurable way take over as the primary means, and primary relationships. The addiction or the relationship that is formed is driven by the need to relieve pain. The Relationship Model of Addiction accounts for etiology by or attributing the cause of addiction to be unmet emotional needs stemming from dysfunctional, non-emotionally nourishing relationships.
The existence of a relatively high degree of pain from unmet emotional needs is a predisposing condition -- the greater the pain, the more susceptible one is to getting hooked on a means of relief. The greater the pain, the more relief is derived, the more extraordinary the effect, the more dependent on the relationship that forms with the means of relief, this the stronger the addiction, albeit subjective and immeasurable.
Why do some people get addicted and not others?
The medical model approach to these questions is that alcoholism and chemical dependency are largely the result of genetic and biochemical factors. Evidence suggests that a history of addiction in one's family of origin or prior generations predisposes one to becoming addicted. Evidence also suggests biochemistry -- the unique combination of chemicals in the brain with mind/mood-altering substances brings about some kind of extraordinarily pleasurable experience and irresistible craving.
However, there are those who have addiction running rampant in their families or who have a biochemical predisposition for becoming an addict who do not become dependent. The same goes for a chemical imbalance. We may surmise, therefore, that becoming addicted involves more than just genetics or biology. By the same token, we know that the incidence of abuse in ones family of origin also correlates, but we don't know exactly why or how significant a role it has. Some people with a history of family of origin abuse may experiment with various mind/mood substances or activities, but don't become addicted. We might, therefore, strongly consider the level of pre-existing (emotional and physical) pain at the time of discovery another way to explain why some people and not others become addicted.
Perhaps the simplest explanation for the phenomenon of addiction is that it is a matter of the right chemistry. It is when the right person discovers the affect that a need for more develops. The right person could be anyone whose level of pre-existing emotional pain causes an extraordinarily pleasurable or pain-relieving gratifying experience.
The Relationship Model of Addiction establishes a new standard for understanding and treating addiction. It expands the disease concept by re-defining addiction as a relationship. It integrates experiential, humanistic and existential perspectives; sheds light on the emotional and psychological dynamics of addiction; and has powerful implications for treatment and recovery. We know that recovering addicts must eventually make the transition from pathologically dependent relationships based on the need for relief to sober healthy, intimate, emotionally nourishing relationships. Regardless of one's experience in past and current relationships, doing the necessary self-work and learning some basic principles, pitfalls, challenges and skills, can make the transitions to healthy, emotionally nourishing, intimate relationships possible.