Understanding Addiction Beyond the Medical Model: A Comprehensive Approach to Care

Addictive disorders are complex processes that are both difficult to understand and address. In contemporary treatment settings, multiple perspectives are often required to fully understand the phenomenon of addiction. While other programs rely heavily on the medical model, which highlights neurochemical imbalances, disturbances in brain connectivity, and differential activity in certain brain regions, this perspective alone does not entirely capture the lived experience of addiction. 

The medical model helps us understand the underlying neurobiological mechanisms of addiction but do not fully capture the experience of addiction, most particularly around the human struggle around control that defines many individuals’ experiences with substances. Helping patients reclaim control over their lives is central to our mission. Addictive processes are therefore uniquely situated within our treatment center, as they are defined by a marked loss of control. Whether someone is “in control” or “out of control,” can, at times, be difficult to assess. 

Individuals who struggle with addiction may fluctuate along a spectrum, sometimes managing their use effectively and at other times feeling overwhelmed by urges or compulsions. Where a person resides on this spectrum carries significance beyond a simple neurobiological disturbance. It reflects their emotional life, their relationships, their environment, and how their internal experiences shape their behaviors. 

Alongside a medical perspective, our treatment model includes a relational and dynamic approach rooted in the belief that addiction is not primarily about the substance or behavior itself. Instead, it is intimately tied to emotional regulation. Individuals often use substances or addictive behaviors to manage internal emotional states—to numb painful feelings, escape distress, or temporarily access feelings otherwise out of reach. 

In this framework, substances are not ends in themselves but rather tools used to cope with underlying emotional needs. The relationship with the substance becomes a symptom pointing to deeper pain, conflict, or unmet needs. Our work centers on helping patients uncover and understand the meaning or story behind their addiction. 

In support of a relational, dynamic approach that pays attention to how emotions and behaviors emerge within contexts, is a study of heroin-addicted Vietnam War veterans. Remarkably, about 75 percent of those who became addicted during the war stopped using once they returned home. This serves as a human parallel to Bruce Alexander’s Rat Park experiments. When isolated in cages and given a choice between plain water and drug-laced water, rats consistently consumed the drug-laced option compulsively. But when Alexander recreated the experiment by placing rats in enriched “Rat Park” environments, where they could roam, play, and interact with other rats, the animals overwhelmingly chose plain water.

These examples highlight a crucial theme in our approach: addiction can be understood, in part, as a response to painful emotional states that emerge in relational contexts, such as loneliness or disconnection, rather than solely as the result of chemical disturbances caused by a substance. Considering both frames, substance use is best understood as an interaction between pharmacology and the context in which drugs are available. 

To engage fully in the intensive work our model offers, individuals must maintain enough control over their substance use to meaningfully participate in intensive psychotherapy. Someone actively and compulsively using alcohol or drugs is unlikely to be in a psychological state that supports the sustained commitment required for four-times-weekly treatment. 

Because our therapeutic setting is open and relies on trust rather than external controls such as locked units, rigid prohibitions, or surveillance, patients must be able to sustain periods of sobriety through the various treatment and relational supports available at the center. Individuals unable to do so often require a different treatment environment first, one designed to promote initial stability and self-regulation. 

Individuals in the throes of uncontained or compulsive substance use often benefit from alternative levels of care that offer higher structure; settings such as detox, residential addiction programs, or early-recovery intensive outpatient environments. These programs provide the containment and support necessary to help individuals reestablish some measure of control. 

Once that stability is achieved, patients are far better prepared to engage in the deeper relational and emotional work our approach requires, laying the foundation for more enduring change.