Bio-Psycho-Social framework


According to the world health organization, drugs are any substance other than those required to maintain normal health, which, when consumed, modify one or more body functions. Among such drugs is marijuana which has a long history in its use and which is among the most common drug in the United Kingdom and globally. Furthermore, marijuana is shown to have excellent addiction ability, which leads to physical dependence to prevent a withdrawal syndrome. Unfortunately, drug addiction costs an estimated $524 billion a year, especially in productivity loss, health care, incarceration and crime, and drug enforcement (Roditis et al., 2019). Also, drugs are associate with chronic diseases, including various types of cancer. Regardless of these negative impacts, adduction to drugs like cannabis impacts individual decisions, judgments, and emotional regulation. Addiction plays a significant role in this uninformed decision, thus the need to understand addiction and how it occurs. Therefore, this study will explore cannabis and its history, evaluate dependence using Operant Conditioning and Social Learning theories and link these theories to the WHO's, Bio-Psycho-Social framework.

Cannabis and Its History

Cannabis, also known as marijuana, is described as a group of three plants with psychoactive properties. Some of its names include Cannabis ruderalis, Cannabis indica, and Cannabis sativa. The flowers and leaves of these plants are harvested and dried, creating one of the most popular drugs globally. Though the drugs are illegal in most of the world, it is being legalized in most of the world including the United States and Canada. Therefore, most people consume the drug to enjoy its relaxing and calming effects (Sulak, 2015). Also, it six being used to treat some conditions like chronic pain, poor appetite, and glaucoma. Marijuana has a long history of human use (Ren et al., 2019). However, most of the ancient communities used the plant for medicinal purposes other than recreational purposes. The plant is indigenous to Central Asia and was used primarily for fabric and rope. Some cannabis ropes have been dated back to the Neolithic age in japan and China. However, during these periods, it is unclear when the plant's psychoactive properties were known. Similarly, the oldest archeological evidence was discovered in Romanian kurgans and dated 3,500 BC (Burillo-Putze et al., 2013). Researchers show that the plant was being used for ritual festivals by Proto-Indo-European tribes before spreading during the Indo-European migrations to western Eurasia. In the recent period, cannabis was discovered in a burial tomb that dated to 500 BCE. The tomb contained a wooden bowl and leather basket filled with cannabis leaves, seeds, and shoots near the feet and head of the deceased (Ren et al., 2019). Individuals use psychoactive drugs for fun or excitement. They use the drugs to feel good and counteract negative feelings or when bored. Psychoactive drugs are substances that affect mental processes, including consciousness, perception, cognition, and emotions.


Cannabis and How It’s Work

Marijuana acts as a neurotransmitter since it contains Tetrahydrocannabinol (THC) chemical structure similar to anandamide, a brain chemical. This chemical transmits chemical messages between the nervous system and nerve cells. It mainly impacts the brain region of thinking, movement, concentration, pleasure, memory, and time perception. The THC can attach to molecules called cannabinoid receptors and activate them. Therefore, it disrupts many mental and physical functions, thus impacting thinking and sensory (Sulak, 2015). For instance, THC can change the functioning of the hippocampus and orbitofrontal cortex, thus enabling the individual to create new memories. Therefore, the use of marijuana causes impaired judgment and thinking and interferes with individual learning ability (Sulak, 2015). Moreover, the THC disrupts cerebellum and basal ganglia functioning, which regulate balance and coordination. Therefore due to its ability to stimulate the brain, marijuana use leads to addiction which is associated with dependence. In this condition, an individual feels withdrawal symptoms after not taking the drug. Also, individuals report moods swing, irritability, and sleep difficulties. These symptoms occur when the brain adapts to a vast amount of substance by minimizing production and sensitivity to its neurotransmitters, endocannabinoid; thus, its use termination leads to reduced body functioning thus subsequent side effects. Therefore, at this level, individuals cannot stop using marijuana addiction.

Prevalence of Cannabis

In the United Kingdom, cannabis is among the most used drug, and most of its use is recreational other than medicinal functions. As per the Department of Health, marijuana use is the most commonly used drug after tobacco and alcohol (Yu et al., 2020). For instance, in 1996, Home Office Statistical Bulletin showed that 72,745 drug perpetrators committed offenses involving marijuana (Cooper et al., 2017). Similarly, the study reveals that there were 91,432 seizures of cannabis in 1996. However, the study agrees that it is difficult to determine the prevalence of marijuana use in the UK. According to the Parliamentary Office of Science and Technology, one out of five adults had used marijuana once in their lives among the adult population. Also, in 1994, one in twenty individuals had used drugs in the past one month. These figures were similar to those presented by WHO for other countries in Europe (Okahara et al., 2020). The study also reveals that the Independent Drug Monitoring Unit showed that most daily cannabis users had a consumption rate of 24.8g of cannabis resin per month. Most than 60% of these individuals believe that cannabis is beneficial to their physical or mental health. According to Statista.Com (2021), in 2019, more than 29.6% of individuals in wales and England aged between 15 and 60 used marijuana at least once in their lifetime. This percentage was more than 23.6 percent in 2001/02. Similarly, growing evidence that marijuana use among United Kingdom youths aged 14–19 years is increasing. Taylor et al. (2017) state that more than one-fifth of the adolescents occasionally or regularly use cannabis, and most youths were more likely to progress to harmful drug use behaviors in early adulthood. Moreover, the study reveals that in 2017, 9% of boys and 7.1 percent of girls aged between 10 and 14 years old used marijuana.

Other than recreational use of marijuana, in 2018, the country legalized cannabis for medical use and can be prescribed like any other licensed medicine to help treat various disorders. The policy to legalize marijuana for medical purposes was supported by the overwhelming country population. However, only specialist doctors can prescribe this drug. According to the NHS, cannabis is used in cases of severe or rare epilepsy for individuals dealing with chemotherapy and multiple sclerosis (Tallon, 2020). According to the National Health Service, the study also reveals that medical cannabis use will rise to 20,000 UK patients in two years. The legalization has already had substantial public support though buyers need to be over 18, and it would only be (legally) available from licensed premises.

Theories of Addiction

Various models explain addiction to drugs. Some of the theories include the Social Learning Theory and Operant Conditioning. Marijuana use can be moderate, severe, and mild. Another theory that explains addiction is the WHO Model of Dependence: Bio-psycho-social model that describes the cycle that exists and which promotes the use of marijuana.

Social Learning Theory

Social learning theory is a learning approach that suggests that new behavior can be learned through observation and imitation of others. Also, the theory reveals that learning also occurs through the observation of punishment and rewards, reinforcement (Akers & Jensen, 2017). The Social learning theory was developed by Albert Bandura, who highlighted the significance of observation, modeling, behavior imitating, and emotional reactions of other individuals. The theory shows how cognitive and environmental elements interact to influence human behavior and learning. The theory reveals that children observe the people around them and behave similarly, as illustrated in the Bobo doll experiment, where children copied aggressive behaviors (Akers & Jensen, 2017). According to the theory, the individual being observed are called a model. Young people in the community are surrounded by many models, including peers, parents, family, and characters on children’s TV. Children thus observe and imitate this behavior. Most people pay attention to models and encode their behavior, and at a later period, they may copy the observed behavior. The process of learning often undergoes various processes (Li & Guo, 2020). The learning starts with attention, where individuals notice the behavior and pay attention before it can be imitated. Secondly, the process moves to retention, which involves remembering behavior (Li & Guo, 2020). This process is followed by reproduction which refers to the ability of an individual to perform specific observed behavior. Lastly, the most critical part of the procedure is motivation which is the urge to emulate a behavior.

Hahlbeck and Vito (2021) state that people are social beings. However, social interactions have the most significant impact, especially on individuals who matter most while growing up. Some of these people include relatives, parents, and teachers. When parents and other individuals have specific behavior, like smoking marijuana, this behavior can be imitated and coppiced. When people observe such behavior, they are also more likely to try out these behaviors as well. Smith (2020) states that individuals copy behavior such as smoking marijuana when they observe that smoking had a positive result. For instance, when people observe that individuals who smoke marijuana were more relaxed, had more fans, and had low stress, people also copy this behavior. Also, since people have a great need for social interaction. Therefore individuals often result to using drugs to cooperate with other individuals and to reduce rejection. Thus, in the use of marijuana, when individuals observe other people engaging in addictive behavior, they copy and imitate such behavior leading to addiction (Hahlbeck & Vito, 2021).

Therefore when adolescents observe adult-use marijuana and observe the positive impact such as relaxation, they repeat what they saw, and with a repeat of this behavior, it becomes addictive. For example, according to Dempsey et al. (2016), there were more than 60% of the male college students in the united kingdom, and 55% of the female students reported regular use of marijuana and observed the behavior either from peers, TV character, or parents. McAlaney et al. (2021) also state that most of the addiction from drugs resulted from observation and imitation from parents and peers.

Operant Conditioning Theory

Operant conditioning is a learning method that focuses on the reward and punishment for behavior. Through operant conditioning, there is an association between the behavior exhibited and the consequences achieved. This behavior was demonstrated in rats where when lab rats press a lever when there is a green light to get a food pellet as a reward. However, when there is red light, the rat receives a mild electric shock. The result indicates that the rats learned to press the lever when the green light is on and avoid the red light. However the operant conditioning does not only take place in experimental settings; instead, it also takes place in real life and plays a critical role in everyday learning (Adamczyk et al., 2019). The study also reveals that punishment and reinforcement also occur in natural settings and more structured environments like therapy sessions and classrooms. B.F described the theory. Skinner explained that it is not critical to look at internal thoughts and motivations to explain behavior, instead of looking at the external, observable causes of human behavior was critical.

The theory states some reinforcement in operant conditioning. This reinforcement either strengthens behavior or discourages it. One of the reinforcement is the positive reinforcers which are the favorable outcome presented after the behavior. In this case, the behavior is strengthened by the addition of praise. For example, when individuals smoke marijuana and feel relaxed and less stressed, this activity promotes the use of marijuana (Francis & Kanold, 2017). Another reinforcement is the negative reinforcement that removes the favorable events and outcomes after behavior and behavior are considered unpleasant. For example, when individual smoke marijuana and they have mental problems, this action discourages many people from smoking it (Francis & Kanold, 2017). Another reinforcement is punishment. When the punishment is negative, the behavior is discouraged and weakens behavior by adding a negative stimulus. For instance, after a child is punished for smoking marijuana, behavior is discouraged (Francis & Kanold, 2017). Finally, another state is extinction, where behavior is no longer reinforced by a previously reinforced response, thus weakening the rate of repeat.

Engel and Bleecker (2017) state that the use of marijuana makes people excited, feel good, or different, and counteract negative feelings. This example shows that marijuana has a positive reinforcement to the user, resulting in the need for continuous reinforcement anytime an individual feels bored or stressed. Therefore, with the need for constant reinforcements, individuals become dependent on the drug. Consequently, the theory reveals that addiction occurs because of the body's need for a reward to prevent the pain of withdrawal. This approach is also similar to the biological approach, which suggests that individuals need to take drugs or substances when the body's level goes down, thus creating addiction. Sharma et al. (2012) agree that marijuana contains THC’s chemical structure similar to anandamide, thus altering everyday brain communication. It impacts pleasure, memory, thinking, and concentration. Therefore, when THC attaches to cannabinoid receptors and activating them. This disrupts the various mental and physical functions and limits the production of anandamide. Thus, the study has shown that addiction is due to the body's need to increase anandamide, which is substituted with THC. This research shows that positive operant conditioning is the most common explanation for all addiction to marijuana.

The Bio-Psycho-Social framework

The biopsychosocial model of health and illness refers to an approach developed by George L. Engel, which suggests that interactions between social factors, psychological, and biological factors determine the cause, prevalence, and results of a health condition (Buchman et al., 2010). However, the model was created for therapy in treating various mental illnesses; it is now widely used to understand other health conditions like addiction. Also, due to lack of consensus, Sigmund Freud focused on psychotherapy, and his work set the groundwork for psychotherapy, which helps many people find the root of their issues (Buchman et al., 2010). Today, the model is widely accepted to treat people with mental illness and people struggling with the disease of addiction. The therapy focuses on all factors leading to a health condition other than just one condition, thus giving people higher chances of recovery. The model has become a practical clinical guide for understanding disease, suffering, and illness and how they are affected by multiple levels of the organization. Also, the framework is critical in understanding patient's subjective experiences as essential contributors to diagnosis, humane care, and health outcomes. Moreover, the model is critical to promoting a more participatory clinician-patient relationship while promoting self-awareness (Buchman et al., 2010).

The model includes the biological component, which explains that there are biological aspects that lead to addiction. Its mechanism of action leads to motivation and frontal control, thus making individuals challenged to stop the use of drugs. The biological component includes biological and genetic explanations of addiction. Most people who struggle with addiction also have an underlying mental health condition, though not psychological disorders that can be inherited from one generation to another. However, these genes are not 100 percent passed to siblings, and there are no 100% changes of inheriting such a mental condition; the risk is still high (Wade & Halligan, 2017). Therefore the biological component is based on the chemical imbalances that occur in the body and impact parts of the brain and its functioning. The change often makes the brain more or less active. To treat these biological aspects of addiction, some drugs are mainly prescribed to treat depression and anxiety other than using drugs (Wade & Halligan, 2017). Also, these drugs are used to stabilize moods for individuals struggling with addiction. Since these medicines are non-addictive, they are better used to treat bipolar disorder and other condition which changes how the brain functions. However, the biological model does not explain the initiation of substance use. However, the genetics component can explain the increased influences or vulnerability to drug use.

Another component of the theory is the social component of the approach. This component reveals that the most fundamental reason why individual become addicted, and it persists is because they individual one live with are in same situations that you need to get out of (Bolton & Gillett, 2019). For instance, when you need to quit using marijuana and people around you, including family members, use it. This condition means that the individual you hang out with must encourage you to get high, and due to addiction, one gets lured easily. Therefore it becomes impossible to quit, especially after one starts using drugs like cannabis. Consequently, this model treatment makes someone aware of the factors to consider and the need to stay away from environmental factors that lead to drug re-use (Bolton & Gillett, 2019). When all these factors are addressed well, they help strengthen recovery since it gets easier after self-awareness. This component is similar to the social learning theory, where the individual environment that consists of peers, family, society, and media plays a significant part in making someone copy using drugs.

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A drug is defined as any substance other than those required to maintain normal health, which, when consumed, modify one or more body functions. Among drugs is marijuana which harms health. Its use leads to addiction, and this is associated with massive costs by the government and individuals. Cannabis dates back to the Neolithic age in japan and China. The early trace dates back to 3,500 BC though most modern evidence shows cannabis dating back to 500 BCE. Most of the plant use was during burial and weaving. When used, it acts as a neurotransmitter due to its Tetrahydrocannabinol properties. It mainly impacts the brain region of thinking, movement, concentration, pleasure, memory, and time perception. In the United Kingdom, more than 29.6% of individuals in wales and England aged between 15 and 60 used marijuana at least once in their lifetime. Also, in 2018, it was legalized for medical use, and the National Health Service predicts a rise to 20,000 UK patients suing it for the next two years. Addiction to this drugs can be explained by the Social Learning Theory which suggest that individual learn to use cannabis from their environment. On the other hand, Operant Conditioning Theory reveals that learning is due to reward and punishment for behavior. To understand and treat these addictions, the Bio-Psycho-Social framework form-critical guidelines. The framework includes the biological component, which explains that there are biological aspects that lead to addiction. Also, it consists of the social element, which reveals that the most fundamental reason why an individual becomes addicted. The social learning theory shows the environmental factors leading to addiction, while the operant theory adds knowledge on how reward motivates individuals to take drugs and closely relates to the Bio-Psycho-Social framework's biological components. Therefore, while the social learning theory explains the initiation of substance use due to environmental factors, operant conditioning explains the repeated use/addiction, while the Bio-Psycho-Social framework explains addiction as a whole and the subsequent treatment for both addictions and use.


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