Heterogeneity in choice models of addiction: the role of context

Rationale Theories of addiction guide scientific progress, funding priorities, and policy development and ultimately shape how people experiencing or recovering from addiction are perceived and treated. Choice theories of addiction are heterogenous, and different models have divergent implications. This breeds confusion among laypeople, scientists, practitioners, and policymakers and reduces the utility of robust findings that have the potential to reduce the global burden of addiction-associated harms. Objective Here we differentiate classes of choice models and articulate a novel framing for a class of addiction models, called contextual models, which share as a first principle the influence of the environment and other contextual factors on behavior within discrete choice contexts. Results These models do not assume that all choice behaviors are voluntary, but instead that both proximal and distal characteristics of the choice environment–and particularly the benefits and costs of both drug use and non-drug alternatives–can influence behavior in ways that are outside of the awareness of the individual. From this perspective, addiction is neither the individual’s moral failing nor an internal uncontrollable urge but rather is the result of environmental contingencies that reinforce the behavior. Conclusions Contextual models have implications for guiding research, practice, and policy, including identification of novel target mechanisms while also improving existing interventions.