Addiction is a process that has its origins in childhood. Actually, I go further to the pre-postnatal period, from when the mother and father first notice the woman is pregnant up to the first six or so months postnatal. I have to agree with Donald Winnicott who believed that primary maternal preoccupation and then good enough mothering are in large part responsible for the future wellbeing of the developing human. I purposefully leave out the father at this point, as he doesn't carry the fetus and although he may care for the infant, he cannot breast feed the neonate.

Primary maternal preoccupation refers to a nearly hypnotic state in which nothing is as important to the mother as the developing human being. Winnicott believed that if the woman were not pregnant, this state would be diagnosed as mental illness, so strong is the preoccupation. At any rate, this period ushers in a fantasy world for the developing human has magical control over the environment. First, it sees itself and the mother as a single unit. Later though, as the mother withdraws her attention gradually, she introduces frustration and if mothering (and fathering at this point) is good enough, the developing human comes to tolerate frustration. It is this frustration tolerance which will one day allow the human to become culturally competent; one cannot be competent unless one can tolerate frustration.

Moving ahead to later childhood, good parents take control of their child's development in an attempt to assure cultural competence. This is what Urie Bronfenbrenner referred to as a proximal process. Proximal processes are functions that result in positive development based on the developing person's unique Environmental and Personal (genetic, personality) makeup [i.e., Development=f(PXE)]. One specific example of a proximal process is parental monitoring (e.g., checking on a youth's whereabouts, knowing a child's friends). Another example is enrolling youth in extracurricular activities, such as sport or music lessons. It is these proximal processes that assure that youth will develop cultural competence, even if the youth has a difficult personality disposition that makes the youth more prone to problem behavior (e.g., ADHD, annhedonia), or if the family lives in difficult circumstances (e.g., poverty, a drug-infested neighborhood). In fact Bronfenbrenner proposed that proximal processes are especially beneficial for youth developing in difficult circumstances.

When parents assure that infants and toddlers develop frustration tolerance and then enroll youth in activities that promote cultural competence, they are more likely to produce a young person less prone to need substitute reinforcers such as drugs like cigarettes or marijuana to attain reward. For the youth not receiving good parenting, the need for reinforcement is without a culturally acceptable target. In such cases, youth will need to seek alternative means for reinforcement, such as drugs or other dangerous activities. Most drugs work by stimulating the brain's reward centers (mesolymbic system), acting through dopamine (DA) pathways. Thus, without culturally valuable activities to provide reinforcement, youth must seek alternative pathways that provide reinforcement so long as the youth adapts to the alternative pathways' reward constraints. One such alternative pathway is the antisocial peer context. This context has its own cultural constraints to which the youth must adapt, such as smoking in the peer smoking context; it's a reverse proximal process. While proximal processes are considered positive in nature, a reverse proximal process would necessarily have to be negative by nature. Like the proximal process, though, it would foster a particular developmental outcome, taking advantage of the contextual and personal factors. Therefore, if the youth enters the peer smoking context with a genetic predisposition for addiction, such as having sparse extracellular DA due to over-active transporters or sparse recepters, the reverse proximal process assures addiction as smoking is the constraint to which the youth must adapt; one cannot belong to a peer smoking context unless one smokes.

I will leave this brief introduction to the Psychoadaptation theory of addiction with a brief summary. Development is a process that begins in the prenatal environment. Parents foster positive development by introducing frustration early and managing its development such that children and adolescents learn to tolerate frustration and can become culturally competent. As culturally valued activities generally preclude drug addiction, this means that youth benefiting from positive parenting are less likely to need drugs for reinforcement. Thus, learning to adapt to culturally valued contexts assures positive development whereas having to develop to fringe cultures like antisocial peer contexts will necessarily result in poor developmental outcomes including the possibility of drug addiction. What this says for the treatment of addicted individuals will be discussed in future postings. However, for now I'll say that understanding why an individual is addicted by learning the addict's history through careful therapeutic interviewing will help find the correct long term solution to prevent resumption of the addictive behavior. Although pharmacological treatments will be useful initially, without addressing the root cause of the addiction, the addiction will surely return.

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