依存症研究と治療ジャーナル

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The Multidimensional Developmental Theory of Substance Addiction: Toward Full Recovery through Precision-Guided Treatment

Joshua Matthews and Rajeswari Natrajan-Tyagi

Objective: To develop a comprehensive new theory about the fundamental nature of substance addiction, in the service of significantly improving the low to modest success rates of addiction treatment.

Methods: The resulting “Multidimensional Developmental Theory (MDT)” of substance addiction was developed by the first author via a qualitative, grounded theory methodology. Data analysis consisted of open, axial, and theoretical coding - and gave rise to the constructs of the theory.

Results: The central hypothesis of the MDT is as follows: substance addiction is a multidimensional developmental process that is organized around a particular person-substance relationship - and the unique, evolving manifestation of an individual’s addiction is a function of the 7 features of that process. The 7 features - themselves composed of 20 additional hypotheses form the architecture of the theory and serve as the structure that the central hypothesis rests upon. These 7 features function like variables in an equation, the result of which is an evolving multidimensional developmental “fingerprint” of an individual’s addiction. The degree of severity is posited to be a function of the degree of development and mapped by dimension of development within a multi-spectrum framework. Recovery is posited to be a function of beneficial multidimensional development. To the degree that downward/detrimental developmental trajectories are reversed, one dissolves the very fabric of addiction - and can thus achieve full recovery rather than an interminable remission state of being “in recovery.”

Conclusions: The MDT implies that fully individualized, “precision-guided treatment” would follow naturally from analyzing the unique multidimensional developmental “fingerprint” of each individual. Non-abstinence recovery pathways are potentially viable to the extent that they derive from an analysis of an individual’s multidimensional developmental process. Further research is needed to evaluate the degree to which the hypotheses and clinical implications of the MDT are valid.