Distal Antecedents of the Addiction Syndrome Premorbid Addiction Syndrome Expressions, Manifestations and Sequelae of Addiction Syndrome Neurobiological Elements (e.g., Genetic Risk, Neurobiological System Risk) Psychosocial Elements (e.g., Psychological and Social Risk Factors) Yes Exposure to Object or Activity X, Y or Z Yes Object Interaction Underlying Vulnerability Yes Expression Drinking Gambling Smoking Intravenous Drug Using Proximal Antecedents (e.g. biopsychosocial events) Unique Manifestations e.g., Liver Cinhosis & Sequelae e.g., Gambling Debt e.g., Pulmonary Carcinoma e.g., Sepsis Yes Immediate Neurobiological Consequences Resulting in Desirable Subjective Shift Repeated Object Interaction & Desirable Subjective Shifts Shared Manifestations & Sequelae Biological Cluster (e.g., tolerance, withdrawal, neuroanatomical changes, genetic expressions) Psychological Cluster (eg, psychopathology & comorbidity) Natural History (e.g., exposure, relapse rates, temporal sequencing of symptom progression or recovery) Treatment Nonspecificity (e.g., CBT, pharmacotherapy) Social Cluster (e.g., deviant behaviors, delinquency, criminality, social drift) Object Substitution (e.g., increase in sedative use during decrease in opioid use) FIGURE 1. Model of the addiction syndrome. 1) What evidence does Dr. Shaffer provide to make the claim that addiction is an underlying syndrome and that various expressions (i.e. disordered gambling or alcoholism) are symptoms of this addiction syndrome? 2) Is addiction a disease and what evidence would suggest that it is a disease? How does addiction differ from other diseases like cancer or diabetes? 3) Why is it so difficult to understand addiction as a disease? Do you feel confident that you could describe the disease concept of addiction to someone? Do you find this information important to share with others who may be suffering from addiction or have a family member who is suffering?