Addiction psychology

Addiction psychology mostly comprises the clinical psychology and abnormal psychology disciplines and fosters the application of information obtained from research in an effort to appropriately diagnose, evaluate, treat, and support clients dealing with addiction. Throughout the treatment process addiction psychologists encourage behaviors that build wellness and emotional resilience to their mental and emotional problems. Addictions are often separated into two subdivisions; process addictions and/or substance addictions.[1] Substance addictions are related to drugs, alcohol abuse, and smoking, whereas process addictions relate to non-substance related behavior such as gambling, spending, shopping, eating and sexual activity.

Through a research study conducted in Boston at East Boston methadone maintenance treatment program in the 1970s concludes that with any substance or process addiction the drug or behavior in itself is not addictive, but rather the result of a meaningful relationship between a person with the addiction and the object(s)of his or her addiction. This is often why people suffering from addictions are unaware that their problem is causing difficulties for themselves and others through relationships, careers, responsibilities, and their general health. With prolonged engagement in the addiction the behavior can be come compulsive.[2][3]

With prolonged use the substance or behavior becomes compulsive resulting in the liklihood that relationships, daily responsibilities, and health will be affected.[4][5] Though most fields of psychology address the addictive process and related behaviors through cognitive behavioral therapy and behavioralism other approaches (which will be discussed later) are utilized by addiction psychologists and other mental health professionals as well. With the prevalence of people with addiction increasing annually the need for addiction psychologists and other professionals who treat addiction are in demand. An Addiction Psychologist is a doctoral-level profession in which the psychologist has engaged in education, training, and/or supervised experience in the field of addiction. An addiction psychologist may work with people who struggle with process addictions and/or substance addictions. They are trained to carry out psychological assessments, individual and group counseling, consultation, and in the ethical, legal and administrative codes of their profession. They may be employed at an in- or out-patient rehabilitatio treatment center, detox facility, group practice, or they may be self-employed. Regardless of their place of employment each treatment provider must remain within his/her scope of practice while providing treatment.[6]

Typically an addiction psychologist will fit into one of three categories.

1.PhD & CAC-A psychologist who also holds a certificate as a Certified Addiction Counselor (refer to section 'Recognized Certifications in the filed of Addiction Psychology'). 2.PhD who is a member of Division 50-A psychologsit who is a member of the American Psychological Association's Division 50, Society of Addiction Psychology(refer to section 'American Psychological Association'). 3.PhD specializing in addiction and who has completed research in the field of addiction.

History

The word 'addiction' has successfully been traced to the 17th century. During this time period addiction was defined as "being compelled to act out any number of bad habits. Persons absusing narcotics were called opium and morphine 'eaters.' 'Drunkard' referred to abusers of alcohol. Medical textbooks categorized these 'bad habits' as dipsomania or alcoholism[7] However, it wasn't until the 19th century when the diagnosis was first printed in medical literature. In the 1880s neurologist, Sigmund Freud and surgeon, William Halsted began their experiments with cocaine. Unaware of the drug's powerful addictive qualities they inadvertently became guinea pigs in their own research, and as a result, their contributions to psychology and medicine changed the world.

While working in Vienna General Hospital (Vienna Krankenhaus), in Austria, cocaine took possession over Freud's life when he found cocaine to relieve his migrane. When the effect of cocaine decreased the amount of cocaine Freud consumed increased. With information about the pain suppressing properties of cocaine physicians began prescribing cocaine to their patients who required pain relief.[7]

Unaware of each other's experiements with cocaine, Freud and Halsted were conducting research in Austria, while American Physician, W.H. Bentley, was conducting his own similar experiments. The Index Medicus published his article describing how he successfully treated patients with cocaine whom were addicted to opium and alcohol. In the late 1800s the use of cocaine as a recreational drug spread like a worldwie epidemic.[7]

As cocaine continued to spread physicians began looking for ways to treat patients with opium, cocaine, and alcohol addictions. Physicans debated the existence of the label 'addictive personality' but believed the qualities Freud possessed (bold risk taking, emotional scar tissue, and psychic turmoil)were of those that fostered the 'addictive personality'.[7]

Important contributors

Physician, Sigmund Freud, born on May 6, 1856 in Freiberg, Moravia (an area now known as Pribor in the Czech Republic)was instrumental in the field of psychology. Dream interpretation and psychoanalysis (also known as talk therapy) are two of his well known contributions. Psychoanalysis is used to treat a multitude of conditions including addictions.[8]

William Halstead born on September 23, 1852 in New York City, received his degree in medicine in 1877. Throughout his medical career as a surgeon he contributed surgical techniques that ultimately led to improvement of the patient's outcome following surgery. During Halstead's professional career, (along with Freud) conducted experiments with the drug cocaine. While their research was in process they became guinea pigs for their own experiments when they became addicted to cocaine. In 1884 he became the first to describe how cocaine could be utilized as a localized anesthetic when injecting into the trunk of a sensory nerve, and how the localized ischemia prolonged the anesthetic properties of the drug.[7[9]

G. Alan Marlatt was is pioneer in the field of addiction psychology. Born in Vancouver, British Columbia in 1941 he spent his professional career as an addiction psychologist, researcher, and director of the University of Washington's Addictive Behaviors Research Center and professor in the Department of Psychology. Marlatt adopted the theory of Harm reduction, developed and scientifically tested ways to prevent an addict's slip from becoming a relapse. He understood that by expecting immediate and complete abstinence from an addict often detered addicts from seeking the help they needed and deserved. Alan Marlatt died on March 14, 2011.[10][11][12]

A. Thomas McLellan was born in 1949 in Statan Island, NY. He is currently a professor at the University of Pennsylvania School of Medicine at the Center for Studies of Addiction. McLellan serves or has served on editorial boards as a reviewer of medical and scientific journals, and as an advisor to government and non-profit organizations including the National Practice Laboratory of the American Psychiatric Association, and the World Health Organization. He is co-founder and Chief Executive Officer of the Treatment Research Institute located in Philadelphia, PA. McLellan has conducted decades of research for the efficacy of treatment for substance abuse patients, and is recognized both at the national and international level as an addiction psychologist. He is also known for the development of the Addiction Severity Index or ASI and currently serves as Editor in Chief of the Journal of Substance Abuse Treatment and the Deputy Officer of National Drug Control Policy, Research and Evaluation;[13]

Arnold Washton Ph.D. has specialized in addiction since 1975 and is a world renowned addiction psychologist known for his pioneering work in the development of therapeutic approaches to the treatment of drug and alcohol abuse. He is the author of many books and professional journal articles on treatment and addiction. He is a lecturer, clinician, researcher, and has served on the advisory committee for the US Food and Drug Administration. Dr Washton is founder and executive director of Recovery Options,a private addiction treatment practice located in New York City and Princeton, New Jersey.[14][15]

What is addiction?

Addiction is a progressive disease and psychiatric disorder that is defined by the American Society of Addiction Medicine as "a primary, chronic disease of brain reward, motivation, memory and related circuitry. It is characterized by the inability to control behavior, it creates a dysfunctional emotional response, and it affects the users ability to abstain from the substance or behavior consistently.[16] Psychology Today defines addiction as "a state that can occur when a person either consumes a substance such as nicotine, cocaine, or, alcohol or engages in an activity such as gambling or shopping/spending."[17]

When a non-addict takes a drug or performs a behavior for the first time he/she does not automatically become an addict. Over time the non-addict chooses to continue to engage in a behavior or ingest a substance because of the pleasure the non-addict receives. The now addict has lost the ability to choose or forego the behavior or substance and the behavior becomes a compulsive action. The change from non-addict to addict occurs largely from the effects of prolonged substance use and behavior activities on brain functioning. Addiction affects the brain circuits of reward and motivation, learning and memory, and the inhibitory control over behavior. [18]

There are different schools of thought regarding the terms dependence and addiction when referring to drugs and behaviors. One adopted belief is that "drug dependence" equals "addiction." The second belief is that the two terms do not equal each other. According to the DSM, the clinical criteria for "drug dependence" (or what we refer to as addiction) include compulsive drug use despite harmful consequences; inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. The latter reflects physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal). Physical dependence can happen with the chronic use of many drugs—including even appropriate, medically instructed use. Thus, physical dependence in and of itself does not constitute addiction, but often accompanies addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, where the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.

There are some characteristics of addiction that regardless of the type share commonalities. The behavior provides a rapid and potent means of altering mood, thoughts, and sensations of a person which occur because of physiology and learned expectations. The immediate precipitating factors fo the relapse, the timing of the relapse and the rate of relapse following treatment is high.

American Psychological Association

The American Psychological Association (APA) is a professional psychological organization and is the largest association of psychologists in the United States. Over 100,000 researchers, educators, clinicians and students support the association through their membership. Their mission "is to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives." [1]

APA supports 54 divisions, two of which pertain to addictions. Division 50, Society of Addiction Psychology promotes advances in research, professional training, and clinical practice within the range of addictive behaviors. Addictive behaviors include problematic use of alcohol, nicotine, and other drugs as well as disorders involving gambling, eating, spending, and sexual behavior.. [19] Division 28, Psychopharmacology and Substance Abuse promotes teaching, research, and dissemination of information regarding the effects of drugs on behavior.[20]

The College of Professional Psychology (CPP), hosted by the American Psychological Association Practice Organization, previously offered a certificate to psychologists whom demonstrated proficiency in the psychological treatment of alcohol and other substance-related disorders. The CPP maintains the certificate of proficiency for persons who acquired it prior to 2011. The Society of Addiction Psychology certificate will be re-instated while the Society examines other avenues for credentialing professionals in addiction treatment.[21]

Addiction as a Disease

It seems that as long as blood has flowed through human veins, drugs have flowed with it; and wherever you find the phenomenon of intoxication, so too will you find addiction (60). Recently experts discovered the addiction process is like the disease model, which is causal, which contains the organ, the defect, and the symptom of the disease. Addiction is a disorder of genes, reward, memory, stress, and choice. Dopamine surges cause a change in the hedonic set point, causing a lack of pleasure in everyday pleasures (61). ==Disease Model in Addiction Rather than being a disease we are inflicted with, addiction is a disease of choice. It is a disorder of the very parts of the brain necessary to make proper decisions. The process of the disease model is such that the person experiences a defect in an organ, and names the symptom. The following is an example: A young adult is skiing, hits a tree (the cause), and fractures (the defect) his femur (his organ), he is screaming in pain with the now disability and deformity (the symptom). Addiction is in lieu with this model. One becomes addicted to cocaine, the brain is the organ affected, specifically the ventral tegmentum nucleus accumbens in the midbrain (65). The defect is stress induced hedonic regulation. The symptoms are loss of control and craving to name a few. There are however, problems with the disease model. A few of the problems are: it is reductive, materialistic, and tends to be expensive and dramatic. It also fails to involve interventions to prevent future disease (60). The disease model also strips the patient of power. The physician is handed the power to resolve the issue. It also frees the patient of responsibility in certain situations. Genetic (Vulnerability) The genetic makeup of an individual determines “low responders” vs. “high responders” to the effects of alcohol. There are genetic differences in how people respond to methylphenidate (Ritalin) injections (64). Reward (Hedonic System) Increased dopamine means increased pleasure. Dopamine is at the heart of all reinforcing experiences. It tells the brain the drug is better than expected, and controls the learning signal. When an individual uses a drug, there is a surge of dopamine in the midbrain (65). Memory (Learning) The neurochemical glutamate is the most abundant in the brain. It is critical in memory and formation consolidation. All drugs that are used for abuse and many addicting behaviors effect Glutamate which preserve memories and create drug cues. It is also the neurochemical of motivation which initiates the drug seeking (62). Stress (Anti-Reward System) When under stress the brain is unable to achieve homeostasis, as a result the brain relies on allostasis which moves the hedonic threshold. Previous pleasures are no longer pleasurable (63). This is also known as anhedonia, or pleasure deafness. When stressed, the addict experiences extreme craving. This craving isn’t a traditional “crave” for chocolate. It is a crave that is an intense emotional obsessive experience that consumes the addict (60). Choice (Motivation) An addict experiences damage to the Orbitofrontal Cortex (OFC), the Anterior Cingulate Cortex (ACC), and the Prefrontal Cortex (PFC). This damage causes a tendency to choose small & immediate rewards over larger but delayed rewards, deficits in social responding due to decreased awareness of social cues, and a failure of executive function such as insensitivity to consequences.

Who practices addiction psychology?

Many degrees provide space for the treatment of additions. The educational background that each professional obtains will contain similarities but the philosophy and the viewpoint from which the material is delivered may vary. The required amount of education prior to earning a certificate or degree also varies. A few of the more commonly recognized fields of study are included.[22]

Psychologist

Psychologists receive their education in psychology and pursue either a Ph.D. (Doctor of Philosophy) or Psy.D. (Doctor of Psychology) in clinical or counseling psychology. Psychologists may choose to study the brain and the behavior of humans and animals through research or they may choose to work with patients as a clinician.[23][24]

Psychiatrist

Psychiatrists are physicians with training in the assessment, diagnosis, treatment, and prevention of mental illnesses. Their four years of residency training is completed in the mental health field. Additional to their residency they may further their training by completing additional work in the treatment of addiction, geriatric, and child and/or adolescent psychiatry. As psychiatrists are medical doctors they have the authority to prescribe medication.[25]

Social Worker

The field of social work permits different options for licensure. Two options are Licensed Counselor of Social Work (LCSW)and Licensed Social Worker(LSW). Regardless of the licensure they identify and help people overcome challenges in their lives. They help with a wide range of situations and work with many populations. The social worker may facilitate group and/or individual counseling sessions, diagnose and treat mental health issues, develop a treatment plan, help clients adopt new strategies for dealing with their behavior, and assist in accessing outside resources.[26]

Licensed Professional Counselor (LPC)

Licensed Professional Counselor diagnose and treat people with mental health and emotional disorders. They use techniques focused on the prevention of disorders while providing treatment to individuals, couples, families, groups, and the community.[27]

Paraprofessional

A job title given to people in various occupational fields that have earned a certificate by passing an exam, but lack the occupational license to perform at the professional level in the field. Paraprofessionals perform tasks that assist the professional. This title is often used in the healthcare and education occupational fields.[28]

Recognized Certifications in the Field of Addiciton Psychology

Certification for Alcohol and Drug Counselor Candidate

Must earn a bachelor's degree or the equivalent and substantial training in alcohol and drug education. 4,000 hours of supervised counseling experience is also required.[29]

Credentialed Alcoholism and Substance Abuse Counselor

Intended for candidates who intend to provide alcoholism and substance abuse counseling services. The candidate must meet specific education and training requirements, and pass the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse, Inc. (ICRC/AODA) written examination for Alcohol and Other Drug Abuse Counselors.[29]

A Certified Chemical Dependency Counselor

A candidate must complete 300 hours of supervised training in a drug and alcohol setting where alcohol and drug counseling is provided. A candidate must also complete up to 6,000 hours of relevant work experience.[29]

Substance Abuse Counselor/Certified Addiction Counselor

Counselors often work with people in times of crisis. They may refer clients to various services including a family agency, food pantry, vocational training center, and/or welfare. Generally, the candidate wishing to be a substance abuse counselor must earn B.A. Degree and obtain two or more years of experience in a counseling setting in a related field or other life experience.[29]

The Certified Addiction Professional

Specializes in treating client's with various addiction problems. Requires a bachelor’s degree or the equivalent, supervised training, and has passed a qualifying exam.[29]

Certified Addiction Treatment Counselors

Recognized by the National Commission for Certifying Agencies (NCCA). Counselors have completed academic and experiential requirements related to drug and alcohol studies.[29]

Treatment

Both process addiction and behavioral addiction have many dimensions causing disarray in many aspects of the addicts' life. Treatment programs are not a one size fits all phenomenon, hence there are different modalities or levels of care. Effective treatment programs incorporate many components to address each dimension. The addict suffers from psychological dependence and some may suffer from physical dependence. Helping an individual stop using drugs is not enough. Addiction treatment must also help the individual maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Addiction is a disease which alters the structure and function of the brain. The brain circuitry may take months or years to recover after the addict has recovered. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences. Research shows that most addicted individuals need a minimum of 3 months in treatment to significantly reduce or stop their drug use, however treatment in excess of 3 months has a greater success rate. Recovery from addiction is a longterm process.[30]

Modalities of Care

The modality or level of care needed for a patient is decided by the treating professional in conjunction with the patient when feasible. As expected the patient receiving treatment will likely take steps forward and backward the level of care will likely to fluctuate. Common modalities are explained.

Detoxification and Medically Managed Withdrawal

The process when the body rids itself of drugs is referred to as detoxification, and is usually concurrent with the side effects of withdrawal which vary depending on the substance(s) and are often unpleasant and even fatal. Physicians may prescribe a medication that will help decrease the withdrawal symptoms while the addict is receiving care in an inpatient or outpatient setting. Detoxification is generally considered a precursor to or a first stage of treatment because it is designed to manage the acute and potentially dangerous physiological effects of stopping drug use. [31][32]

Long-term Residential

Treatment is structured and operates 24 hours a day. Residents will remain in treatment from usually 6 to 12 months while developing accountability, responsibility and socialization skills. Activities are designed to help addicts recover from destructive behavior patterns while adopting positive behavioral patterns. Constructive methods of interacting with others and improving self-esteem are other areas of focus. The therapeutic community model is an example of one treatment approach. Many therapeutic communities provide a more comprehensive approach to include employment training and other support services.[32][33][34][35]

Short-term Residential

Short-term residential programs are on average 3–6 weeks in a residential setting. The program is intensive followed by more extended outpatient treatment to include individual and/or group therapy, 12-step Anonymous programs, or other forms of support. Because of the short duration of this modality it is even more important for individuals to remain active in outpatient treatment programs to help decrease the risk of relapse following residential treatment.[32]

Outpatient-treatment Programs

Outpatient treatment program vary regarding the services offered and the intensity. It's more affordable and may be more suitable for patients who are employed full-time and/or who have secured multiple social supports. Outpatient programs may include group and/or individual therapy, intensive outpatient program, and partial hospitalization. Some outpatient programs are also designed to treat patients with medical or other mental health problems in addition to their drug disorders.[32][36]

Individualized Drug Counseling

Individualized drug counseling not only focuses on reducing or stopping illicit drug or alcohol use; it also addresses related areas of impaired functioningsuch as employment status, illegal activity, and family/social relationsas well as the content and structure of the patient's recovery program. Through its emphasis on short-term behavioral goals, individualized counseling helps the patient develop coping strategies and tools to abstain from drug use and maintain abstinence. The addiction counselor encourages 12-step participation (at least one or two times per week) and makes referrals for needed supplemental medical, psychiatric, employment, and other services.[32]

Group Counseling

An outpatient treatment option facilitated by a treatment provider and used to expand on the support system the patient already has. Groups foster a non-judgmental environment allowing patients to meet and discuss difficulties and successes of their addiction while providing on-going support that is needed to be successful with recovery.[32]

Intensive Outpatient Program (IOP)

As the name implies this is an outpatient treatment option designed for addicts who for various reasons do not have the opportunity to attend an inpatient treatment program, yet who otherwise would not be able to receive the level of support needed to recover from their addiction. Programs vary in duration based on the patients need. Because of the lower level of support offered IOP is frequently used as a step down approach from patients leaving inpatient treatment but who are still in need of intensive therapy.[32]

Prevention, Relapse & Recovery

Therapeutic Orientations & Approaches

In 1878 the Index Medicus published research conducted and written by American physician W.H. Bentley. Bentley's research described his success in treating patients addicted to the ‘opium habit’ w/cocaine. Two years later he reported success in treating both opium and alcohol abusers w/cocaine.[7]. Today, the swapping one addiction for another is referred to as crossover addiction.[37]

A variety of treatment approaches are utilized by health professionals in order to provide their clients the highest possible level of success to overcome their addictions. There is no one specific approach and often therapists will use multiple techniques. The most common are discussed.

Behaviorism

Behaviorism, a new school of thought in the early 20th century provided structure and allowed for the rejection of the previous theoretical perspectives, the conscious and unconscious mind. It is based on the belief that behaviors can be measured, trained, and changed and that only observable behaviors should be studied, since internal states such as cognitions, emotions and moods are too subjective. Behaviorism pushed psychology to become a more scientific discipline by focusing purely on observable behavior. Ivan Pavlov, Russian psychologist was credited with the discovery of classical conditioning by conducting research of dogs and their digestive system. His research gave behaviorism its start.[38]

John B. Watson, an American psychologist became one of the strongest advocates of behaviorism, and in 1913 wrote a paper titled Psychology as the Behaviorist Views It. Watson later offered a definition in his classic book Behaviorism in the early 1920s: "Behaviorism...holds that the subject matter of human psychology is the behavior of the human being. Behaviorism claims that consciousness is neither a definite nor a usable concept. The behaviorist, who has been trained always as an experimentalist, holds, further, that belief in the existence of consciousness goes back to the ancient days of superstition and magic."[39]

Psychologsit, B.F. Skinner developed the concept of operant conditioning which furthered the behaviorist perspective. Operant conditioning demonstrated the effect of punishment and reinforcement on behavior.[40]

Humanistic Therapy

The development of the humanistic therapy by Carl Rogers occurred in the 1940s It offered an alternative to existing orientations that relied more on guidance or interpretation. It emphasizes a non-judgemental approach utilizing open-ended questions in an effort to encourage self-awareness and mindfullness to aid in the release of reactionary behaviors. The term "humanistic therapy" has also been used as a general category that includes client-centered therapy, existential therapy and gestalt therapy. Humanistic therapy (along with gestalt, and client-centered therapies) focues on the present. It aims at promoting a greater understanding of the patient's past experiences and how these experiences contribute to who the patient is today. Benefits of humanistic therapy include a decrease in depression, anxiety and stress, healthier relationships, the ability to trust oneself,and increased self-esteem.[41][42][43]

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy, also known as Cognitive Behavior Therapy or CBT for short, is a type of “talk” therapy, based on the psychological principles of behaviorism and theories of cognition. It is a variation of behavior therapy, which focuses on changing behavior through positive and negative reinforcement, or rewards and punishment. CBT is based on the idea that our thoughts cause our feelings and behaviors. Because of this we have the ability to change the way we think to feel and/or act. If the cause of our thoughts and behaviors were a result of external things than the opportunity or the control to change feelings and behaviors would not be possible. Therapists are direct in that they show their clients how to think and behave in ways to obtain what they want, but they don't tell their clients what to do. Instead they teach their clients how to do. Throughout this process clients learn how to think differently. When a client is aware of their thoughts, emotions, and beliefs about various situations then they are able to identify and challenge negative and/or inaccurate thinking as it arises. When people understand how and why they are improving, then when they are later faced with difficulties they know what to do and/or change to continue doing well.[44][45][46]

CBT particularly explores the conflicts between what we want to do and what we actually do. Addiction is a clear example of this –- while addicts will often say they want to change their addictive behavior, and may genuinely want to quit alcohol, drugs, or other compulsive behaviors that are causing them problems, they find it extremely difficult to do so. By recording our thoughts and associated feelings, along with the events that trigger those thoughts and feelings, and the behavior that we exhibit as a result, we can begin to change the automatic processes that sabotage our efforts at changing our behaviors. According to the cognitive behavioral therapy approach, addictive behaviors, such as drinking, drug use, problem gambling, compulsive shopping, video game addiction, food addiction, and other types of harmful excessive behavior, are the result of inaccurate thoughts and subsequent negative feelings.[47]

Dialectical Behavioral Therapy (DBT)

Originally referred to as the standard model created by Dr. Marsha Linehan, Dialectical Behavioral Therapy or DBT has evolved since its commencement. It was modified from the cognitive behavioral therapy approach and includes elements of acceptance,and mindfulness while emphasizing non-judgement and validation. Dr. Linehan designed DBT specifically for people who harm themselves, for those diagnosed with borderline personality, and for those who suffer from pervasive suicidal thoughts and/or attempts. It has since been expanded across clinical settings for a variety of problems.[48]

Psychodynamic

Psychodynamic therapy is the oldest of the modern therapies and focuses on unconscious processes as they are made clear in a person’s present behavior. the client's self-awareness and their understanding of how past circumstances influence present behaviors is the goal of psychodynamic therapy. In essence this approach enables the client to examine unresolved past conflicts as they arise and how these conflicts affect the need and desire to abuse substances.[49]

Expressive

According to the International Expressive Arts Therapy Association expressive arts combine the visual arts, movement, drama, music, and writing to develop personal growth and community development. By integrating the arts processes we gain access to our inner resources for healing and clarity.[50]

Integrative

Integrative therapy (also referred to as Integrative psychotherapy) is the process of making whole; bringing together the behavioral, cognitive, affective and physiological systems within a person with their awareness of social and transpersonal aspects that surround a person. It integrates multiple types of therapeutic techniques to address the client's issues. The therapist will aid the client in reducing their use of defense mechanisms that limit the flexibility in areas of the client's life. Through integration, it becomes possible for the client to face life in an open mindset without the protection of preformed opinions, attitudes, or expectations.[51]

Harm Reduction

Harm reduction is a compassionate and pragmatic approach to counseling that emphasizes the importance of reducing harm associated with ongoing or active addictive behaviors for an individual or in the community.[52][53][54][55] Marlat and Tapert propose a harm reduction continuum model where the left side represents excess, the middle is moderation and, the far right is abstinence. The goal of harm reduction programs is to help the client move from the left to the right of the continuum. [53][56] This technique maybe be incorporated into various therapeutic approaches and will look slightly different when applied to a person who suffers from drug and alcohol abuse, gambling, an eating disorder, or one who self-mutilates. A first attempt might be to limit drinking to weekends or to limit the amount of drinks to 4 or 5 over a long evening or switching from liquor to beer. Another harm reduction technique is refraining from hard drugs but continuing to smoke pot. Other examples may be a needle exchange program, and nicotine replacement for therapy for smokers.[52] [53] Harm reduction reduces the possibility of the client responding in a negative manner if abstinence is not acieved or maintained because the client succeeded in reducing harm.[53] Although the therapist will help the client find alternatives, decreasing harm is ultimately up to the client. For many clients a harm reduction technique is the first step in recognizing that their behavior is having very real detrimental consequences.[52][53]

Eclectic

Eclectic therapy is a therapeutic approach or school of thought that combines multiple therapeutic principles and techniques for the purpose of creating an individualized treatment program specific to the client's needs. Its versatality offers the benefit of treating any condition or problem of the client including addictions.[57]

Animal Assisted Therapy

Animal-assisted therapy is one of the most effective forms of experiential therapy and has been implemented since the 1800s when doctors realized patients were healing more quickly when around animals. Animal-assisted therapy has been shown to be successful in helping individuals with numerous issues including substance abuse, eating disorders and adolescents with emotional problems. As animals offer unconditional acceptance and prove to be non-judgmental toward people the clients feel safe and are more apt to let down their guard thus reducing stress. Animals have the unique ability to mirror exactly what human body language is telling them; In turn the animal helps the client gain perspective on their behaviors and feelings that are causing them pain which ultimately feeds the addiction process.[58][59]

Current Statistics

External links

http://www.hbo.com/addiction/thefilm/bios/6412_a_thomas_mclellan.html http://www.apa.org/pubs/videos/4310902.aspx (Integrative TherapyWith John C. Norcross, PhD) www.recoveryoptions.us

References

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