Fourth Step: Discourse with an Addict

This article is an authentic, unrehearsed, verbatim dialogue between an adult sister and a drug-addicted brother. It deeply reflects the compulsive nature of addiction despite the full comprehension of the consequences of continuing it. It sensitively touches upon the pain and sorrow within the family, although hardly any manifestations of the agony come clearly to the surface. It concludes without any real hope for change. That inevitability brings to the surface the true nature of an addiction.     

An exploratory study of gambling cross addictions

A growing body of empirical and theoretical research has concentrated on the overlaps and commonalities among chemical and non-chemical (behavioural) addictions. Pathological gambling has perhaps been the most widely researched behavioural addiction and some of this research has concerned the co-existing links between pathological gambling and alcohol/drug addiction in both the gambling substance abuser and the substance abusing gambler (i.e. cross addiction). This study was of an exploratory nature and attempted to gather information and data regarding gambling cross addictions in the UK. To achieve this, 456 letters were sent to all drug and alcohol helping agencies in England requesting such information. This yielded 210 returns (46% response rate). Results indicated that gambling cross addictions occur in both adults and adolescents and were almost exclusively a male condition. However, it must be noted only just over half of the responding agencies had encountered gambling cross addiction and reasons for this are speculated. Results also indicated the existence of various cross addicted subgroups including an adolescent subgroup who were addicted to fruit machines and abused solvents. Future research ideas are also discussed.A more detailed version of this paper is available from the author on request.     

The influence of unconscious fantasy process in addictions and relapse

This discussion reaffirms the connection between addiction and underlying unconscious fantasy process. It suggests that unconscious fantasies play a determining role in persisting patterns of substance abuse and addiction. Within this context, addiction is understood both as a derivative of thepersistence of these unresolved fantasies and an inadequate compromise formation. It suggests that relapse is a manifestation of the episodic reassertion and influence of these powerful fantasies. Consequently, successful treatment requires the working through of the underlying fantasy process and the establishment of healthier compromise formations.     

Sociological Perspectives on Addiction

This article provides a critical survey of sociological research on addiction. It begins with the seminal research of Alfred Lindesmith on heroin addiction then proceeds through discussions of functionalist contributions, research that exemplifies what David Matza called the ‘appreciative’ turn in the sociology of deviance, rational choice theories, and social constructionist approaches. It is confined to research on addiction in its original meaning as putative enslavement to a substance or activity rather than merely deviant or disapproved activity more broadly. As will be seen, though, there is a ubiquitous and theoretically interesting tendency even among those who contend to be writing about addiction as such to slip into modes of analysis that effectively substitute questions regarding the social approval of an activity for questions concerning whether it is voluntary or involuntary. Hence, one purpose of this article is to explore whether, and how, this slippage might be avoided.     

Drug trafficking and addiction among low-income urban youths: An ecological perspective

Drug addiction and drug trafficking continue to be a major problem during adolescence and a primary cause of significant problems in adulthood. For low-income, urban, African American youths, these problems are compounded by environmental factors-such as communities that are depleted of resources, schools that are inadequately funded, family members who are unemployed-and other physical, legal, spiritual, social and psychological factors. These ecological factors have the potential to impinge significantly on the lives of those who become involved with drug use and sales. The problems resulting from these issues not only affect the individual but also family members, communities and the nation.

This paper examines the patterns of drug addiction and trafficking among African American youths in poverty, with an eye toward answering the following questions: What is drug trafficking? What is the youths perception of drug addiction? What role does drug trafficking play in subsequent drug use? What is the nature and role of ecological factors, such as poverty, in the interaction between drug addiction and drug trafficking? How do these issues reflect on developmental theories of addiction?     

An ethical code for AOD faculty: a proposed set of guidelines

Ethical codes of conduct are accepted requirements for membership in state and national organizations that grant credentials to those who are employed as alcohol and other drug (AOD) counselors, prevention specialists, and clinical supervisors. It seems appropriate to explore the possibility of an ethical code directly linked to addiction faculty which will outline their unique educational responsibilities and standards. The authors suggest development and adoption of such an ethical code for college-level addiction studies faculty and this proposal is offered as a move toward that possibility.     

Response to Shaffer (1996): The Case for a 'Complex Systems' Conceptualisation of Addiction

This paper responds to some of the issues raised by Shaffer's (1996) paper, Understanding the Means and Objects of Addiction. The authors agree with, and in many respects support, the assertions made by Shaffer with respect to the conceptualisation of the problem of addiction. In particular, that it is the relationship of the addicted person with the object of their behaviour that defines addiction. However, it is argued that in addition to providing an operational definition for addiction, it is important to provide an explicit framework for the development of insight into the 'synergistic nature' of the multiple factors affecting the addiction process. That is, it is necessary to account for both the commonalities and the differences found across the spectrum of addictive behaviours. It is proposed that this might be provided by a 'complex systems' approach to the field of addiction.     

Trajectories of heroin addiction: growth mixture modeling results based on a 33-year follow-up study

This study investigates trajectories of heroin use and subsequent consequences in a sample of 471 male heroin addicts who were admitted to the California Civil Addict Program in 1964-1965 and followed over 33 years. Applying a two-part growth mixture modeling strategy to heroin use level during the first 16 years of the addiction careers since first heroin use, the authors identified three groups with distinctive profiles: stably high-level heroin users (n = 278), late decelerated users (n = 149), and early quitters (n = 44). Study findings empirically demonstrate the chronic nature of heroin addiction and subsequent adverse consequences including mortality, mental health, and employment.     

Repeated suicide attempts

Attempted suicide is an act associated with childhood sexual abuse, depression, bipolar illness, substance abuse, and other diagnoses, as documented in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association [APA], 1994). Three women, who attended a group to decrease their depression and increase their self-esteem and who had histories of multiple suicide attempts, agreed to participate in interviews designed to determine the common factors associated with their suicide attempts and to examine the assertion that their suicide attempts were an addiction, similar to their addictions to alcohol and drugs. The common factors found were depression, substance use disorders with early abuse and risky behaviors, history of sexual abuse, faulty relationships, alteration of mood with a suicide plan, and distorted and illogical thinking and motivation. The similarities to addiction also were described. Based on the complexity of factors that emerged and the addictive nature of the suicide attempts, treatment for similar patients needs to be multidimensional and ongoing to allow sufficient time to monitor progress and address the numerous factors involved.     

Gendered gambling domains and changes in Sweden

Pachinko is an ‘amusement arcade’ type machine that is popular throughout Japan, with an estimated 17.1 million ‘players’ providing an enormous annual revenue of 2.87 trillion yen (US$250 billion). It is simple and easy to play and has all the hallmarks and structural features of gaming machines worldwide. While academic discourses on the addictive potential of gaming machines are well developed, their application to pachinko is very limited. This is, perhaps, due to a number of factors. First, pachinko is portrayed as a game rather than as gambling in Japan, so that addiction issues are ignored or downplayed. Second, most accounts of ‘playing’ pachinko are journalistic rather than academic. Third, academics tend to focus on police corruption and organized crime rather than addiction. Here, we take the approach that pachinko represents ‘gambling by proxy’ and explore its addictive potential. We conclude that unless pachinko is recognized as a form of gambling, present changes in Japanese legislation will be of limited value in tackling addiction.     

Integrating Art Therapy Methodology in Brief Inpatient Substance Abuse Treatment for Adults

ABSTRACT

Decades of drug addiction research and clinical work have underscored the need for multifaceted and comprehensive treatment responses in order to sufficiently address the varied needs of individuals struggling with addiction. One valuable treatment component that can be incorporated into traditional treatment protocols to expand the comprehensive nature of treatment response is art therapy. A conceptual framework is presented, detailing the integrative opportunities and benefits of including an art therapy component to short-term hospital-based inpatient substance abuse treatment programs. A creative arts component can be particularly beneficial for brief inpatient programs, where the client population is diverse, in crisis, and at high-risk for relapse; and where clinicians need to obtain comprehensive client information from multiple sources in a short amount of time. Art therapy methodology can provide a mechanism for collecting such collateral information for assessment purposes, can be employed to facilitate therapeutic change, and is used to track and document client progress and clinical change over time. Practice guidelines and specific treatment techniques are presented through short case examples.     

Psychological Well-Being and Adolescents’ Internet Addiction: A School-Based Cross-Sectional Study in Hong Kong

This study examines the correlations of adolescents’ self-esteem, loneliness and depression with their internet use behaviors with a sample of 665 adolescents from seven secondary schools in Hong Kong. The results suggest that frequent online gaming is more strongly correlated to internet addiction and such correlation is higher than other predictors of internet addiction in online behaviors including social interactions or viewing of pornographic materials. Male adolescents tend to spend more time on online gaming than female counterparts. In terms of the effect of internet addiction on adolescents’ psychological well-being, self-esteem is negatively correlated with internet addiction, whereas depression and loneliness are positively correlated with internet addiction. Comparatively, depression had stronger correlation with internet addiction than loneliness or self-esteem. A standardized definition and assessment tool for identifying internet addiction appears to be an unmet need. Findings from this study provide insights for social workers and teachers on designing preventive programs for adolescents susceptible to internet addiction, as well as emotional disturbance arising from internet addiction.     

Gambling and the risk society: the liberalisation and legitimation crisis of gambling in the Netherlands

The liberalisation of gambling is associated with gambling addiction; thus gambling markets can be interpreted in line with Ulrich Beck's thesis of the ‘risk society’. This article analyses the dynamics of the risk society in the case of Dutch gambling markets. It is argued that a paradigm shift relative to gambling policy—from the ‘alibi model’ to the ‘risk model’—has created a legitimation crisis of gambling policy in the Netherlands. This crisis is characterised by a chain of small but significant adjustments to market forces, justified by changing and often contradictory policy motives. Although gambling markets increasingly tend to be regulated with reference to risks, what exactly constitutes these risks is in many cases controversial. This article highlights the ambiguous nature of the risk society and commercialised gambling.     

Sexual addiction and marriage and family therapy: facilitating individual and relationship healing through couple therapy

In recent decades there has been an increase in literature regarding sexual addiction as well as a growing number of clients presenting in therapy with problems related to their sexual behaviors (including internet sexual addiction). This article (a) presents a synthesis of the research on the impact of sexual addiction on the addict, the partner, and the couple; (b) outlines the process of healing for each based on the research synthesis; and (c) discusses the role of marriage and family therapy in facilitating both individual and relationship healing from sexual addiction. Implications for future research in sexual addiction, generally, and in marriage and family therapy, specifically, are presented.     

Community-based addiction treatment staff attitudes about the usefulness of evidence-based addiction treatment and CBO organizational linkages to research institutions

This national study of community-based addiction-treatment organizations' (CBOs) implementation of evidence-based practices explored CBO Program Directors' (n=296) and clinical staff (n=518) attitudes about the usefulness of science-based addiction treatment. Through multivariable regression modeling, the study identified that identical factors were associated with directors, and staff attitudes about the usefulness of science-based addiction treatment. For both directors and staff working in an organization that was affiliated with a research institution, working in an organization with better internet technology (measured through TCU-ORC scores) and having higher levels of education were all significantly associated with having more positive attitudes regarding science-based addiction treatment. Implications: government policy that promotes the hiring of addiction treatment clinical staff with professional degrees and encourages the development of linkages between addiction treatment researchers and treatment staff may positively impact attitudes and use of evidence-based addiction treatment practices (EBPs) in CBOs.     

Life Balance and Work Addiction Among NCAA Administrators and Coaches

Intercollegiate athletics represent an industry prone to challenges of work addiction and life balance. Work addiction and life balance domains in male and female intercollegiate athletic coaches and administrators (N = 245) were examined using multiple regression analysis. Higher levels of stress/anxiety, sleep disturbance, and career satisfaction and lower levels of quality of relationships and friendships were the strongest predictors of work addiction. Counseling focused on reducing the negative aspects of work addiction, while maintaining job performance, may benefit this population.     

A preliminary investigation of the components of a curriculum for the preparation of master's-level addiction counselors

This study identified the preliminary curriculum components for the preparation of graduate-level addiction counselors. A review of the related literature revealed no agreed upon standards for post baccalaureate instruction of addiction counseling. The Delphi method was used to establish curriculum items from a list of 198 previously identified work behaviors associated with graduate-level addiction counseling. A panel of 28 addiction counseling experts responded to three administrations of an evolving questionnaire and reached consensus on a final list of 89 curriculum items. Consensus of expert judgments was corroborated by a post hoc multivariate of analysis of variance (MANOVA) that revealed no significant differences in ratings of importance among panelist subgroups.     

Attitudes about addiction: a national study of addiction educators

The following study, funded by the National Institute of Drug Abuse (NIDA), utilized the Addiction Belief Inventory (ABI; Luke, Ribisl, Walton, & Davidson, 2002) to examine addiction attitudes in a national sample of U.S. college/university faculty teaching addiction-specific courses (n=215). Results suggest that addiction educators view substance abuse as a coping mechanism rather than a moral failure, and are ambivalent about calling substance abuse or addiction a disease. Most do not support individual efficacy toward recovery, the ability to control use, or social use after treatment. Modifiers of addiction educator attitudes include level of college education; teaching experience; licensure/certification, and whether the educator is an addiction researcher. Study implications, limitations, and directions for future research are discussed.     

Incorporating Spirituality and the Strengths Perspective into Social Work Practice with Addicted Individuals

Abstract

In the last two decades, the social work profession began to confront the professional avoidance of alcoholics and other drug addicts, and discussions of spirituality. While acknowledging the importance of 12-Step Programs of Alcoholics/Narcotics Anonymous, we also acknowledge that spirituality is a major aspect of addiction and recovery from an addiction. The authors present the Strengths Perspective and apply key concepts to Steps 1-3 of the 12-Steps to increase our understanding of addiction and recovery from alcoholism and other drug addiction. The article concludes that social workers must continue to increase their understanding of the recovery and spiritual issues of alcoholics and other drug addicts.     

One physician's path to addiction medicine

Ajay Manhapra, M.D., began his medical career as a hospitalist. Eventually, he became an addiction treatment specialist. He described his path to addiction medicine in an interview with ADAW last month.