9781572304116

This popular text reviews and critiques major contemporary perspectives on alcoholism and drug dependence, including the disease models, psychoanalytic formulations, and theories based on conditioning, social learning, family systems, and sociology. Throughout, applications to the helping process are emphasized and learning is facilitated by case examples and review questions. With all chapters extensively revised to reflect the expanding knowledge base in addictive behavior, the second edition incorporates recent advances in such areas as behavioral genetics, neuroscience, dual diagnosis, contingency management, cognitive expectancy, children of alcoholics, drug subcultures, and motivation enhancement.

Dennis L. Thombs, PhD, is Associate Professor in the Department of Adult, Counseling, Health and Vocational Education at Kent State University. Dr. Thombs has worked in the mental health field, including substance abuse treatment and prevention, for more than 15 years. The author of numerous articles in the area of health behavior, his chief research focus is adolescent and young adult alcohol abuse.

1 The Multiple Conceptions of Addictive Behavior and Clinical Practice Today

1

(28)

Conceptions of Addiction in U.S. History

1

(3)

Addiction as Immoral Conduct

4

(2)

Addiction as a Disease

6

(2)

Addiction as Maladaptive Behavior

8

(1)

The Need for Theory

9

(1)

What Exactly Is a Theory?

10

(1)

Formal Attributes of a Good Theory

11

(1)

Substantive Attributes of Theories on Addictive Behavior

12

(2)

Theory, Research, and Contemporary Clinical Practice

14

(2)

Barriers to Change in the Treatment Community

16

(2)

Practical Issues Ignored by Researchers

18

(1)

Recent Efforts to Bridge the Gap: Technology Transfer

19

(2)

Competently Administered Prevention and Treatment Programs Are Effective

21

(2)

Purpose of the Book

23

(1)

Review Questions

24

(1)

References

25

(4)

2 The Disease Models

29

(52)

Different Disease Conceptions

30

(1)

Tolerance and Withdrawal

31

(1)

Addiction as a Primary Disease

32

(2)

Genetic Origins of Addiction: The Susceptibility Model

34

(20)

Effects of Drugs on Brain Structure and Function: The Exposure Model

54

(7)

Loss of Control

61

(3)

Addiction as a Progressive Disease

64

(4)

Addiction as a Chronic Disease

68

(1)

Denial

69

(1)

Strengths of the Disease Models

70

(1)

Weaknesses of the Disease Models

71

(1)

Review Questions

72

(1)

References

73

(8)

3 Psychoanalytic Formulations

81

(28)

Freud

81

(1)

Psychoanalysis: A Type of Psychotherapy

81

(3)

Personality Structure

84

(2)

Anxiety, Defense Mechanisms, and the Unconscious

86

(3)

Psychosexual Development

89

(3)

Insights into Compulsive Substance Use

92

(7)

Contemporary Treatment of Addiction

99

(3)

The Importance of Psychoanalytic Concepts in Substance Abuse Counseling

102

(1)

General Criticisms of Psychoanalysis

103

(1)

Criticism of the Psychoanalytic View of Addiction

104

(1)

Review Questions

105

(1)

References

106

(3)

4 Conditioning Models and Approaches to Contingency Management

109

(35)

Conditioned Behavior

110

(4)

Initiation of Alcohol and Drug Use

114

(1)

Addiction

115

(1)

Relationship between Addiction and Physical Dependence

115

(1)

Cessation and Relapse

116

(1)

Blood Alcohol Discrimination

117

(2)

Behavioral Tolerance

119

(5)

Principles of Contingency Management

124

(1)

Applications of Contingency Contracting

125

(15)

Effectiveness of Contingency Management Approaches

140

(1)

Review Questions

140

(1)

References

141

(3)

5 Cognitive Models

144

(40)

Basic Social Cognitive Concepts

144

(4)

Modeling and Substance Use

148

(2)

Self-Efficacy and Treatment Outcomes

150

(3)

Role of Outcome Expectancy in Alcohol and Drug Use

153

(10)

Alcohol and Stress: Cognition as a Mediating Process

163

(3)

Stress Response Dampening

166

(1)

Tiffany's Model of Drug Urges and Cravings

167

(2)

Relapse

169

(8)

Project MATCH: A Test of Cognitive Therapy

177

(1)

Summary

177

(1)

Review Questions

178

(2)

References

180

(4)

6 The Family System

184

(52)

Clinically Generated Concepts

184

(12)

Bowen's Family Systems Theory

196

(7)

Codependency

203

(3)

Children in Alcoholic Families: Clinical Accounts

206

(2)

Role Behavior

208

(5)

The Process of Family Therapy

213

(3)

Findings from the Research Literature

216

(13)

Summary

229

(1)

Review Questions

230

(1)

References

231

(5)

7 Social and Cultural Foundations

236

(34)

Resistance to Considering the Social Origins of Alcoholism

236

(1)

Time and Place as Social Determinants of Illicit Drug Use

237

(2)

The Influence of Culture on Diagnostic Determinations

239

(2)

Sociological Functions of Substance Abuse

241

(1)

Social Facilitation

242

(2)

"Time Out" from Social Obligations

244

(2)

Promoting Group Solidarity/Establishing Social Boundaries

246

(5)

Drug Subcultures: Repudiation of Middle-Class Values

251

(10)

Implications for Counseling

261

(3)

Limitations

264

(1)

Review Questions

265

(1)

References

266

(4)

8 Conditions That Facilitate and Inhibit Change in Addictive Behavior

270

(20)

Addictive Behavior Models and Client Motivation

271

(2)

Stages of Change in Addictive Behavior

273

(5)

Coercion

278

(3)

Confrontative Treatment

281

(1)

Motivation Enhancement

282

(1)

Harm Reduction Approaches

283

(1)

The Impact of Managed Care

284

(2)

Review Questions

286

(1)

References

286

(4)

Author Index

290

(7)

Subject Index

297

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Introduction to Addictive Behaviors, Second Edition

1572304111

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