Addiction

Paul Davis is a Consultant Clinical Psychologist in Addiction, and Teaching Fellow in Clinical Psychology at the University of Surrey, UK. He has contributed at a national level on substance misuse treatment guidelines, policies and service developments and has published widely in the field of psychosocial interventions for substance misuse. Bob Patton is a lecturer in Psychology at the University of Surrey, UK, Director of Short Term Solutions Ltd and Director of AdApped Ltd. He has previously worked as a consultant for the Home Office Drugs Prevention Initiative and as a Research Fellow in Addiction at Imperial College, King's College London and the Maudsley Hospital Hospital. Sue Jackson is a chartered psychologist specialising in the psychosocial impact and treatment of chronic health conditions. In addition to managing an extensive research portfolio, she is a teaching fellow on the Clinical Psychology Doctorate Programme at the University of Surrey and is the first psychologist to serve on the Medical Advisory Committee for the Pituitary Foundation.

List of contributors xi

Foreword xiii

Preface xvii

Notes on Contributors xix

PART 1 Understanding the Psychology and Treatment of Addictions 1

CHAPTER 1 Addiction: A Comprehensive Approach 3
Jamie Brown and Robert West

1.1 Introduction 4

1.2 Existing theories 5

1.3 The human motivational system 8

1.4 Internal and external sources of influence 11

1.5 The dynamics of the system 12

1.6 The unstable mind and chreods 13

1.7 Testing the theory 15

Suggestions for further reading 16

References 16

CHAPTER 2 An Attachment-Informed Approach to Working with Addiction 20
David B. Curran and Mani Mehdikhani

2.1 Introduction to attachment 21

2.2 Attachment and psychopathology 23

2.3 Attachment and addiction 25

2.4 Attachment styles in clinical samples 28

2.5 Assessment and formulation through an attachment lens 29

2.6 Treatment implications 32

2.7 Conclusion 35

Suggestions for further reading 35

References 36

CHAPTER 3 Families, Friends and Addiction: Impacts, Psychological Models and Interventions 42
Alex Copello and Kathryn Walsh

3.1 Introduction 43

3.2 The composition of alcohol and drug users’ social networks 43

3.3 Impacts of addictions on others 44

3.4 Theoretical models of addiction and the family: stress-strain-coping-support 47

3.5 From models to interventions 48

3.6 Conclusion 52

Suggestions for further reading 53

References 54

CHAPTER 4 Working Systemically with Alcohol Misuse 57
Arlene Vetere and Rudi Dallos

4.1 Introduction 58

4.2 Family life 59

4.3 Family systems approaches 60

4.4 Working therapeutically with violence and abuse 64

4.5 Engagement and the therapeutic relationship 65

4.6 Conclusion 66

Suggestions for further reading 66

References 67

CHAPTER 5 Dangerous Desires and Inanimate Attachments’: Modern Psychodynamic Approaches to Substance Misuse 68
Martin Weegmann and Edward J. Khantzian

5.1 Introduction 69

5.2 Primitive emotional states: Kleinian views 70

5.3 Comforting self-objects: Kohutian views 72

5.4 Inanimate attachments: Bowlbian views 74

5.5 Bringing it together: addiction as disorder of self-regulation 76

5.6 Reflective practice 78

5.7 Internal recovery 79

5.8 Conclusion 81

Suggestions for further reading 82

References 82

CHAPTER 6 Mindfulness, Acceptance and Values in Substance Misuse Services 84
Liz McGrath and Dominic O’Ryan

6.1 Introduction: what are the principles and methods of mindfulness, acceptance and values? 85

6.2 How does ACT integrate with other approaches? 87

6.3 How does the service use these principles and methods of ACT? 90

6.4 How do mindfulness, acceptance and values support the resilience of staff in the face of seemingly relentless relapse and other behaviours? 92

6.5 What are the experiences of staff working with ACT? 94

6.6 What are the experiences of clients working this way? 96

6.7 Our experience of ACT 97

Suggestions for further reading 98

References 98

PART 2 Clinical Applications of Addiction Psychology 103 CHAPTER 7 The Role of Clinical Psychology within Alcohol Related Brain Damage 105
Fraser Morrison and Jenny Svanberg

7.1 Introduction 106

7.2 Clinical definition of alcohol-related brain damage and related syndromes 106

7.3 Epidemiology of ARBD and related syndromes 107

7.4 Cognitive function in ARBD 108

7.5 Psychosocial and cognitive rehabilitation 111

7.6 Legal framework: mental capacity 117

7.7 Recovery 118

Suggestions for further reading 119

References 119

CHAPTER 8 Trauma and Addiction 124
David B. Curran

8.1 Psychological trauma and PTSD 125

8.2 The relationship between addiction and psychological trauma 127

8.3 Assessment 129

8.4 Treatment of co-existing trauma and substance use disorders 131

8.5 Clinical implications 135

8.6 Conclusion 139

Suggestions for further reading 139

References 139

CHAPTER 9 Narrative Identity and Change: Addiction and Recovery 144
Martin Weegmann

9.1 Narrative theory 145

9.2 Narrative therapy 145

9.3 Narrative theory and addiction 146

9.4 Client talk 147

9.5 Generating narrative 149

9.6 Narratives of recovery 152

9.7 Varieties of recovery story 152

9.8 Conclusion 154

Acknowledgements 155

Notes 155

Suggestions for further reading 155

References 156

CHAPTER 10 Addiction and Mental Health 158
Adam Huxley

10.1 Introduction 159

10.2 Association between substance misuse and psychosis 160

10.3 Prevalence and epidemiology 162

10.4 Outcomes associated with co-occurring disorders 163

10.5 Treatment approach and effectiveness 163

10.6 Evidence for effectiveness 164

10.7 Conclusion 166

Suggestions for further reading 167

References 167

CHAPTER 11 Substance Misuse in Older Adults 172
Sarah Wadd and Tony Rao

11.1 Introduction 173

11.2 Definition of older adult 173

11.3 Alcohol 173

11.4 Illicit drug use 176

11.5 Medication misuse 178

11.6 Assessment of older people with substance misuse 179

11.7 Psychosocial interventions 184

11.8 Legal and ethical considerations 185

11.9 Using and evaluating health and social outcomes 186

11.10 Conclusion 187

Suggestions for further reading 188

References 188

CHAPTER 12 Issues Arising in Hepatitis C Work: The Role of the Clinical Psychologist 193
Jo M. Nicholson

12.1 Introduction 194

12.2 Hepatitis C background: the virus and treatment 194

12.3 Social and clinical characteristics of the HCV patient population 195

12.4 HCV treatment challenges 196

12.5 Pegylated Interferon-related adverse psychiatric side-effects 197

12.6 HCV-infected mental health populations 198

12.7 So what is the role of the psychologist? 200

12.8 Psychological stepped-care model in HCV treatment 206

12.9 Future challenge 208

12.10 Conclusion 208

Suggestions for further reading 209

References 209

CHAPTER 13 The Psychology and Treatment of Gambling Disorders 213
André Geel, Rebecca Fisher and Aska Matsunaga

13.1 Introduction 214

13.2 Definition 214

13.3 Prevalence 215

13.4 Demographic risk factors 216

13.5 Treatment of gambling disorders 222

13.6 Personal comment and reflections 224

13.7 Conclusion 224

Suggestions for further reading 225

References 225

CHAPTER 14 Alcoholics Anonymous and 12 Step Therapy: A Psychologist’s View 230
Martin Weegmann

14.1 Introduction: personal context 231

14.2 History 232

14.3 Philosophy 233

14.4 How does it work? 235

14.5 What can psychologist and helping professionals do? 239

14.6 Criticisms of AA 240

14.7 Postscript 241

Notes 241

Suggestions for further reading 242

References 242

CHAPTER 15 Relapse Prevention: Underlying Assumptions and Current Thinking 245
Robert Hill and Jennifer Harris

15.1 Introduction 246

15.2 What is relapse prevention? 246

15.3 Models of relapse prevention 250

15.4 Addressing co-existing mental health 254

15.5 Neuropsychological and associated difficulties when undertaking RP 255

15.6 Conclusion 257

Suggestions for further reading 258

References 259

CHAPTER 16 Working with Ambivalence about Change: Motivational Interviewing 262
Lisa Dutheil and Alina Galis

16.1 Introduction 263

16.2 Definition 263

16.3 Historical perspective 264

16.4 Theoretical influences 265

16.5 The spirit of MI 266

16.6 Change talk, sustain talk and discord 266

16.7 The four MI processes 267

16.8 Core MI skills 269

16.9 MI strategies more specific to particular processes 271

16.10 Evidence for the efficacy of MI 272

16.11 Integrating MI with other approaches 274

16.12 Using MI in groups 275

16.13 Learning MI 277

16.14 Conclusion 278

Suggestions for further reading 279

References 279

CHAPTER 17 ‘Beyond Workshops’: Turning Evidence for Psychosocial Interventions into Embedded Practice 284
Luke Mitcheson, Christopher Whiteley, and Robert Hill

17.1 Introduction 285

17.2 What is implementation? 285

17.3 Implementation science 287

17.4 Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) 287

17.5 Implement what? Evidence-based interventions versus evidence-based practices 292

17.6 Case studies in Motivational Interviewing and treatment effectiveness (Mapping) 294

17.7 Conclusion 298

Notes 300

Suggestions for further reading 300

References 300

Index 303