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INTRODUCTION to ADDICTIVE BEHAVIORS the Guilford Substance Abuse Series Howard T

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INTRODUCTION to ADDICTIVE BEHAVIORS the Guilford Substance Abuse Series Howard T INTRODUCTION TO ADDICTIVE BEHAVIORS The Guilford Substance Abuse Series Howard T. Blane and Thomas R. Kosten, Editors RECENT VOLUMES Introduction to Addictive Behaviors, Third Edition Dennis L. Thombs Clinical Work with Substance-Abusing Clients, Second Edition Shulamith Lala Ashenberg Straussner, Editor Treating Substance Abuse: Theory and Technique, Second Edition Frederick Rotgers, Jon Morgenstern, and Scott T. Walters, Editors Addiction and Change: How Addicitions Develop and Addicted People Recover Carlo C. DiClemente Seeking Safety: A Treatment Manual for PTSD and Substance Abuse Lisa M. Najavits Substance Abuse Treatment and the Stages of Change: Selecting and Planning Interventions Gerard J. Connors, Dennis M. Donovan, and Carlo C. DiClemente Psychological Theories of Drinking and Alcoholism, Second Edition Kenneth E. Leonard and Howard T. Blane, Editors New Treatments for Opiate Dependence Susan M. Stine and Thomas R. Kosten, Editors Couple Therapy for Alcoholism: A Cognitive-Behavioral Treatment Manual Phylis J. Wakefield, Rebecca E. Williams, Elizabeth B. Yost, and Kathleen M. Patterson Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach Robert K. Meyers and Jane Ellen Smith Psychotherapy and Substance Abuse: A Practitioner’s Handbook Arnold M. Washton, Editor Introduction to Addictive Behaviors THIRD EDITION DENNIS L. THOMBS THE GUILFORD PRESS New York London © 2006 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved No part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 987654321 Library of Congress Cataloging-in-Publication Data Thombs, Dennis L. Introduction to addictive behaviors / Dennis L. Thombs.—3rd ed. p. cm. — (The Guilford substance abuse series) Includes bibliographical references and index. ISBN-10 1-59385-278-9 ISBN-13 978-1-59385-278-8 (cloth) 1. Substance abuse—Etiology. 2. Substance abuse— Treatment. I. Title. II. Series. [DNLM: 1. Substance-Related Disorders—etiology. 2. Substance-Related Disorders—therapy. WM 270 T465i 2006] RC564.T55 2006 616.86—dc22 2005030211 About the Author Dennis L. Thombs, PhD, FAAHB, is Associate Professor in the Department of Health Education and Behavior at the University of Florida. The focus of his scholarship is addictive behavior, with special interests in the epistemol- ogy of addiction and in alcohol and drug use during the period of emerging adulthood. Dr. Thombs’s research has been supported by the National Institute on Alcohol Abuse and Alcoholism. He is a Fellow in the American Academy of Health Behavior. v Acknowledgments The following publishers have generously given permission to use extended quotations or paraphrases, and/or to reprint or adapt tables or figures, from published works: Beyond Freedom and Dignity by B. F. Skinner, 1975, New York: Ban- tam. Copyright 1975 by B. F. Skinner. Used by permission of Random House, Inc. “Theory in the Practice of Psychotherapy” by M. Bowen, 1976, in P. J. Guerin (Ed.), Family Therapy: Theory and Practice, New York: Gardner Press. Copyright 1976 by Gardner Press, Inc. “Principles of Alcoholism Psychotherapy” by S. Zimberg, 1978, in S. Zimberg, J. Wallace, and S. Blume (Eds.), Practical Approaches to Alcohol- ism Psychotherapy, New York: Plenum Press. Copyright 1978 by Springer Science and Business Media. “What Motivates People to Change?” by W. R. Miller and S. Rollnick, 1991, in Motivational Interviewing: Preparing People to Change Addictive Behavior, New York: Guilford Press. Copyright 1991 by The Guilford Press. “Drugs of Abuse: Anatomy, Pharmacology and Function of Reward Pathways” by G. F. Koob, 1992, Trends in Pharmacological Sciences, 13, 177–184. Copyright 1992 by Elsevier Science Ltd. “Sex and Age Effects on the Inheritance of Alcohol Problems: A Twin Study” by M. McGue, R. W. Pickens, and D. S. Svikis, 1992, Journal of Abnormal Psychology, 101, 3–17. Copyright 1992 by the American Psy- chological Association. “Dual Diagnosis: A Review of Etiological Theories” by K. T. Mueser, R. E. Drake, and M. A. Wallach, 1998, Addictive Behaviors, 23, 717–734. Copyright 1998 by Elsevier. vii viii Acknowledgments Diagnostic and Statistical Manual of Mental Disorders, Fourth Edi- tion, Text Revision, by the American Psychiatric Association, 2000, Wash- ington, DC: American Psychiatric Association. Copyright 2000 by the American Psychiatric Association. “Rates of Psychiatric Comorbidity among U.S. Residents with Lifetime Cannabis Dependence” by V. Agosti, E. Nunes, and F. Levin, 2002, Ameri- can Journal of Drug and Alcohol Dependence, 28, 643–652. Copyright 2002 by the Taylor and Francis Group. “Nicotine Dependence and Psychiatric Disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions” by B. F. Grant, D. S. Hasin, S. P. Chou, F. S. Stinson, and D. A. Dawson, 2004, Archives of General Psychiatry, 61, 1107–1115; “Preva- lence and Co-Occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions” by B. F. Grant, F. S. Stinson, D. A. Dawson, S. P. Chou, M. C. Dufour, W. Compton, R. P. Pickering, and K. Kaplan, 2004, Archives of General Psychiatry, 61, 807–816; and “Co- Occurrence of 12-Month Alcohol and Drug Use Disorders and Personality Disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions” by B. F. Grant, F. S. Stinson, D. A. Dawson, S. P. Chou, W. J. Ruan, and R. P. Pickering, 2004, Archives of General Psychiatry, 61, 361–368. Copyright 2004 by the American Medi- cal Association. Preface This book was written for practicing health and human services profession- als with no formal training in substance abuse prevention and treatment, and for undergraduate and graduate courses on addictive behavior. The book has two primary goals. The first is to challenge and strengthen the reader’s understanding of addiction by exploring how others in the field have come to know it. I hope that this will enable the reader to create a clear and logically consistent perspective on addiction. The second goal is to show the reader how theory and research are important to both the pre- vention and the treatment of substance abuse. This should provide the reader with an array of strategies for addressing substance abuse problems, and help make him or her an effective practitioner. There are a number of good books currently available on substance abuse and dependence. For the most part, however, these books either are written at an advanced level for the sophisticated practitioner or researcher or focus on a limited set of theoretical orientations. The present text is unique in that it attempts to present a comprehensive and thoughtful review of theory and research with the front-line practitioner and student in mind. Exposure to complex and divergent theories of addictive behavior has often been neglected in the preparation and training of health and human services professionals, including substance abuse counselors, pre- vention specialists, social workers, psychologists, nurses, and so forth. Some of these practitioners are familiar with one or more of the disease models, but even here they often have not had the opportunity to examine its propositions critically. This book assumes virtually no preexisting knowledge in the biological and behavioral sciences, medicine, or public health. In each chapter, a careful attempt has been made to explain the con- ceptual underpinnings of the theories and approaches described herein, as well as the research supporting these frameworks. ix x Preface The third edition of Introduction to Addictive Behaviors has been revised to appeal to a broader audience of practitioners and students. The primary focus of the first two editions was to provide a multidisciplinary foundation for addiction treatment. The third edition has been revised to include a theoretical and research foundation for substance abuse preven- tion as well. The third edition also includes two new chapters. Each pre- sents cutting-edge knowledge in two very different but important areas in the study of addictive behavior. The new chapters are titled “Public Health and Prevention Approaches” and “Toward an Understanding of Comor- bidity.” All the chapters from the second edition have been updated and included in the third edition. Special thanks are in order to those who helped me complete the third edition. I am grateful to The Guilford Press, and especially to Jim Nageotte and Jane Keislar, for their encouragement and assistance in preparing the third edition. A number of anonymous reviewers provided feedback that also was extremely helpful in steering the direction of the book. DENNIS L. THOMBS University of Florida Contents CHAPTER 1 The Multiple Conceptions of Addictive Behavior 1 and Professional Practice Today Conceptions of Addiction in U.S. History 1 Addiction as Immoral Conduct 4 Addiction as Disease 6 Addiction as Maladaptive Behavior 8 The Need for Theory 9 What Exactly Is a Theory? 10 Attributes of a Good Theory 11 The Dissemination of Evidence-Based Practice 12 Effective Prevention and Treatment Programs 14 Purpose
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