ebook THE GUILFORD PRESS INTRODUCTION TO ADDICTIVE BEHAVIORS Introduction to Addictive Behaviors FOURTH EDITION Dennis L. Thombs Cynthia J. Osborn THE GUILFORD PRESS New York London © 2013 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: 9 8 7 6 5 4 3 2 1 The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editor and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. Library of Congress Cataloging-in-Publication Data Thombs, Dennis L. Introduction to addictive behaviors / Dennis L. Thombs and Cynthia J. Osborn. — Fourth edition. pages cm Includes bibliographical references and index. ISBN 978-1-4625-1068-9 (hardback : alk. paper) 1. Substance abuse—Etiology. 2. Substance abuse—Treatment. I. Osborn, Cynthia J. II. Title. RC564.T55 2013 616.86—dc23 2013011394 About the Authors Dennis L. Thombs, PhD, FAAHB, is Professor and Chair of the Depart- ment of Behavioral and Community Health at the University of North Texas Health Science Center in Fort Worth. The focus of his scholarship is addic- tive behavior, with special interests in the epistemology of addiction and in alcohol and drug use during the period of emerging adulthood. In recent years, his research has focused on analyzing drinking practices and their consequences in natural settings. Dr. Thombs is Managing Coeditor of the American Journal of Health Behavior. He is past president and Fellow of the American Academy of Health Behavior. Cynthia J. Osborn, PhD, LPCC, LCDC III, is Professor of Counseling and Human Development Services at Kent State University in Ohio. Her clinical background focused on treating adults with co- occurring dis orders (addic- tion and mental illness). Her teaching, supervision, and scholarship focus on addictions counseling, particularly evidence- based practices such as moti- vational interviewing. She is a member of the Motivational Interviewing Network of Trainers and has extensive experience in the clinical super- vision of counselors- in- training and professional counselors. Dr. Osborn served as coeditor of Counselor Education and Supervision and is coau- thor (with Sherry Cormier and Paula S. Nurius) of the book Interviewing and Change Strategies for Helpers. v Acknowledgments e thank the publishers of the following works, who have generously W given us permission to use extended quotations or paraphrases and to reprint or adapt tables and figures: “Principles of Alcoholism Psychotherapy” by S. Zimberg, 1978, in S. ­Zimberg, J. Wallace, and S. Blume (Eds.), Practical Approaches to Alcoholism Psychotherapy, New York: Plenum Press. Copyright 1978 by Springer Science and Business Media. “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. “Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being” by R. M. Ryan and E. L. Deci, 2000, American Psychologist, 55, 68–78. Copyright 2000 by the American Psy- chological Association. Addiction and Change: How Addictions Develop and Addicted People Recover by C. C. DiClemente, 2003, New York: Guilford Press. Copyright 2003 by The Guilford Press. Motivating Substance Abusers to Enter Treatment: Working with Family Members by J. E. Smith and R. J. Meyers, 2004, New York: Guilford Press. Copyright 2004 by The Guilford Press. Motivational interviewing: Helping people change (3rd ed.) by W. R. Miller and S. Rollnick, 2013, New York: Guilford Press. Copyright 2013 by The Guilford Press. vii Preface his book was written for practicing health and human services profes- T sionals with no formal training in substance abuse prevention and treat- ment, 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. We 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 information should pro- vide 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 ser- vices professionals, including substance abuse counselors, public health practitioners, prevention specialists, social workers, psychologists, and nurses. 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 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 is made to explain the conceptual underpinnings of the theories and approaches described herein, as well as the research supporting these frameworks. ix x Preface The fourth edition of Introduction to Addictive Behaviors has been revised to appeal to a broad 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 was revised to include a theoretical and research foundation for substance abuse prevention as well. The fourth edition continues to be a foundational volume for both the prevention and treatment of substance abuse and includes three new chapters: “The Controversial Science of Behavioral Addiction,” “Promot- ing Motivation and Autonomy for Personal Change Process,” and “Link- ing Theory, Evidence, and Practice.” Each presents cutting- edge knowledge in three very different but important areas of study in addictive behavior. Other chapters from the third edition have been updated for the fourth edi- tion, including “The Family System,” which has been extensively rewritten. Special thanks are in order to those who helped us complete the fourth edition. We greatly appreciate the efforts of Gabrianna Saks in assisting us with updating a number of areas of research and in identifying new and emerging areas for inclusion in the fourth edition. We also are grateful to The Guilford Press, and especially to Jim Nageotte and Jane Keislar, for their encouragement and assistance in preparing the fourth edition. A num- ber of anonymous reviewers provided feedback that also was extremely helpful in steering the direction of the book. DENNIS L. THOMBS University of North Texas Health Science Center at Fort Worth CYNTHIA J. OSBORN Kent State University Contents CHAPTER 1. Conceptualization of Addictive Behavior 1 and the Need for Informed Practice What Exactly Is a Theory? 3 Attributes and Functions of Good Theory 4 Theory as a Road Map 6 Conceptions of Addiction in U.S. History 6 Then and Now: Three Broad Perspectives on the Nature of Addiction 20 Evidence in Support of Prevention and Treatment 25 Chapter Summary 27 Review Questions 29 CHAPTER 2. The Disease Models 30 Different Disease Conceptions 31 Tolerance and Withdrawal 33 Genetic Origins of Addiction: The Susceptibility Model 34 Effects of Drugs on Brain Structure and Function: The Exposure Model 39 Historical Disease Concepts 43 Chapter Summary 51 Review Questions 53 CHAPTER 3. Public Health and Prevention Approaches 54 What Is Public Health? 54 Healthy People 2020: The National Health Priorities on Tobacco, Alcohol, and Drug Use 60 xi xii Contents Public Health Surveillance of Substance Abuse 60 Age of Onset and the Gateway Hypothesis 66 Types of Prevention Programs and Strategies 70 Community Coalition Building 82 Results from Community Intervention Trials 83 The Participatory Research Approach 93 The Community Mobilization Approach 94 Chapter Summary 95 Review Questions 97 CHAPTER 4. Toward an Understanding of Comorbidity 98 The Epidemiology of Comorbidity