Selected excerpts from the book The Addiction Counselor’s Desk Reference, by Robert Holman Coombs and William A. Howatt.
THE BRAIN AND PSYCHOACTIVE DRUGS
The brain’s normal circuits include a system—the brain reward system—that induces pleasurable feelings when stimulated.
To regain these rewarding feelings, this circuit encourages a repeat of the behaviors that stimulate pleasurable feelings.
For more information on how the brain reward system operates, visit Bardo (1998), Neuropharmacological Mechanisms of Drug Reward: Beyond Dopamine in the Nucleus Accumbens.
Available from www.biopsychiatry.com/reward.htm.
All addictive drugs disrupt normal neurotransmission in the brain. “Addictive drugs change the brain’s communication system by interfering with synaptic transmission,” state Friedman and Rusche (1999, p. 48).
“Some drugs mimic certain neurotransmitters and convey false messages,” note Friedman and Rusche (p. 40). “Other drugs block neurotransmitters and prevent real messages from getting through.”
Still other drugs have different kinds of effects that modify the flow of information among neurons. But all addictive drugs interfere with the way neurons communicate.
“They change the way the brain works, and that changes how people perceive the world, how they feel about themselves and their world, and how they behave” (p. 48).
False messengers, the term Friedman and Rusche (1999), give to psychoactive drugs, mimic the actions of natural brain chemicals, the real messengers, some of which make people feel pleasure by activating their brain’s reward system.
With a speed and intensity that greatly exceeds normality, these extremely pleasurable feelings lead some to seek them at any risk. As this use continues, changes occur in the brain to perpetuate continued use until it becomes compulsive, beyond control, and problematic.
Drugs of abuse negatively impact regions of the brain by sending false messages, or by weakening or intensifying real messages. Drug users describe the intensified pleasure produced by drugs as being “high.”
In fact, drugs turn on the brain’s reward system with a potency that natural rewards can rarely match. Because of this, “drugs actually teach people to use more drugs” (Friedman & Rusche, 1999, p. 2).
Psychoactive drugs masquerade as neurotransmitters and interact with receptors and other components of the brain’s synapses. “As such they interfere with normal synaptic transmission by introducing false messages or by changing the strength of real ones” (Friedman & Rusche, 1999, p. 51).
Repeated drug use also results in tolerance, meaning that after continued use, one needs more and more of the drug (or addictive behavior) to feel the same pleasurable effects. Not surprisingly, as drug tolerance develops, users tend to escalate their use to achieve their desired state.
This increases the risk for physical and perhaps psychological dependency. “The long-term abuse of drugs causes profound changes in the brain,” notes Friedman and Rusche.
“The behavior of addicts is strongly influenced by the maladaptive learning that takes place as addiction develops. As a result, recovering from drug addiction does not mean returning to a condition like the one that existed before drug abuse began. Instead, addicts must grow into a new level of personal awareness, with new patterns of behavior. That is one reason why the treatment of addiction is so difficult” (Friedman & Rusche, 1999, p. 63).
THE BRAIN AND ADDICTIVE BEHAVIORS
Until recently, researchers and clinicians limited the term addiction to chemical (alcohol and other drugs) dependence. But neuroadaptation, the technical term for the biological processes of tolerance and withdrawal, also occur when substance-free individuals become addicted to pathological gambling, pornography, forms of sexual excess, eating excesses, overwork, compulsive buying, and other compulsive excesses (Coombs, 2004).
New studies of the brain’s reward system, using PET brain scan technology, dramatically show that drugs of addiction and behaviors that stimulate pleasure and elation (e.g., compulsive gambling) affect brain functions (Coombs, 2004).
The human brain processes all positive rewards similarly, whether the reward comes from a chemical or a behavior such as gambling, shopping, sex, or work. Hence, those who become addicted do not necessarily crave a specific drug per se, but the rush of dopamine these drugs produce.
Remarkably, the term addiction was not included in the latest diagnostic manual of the American Psychiatric Association—the Diagnostic and Statistical Manual of Mental Disorders, text revision (DSM-IV-TR, 2000).
Instead, DSM-IV-TR lists three forms of chemical abuse:
1. Substance abuse disorders: A maladaptive use of chemical substances leading to clinically significant outcomes or distress (recurrent legal problems and/or failure to perform at work, school, home, or physically hazardous behaviors, such as driving when impaired)
2. Substance dependency disorders: Loss of control over how much a substance is used once begun, manifested by seven symptoms: tolerance; withdrawal; using more than was intended; unsuccessful efforts to control use; a great deal of time spent obtaining and using the substance; important life activities given up or reduced in order to use the substance; and continued use despite knowing that it causes problems
3. Substance induced disorders: Manifesting the same symptoms as depression and/or other mental health disorder, which symptoms, the direct result of using the substance, will cease shortly after discontinuing the substance
Compulsive gambling, an addictive disorder that affects the pleasure center of the brain the same way as alcohol and other psychoactive drugs, is listed in DSM-IV-TR as an “impulse control disorder” and groups it with pyromania (fire setting), kleptomania (impulsion to steal), intermittent explosive disorder (failure to control aggression) and trichotillomania (constant pulling out of one’s hair; DSM-IV-TR, 2000).
Yet, research on the brain’s reward system indicates that, as far as the brain is concerned, “a reward is a reward, regardless of whether it comes from a chemical or an experience” (Holden, 2001, p. 980; Shaffer & Albanese, 2005, p. 6).
For this reason, “. . . more and more people have been thinking that, contrary to earlier views, there is a commonality between substance addictions and other compulsions” (Alan I. Leshner, cited by Holden, 2001, p. 980).
Contemporary research shows that the neurobiology of nonchemical addictions approximates that of addiction to alcohol and other drugs. Some chemicals or excessive experiences activate brain reward systems directly and dramatically, notes addictionologist William McCown (2005, pp. 459–481).
CONCEPTUAL TOOLS TABLE II.
Commonalities between Pharmacological Addictions and Gambling
Symptoms or Behavior | Alcohol and Other Drugs | Compulsive Gambling
Cravings Yes Yes
Denial of problem’s
severity or existence Yes Yes
Disruption of families Yes Yes
Effects on specific
neurotransmitters Yes Unknown
High relapse rate Yes Yes
Loss of control Yes Yes
Lying to support
use or activity Yes Yes
Preoccupation with
use or activity Yes Yes
Progressive disorder Yes Yes
Tolerance developed Yes Yes
Used as a means of
escaping problems Yes Yes
Withdrawal symptoms
common Yes --
Source: Best Possible Odds: Contemporary Treatment Strategies for Gambling Disorders (p. 17), by W. McCown and L. Chamberlain, 2000, New York: Wiley.
Essentially, substances and behaviors provide too much reward for an individual’s neurobiology to handle. Ingestion of certain chemicals is accompanied by massive mood elevations and other affective changes.
These may lead to a reduction in other activities previously considered rewarding. Similarly, the ability of excessive behaviors to activate brain reward mechanisms alters normal functioning.
This also results in a potentially addictive state (McCown, 2005). Some traditionalists may argue that nonchemical addictions are really obsessive- compulsive disorders (OCD). But, as McCown (2005) points out, “There are no rewards associated with OCD behaviors except for the overwhelming reduction in anxiety.
By contrast, addictions are initially extremely pleasant experiences. OCD, which plagues people with intrusive, unwanted thoughts or obsessions, is inherently distasteful” (McCown, 2005, pp. 468–469).
When comparing the characteristics of alcohol and other psychoactive drugs with compulsive gambling, Chamberlain (2004, p. 133) notes little difference (see Table II.1).
Addictions occur in constellations (Carnes, Murray, & Charpentier, 2004). That is, people addicted to one substance are often addicted to other substances and behaviors, as they note in these summaries of research studies:
• “For the contemporary drug addict, multiple drug use and addiction that includes alcohol, is the rule. The monodrug user and addict is a vanishing species in American culture” (N. S. Miller & Gold, 1990, p. 597).
• “As many as 84% of cocaine addicts, 37% of cannabis addicts, 75% of amphetamine addicts, and 50% of opiate addicts were also alcoholic. Other studies have shown that 80% to 90% of cocaine addicts, 50% to 75% of opiate addicts, and 50% of benzodiazepine/sedative-hypnotic addicts were alcoholics” (N. S. Miller & Gold, 1993, p. 122).
• “. . . clinical studies suggest a high comorbidity between eating and alcohol use disorders . . .” (Stewart, Angelopoulos, Baker, & Boland, 2000, p. 77).
• “. . . Lesieur and Blume (1993) noted that 47% to 52% of pathological gamblers also exhibit symptoms of abuse or dependency for alcohol or other drugs” (Winters, Bengston, Dorr, & Stinchfield, 1998, p. 186).
• “The alcoholic under the age of 30 is addicted to at least one other drug-most commonly cannabis, followed by cocaine, and then benzodiazepines” (Sweeting & Weinberg, 2000, p. 22).
• “Therapists working with individuals abusing alcohol, tobacco, and other drugs should be aware of the comorbidity of gambling in this population” (Sweeting & Weinberg, 2000, p. 46).
• “Similarly, in female alcoholics, comorbid eating disorder rates far exceed prevalence estimates for eating disorders in the general female population” (Stewart et al., 2000, p. 77).
• “The results of our co-twin control analyses indicated that early initiation of cannabis use was associated with significantly increased risks for other drug use and abuse/dependence and were consistent with early cannabis use having a causal role as a risk factor for other drug use and for any drug use or dependence” (Sweeting & Weinberg, 2000, p. 431).
• “. . . identification of multiple drug addiction is critical in the diagnosis and treatment of today’s alcoholics and drug addicts. Unless contemporary treatment methods are adapted to fit changing patient characteristics, attempts at rehabilitation may be futile” (N. S. Miller & Gold, 1990, p. 596).
ADDICTIVE INTERACTION DISORDER
Coining the diagnostic label, “Addictive Interaction Disorder,” Carnes et al. (2004) define 11 ways that types of addiction impact one another:
1. Cross tolerance: A simultaneous increase in addictive behavior in two or more addictions or a transfer of a high level of addictive activity to a new addiction with little or no developmental sequence;
2. Withdrawal mediation: One addiction moderates, provides relief from, or prevents physical withdrawal symptoms from another;
3. Replacement: One addiction replaces another with a majority of the emotional and behavioral features of the first;
4. Alternating addiction cycles: Addictions cycle back and forth in a patterned systemic way;
5. Masking: An addict uses one addiction to cover up for another, perhaps more problematic, addiction;
6. Ritualizing: Addictive rituals or behavior of one addiction serves as a ritual pattern to engage another addictive behavior;
7. Intensification: One addiction is used to accelerate, augment, or refine the effects of another addiction through simultaneous use;
8. Numbing: An addiction is used to medicate (soothe) shame or pain caused by another addiction or addictive bingeing;
9. Disinhibiting: One addiction is used frequently to chronically to lower inhibitions for other forms of addictive acting out;
10. Combining: Addictive behaviors are used to achieve certain effects that can only be achieved in combination; and
11. Inhibiting: One addiction is used to substitute or deter the use of another addiction that is thought to be more destructive or socially unacceptable.
Carnes et al. (2004) suggest that diagnostic codes should be reorganized to reflect this reality.
Additional Resources -- For a review of the most current research and thinking on various addictive disorders, see Coombs, R. H. (Ed.). (2004). Handbook on addictive disorders: A practical guide to diagnosis and treatment. Hoboken, NJ: Wiley.
For additional information on the Dopamine Reward System, see The brain’s drug reward system (1996, September/October). National Institute on Drug Abuse Notes. Addictions: Neurological/Biochemical aspects.
Available from www.aizan.net/families/npsy_substance_abuse.htm.
Also see The brain & the actions of cocaine, opiates, and marijuana at
www.udel.edu/skeen/BB/Hpages/Reward%20&%20Addiction2/actions.html.
This section provides a brief overview of key clinical models available to the addiction counselor.
SIGMUND FREUD’S PSYCHOANALYTIC THERAPY
Psychoanalytic Therapy (also called psychodynamic and psychoanalysis) is based on the assumption that behavior results from the conflict between the conscious and unconscious minds, and biological and social forces (H. S. Friedman & Schustack, 2003).
Every personality has three parts: id, the source of psychic energy that drives the instincts for survival and pleasure; superego, the conscience that promotes personal ideals and acts as moral judge of right and wrong; and the ego, the executive part that mediates between id and the superego, between inner strivings and reality, and tries to maintain mastery over the id’s drives (Corsini & Wedding, 2001).
Freud (1961) postulated that all human motivation derives from a biological drive to obtain pleasure and avoid pain—a dynamic he called “the pleasure principle” (Freud, 1958).
According to Freud, a client’s adult pathology can be traced to early sexual development, particularly a lack of sexual gratification during one of five psychosexual developmental stages that Freud labels oral, anal, phallic, latency, and genital.
THERAPEUTIC APPROACH
The client comes into the therapist’s office, reclines comfortably on a couch, and free associates (there is no predetermined agenda) about thoughts that come spontaneously to mind.
The counselor helps the client uncover unconscious dynamics by going with the flow of these unplanned expressions. The therapist helps the client understand how unconscious ego states and defense mechanisms can negatively impact personal development.
Although the following ego defense mechanisms may help a client manage unwanted emotions, they can also impede emotional growth: Repression (pushing a memory out of conscious memory), Regression (returning to an earlier stage of development), and Reaction Formation (reacting in the opposite way to an unacceptable impulse) (Corey, 2000).
Additional Resources
Dr. C. George Boeree provides a user-friendly introduction to the core work of Freud at www.ship.edu/∼cgboeree/freud.html.
CARL G. JUNG’S ANALYTIC PSYCHOANALYSIS
Fascinated with the importance of spiritual development for an individual’s mental health, Jung also assumed that people can find their place in the world by understanding their unconscious mind.
He believed that each person has a personal unconscious made up of repressed events, wishes, feelings, and conflicts and also shares a “collective unconscious”—memories of their ancestral and racial heritage.
These latter memories are organized around images called archetypes (Howatt, 2000).
THERAPEUTIC APPROACH
The unconscious mind, once explored, opens the door for healing mental illness ( Jung, 1954a). Dream Analysis, Jung’s method for communicating with the unconscious mind, reveals archetypes that the therapist interprets for the client ( Jung, 1954b).
Although addiction counselors may not be trained in Dream Analysis (which takes years), they can use two counseling applications—personality and spirituality. Exploring personality traits such as introversion and extroversion assists clients in understanding how they interact with others.
Jung’s seminal work on extroversion and introversion led to the development of the Myers- Briggs Type Indicator (Howatt, 2005). Clients may complete this scale and use the results to develop awareness and determine core competencies needed to support their recovery.
As the history of Alcoholics Anonymous shows, addressing and strengthening spirituality in daily living can be vital in helping clients recover from their addictive disorders and develop healthier personalities.
Additional Resources
See the Jung web site at www.cgjungpage.org.
ALFRED ADLER’S INDIVIDUAL PSYCHOLOGY
Adler taught that each client pursues fictional goals in an unhealthy quest for superiority. Unrealistic goals may be overwhelming and lead to discouragement and such self-destructive behaviors as crime, addiction, and psychosis (Adler, 1929, 1958).
THERAPEUTIC APPROACH
The first step—assessment—is to learn about the client’s family of origin, birth order, early recollections, dreams, and current life tasks. Next is helping the client develop insight about the cost of trying to fulfill unrealistic goals. With these insights, the client makes new, healthier goals.
To move the client away from feelings of discouragement and inferiority, the therapist helps the client make a realistic action plan and develop the necessary skills to achieve his new goals (Howatt, 2005).
Other Adlerian techniques, such as the Magic Wand and Confrontation, can also be used (see “Counseling Techniques” later in Part IV).
Additional Resources
See the web site of the International Association of Individual Psychology at www.iaiponline.org.
CARL ROGERS’S PERSON-CENTERED THERAPY
Rogers’s client-centered philosophy assumes that each person is, by nature, good, worthy, and valuable (1951). This person-centered therapy trusts that clients have within themselves resources to improve their life situation. If this inner potential and ability emerges, the client needs only support, not direction.
THERAPEUTIC APPROACH
This nondirective and nonconfrontational counseling method assumes clients possess innate ability to evaluate and wisely choose their behaviors.
The effective counselor adheres to what Rogers (1959) calls three core conditions of counseling: (1) empathy—responding to the client with intense interest, valuing the client’s perception of the world and the meaning they attach to it; (2) congruence—being honest and consistent in behavior and thought; and (3) warm regard—showing nonjudgmental, accepting, positive regard for the client through word and deed.
These three core conditions may appear simple, but their mastery takes a strong commitment of time and effort by the counselor.
Additional Resources
Visit the Center of Studies of the Persona at
www.centerfortheperson.org/organizations.html.
FRITZ PERLS’S GESTALT THERAPY
Awareness, the principal goal of Gestalt Therapy (Perls, 1969), comes by focusing on clients’ present situations and current behaviors, how they perceive their behaviors and how they interpret their experiences (Corey, 2000).
The therapist observes only the client’s behavior and does not attempt to determine the causes of the behavior.
THERAPEUTIC APPROACH
Awareness, the therapist’s principal tool, is achieved by exploring current behaviors, feelings, and thoughts. The therapist assigns homework and assists the client in creating life experiments that demonstrate and reinforce how maladaptive behaviors have a negative impact on health and wellness.
Experiments may include role-play to stress dysfunctional interaction patterns and to experiment with healthier ways (Perls, 1969, 1973). Getting to the core of personality, Perls states, is much the same as peeling off the layers of an onion.
These are the five layers of awareness (metaphoric onion): (1) phony—responding to others in an inauthentic and stereotypical manner; (2) phobic—avoiding the pain of realistic self-examination and taking responsibility for one’s own actions; (3) impasse—stalling in the present level of maturity; (4) implosive—starting to get in touch with true self by questioning defense mechanisms; (5) explosive—a great release of energy when one finally lets go of all phony roles and pretenses (Howatt, 2000).
Because impasse in therapy is caused by the client’s defense mechanisms (e.g., introjections—accepting others’ beliefs without testing them), the therapist designs experiments to teach the client about these layers of awareness and how defense mechanisms underlie faulty perceptions of reality.
Additional Resources
For more information about Gestalt Therapy, see www.gestaltri.com.
IRVIN YALOM’S EXISTENTIAL PSYCHOTHERAPY
Existential means pertaining to existence. Working with the conscious rather than the unconscious mind, existential counseling seeks to ask and answer fundamental questions about being a human being (e.g., finding meaning in life) and the struggles inherent in this existence.
Yalom (1981) postulates that many psychological problems are directly rooted in one of four ultimate concerns: death (there is no escape), freedom (each client is free to define his or her own world), isolation (there is a gulf between self and others and self and the world), and meaninglessness (how one defines the meaning of life and its purpose).
THERAPEUTIC APPROACH
The therapist assists the client in exploring each of the four ultimate concerns and provides examples of how addressing them can improve life. As active participants, therapists share their personal views and ask questions related to the client’s internal struggle.
For related strategies such as helper self-disclosure and paraphrasing, see Counseling Techniques and ClinicalMicroskills, later in Part IV.
Additional Resources To learn more, visit the web site at www.yalom.com.
VIKTOR FRANKL’S LOGOTHERAPY
Viktor Frankl, observing how he and his fellow prisoners coped with extraordinarily stressful circumstances in Nazi concentration camps, concluded that circumstances and events in the outer world (things outside the inner self) do not matter as much as the ultimate freedom of people to determine the meaning of their situation.
In his classic book Man’s Search for Meaning, Frankl (1963) explains that, although brutal guards may have inflicted suffering and pain on his body, they could not control his mind.
Logotherapy, the idea that clients have the ability and responsibility to make their own choices regardless of their environment, assumes that a client always has a choice; and no-choice is still a choice.
THERAPEUTIC APPROACH
The therapist teaches clients how to avoid the victim role by mentally separating from their external environment and taking responsibility for their own lives. Two of Frankl’s techniques are dereflection (turning clients’ attention from their problematic situation to the creative ways they are coping or could cope) and paradoxical intentions (encouraging an exaggerated form of the undesired behavior).
Additional Resources
To learn more, visit the web site at http://logotherapy.univie.ac.at.
ALBERT ELLIS’S RATIONAL-EMOTIVE BEHAVIOR THERAPY
Ellis postulates that most, if not all, of a client’s emotional problems result from irrational thinking, and moreover, everyone can learn how to think effectively (Ellis, 1962). Directive and didactic, this cognitive-behavioral approach works with clients at a conscious level, teaching new insights and skills in the therapist’s office to be practiced at home.
Ellis’s Rational-Emotive Behavior Therapy (REBT) shares a common thread with Glaser’s Reality Therapy and Beck’s Cognitive Behavioral Therapy, all of which use problem-solving and learning by employing new behavioral skills (discussed in the paragraphs that follow).
THERAPEUTIC APPROACH
REBT addresses the client’s irrational thinking with an ABC model: (1) Activating Event—an external event that upsets the client; (2) Belief—client’s irrational belief about A; and (3) Consequences—what clients do and feel in response to their irrational belief about the activating event (Ellis, 1994).
Next the counselor focuses on the DEF part of the ABC model: (4) Disputing— the counselor challenges the client’s irrational thinking and conclusions about A and B. Using techniques such as REBT homework sheets, the counselor teaches the client to recognize irrational thinking and to think realistically; (5) Effect— cognitive change in the client, rational thinking; and (6) Feeling—instead of anxiety or depression, client’s feelings are appropriate to the situation.
Additional Resources
To learn more about the works, training, and publications of Ellis, visit www.rebt.org.
WILLIAM GLASSER’S CHOICE THEORY AND REALITY THERAPY
Choice Theory assumes that individuals choose most of their behavior and that it is internally motivated by the need to meet one or more of the following basic needs: love and belonging (the most important), power, fun, freedom, and survival. All behavior is total, meaning that clients’ actions will affect their thinking, which in turn will control feelings and physiology.
Using a car as a metaphor, Glasser (1998) teaches that what the front wheels (behavior and thinking) do, the rear wheels (feeling and physiology) will follow. For example, a depressed, lethargic client who is sitting around the house can change his or her emotional state by doing something different.
THERAPEUTIC APPROACH
Based on choice theory, reality therapy seeks to help clients build their love and belonging relationships. Glasser (1998) names Seven Caring Habits: supporting, encouraging, listening, accepting, trusting, respecting, and negotiating differences.
He also identifies Seven Deadly Habits: criticizing, blaming, complaining, nagging, threatening, punishing, and bribing or rewarding to control. Promoting the concept of an internal locus of control (self-responsibility), reality therapy offers a frame of reference to help clients see why they do what they do and how changing any element (e.g., spending time around the house) will change other aspects of the whole (e.g., feeling depressed and having low physical energy).
Therapists ask strategic questions—What do you have now that meets your needs? What do you want? What are you doing to get what you want? Is what you are doing working? Reality therapy helps clients learn to meet their own needs.
Additional Resources
To learn about Glasser’s work, training, and writing, visit www.wglasser.com.
AARON BECK’S COGNITIVE BEHAVIORAL THERAPY
Based on the premise that most of a client’s negative thinking derives from automatic faulty thinking, Beck (1976) suggests that the client’s present difficulties (e.g., depression) result from thinking errors and negative thinking.
The therapist’s goal is to help the client become aware of negative thought patterns and change them. Beck authored four popular clinical scales: Beck Depression, Beck Anxiety, Beck Hopelessness, and Beck Suicide (see Part III).
THERAPEUTIC APPROACH
The therapist first reduces the client’s present level of anxiety by using empathy and reframing, then uncovers and monitors the client’s faulty processing and negative schema. Using Socratic dialogue (thoughtful questioning of client), the client is taught how to think more accurately and effectively.
After this, therapist and client design a behavioral experiment to test the client’s beliefs and assumptions. Finally, behavioral strategies are implemented (e.g., journaling) to reinforce the new skills designed to prevent further faulty processing. Cognitive Behavioral Therapy (CBT) works best, Beck (1970) explains, with clients who have acceptable reality levels (no delusions).
Additional Resources
To learn more, visit the Beck Institute at www.beckinstitute.org.
ERIC BERNE’S TRANSACTIONAL ANALYSIS
Berne taught that everyone interacts from three ego states—each with its own feelings, thoughts, and ways of behaving—that make up the human personality: Parent, Adult, and Child (Berne, 1972).
THERAPEUTIC APPROACH
Helping clients develop a healthy life script—“I’m OK–You’re OK ”—is the clinical objective (Berne, 1961). All clients have the potential to make change and have a part in them that is acceptable to others.
The actual work of Transactional Analysis (TA) revolves around four constructs: (1) exploration of transactions— what people say and do to and with each other; (2) games and cons—the games people play to get what they want; (3) scripts—how feedback from early transactions in childhood affect adulthood; (4) structures—the analysis of the different ego states a client communicates from in different transactions.
“Strokes” (i.e., positive feedback) is one of the biggest motivators for behavior (Berne, 1961).
Additional Resources
To learn more, visit the International Transactional Analysis Institute at www.itaa-net.org.
OTHER BEHAVIORAL APPROACHES
Several other key behavioral approaches are available, such as Pavlov’s classical conditioning, Skinner’s operant conditioning, and Bandura’s social learning theory. Although each stands alone as an independent therapeutic model, they all emphasize the environment’s impact on behavior.
Pavlov (1960) taught that behavior is the result of conditioned reflexes whereas B. F. Skinner (1971) states that behavior is the result of rewards (positive or negative). Bandura (1977) emphasizes that a person can learn by simply observing the environment.
THERAPEUTIC APPROACH
The counselor designs activities in five stages to help the client modify unwanted behaviors: (1) study the client’s present behaviors; (2) define the primary problems; (3) determine client’s goals; (4) select interventions and make an action plan; (5) start action plan, monitor, and follow up (Wilson, 2001).
Additional Resources
To learn more about Behavioral Therapy visit the Association for the Advancement of Behavioral Therapy, a comprehensive source of the current thinking and advancements in behavioral therapy at www.aabt.org.
See also, James, R. K., & Gilliland, B. E. (1998). Theories and strategies in counseling and psychocounseling (4th ed.). New York: Allyn & Bacon, for detailed reviews of the most commonly used counseling theories applicable to addiction counseling. Howatt, W. A. (2000).
The human services counseling toolbox. Pacific Grove, CA: Brooks/Cole, contains information on theory, techniques, and strategies for working with persons with addictive disorders; it was developed with students learning to be addiction counselors.
See also, Corsini, R. J., & Wedding, D. (Eds.). (2001). Current psychotherapist (6th ed.). Belmont, CA: Brooks/Cole (a detailed book on counseling theory).