Controlling the uncontrollable. Self-regulation and the dynamics of addiction

The multidisciplinary research on addictions generally promotes the assumption that addictive behavior is caused and maintained by the external psychoactive substance, which accordingly is considered to be ‘addictive in itself’. The present article challenges this widespread assumption by engaging in a detailed examination of the psychodynamic structures of addiction. Tracing addictive behavior back to problems in affect regulation, the article discusses the object, motivation, dynamics, and developmental origins of addiction. Linking the problem with the topic of transitional object relations, the article eventually argues that addictive behavior amounts to a desperate pursuit for self-control. The tragedy of the addict is that he or she only manages to replace one sense of uncontrollability with another.     

Élaboration du Questionnaire de mesure de l’intensité des conduites addictives (QMICA) : évaluation des addictions et co-addictions avec et sans substances

Referring to studies about addictive behaviors, the objective of this article is to present the validation of a new tool for the assessment of the addictive behaviors with or without substances: the Addictive Intensity Evaluation Questionnaire (AIEQ). Twelve different versions of the AIEQ have been administered to 354 participants in order to assess their addictive behaviors. The study of the factorial structure of the questionnaire and its reliability allow us considering the psychometric qualities of the AIEQ as satisfactory. The results suggest the existence of a continuum between the absence of addiction and the severe forms of addiction. The discussion section proposes a classification based on the severity of the addictive behaviors and applications of the use of the AIEQ.     

Conceptualizing Nonsuicidal Self‐Injury as a Process Addiction: Review of Research and Implications for Counselor Training and Practice

Nonsuicidal self‐injury (NSSI) may be characterized as a process addiction for some individuals who self‐injure. The authors review findings on the addictive features of NSSI, including compulsivity, loss of control, continued use despite negative consequences, and tolerance.     

Chinese Internet addiction inventory: developing a measure of problematic Internet use for Chinese college students.

The current study developed a psychometrically sound multidimensional measure of Internet addiction: the Chinese Internet Addiction Inventory (CIAI). Data were collected from 1,029 Chinese undergraduate students from 14 universities and colleges. The initial sample was split randomly into two samples (N1=516; N2=513). An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were conducted on the two samples respectively. Findings from the EFA suggest that this measure assesses three dimensions of Internet addiction: conflicts, mood modification, and dependence. Items in each dimension showed high internal consistency and acceptable test-retest reliability. Findings from the CFA further confirmed the three-factor measurement structure of CIAI. Test of criterion-related validity also showed good abilities for all three CIAI subscales to discriminate between an Internet addictive group and non-Internet addictive group. The theoretical and clinical implications of CIAI and its limitations are discussed.     

Extraversion and exercise addiction

Extraversion has been suggested as a factor associated with addiction. This claim was tested in relation to exercise addiction. Twelve exercise addicts were compared with 12 nonaddicted individuals who were committed to regular exercise and with 12 nonexercising individuals drawn from the same student population. Addicted exercisers did not differ from nonaddicted exercisers in extraversion, although exercisers as a group were more extraverted than nonexercisers. The results are interpreted as evidence against the claim that extraversion is a component of the addictive personality profile.     

成瘾的生物心理社会模型

成瘾的易感因素和维持因素是一个复杂的因果网络系统．有三种研究取向。生物学取向综述了成瘾的脑机制和遗传基因观。心理学模式主要介绍成瘾人格的研究现状,以及成瘾的强化观。社会因素则阐述了创伤性事件、父母及同伴压力对成瘾的影响。本文支持三个因素的相互作用导致了成瘾行为的发生,以期从成瘾易感和维持因素的探析上为生物心理社会模型(BPS)提供依据。     

The application of mindfulness-based cognitive interventions in the treatment of co-occurring addictive and mood disorders

This article reviews the theory, clinical application, and empirical findings on mindfulness-based cognitive therapy (MBCT) for mental health and addictive disorders. Expanding upon the research demonstrating the efficacy of cognitive-behavioral therapy (CBT) for addiction, this article develops and explores the rationale for combining mindfulness-based interventions with evidence-based CBTs in treating addictive disorders, with an emphasis on substance use disorders with co-occurring mood disorders. This article proposes that deficits in affect--regulation related to the behavioral and emotional effects of neurobiological changes that occur with long-term substance abuse--pose a unique set of challenges in early recovery. Prolonged use of addictive substances impairs the brain pathways that mediate certain affect regulation functions. These functions involve attention and inhibitory control, the saliency of and response to addictive versus natural reward stimuli, and the ability to detach or maintain perspective in response to strong emotional states. In treating this affective dysregulation, which can contribute to the vulnerability to relapse in the early stages of recovery, the affect-regulation-specific focus of MBCT adds a valuable element to augment CBT for addiction. Summarizing magnetic resonance imaging and positron emission tomography findings on the effects of MBCT and the neurobiology of drug addiction, this article outlines directions for further research on potential benefits of MBCT for the recovering individual. Finally, this article describes a structured protocol, developed at the Mount Sinai School of Medicine in New York City, which combines CBT with mindfulness-based intervention, for the treatment of affect-regulation issues specific to co-occurring addictive and mood disorders.     

Direct and indirect freedom in addiction: Folk free will and blame judgments are sensitive to the choice history of drug users

People view addiction as a source of diminished free will and moral responsibility. Yet, people are also sensitive to the personal histories of moral actors, including, perhaps, the way by which people became addicted. Across two studies (N = 806), we compare people’s moral intuitions about cases in which the actor becomes addicted by force or by choice. We find that perceptions of reduced free will partially mediate an association between choice (vs. no choice) in addiction and moral blame for a bad act (Study 1). We replicate this pattern and show that blame judgments are stronger when the bad act is related (vs. unrelated) to obtaining the addictive substance (Study 2). Our work is novel in demonstrating that lay people evince relatively nuanced intuitions about the role of free will in addiction and morality—they track direct and indirect paths to choices when making free will and blame judgments.     

冲动性对不同成瘾行为发展的调控及其神经机制

近年来越来越多的研究证据提示, 个体冲动性在成瘾疾患发生发展机制中具有关键作用, 可能成为成瘾行为的潜在易感标记以及早期识别和干预的重要靶点, 但冲动性对不同成瘾行为变化发展的调控机制尚不明确。项目拟综合跨成瘾谱系比较、纵向追踪设计、冲动行为干预等研究途径, 采用人格测量、神经认知、神经影像等技术, 首先比较尼古丁依赖者与网络游戏成瘾者的冲动性结构及其在前额叶–纹状体环路的结构功能改变; 然后采用混合分组设计筛选出具有高低冲动性的非成瘾青少年进行连续追踪研究, 考察冲动性对尼古丁依赖与网络游戏成瘾的预测效力; 并采用认知行为训练, 对吸烟成瘾者与网络游戏成瘾者进行冲动干预, 考察行为干预对冲动性水平及前额叶–纹状体环路功能的改变, 以及对不同成瘾行为发展的抑制后效。旨在探索冲动性作为成瘾的潜在易感标记及干预靶点的效力。     

Helping Clients Manage Addictions with REBT

Most private practitioners of REBT and other cognitive-behavioral therapies avoid work with problems of addiction. Reasons to reconsider this choice are offered and specific methods for productive private work with addictive problems are provided.     

In search of how people change. Applications to addictive behaviors.

How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.     

Blame Without Punishment for Addicts

Philosophia - On the moral model of addiction, addicts are morally responsible and blameworthy for their addictive behaviours. The model is sometimes resisted on the grounds that blaming addicts is...     

Disorders of Desire: Addiction and Problems of Intimacy

This essay investigates the tensions produced by the categorization of different forms of excessive desire under the singular model of addiction, and it challenges the increasing acceptance of addiction as an all-purpose explanation for unruly desires through a comparison of the different forms of disordered desire in sex addiction and alcoholism. Moreover, it argues for a broad understanding of addictive processes to undermine the normative and moralizing assumptions of addiction discourses. Refiguring addiction as a kind of intimacy is one way of making sense of the intense relationships people can develop with substances and with activities.     

Facing the Music

Abstract

This article outlines how group practitioners can harness creative strategies to assist addicted clients in verbalizing and addressing the losses associated with addictive disorders. This article overviews the implementation of an experiential process that includes a warm up activity, a psychodrama, and utilization of empty chair techniques to address addiction related grief and loss. In addition, these models assist clients to discuss change and healing from the interpersonal devastation of addiction. Finally, the appropriate use and timing of these models are discussed and a case study is included to illustrate these principles in action.     

Pavlovian conditioning of drug reactions: Some implications for problems of drug addiction

This paper reviews the classical conditioning of drug reactions, with special emphasis on the relationship of this phenomenon to drug addiction. Several aspects of drug addiction such as drug craving, high relapse tendencies, and the recurrence of withdrawal symptoms are reviewed and interpreted in light of classical conditioning theory and data. A theory is proposed that attempts to account for various aspects of the addictive process. The implications and empirical methods for testing this theory are outlined.     

Addiction, helplessness, and narcissistic rage

In many cases addictive behavior serves to ward off a sense of helplessness or powerlessness via controlling and regulating one's affective state. Addicts have a vulnerability to feelings of powerlessness, which reflects a specific narcissistic impairment. The drive in addiction to re-establish a sense of power is, correspondingly, impelled by narcissistic rage. This rage gives to addiction some of its distinctive clinical properties. The narcissistic vulnerability in addicts is discussed. Several brief clinical cases are provided, and the view proposed is correlated with other psychoanalytic perspectives.     

青少年自我概念与网络成瘾的关系:网络消极体验和学校类型的调节效应

本研究从贵州、江苏等十个地区选取4500名四年级以上的小学生和初中生,采用问卷调查的方法,探讨自我概念对网络成瘾倾向的影响及网络消极体验和学校类型的调节作用。结果发现:(1)自我概念对能够负向预测网络成瘾,重点学校学生的网瘾得分高于非重点学校学生;(2)网络消极体验、学校类型都会影响自我概念的作用。结论:重点学校通过自我概念能够稳定预测网瘾,非重点学校则需考虑网络消极体验的影响。在此基础上对青少年网瘾干预及学校环境进行讨论。     

Manufacturing multiple meanings of addiction: Time-limited realities

This article explores how clinicians, patients, and addiction as a youthful science manufacture meaning. Explanations of addictive behavior and addictive disease are viewed as constructs, ideologies, or ways of making meaning. This analysis considers the controversy—over whether addiction qualifies as a disease—to be primarily a matter of epistemology and social perception. Since there is no widespread agreement about what isease means in general, it is not possible to determine whether or not addiction is a disease in particular. The discussion also envisions how treatment for addicted clients might be reformulated as a transactional process utilizing the range of relevant theoretical models as time-limited reframes of addictive reality instead of dichotomizing addiction as either a disease or not.The authors extend thanks to Michelle Bowdler, Nancy Costikyan, Blase Gambino, Teri Loughead, Janet Mann, Peter Monius, Arthur Robbins, and Mitchell Young for their helpful assistance, suggestions, and comments on earlier drafts of this article.     

Sexual Compulsivity in Gay Men: Controversy and Treatment

Compulsive sex among some gay men has been made a more significant issue by the AIDS epidemic. There is controversy as to whether or not compulsive sex is a disorder or if it should be thought of as addiction. The clinical usefulness of the addictive model is discussed, along with the commonalities between the two most prevalent and successful approaches used to treat this disorder: namely, group treatment and the self-help Twelve Step addictive model.     

The God‐Shaped Hole: Addictive Disorders and the Search for Perfection

Clients with addictive disorders who have an internalized need for perfection benefit from an integration of spirituality into counseling treatment. This article provides a review of the literature, offers a spiritual approach for working with clients who struggle with addiction and perfectionism, and provides a case study to demonstrate the effectiveness of the integration of spirituality and counseling.