Expanding the Theoretical Lenses of Addiction Treatment Through Art Therapy Practice

189 Pages·2015·9.24 MB·English

by  Lily F. Braverman

LMU/LLS Theses and Dissertations
Spring April 2015
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Lily F. Braverman
Loyola Marymount University, [email protected]
Follow this and additional works at: https://digitalcommons.lmu.edu/etd
Part of the Art Therapy Commons, and the Marriage and Family Therapy and Counseling Commons
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Braverman, Lily F., "Expanding the Theoretical Lenses of Addiction Treatment Through Art Therapy
Practice" (2015). LMU/LLS Theses and Dissertations. 166.
https://digitalcommons.lmu.edu/etd/166
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Expanding the Theoretical Lenses of Addiction Treatment
Through Art Therapy Practice
by

Lily Braverman

A research paper presented to the
Faculty of the Department of
Marital and Family Therapy
Loyola Marymount University

In partial fulfillment of the
Requirements for the Degree
Master Of Arts

May 10, 2015
EXPANDING THE THEORETICAL LENSES OF ADDICTION TREATMENT ii

Signature Page
EXPANDING THE THEORETICAL LENSES OF ADDICTION TREATMENT iii

Acknowledgements

I am sincerely grateful for the faculty and students I have had the opportunity to learn
from within LMU’s art therapy program. In particular I commend my research mentor,
Debra Linesch, for her instrumental role in the construction and execution of this project.
I acknowledge Joellen Lapidus for her careful consideration in assisting my editing
process, and for sharing her expertise in substance abuse. I have been challenged and
supported by a multitude of individuals throughout this project, and I am honored to carry
with me at its close a stronger sense of personal and clinical identity.

I also acknowledge Tarzana Treatment Centers for supporting this research in the service
of both the substance abuse population and the art therapy field.
EXPANDING THE THEORETICAL LENSES OF ADDICTION TREATMENT iv

Dedication
This paper is dedicated to the four clients whose openness and authentic experiences in
treatment formed its basis. I have been humbled, moved, joyful, and saddened in my
various moments with these individuals, and I have learned invaluable lessons through
my work with them. If ever I doubted the power of art therapy, the moments I have been
privileged to share with these courageous and genuine people wholly dissolved my
skepticism.
EXPANDING THE THEORETICAL LENSES OF ADDICTION TREATMENT v

Abstract
This research explores the connection and interaction between literature
describing addiction theory and clinical art therapy practice. Literature spanning a wide
variety of theoretical understandings of addiction and recovery was reviewed, as well as
literature published on the use of art therapy with the substance abuse population. Using
the review of the substance abuse literature as a base, key theoretical concepts were
identified and formatted into a table that came to serve as a data coding system.
Applying case study methodology, this coding system was then utilized as an analysis
tool for the art therapy process and artwork of four clients in residential substance abuse
treatment. Analysis of the data resulted in the emergence of five prominent themes
amongst those listed in the coding system: 1) Intolerance of negative emotion 2)
Problematic family dynamics 3) Traumatic experiences 4) Schemas and restructured
cognitions and 5) Cultural issues. These findings were then examined in the context of
the art therapy literature on substance abuse. The meanings derived from these findings
make a case for greater integration between substance abuse literature and art therapy
literature, illustrating the utility of clear and organized incorporation of theoretical ideas
about addiction into art therapy with substance abuse clients.
EXPANDING THE THEORETICAL LENSES OF ADDICTION TREATMENT vi

Table of Contents
Signature Page…………………………………………………………………………..…i
Acknowledgments………………………………………………………………………...ii
Dedication……………………………………………………………………………...…iii
Abstract…………………………………………………………………………………...iv
Table of Contents………………………………………………………………………….v
List of Figures……………………………………………………………………………
Introduction………………………………………………………………………………..2
The Study Topic…………………………………………………………………...2
Significance of the Study……………………………………………………….…2
Background of the Study Topic…………………………………………………………...3
Literature Review………………………………………………………………………….4
Substance Abuse Literature……………………………………………………….4
Defining Key Terms………………………………………………………5
Defining Addiction………………………………………………..6
Defining Recovery………………………………………………...7
Implications of Terminology……………………………………...8
Theories in Discord………………………………………………………..9
The Moral Model………………………………………………...10
The Disease Model………………………………………………11
The 12-Step Model………………………………………………12
Other Spiritual Models…………………………………………..14
Behavioral and Cognitive-Behavioral Models…………………...16
EXPANDING THE THEORETICAL LENSES OF ADDICTION TREATMENT vii

Intersections with Behavioral Principles………………………...17
Neurobiological Process…………………………………………19
Psychodynamic Theories………………………………………...20
Emotion-Based Models…………………………………………..23
Personality Models…………………………………………….…24
Family Models……………………………………………...……25
The Transtheoretical Model………………………………...……28
Harm Reduction Framework……………………………………..30
The Biopsychosocial Model and Other Integrative Theories……31
Art Therapy Literature…………………………………………………………...34
Psychodynamic Concepts……………………………………………..…35
The 12-Step Model………………………………………………………45
The Disease Model………………………………………………………48
Confrontation-Based Treatment Programs………………………50
Breaking Through Denial……………………………………..…51
Personality Theories…………………………………………………..…53
Emotion-Based Models……………………………………………….…56
Family Models…………………………………………………………...59
Combined and Integrative Models……………………………………….60
Atheoretical Discussions of Addiction……………………………..……63
Conclusion……………………………………………………………….68
Research Approach………………………………………………………………………71
Methods……………………………………………………………………..……………71
EXPANDING THE THEORETICAL LENSES OF ADDICTION TREATMENT viii

Definition of Terms………………………………………………………………71
Addiction…………………………………………………………………72
Substance Abuse…………………………………………………………72
Recovery…………………………………………………………………72
Sobriety……………………………………………..……………………72
Design of Study……………………………………………………………………….…72
Sampling…………………………………………………………………………73
Gathering and Analysis of Data………………………………………….………73
Results……………………………………………………………………………………75
Presentation of Data……………………………………………………………...75
Introduction of Participating Clients………………………………………..……75
Tracy……………………………………………………………………..75
John………………………………………………………………………89
Monique……………………………………………………….…………98
Carmen……………………………………………………….…………112
Analysis of Data………………………………………………………………...123
Development of Coding System……………………………………..…123
Application of Coding System……………………………………….…124
Process of Data Analysis…………………………………………….…125
Discussion of Emergent Themes…………………………………….…128
Intolerance of Negative Emotion………………………………128
Problematic Family Dynamics……………………………….…130
Traumatic Experiences………………………………………….133
EXPANDING THE THEORETICAL LENSES OF ADDICTION TREATMENT ix

Schemas and Restructured Cognitions……………………….…137
Cultural Issues…………………………………………………..140
Emergent Themes Not Coded from Literature…………………143
Concepts from Literature Not Identified in Case Studies………143
Findings……………………………………………………………………………...…145
Meanings………………………………………………………………………..………146
Meanings Related to Substance Abuse Literature……………………………...146
Meanings Related to Art Therapy Literature…………………………………...147
Limitations of the Study………………………………………………………...149
Conclusion……………………………………………………………………………...149
References………………………………………………………………………………154
Appendices……………………………………………………………………………...166
A. Coding System for Data Analysis…………………………………………..166
B. Letter of Agreement from Agency…………………………………………..168
C. IRB Letter of Approval and Application…………………………………….169
D. LMU Experimental Subjects Bill of Rights…………………………………176
E. Informed Consent Document…………………………………………….…177
F. “Protecting Human Research Participants” Certificate of Completion…..…178