Treating Addictive Behaviors: Processes of Change

464 Pages·1986·17.46 MB·English

by  James O. Prochaska

Treating Addictive
Behaviors
Processes of Change
APPLIED CLINICAL PSYCHOLOGY
Series Editors:
Alan S. Bellack, Medical College of Pennsylvania at EPPI, Philadelphia, Pennsylvania,
and Michel Hersen, University of Pittsburgh, Pittsburgh, Pennsylvania
Current Volumes in this Series
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Edited by Rowland P. Barrett
SUBSTANCE ABUSE AND PSYCHOPATHOLOGY
Edited by Arthur I. Alterman
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Processes of Change
Edited by William R. Miller and Nick Heather
A Continuation Order Plan is available for this series. A continuation order will bring delivery
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Treating Addictive
Behaviors
Processes of Change
Edited by
William R. Miller
Univmily of New Mexico
Albuquerque, New Merico
and
Nick Heather
Universily of Dundee
Dundee, Scolland
Plenum Press • New York and London
Library of Congress Cataloging in Publication Data
Treating addictive behaviors.
(Applied clinical psychology)
Based on papers presented at the 3rd International Conference on Treatment of Ad
dictive Behaviors, held at North Berwick, Scotland in Aug. 1984.
Includes bibliographies and index.
1. Compulsive behavior-Treatment-Congresses. 2. Substance abuse-Treatment
-Congresses. I. Miller, William R. II. Heather, Nick. III. International Conference on
Treatment of Addictive Behaviors (3rd: 1984: North Berwick, Scotland) IV. Series.
[DNLM: 1. Compulsive Behavior-therapy-congresses. 2. Substance Dependence
therapy-congresses. WM 176 T784 1984J
RC533.T73 1986 616.85'227 86-20463
ISBN-13: 978-1-4612-9289-0 e-ISBN-13: 978-1-4613-2191-0
001: 10.1007/978-1-4613-2191-0
1098765
© 1986 Plenum Press, New York
Softcover reprint of the hardcover 1s t edition 1986
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, 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
To
Lillian and Richard
W. R. M.
In loving memory of
Nicholas Heather
N.H.
Contributors
Helen M. Annis, Addiction Research Foundation, and University of
Toronto, Toronto, Ontario, Canada
Claus-Peter Appel, Department of Applied Psychology, University of
Lund, Lund, Sweden
Geir Berg, The Hjellestad Clinic, Hjellestad, Norway
Gerhard Biihringer, Addiction Research Group, Department of Psychol
ogy, Max-Planck Institute for Psychiatry, Munich, West Germany
Sabine Dehmel, Addiction Research Group, Department of Psychology,
Max-Planck Institute for Psychiatry, Munich, West Germany
Carlo C. DiClemente, Texas Research Institute of Mental Science, Hous
ton, Texas
Dennis M. Donovan, Department of Psychiatry and Behavioral Sciences,
University of Washington, and Alcohol Dependence Treatment
Program, Veterans Administration Medical Center, Seattle, Wash
ington
Christopher P. Freeman, Department of Psychiatry, University of Edin
burgh, and Royal Edinburgh Hospital, Morningside Park, Edin
burgh, Scotland
Marcus Grant, Division of Mental Health, World Health Organization,
Geneva, Switzerland
vii
viii CONTRIBUTORS
Nick Heather, Department of Psychiatry, Ninewells Medical School, Uni
versity of Dundee, Dundee, Scotland
Reid K. Hester, Behavior Therapy Associates, Albuquerque, New Mexico
Joanne R. Ito, Department of Psychology, University of Washington, and
Health Services Research and Development, Veterans Administra
tion Medical Center, Seattle, Washington
Frederick H. Kanter, Department of Psychology, University of Illinois,
Champaign, Illinois
Franz Klett, Addiction Research Group, Department of Psychology,
Max-Planck Institute for Psychiatry, Munich, West Germany
Simonne LeBreton, Addiction Research Foundation, Toronto, Ontario,
Canada
Gloria K. Litman, Addiction Research Unit, Institute of Psychiatry, Lon
don, England
Barbara S. McCrady, Center of Alcohol Studies, Rutgers University, Pis
cataway, New Jersey
William R. Miller, Department of Psychology, University of New Mexico,
Albuquerque, New Mexico
Jim Orford, Department of Psychology, University of Exeter, Exeter,
England
James O. Prochaska, Department of Psychology, University of Rhode Is
land, Kingston, Rhode Island
Howard Rankin, St. Andrew's Hospital, Northampton, England
Martin Raw, Department of Psychology, St. George's Hospital Medical
School, London, England
Bruce Ritson, Department of Psychiatry, University of Edinburgh, An
drew Duncan Clinic, Royal Edinburgh Hospital, Edinburgh,
Scotland
lan Robertson, Department of Psychology, Astley Ainslie Hospital, Edin
burgh, Scotland
CONTRIBUTORS ix
David Robinson, Addiction Research Centre, University of Hull, Hull,
England
Arvid Skutle, The Hjellestad Clinic, Hjellestad, Norway
Stephen Sutton, Addiction Research Unit, Institute of Psychiatry, Lon
don, England
D. Adrian Wilkinson, Addiction Research Foundation, Toronto, Ontario,
Canada
Preface
About a decade ago, psychologists began exploring the commonalities
among alcohol and drug abuse, smoking, and obesity. The term sub
stance abuse evolved into the current concept of addictive behaviors,
which recognizes similarities with other behaviors that do not involve
consummatory responses (e.g., pathological gambling, compulsions,
sexual deviations). Professional societies and journals now have been
founded in both Britain and the United States with the purpose of focus
ing on research and treatment in the area of addictive behaviors.
As the field has evolved, new models have emerged to address the
questions and puzzles that face professionals. This volume examines
some of these current issues and, in particular, explores common pro
cesses of change that seem to cut across the addictive behaviors. The
chapters are based on papers presented at the Third International Con
ference on Treatment of Addictive Behaviors, which was held at North
Berwick, Scotland, in August of 1984. The conference was organized
around an integrative model of stages and processes of change that has
been useful in organizing new knowledge about how to intervene with
addictive behaviors. This model is set forth by its authors, Jim Prochaska
and Carlo DiClemente, in Chapter 1. In Chapter 2, Fred Kanfer ex
pounds his own model of self-regulation, which overlaps nicely with the
Prochaska-DiClemente framework and provides a behavioral-theoretical
context.
The remainder of the book is organized around stages at which
clients come into treatment, and at which professionals are called on to
intervene. Part II addresses issues of motivation for change. Marcus
Grant opens this section with a commentary on the roles of the World
Health Organization in engendering change in the addictive behaviors.
Claus-Peter Appel explores applications of experimental social psychol-
xi
xii PREFACE
ogy in general, and decision-making models in particular, to problems
of individual client motivation. Jim Orford discusses research on the
critical minimal conditions for change, and Steve Sutton reviews data on
how smokers decide to quit.
Part III, the largest section of this volume, is a compendium of
theory and research on how people change once they begin taking ac
tion to alter addictive behaviors. Miller and Hester, in two chapters, first
survey current knowledge on the effectiveness of alternative treatments
for alcohol abuse, then review research on matching clients with optimal
intervention approaches. Geir Berg and Arvid Sku tie present the results
of an early intervention program for Norwegian problem drinkers. Chris
Freeman discusses the eating disorders and raises controversial ques
tions as to whether all of these should be classed with the addictive
behaviors. Two chapters describe and evaluate behavioral treatment
programs for drug abusers in Toronto (Wilkinson and LeBreton) and
Munich (Dehmel, Klett, and Biihringer). The literature on smoking ces
sation methods is summarized by Martin Raw.
The remaining six chapters in Part III explore important aspects of
treatment and change that transcend particular intervention approaches.
David Robinson traces the history and role of mutual-aid groups. Barbara
McCrady discusses family involvement in addictive behaviors and the
change process, reporting the results of a study and incorporating the
larger literature on social support. Ian Robertson explores the ap
plicability of cognitive theory and research in understanding and treating
addictive behaviors. Nick Heather expounds on the use of self-help
manuals to assist individuals in changing their behavior, clarifying the
most common method by which people change: self-directed change
without the aid of a therapist. The transtheoretical issue of dependence
remains important for addictive behaviors, and Howard Rankin presents
theoretical perspectives and recent experimental evidence relevant to
treatment. Finally, Bruce Ritson commends "the merits of simple inter
vention," pointing to data that suggest that we have been making treat
ment and change altogether too expensive and complicated, bypassing
some relatively simple interventions that suffice for a large percentage of
clients.
Any professional working in this field recognizes that initial change
is only a beginning and is no guarantee of long-range success. One of
the more important insights of the past decade has been increased
awareness of the need for special measures to prevent relapse. Gloria
Litman provides an exegesis of her "survival" model for predicting and
preventing relapse in addictive behaviors, and Helen Annis presents a
comprehensive approach by which relapse risk can be assessed and
reduced. In the final chapter of this volume, Joanne Ito and Dennis