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DETAILED CONTENTS
Preface xvi
About the Editors xviii
About the Contributors xix
1. F
rom Treatment Lore to Theory Application:
An Introduction to Addiction Theory and Practice 1
John R. Culbreth, Pamela S. Lassiter
Treatment Lore 2
Overview of Book Sections and Chapters 6
Addiction Counseling Case Study 10
Appendix: National Association of Alcohol and Drug Abuse
Counselors: Code of Ethics 13
2. H
istorical Perspectives and the Moral Model 27
Pamela S. Lassiter, Michael S. Spivey
Colonial Era (1492–1763) 27
American Revolution and Young Republic (1763–1820s) 28
Temperance Movement (1826–1919) 28
Prohibition (1919–1933) 31
World War II Era (1939–1945) 32
Nixon Era (1969–1974) 33
Carter Era (1977–1981) 34
Reagan Era (1981–1989) 35
The 1990s and 2000s 36
Cultural Views of Addiction 38
Basic Tenets of the Moral Model 39
Strengths and Weaknesses of the Theory 40
Influences on Social Policy 41
Influences on Clinicians 42
Case Study Responses 43
Summary 45
3. Biological Theory: Genetics and Brain Chemistry 47
Kathleen Brown-Rice, Regina R. Moro
Overview of Empirical Research Findings on the Addictive Process 47
Neurotransmitters 47
Brain Reward Pathway 48
Cycle of Addiction 49
Basic Tenets of the Theory 50
Philosophical Underpinnings and Key Concepts of the Theory 51
Dispositional Model 51
Neurobiological Model 52
Hijacked Brain Theory 53
Addictive Substances 53
Depressants 53
Stimulants 58
Latest Trends 60
Polysubstance Use 62
How the Theoretical Approach Is Used by Practitioners 62
Conceptualization 62
Psychoeducation 63
Assessment and Prevention Implications 65
Strengths and Weaknesses of the Theory 66
Strengths 66
Weaknesses 67
Case Study Responses 68
Summary 70
5. S
elf-Psychology Theory: Addiction and the Wounded Self 101
Joseph B. Cooper
Philosophical Underpinnings and Key Concepts of the Theory 102
Development of Self 102
Selfobject Needs 102
Transmuting Internalization 103
Development of Addictive Behavior 104
How the Theoretical Approach Is Used by Practitioners 106
Early Stage Treatment Issues 106
Individual Counseling 107
Development of New Psychic Structure 107
Group Counseling 107
Guidelines for Group 108
Assessment and Prevention Implications 109
Strengths and Weaknesses of the Theory 109
Case Study Responses 110
Internalization of Recovery 111
Shame 112
Affect Regulation 113
Empathic Attunement and Transmuting Internalization 113
Outcome 114
Summary 115
15. C
onstructivist Approaches to Addiction Counseling:
Feminist, Womanist, and Narrative Theories 299
Pamela S. Lassiter, Anneliese A. Singh, Taryne M. Mingo
Philosophical Underpinnings and Key Concepts of Feminist and Womanist
Theories 299
Feminist Theory 300
Womanist Theory 301
How the Theoretical Approach Is Used by Practitioners 303
Feminist Counseling Practices 303
Womanist Counseling Practices 304
Assessment and Prevention Implications 305
Feminist 305
Womanist 306
Strengths and Weaknesses of the Feminist and Womanist
Theories 307
Philosophical Underpinnings and Key Concepts of
Narrative Theory 308
Dominant Narratives 309
Goal of Narrative Counseling 309
How the Theoretical Approach Is Used by Practitioners 310
Externalizing Conversations 310
Deconstructive Listening 310
Unique Outcomes 311
Thickening the Plot and Spreading the News 312
Reflective Practices 313
Assessment and Prevention Implications of Narrative
Theory 313
Strengths and Weaknesses of Narrative Theory 314
Feminist Theory Case Study Response 314
Womanist Theory Case Study Response 315
Narrative Theory Case Study Response 317
Summary 318
Index 383
PREFACE
Nearly one in four Americans will face an addiction problem in their lifetime. This
widespread problem has reached alarming heights. Likewise, nearly all the clients a
professional counselor will serve have, in some way, been affected by addiction. Addiction
impacts families, the workplace, friendships, and nearly all aspects of daily living. Because
so many clients are impacted by addiction, all counselors, regardless of the setting, need to
have skills to work effectively with addiction issues.
Addiction is a multifaceted problem supported and maintained by interpersonal,
intrapersonal, social, psychological, spiritual, and biological factors. It is almost impossible
to effectively understand and treat addiction issues as an isolated problem because of the
complexity of its epistemology. For a given client, addiction may be a way of coping with
childhood trauma such as physical or sexual abuse (psychological factors), or it may be a way
of dealing with societal oppression and discrimination (sociological factors). Or biologically,
a client may be more likely to become addicted due to a genetic predisposition (biological
factors).
Effective counselors need a biopsychosocial perspective that examines and understands
addiction and its maintenance in the lives of clients as an interaction between complex
factors before they can prescribe appropriate treatment. A thorough understanding of
multiple approaches to theory and practice can prepare counselors to address individualized
issues that can enhance the likelihood of recovery and long-term relapse prevention.
Addiction counselors must understand the theoretical epistemology of addiction before
they can select the appropriate approach to treatment. Current theories such as medical,
psychological, sociological, and harm-reduction models all prescribe treatment in a different
way. The theory a counselor practices from will determine which type of treatment the client
receives. This book is intended to be a review of existing theories of addiction that then helps
counselors connect those theories to practice.
There are very few books related to addiction that focus solely on the theories of
addiction. To date, most of the textbooks for this area are more survey oriented. That is,
they provide a brief overview of typically four or five broad theoretical categories, such as
psychological, sociological, and medical models, and only briefly mention different aspects
of those theories in the chapter. They do not connect theory of addiction to practice. These
survey books then go on to provide an overview of assessment issues, family issues, and
12-step approaches, with one or two chapters focused on different treatment approaches or
issues. By contrast, when examining theory textbooks for the general counseling field, you
find that these texts are typically focused only on counseling theories. For addictions courses,
what has been lacking is a book that presents addiction theory as a focal point, similar to
counseling theory texts. Currently, professors teaching a theory course must put together a
collection of textbooks, book chapters, journal articles, and such to create a working group
of readings for students. This book provides all the information for an addiction theories
course in one location.
xvi
Preface • x v ii
ACKNOWLEDGMENTS
We would first like to thank our editors, Abbie Rickard and Kassie Graves, who believed in
this project, saw its potential, and worked hard to help us succeed. Editing a textbook is a
difficult and time-consuming process. It could not have come to fruition without the help of
the whole production team at Sage. We would also like to thank all our contributing authors
for sharing their experience, knowledge, and wisdom in advancing the addiction counseling
profession. Finally, we would like to thank the following reviewers for their thoughtful
recommendations: Chaniece Winfield, Old Dominion University; Kathryn Dziekan, New
Mexico Highlands University; Lia Willis, Columbia College; Ozietta D. Taylor, Coppin
State University; Tiffany L. W. Bates, Louisiana Tech University; Tracy R. Whitaker, Howard
University School of Social Work; Nancy E. Sherman, Bradley University; Tammara P.
Thomas, Winston-Salem University; William J. Elenchin, St. Bonaventure University; An-
Pyng Sun, University of Nevada Las Vegas; Diane Michaelsen, Southern Connecticut State
University; and Jody Huntington, Regis University.
We would like to thank the mentors and teachers who have taught us about counseling
and working with addicted families. Many of them have gone now, but their words and
wisdom live on in us as counselors and counselor educators. Some, but certainly not all,
of these educators include Al Greene, Bette Ann Weinstein, Katherine Townsend, David
Powell, Bettie Dibrell, Patti Mitchell, and John Edwards. Their words reverberate in our
teaching and remind us every day how fortunate we were to have been their students.
ABOUT THE EDITORS
x v iii
ABOUT THE CONTRIBUTORS
Dr. Kathleen Brown-Rice is a licensed professional counselor (SD, NE, and NC), licensed
mental health provider (NE), certified addiction counselor (SD), licensed clinical addiction
counselor (NC), qualified mental health provider (SD), approved clinical supervisor, and
national certified counselor. Her research efforts are on developing and enhancing ethical
and competent services to clients. She has completed several projects and published in the
area of risky substance use. To further understand emotional regulation, resilience, and
risky substance use, she also incorporates neural imaging and epigenetics into her research.
She has worked as a professional counselor in various clinical mental health and addiction
settings and continues to practice part-time.
Dr. Jana Burson earned a BS degree in zoology and microbiology from Ohio University in
Athens, Ohio, and got her medical degree from Ohio State University College of Medicine.
She completed a residency in internal medicine at Carolinas Medical Center and worked
for a decade in primary care. She became interested in addiction medicine in 2001 and has
worked full-time in this field since 2004. She is an active member of the American Society
of Addiction Medicine and is board certified by the American Board of Addiction Medicine.
Her special interest is treating opioid use disorder with medication-assisted therapies.
She won the Fredrick B. Glaser Award in 2015, awarded by the Governor’s Institute on
Substance Abuse, for outstanding work in the field of addiction medicine in the state of
North Carolina. When not at work, she enjoys hiking the Appalachian foothills with her
fiancé and her two dogs. She also relaxes by making quilts and weaving rugs.
Dr. Craig S. Cashwell is professor in the Department of Counseling and Educational Development
at the University of North Carolina at Greensboro. Dr. Cashwell focuses his scholarship on the
competent and ethical integration of spirituality and religion into the counseling process and
behavioral addictions. Dr. Cashwell maintains a part-time private practice focusing on couples
counseling and addictions counseling. He has received numerous awards for teaching, research,
and service. Dr. Cashwell is a fellow in the American Counseling Association and a past chair
of the Council for Accreditation of Counseling and Related Educational Programs (CACREP).
He has served as the Association for Counselor Education and Supervision (ACES) Governing
Council representative to ACA and president of Chi Sigma Iota, the international honor society
for the counseling profession. He lives in Winston-Salem with his wife Dr. Tammy Cashwell,
who is also a counselor educator, and their daughter, Samantha.
xix
xx Theory and Practice of Addiction Counseling
Dr. Astra B. Czerny currently works as an assistant professor in the Community & Trauma
Counseling program at Philadelphia University. Her scholarly work reflects her interest
and passion in women’s issues and empowerment. Her clinical work is focused on trauma,
women’s issues, and addictions. In addition to teaching classes at PhilaU, Dr. Czerny
has a private practice in Jenkintown, Pennsylvania, where she specializes in EMDR and
neurofeedback. In her spare time, Dr. Czerny enjoys crocheting millions of lace doilies, all
of which will be inherited by her loving children, much to their dismay.
Dr. Amanda L. Giordano, LPC, NCC, is an assistant professor at the University of North
Texas. She specializes in addictions counseling, including both substance and process
addictions and religious/spiritual issues in counseling. Giordano received the American
Counseling Association’s Ralph F. Berdie Memorial Award in recognition of her work with
collegiate substance abuse. She founded and cofacilitates an addictions counseling research
team in her department and serves on the editorial board of the Journal of Addiction and
Offender Counseling. Giordano is an avid fan of The Walking Dead.
Dr. Charles F. Gressard is a chancellor professor in the Counseling Program at the College
of William & Mary and is coordinator of the addictions specialty and faculty director of
the New Leaf Clinic. He received his PhD from the University of Iowa and has taught
at the University of Virginia and the College of William & Mary for the past 36 years.
He has served as chair of the Virginia Board of Counseling, chair of the National Board
for Certified Counselors, vice chair of CACREP, and chair of the Virginia Department
of Health Professions’ Impaired Professionals Committee. He currently chairs CACREP’s
International Registry for Counselor Education Programs (IRCEP). His licenses and
certifications include licensed professional counselor, licensed substance abuse treatment
professional (both in Virginia), national certified counselor, and master addiction counselor
certification. In 2007 he received the Virginia Summer Institute for Addiction Studies’
Visionary Leadership Award; in 2008 he received Chi Sigma Iota’s Thomas J. Sweeney
National Professional Leadership Award; and in 2009, along with the CACREP staff and the
other members of the 2009 Standards Revision Committee, he received the ACES Robert
O. Stripling Award for Excellence in Standards.
and their dog Duchess. He spends much of his free time reading, thinking about superheroes,
and watching movies.
Dr. Leigh F. Holman has worked as a mental health professional for more than 20 years
in private practice, hospitals, IOP, PHP, dual diagnosis units, impaired professionals units,
residential treatment, community agency, prison, and private practice settings. She has
taught for 10 years. Dr. Holman is licensed as a LPC-MHSP supervisor and certified as
a registered play therapy supervisor. She has earned the AMHCA diplomate credential in
substance abuse and co-occurring disorders, trauma counseling, and child and adolescent
counseling. She is the past president of IAAOC and was recognized as the Outstanding
Counseling Professional in 2013 for her contributions to the field of process addictions.
She conducts research in prison and community agency settings and has published and
presented nationally and internationally on addiction and offender topics.
Dr. Melanie M. Iarussi is an associate professor and the coordinator of the Counselor
Education Doctoral Program at Auburn University. She earned her PhD in counselor
education and supervision from Kent State University. Her clinical background is in
substance abuse counseling, college counseling, and private practice. She is a licensed
professional counselor and a certified substance abuse counselor. She is also a member of
the Motivational Interviewing Network of Trainers. Melanie’s research interests include
counselor training in substance use and addiction counseling, college student substance use
and recovery, and applications of motivational interviewing. Melanie enjoys life in Auburn
with her husband, two daughters, and black lab Angel.
Dr. Katie A. Lamberson received her master’s of rehabilitation counseling in 2010 and
worked for several years as a counselor for youth and families struggling with addiction.
She then went on to receive her doctorate in counseling and counselor education at the
University of North Carolina at Greensboro. In her current position, Katie teaches courses
for master’s students in the addictions track, as well as ethics in counseling and theories
of family counseling. Her area of research interest includes examining family dynamics
and substance use, specifically, how family influences either promote or deter continued
use of substances in adolescents. Katie lives in North Carolina with her husband, dog,
and cats.
has published numerous book chapters and articles primarily focused on issues related to
addiction, youth, and families.
Dr. Todd F. Lewis is an associate professor of counseling and counselor education at North
Dakota State University. He is a licensed professional counselor and a national certified
counselor. Dr. Lewis is past treasurer and president of the International Association of
Addictions and Offender Counselors (IAAOC), a subdivision of the American Counseling
Association. He recently served as the IAAOC representative on the Governing Council of
the American Counseling Association. Throughout his career, he has taught graduate-level
students in motivational interviewing, substance abuse counseling, assessment, diagnosis,
and treatment planning. He has presented on these topics at numerous local, state, national,
and international venues. Dr. Lewis has published numerous research articles related to
substance abuse, collegiate drinking, and theoretical approaches to addictions treatment. He
has twice received the Exemplary Research Award from IAAOC for his research and was
the 2012 recipient of the Teaching Excellence Award from the University of North Carolina
at Greensboro School of Education. In 2014, he published his first textbook, Substance
Abuse and Addiction Treatment: Practical Application of Counseling Theory, published by
Pearson Education. Dr. Lewis is a member of the Motivational Interviewing Network of
Trainers (MINT). He has secured internal and external funding for his work in motivational
interviewing, primarily using the approach to address health disparities within surrounding
communities. In addition to his full-time faculty work, Dr. Lewis has garnered significant
clinical experience where he has coordinated substance abuse clinical research and treatment
services with clients struggling with a range of substance abuse and mental health issues. In
his spare time, Dr. Lewis enjoys reading, hiking, being outdoors, and spending time with his
family.
Dr. Jeremy M. Linton is an associate professor of counseling and human services and
director of the Student Counselor Training Clinic at Indiana University South Bend. He
is also the counseling director at Collaborative Family Solutions in South Bend, Indiana.
Jeremy earned a bachelor’s degree in psychology from the University of Michigan, a master’s
degree in counseling from Valparaiso University, and a PhD in counselor education and
supervision from Western Michigan University. He is a licensed clinical addictions counselor
and licensed mental health counselor in the state of Indiana and a licensed professional
counselor in the state of Michigan. Jeremy is the author of the book Overcoming Problematic
Alcohol and Drug Use published by Routledge and more than 20 other journal articles and
book chapters. When he is not working, Jeremy enjoys reading, skateboarding, and spending
time with his wife, four kids, and two loyal golden retrievers.
Dr. Taryne M. Mingo is an assistant professor at Missouri State University and has a
career background as an elementary professional school counselor for rural populations in
Georgia. Her research interests include advocating for marginalized student populations
across P–16 settings, using intersectionality theory to support marginalized student
populations, womanist theory and supervision, and incorporating a social justice lens
within school counseling programs. Dr. Mingo serves as a member on the Department
of Elementary and Secondary Education (DESE) Writing Team for Missouri school
About the Contributors • x xiii
counselors and was invited to participate in the White House convening for school
counselors as part of the Reach Higher Initiative in 2014. Dr. Mingo identifies as a social
justice change agent who seeks to find new and innovative methods toward accessing
education, to support student learning, and to promote every student reaching his or her
highest potential.
Dr. Regina R. Moro serves as an assistant professor in counselor education at Boise State
University in Boise, Idaho. She received her PhD in counseling from the University of
North Carolina at Charlotte with an emphasis in multicultural counseling, received a
graduate certificate from UNC Charlotte in substance abuse counseling, and earned an
MS in community counseling from Syracuse University. Regina is a licensed mental health
counselor (FL), a licensed clinical addictions specialist (NC), and a national certified
counselor. Her clinical passion involves work with crisis and trauma, including a focus on
addiction with individuals and families. She enjoys spending her free time enjoying the great
outdoors with her partner and their dog, Barkley.
Dr. Marsha Riggio is chairperson and associate professor with the Counseling Department
at Argosy University, Washington, DC, where she recently received the 2016 Faculty
Mentor Award. Dr. Riggio received her PhD in counselor education and supervision, and
her background includes 20 years of teaching and mental health experience that involves 15
years in the U.S. Army as a behavioral science specialist/mental health officer and several
years as a licensed professional counselor/supervisor and national certified counselor. She has
a private counseling and supervision practice. Dr. Riggio is also the executive director of the
Maryland Counseling Association, president of the Maryland Association for Marriage and
Family Counseling, and a member of the board of directors for the William V.S. Tubman
University Foundation in Liberia. When not working, Dr. Riggio spends time with her
husband, six children, two cats, and one fish.
Dr. Rebecca G. Scherer joined the Counseling and Educational Psychology program at
the University of Nevada, Reno, in the fall of 2014. She is a licensed professional counselor
(LPC) in North Carolina, an approved clinical supervisor (ACS), and a nationally certified
counselor (NCC). Her professional interests include multiculturalism and social justice
in counseling, attachment theory/therapy, and clinical supervision. She has presented at
numerous workshops at state, regional, national, and international conferences. In her free
time, Rebecca enjoys hiking in the summer and skiing in the winter in the Lake Tahoe area.
Dr. Anneliese A. Singh is an associate professor and associate dean for diversity, equity,
and inclusion in the College of Education at the University of Georgia. Dr. Singh is a past
president of the Association for Lesbian, Gay, Bisexual & Transgender Issues in Counseling,
where she developed transgender counseling competencies and queer and trans people
of color initiatives. She cofounded the Georgia Safe Schools Coalition to work on the
intersection of heterosexism, racism, sexism, and other oppressions in Georgia schools. She
founded the Trans Resilience Project to translate findings from her 15 years of research
on the resilience that transgender people develop across the life span and across multiple
identities to navigate societal oppression. She passionately believes in and strives to live by
x xi v Theory and Practice of Addiction Counseling
the ideals of Dr. King’s beloved community, as well as Audre Lorde’s reminder that “without
community, there is no liberation.”
Michael S. Spivey holds bachelor of arts degrees in Spanish and history from the University
of North Carolina at Charlotte and a master of arts in education and human development
from the George Washington University. After working as a senior facilitator and consultant
for 25 years in the financial and manufacturing arenas, Michael is currently pursuing a
master of arts in counseling with a concentration in clinical mental health at the University
of North Carolina at Charlotte. He is a member of the American Counseling Association
and the North Carolina Counseling Association. He is also a current member and past board
member of the International Association of Facilitators, having served two terms in the role
of global director of professional development. Michael is also a member of the Chi Sigma
Iota and Kappa Delta Pi honor societies. In his spare time, he enjoys traveling, hiking, and
gardening.
Paula J. Swindle, MA, NCC, LPCS, is a doctoral student at the University of North
Carolina at Greensboro. She returned to pursue her PhD after 15 years in the counseling
profession, including designing and implementing mental health programming for cardiac
and cancer services in a hospital setting. Paula plans to go into counselor education, and
her research interests include counseling and spirituality, religious abuse, process addictions,
counselor self-care, and counseling in medical settings. Raised in the beautiful Blue Ridge
Mountains of North Carolina, Paula and her husband Dustin currently live in Winston-
Salem, North Carolina.
Heidi Unterberg is a doctoral student at Argosy University, Washington, DC, and has
worked as a teaching assistant (TA) in the Master’s Level Counseling Department for 2
years. She has presented at the International Association of Marriage and Family Counselors
(IAMFC) World Conference, sponsored by the International Association of Addictions
and Offender Counseling (IAAOC), on addictions and the family system: systems theory
with families affected by addiction. She also presented at the Association for Specialists
in Group Work (ASGW) National Conference, on criminogenic juveniles: morality
development using a restorative justice model. She is a member of the Restorative Justice
Committee in the division of IAAOC working with cohorts toward increasing knowledge
and counselor skills in restorative justice practices. She is a mental health therapist with
Valley Youth House, in Allentown, Pennsylvania, working toward certification in eco-
systemic family therapy (ESFT) with the Philadelphia Child Guidance Center (PCGC)
and toward certification in trauma focused–cognitive behavioral therapy (TF–CBT). She
lives in the Great Pocono Mountains with her supportive husband, David, of 19 years,
and her two amazing children, Samuel and Stephanie. The family enjoys spending time
outdoors together taking care of their five English mastiffs, four horses, ten chickens, and
duck Sparky. Oh, and their pig, Kevin.
in the areas of college student drinking prevention, addiction treatment, counselor training,
and clinical supervision. Dr. Wahesh earned his doctorate in counseling and counselor
education from the University of North Carolina at Greensboro. He is a member of the
Motivational Interviewing Network of Trainers and is an approved clinical supervisor (ACS)
and national certified counselor (NCC). In 2015, he received the New Professional Award
from the North Atlantic Region Association for Counselor Education and Supervision
(NARACES). Originally from Brooklyn, New York, Dr. Wahesh loves pizza, water ice, and
the New York Yankees.