ArticlePDF Available

Addiction in existential positive psychology (EPP, PP2.0): from a critique of the brain disease model towards a meaning-centered approach

Authors:

Abstract

Addiction is widely considered to be a chronic brain disease. Under this view, neuroscientists have spent lots of resources to study the brain and identify pharmacological targets to palliate addiction. However, the brain disease model presents serious epistemological and practical limitations. Firstly, this article collects important critiques to the medical model and calls for a more pluralistic approach to addiction. Secondly, we discuss the problematic self-regulation of people with addiction from an existential positive perspective (also termed PP2.0). People with addiction, whether it is related to substance abuse, gambling, internet surfing, shopping or eating, usually manifest existential struggles that could account for the development and maintenance of their addiction. Relational problems, evasion of guilt and responsibility, and a lack of meaning in life have been evidenced in the literature. At the base of this psychological problem, there are both an inability to cope with the dark side of life and a maladaptive search for positive emotions that cannot be naturally obtained from meaningful social interactions. Finally, the Meaning-Centered Approach (MCA) is proposed for addiction recovery. MCA helps clients find a purpose in life and integrate into society. This existential positive approach can be a fundamental complement for mainstream addiction treatments.
Full Terms & Conditions of access and use can be found at
https://www.tandfonline.com/action/journalInformation?journalCode=ccpq20
Counselling Psychology Quarterly
ISSN: 0951-5070 (Print) 1469-3674 (Online) Journal homepage: https://www.tandfonline.com/loi/ccpq20
Addiction in existential positive psychology (EPP,
PP2.0): from a critique of the brain disease model
towards a meaning-centered approach
David F. Carreno & José Antonio Pérez-Escobar
To cite this article: David F. Carreno & José Antonio Pérez-Escobar (2019): Addiction
in existential positive psychology (EPP, PP2.0): from a critique of the brain disease
model towards a meaning-centered approach, Counselling Psychology Quarterly, DOI:
10.1080/09515070.2019.1604494
To link to this article: https://doi.org/10.1080/09515070.2019.1604494
Published online: 19 Apr 2019.
Submit your article to this journal
View Crossmark data
ARTICLE
Addiction in existential positive psychology (EPP, PP2.0):
from a critique of the brain disease model towards a
meaning-centered approach
David F. Carreno
a
*and José Antonio Pérez-Escobar
b
*
a
Department of Psychology, University of Almeria, Almeria, Spain;
b
Chair of History and Philosophy of
Mathematics, Department of Humanities, Social and Political Sciences, ETH Zürich, Zurich, Switzerland
ABSTRACT
Addiction is widely considered to be a chronic brain disease.
Under this view, neuroscientists have spent lots of resources to
study the brain and identify pharmacological targets to palliate
addiction. However, the brain disease model presents serious
epistemological and practical limitations. Firstly, this article collects
important critiques to the medical model and calls for a more
pluralistic approach to addiction. Secondly, we discuss the proble-
matic self-regulation of people with addiction from an existential
positive perspective (also termed PP2.0). People with addiction,
whether it is related to substance abuse, gambling, internet surf-
ing, shopping or eating, usually manifest existential struggles that
could account for the development and maintenance of their
addiction. Relational problems, evasion of guilt and responsibility,
and a lack of meaning in life have been evidenced in the literature.
At the base of this psychological problem, there are both an
inability to cope with the dark side of life and a maladaptive
search for positive emotions that cannot be naturally obtained
from meaningful social interactions. Finally, the Meaning-
Centered Approach (MCA) is proposed for addiction recovery.
MCA helps clients nd a purpose in life and integrate into society.
This existential positive approach can be a fundamental comple-
ment for mainstream addiction treatments.
ARTICLE HISTORY
Received 7 February 2019
Accepted 3 April 2019
KEYWORDS
Addiction; existential;
positive psychology; PP2.0;
meaning; pluralism; brain
disease model
The problem of addiction has reached enormous proportions and is distributed across
all strata of society. It is suggested that the percentage of US adults suering from any
form of addiction oscillates between 15% and 61%, being highly plausible that around
47% of US adults manifest maladaptive signs of an addictive disorder over the period of
a year (Sussman, Lisha, & Griths, 2011). Moreover, the track record of addiction
treatment shows discouraging results: about 90% of addicts undergoing treatment
experience relapse (Brandon, Vidrine, & Litvin, 2007) and many suer from the revolving-
door phenomenon and the false-hope syndrome (Polivy & Herman, 2000). Beyond its
classication as a disease health issue, addiction is also a societal, economic and
CONTACT José Antonio Pérez-Escobar jose.perez@gess.ethz.ch; David F. Carreno carrenodf@ual.es
*These authors contributed equally to this work
COUNSELLING PSYCHOLOGY QUARTERLY
https://doi.org/10.1080/09515070.2019.1604494
© 2019 Informa UK Limited, trading as Taylor & Francis Group
spiritual issue. Addiction can psychologically impoverish and biologically kill the indivi-
dual, hurt the family, and harm society (Wong, 2013).
In this work, we want to examine both the medical model and the existential
approach to the complex phenomenon of addiction at dierent stages. Todays main-
stream medical model of addiction locates the problem in a physiological disorder of the
brain. This is why most research and clinical eorts are focused on this direction. We
believe that, in the best of cases, the medical model oers a partial perspective of the
phenomenon of addiction. Therefore, in this paper we will rst conceptualize addiction
as a plural phenomenon after an epistemological critique of the medical model.
Secondly, we discuss the underlying existential struggles discovered in people with
addiction from the dialectical perspective of Existential Positive Psychology (EPP;
Wong, 2009), also labelled as PP2.0 (Wong, 2011a). Finally, we introduce the Meaning-
Centered Approach (MCA) to addiction recovery which is aimed to help the client to
cope with existential challenges and nd purpose in life.
An overview of the neurobiological approach to addiction
Addiction is widely considered to be a chronic brain disease, a dysfunction of the reward
system in which genetic vulnerability produces about half of the risk for its emergence
and maintenance (American Psychiatric Association, 2017; American Psychological
Association, 2018; Volkow et al., 2010). The results of hundreds of laboratory studies,
mainly employing rodents and chronic drug addicts as test subjects, are used to support
the argument for this biological understanding of addiction.
The neurobiological approach to addiction has beneted from enormous amounts
of research funding and the interest of addiction researchers from biomedical dis-
ciplines. In the last few years, the middle and late stages of drug addiction have
caught the eye of most neurobiologists and neuropharmacologists. Recent research
has unveiled an ever-growing neurochemical imbalance across a wide variety of brain
systems, and has led to the belief that the dening characteristics of addiction (and
thus the key insights for potential treatments) are found in these stages (Koob &
Volkow, 2010).
However, some types of occasional and recreational use of drugs or activities like
gambling, eating, and shopping (which share key neurochemical pathways with drug
use; Holden, 2001) also play a key role in understanding the essence of addiction and
preventing its development. The early stages of addiction, characterized by recreational
binging (Koob & Volkow, 2010) involve the reward center of the brain (particularly, but
not exclusively, dopaminergic projections from the ventral tegmental area to the
nucleus accumbens) and the psychological mechanism of impulsive behavior.
Addictive agents hijack the reward system of the brain, whose function is to direct the
individual towards natural reinforcers of goodbehaviors (Berridge & Robinson, 2003).
Natural reinforcers, eclipsed by the addictive agents, progressively lose their ability to
trigger normal responses in the reward system (Volkow et al., 2010). In addiction, the
addicted individuals willpower to resist drug consumption is diminished, as activity in
cortical areas responsible for inhibitive control is decreased (Volkow, Fowler, & Wang,
2003), resulting in compulsive consumption instead of the impulsive consumption
characteristic of the early phases of addiction.
2D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
Consolidated addiction in later stages is a complex phenotype characterized by
compulsive drug consumption, constant anticipation of drug use, and relapse when
trying to quit consuming, which results in a deadly positive feedback loop of ever-
increasing severity of addiction. The addict, unlike the recently initiated in drug con-
sumption, does not consume for joy, but, according to the allostasis model (Koob &
Volkow, 2010), for relief from the sensitization of stress systems, which reects
amotivational withdrawal syndrome. The allostasis model predicts progressive sensi-
tization of stress systems through chronic drug consumption by vulnerable individuals,
during transition and late phases of addiction. This sensitization is reected in an
increased activity of diverse systems mediated by the monoamine noradrenaline and
several neuropeptides such as CRF, NPY, dynorphin, and substance P, among others.
These long-lasting changes, termed between-systemsneuroadaptations (Koob & Le
Moal, 1997), occur as unadaptive counter-responses to chronic drug use, and are the
base of a basal negative emotional state, increased and compulsive drug consumption,
enhanced reactivity to stressors, and increased vulnerability to, and therefore likelihood
of, relapse (Koob & Le Moal, 2001).
Pluralism
In this paper, we commit to a pluralist approach to addiction. We do so after the careful
consideration of two reasons. The rst is that there is no privileged level of analysis of
reality (and a fortiori, of addiction). The second is that, given the rst, we feel allowed to
advocate the use of whatever theoretical framework and techniques that yield desired
practical outcomes. In our case, this means the justication of an existential, meaning-
centered approach to addiction.
Due to the deeply rooted belief that hard sciences(neurobiology among them)
provide more fundamental explanations than softsciences (Campbell, 2005; Hedges,
1987; Platt, 1964; Storer, 1967; VanLandingham, 2014), neurobiological theories of
addiction are the default and most prevalent accounts for explaining and treating
addiction. Mechanistic worldviews are rooted in modern scientic thinking and appear
to be a very convincing way to earn credibility and public trust. It is for this reason that
we feel that, before proposing an existential approach to addiction, we must shortly
address the problem that reductionism, fundamentalism and methodological purism
pose.
First o, we reject the views that grant biology a privileged position in terms of
fundamentality against psychological constructs (biological reductionism), or that
straight away support the facticity of the former but denies the latter (eliminative
materialism). It has been argued that all-encompassing theories, by being too general
and unspecic, fail to be about anything real (Cartwright, 1983). This is what happens in
addiction: a general biological theory of addiction fails to represent any addict indivi-
dually considered. For this reason, we advocate local methods of study, rather than all-
encompassing generalization, and reject reductionist stances.
It could still be said that biology, as a science, is more rigorous than psychology,
especially when the latter is intertwined with existential theory. However, we should put
the rigor of biology in context. If the claim is made that the study of the biological
substrata of addiction is the most rigorousway to study addiction, then we should be
COUNSELLING PSYCHOLOGY QUARTERLY 3
reminded that biological rigor and physical rigor are dierent (Keller, 2007) and, in
addition, physical rigor and mathematical rigor dier too (Davey, 2003). What we
mean is that, ultimately, each eld has its own notion of rigor, and rigor should be
understood within disciplines, and not between disciplines. Therefore, biologists should
be concerned about doing good biology, and psychologists about doing good psychol-
ogy, without relegating their discipline to a brain-centrist perspective in order to achieve
recognition or be qualied as rigorous. The inquiry about rigor, in this scenario, must
always be followed by the question whose rigor?. For this reason, we advocate for the
use of multiplicity of methods, without being restricted to a given notion of rigor.
All in all, we believe that there is no privileged level of analysis to which all else is to be
reduced. For this reason, we consider that dierent approaches should be judged on their
practical virtues rather than on their t to a supposed fundamental truth, reality, purity or
methodological rigor. Even more, we think dierent incommensurable approaches can
coexist. One advantage of the pluralist approach is that dierent methodologies from
dierent theoretical frameworks can be combined in order to shed light to complex and
multifaceted phenomena, as addiction is. The other is that these approaches can be judged
solely in terms of their practical consequences, of custom criteria of success. Later on, we
will discuss the practical benets of the existential approach to addiction. Feyerabend
(1962) shows how phenomena admit several alternative theoretical descriptions equally
compatible with them, but which feature dierent theoretical constructs. Regarding addic-
tion, this means that it can be approached from a biological perspective as well as from
a non-materialist meaning-centered perspective.
This line of argumentation leads us directly to a need to redene addiction itself.
What kind of problem is addiction? The denitions of problems are always theory-laden,
that is, there is no neutral description of a problem that is not itself part of a theoretical
framework. Therefore, the very denition of the problem constrains how it is to be dealt
with. As such, if addiction is dened as a dysfunction of the brain, the focus of research,
prevention, treatment and follow-up will be brain-related (and alternative approaches
will be relevant inasmuch as they are linked to eects in the brain).
A biological disease to be medicated or a psychological problem to be
elsehow treated? The example of tobacco addiction
The rationale behind pharmacological treatments is that if addiction is better understood
as a neurochemical dysfunction, then a direct intervention into the brain using pharma-
ceuticals that modify the neurochemical system implicatedmay be the most eective
solution. However, are the current pharmacological treatments more eective than psy-
chological interventions? Let us consider the example of tobacco addiction treatment.
Among the most eective pharmacological treatments for smoking cessation is the
use of varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist. Among some
of the most relevant studies is the one of Jorenby et al. (2006), who found that 23% of
smokers subjected to a 12-week varenicline treatment were continously abstinent from
smoking for weeks 9 to 52, but only 10% in a placebo group and 15% of smokers
subjected to bupropion SR treatment (another recommended pharmacological treat-
ment). Knight, Howard, Baker, and Marton (2010) also found that 27.7% of patients
under varenicline treatment remained abstinent after 1 year.
4D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
However, when compared with psychotherapy, pharmacological interventions have
been shown to be less eective. For instance, Giord et al. (2004) compared Acceptance
and Commitment Therapy (ACT) with nicotine replacement treatment (NRT). A 1-year
follow up showed that 35% of participants in the ACT condition quit smoking versus
15% in the NRT condition (see also, Giord et al., 2011). In a similar study, Zernig et al.
(2008) found that 39% of participants in a short psychotherapy group, but only 12% of
participants in a bupropion SR group, remained abstinent after 1 year. These studies
suggest that psychological interventions for smoking cessation can be more eective
than pharmacological treatments.
Other studies provided evidence about the benets of combining pharmacotherapy
with behavioral support (e.g., Oostveen, van der Galien, Smeets, Hollinga, & Bosmans,
2014; for a review see Stead, Koilpillai, Fanshawe, & Lancaster, 2016). However, the
smoking cessation rates presented one year after treatment are similar to the ndings
from the aforementioned studies. According to the available literature, tobacco addic-
tion might be better considered as a psychological problem to treat rather than
a chronic brain disease to palliate with pharmaceuticals.
But, although psychological interventions seem to be moderately more eective than
pharmacological ones in tobacco addiction, there is a by far stronger predictor of smoking
cessation: the diagnosis of a smoking-related disease. According to an epidemiological
study by Twardella et al. (2006) with 4,575 individuals, the relative cessation rates in a year
after diagnosis were 11.2 for myocardial infarction, 7.2 for stroke, 2.5 for diabetes mellitus,
and 4.8 for cancer in comparison to years before diagnosis, suggesting that when smokers
experience the health consequences of smoking, a high amount of them quit. Park et al.
(2012) found that 63% of patients with lung cancer who had been smoking around the time
of diagnosis had quit by 5 months after such. Among the factors associated with continued
smoking were being unmarried, reporting higher level of depression, and reporting less
emotional support. Cooley et al. (2009) showed that 50% of smokers were able to quit and
not relapse into smoking during 4 months after lung cancer surgery. In this study, only 46%
of patients received smoking cessation treatment. Other studies have shown a higher than
80% rate of smoking cessation after one year of lung cancer diagnosis (Dresler, Bailey,
Roper, Patterson, & Cooper, 1996;Gritz,Nisenbaum,Elasho,&Holmes,1991).
Taken together, the smoking cessation rates mentioned above show that the diag-
nosis of smoking-related diseases like lung cancer produce a clearly higher smoking
cessation rate than both the ordinary pharmacological and psychological treatments.
What could the factors behind this phenomenon be? Below, we argue that existential
struggles related to meaning in life, self, guilt, responsibility, and relationships with
others and society better account for the development and maintenance of addiction.
These existential challenges, including the motivation for survival, surface after the
diagnosis of life-threatening illnesses and they have been generally ignored, under-
estimated, or supercially covered in mainstream treatments for addiction.
The status of the neurobiological approach to addiction and
a reconceptualization of the problem
As we justied before, it is important to evaluate the virtue of each approach in regard
to their practical consequences. We will see that the neurobiological one falls short of
COUNSELLING PSYCHOLOGY QUARTERLY 5
dealing with the problems it purports to solve, and hence, we will reframe the problem
pluralistically.
The allostasis model of addiction mentioned earlier, and other neurobiological the-
ories of addiction, have been quite successful in laboratory conditions, having achieved
considerable internal and face validity, predictive power, and having provided a useful
theoretical framework for neuroscientists to follow. However, their external validity is not
on par, and for this reason, they do not elude the anti-reductionist critique that addic-
tion should not be (only) considered as a biological phenomenon. Consider, for example,
the classical animal self-administration study by Bruce Alexander (Alexander, Beyerstein,
Hadaway, & Coambs, 1981; Alexander, Coambs, & Hadaway, 1978): rats in an enriched
environment (Rat Park) did not display many of the behaviors characteristic of addiction,
while they did when conned in cages resembling the environment in which rats
employed in addiction experiments inhabited. Rat Park, unlike experimental cages,
was a large surface full of toys and stimulation where communities of rats lived together
and could engage in social behavior and mating. Alexander claimed after these results
that animal self-administration studies yielded little to no insight on drug addiction. If
anything, they were evidence that animals in isolation and deprived from rich contexts
and natural reinforcers turned to drug consumption. He called the mainstream concep-
tion of addiction with an emphasis on the drug and its eects on the brain the Myth of
the Demon Drugand this conception is still the most popular to this day.
Furthermore, it has been noted how most soldiers who consumed heroin during the
Vietnam War did not suer from heroin addiction upon return to their homes and
instead ceased heroine consumption (Robins, 1993). The soldiers, who engaged in
heroine consumption because of its anaesthetic properties but also because of the
extreme diculties of the war, did not feel an urge to consume when surrounded by
their relatives and friends in a healthy and prosperous context.
Even more, an emphasis on the biological aspect of addiction may have the eect of
depriving addicts of a sense of agency that might otherwise lead them to implement
meaningful changes in their lives: after all, it is a biological problem only, and therefore
there is nothing I can do about it.
As we see, the neurobiological approach does not seem to be telling the whole story.
Its overgenerality and all-encompassing ambitious stance is precisely what makes it
blind to aspects that are incommensurable with its framework. But treatment is not
the only practical aspect awed as a consequence of this attitude: prevention is aicted
too. The neurobiological approach often explains why some individuals but not others
develop addiction in terms of their biological characteristics. The picture of vulnerable
individualdepicted is a shady one: it is proposed that vulnerable individuals have been
unlucky in the genetic lottery, and have a natural predisposition towards addictive
behavior. However, these genetic vulnerabilities are seldom specied in actual addicts,
and when they are, it is done either in laboratory animals in poorly representative
conditions (a method which further promotes blindness towards existential factors), or
post hoc in humans (on people that are addicts already), which throws away the very
purpose of prevention and furthermore casts doubt on the causal direction. On top of
that, even if specic genetic markers were identied as being directly and causally
related to addiction, gene manipulation would pose challenges in multiple fronts (not
only technically, but also, for instance, ethically). Therefore, genetic vulnerabilities are
6D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
often taken for granted, studied in animals in articial laboratory conditions or post hoc
in addicts, and leave no real room for preventive measures. Worst of all, and similarly to
the above paragraph on treatment, this discourse can have the deleterious eect of
masking or discrediting alternative etiological hypotheses and preventive measures.
All in all, both treatment and prevention are awed in the practical sphere of things.
And yet, the neurobiological approach to addiction holds sway. This is dicult to justify
given that, as we will see, there are other frameworks that oer alternatives to document
which individuals are at risk, provide convenient preventive and treatment solutions,
yield a more holistic approach to the addict and addictive behavior, and in general,
contribute to lling the blind spots that the neurobiological paradigm leaves behind.
And indeed, there is space for alternative frameworks: the partial success that main-
stream psychology has already achieved in this regard speaks for itself (although it
remains for the most part relegated to brain-centrism). It is imperative to go further in
this direction, depart from brain-centrism and arrive to a properly pluralist position. Here
is where the meaning-centered approach comes into play.
Addiction is as much of a biological phenomenon as it is a psychological, social, legal,
anthropological, and as we will argue, even an existential phenomenon. After this
consideration, it should be carefully established whether addiction is a neurochemical
imbalance, a disconnection from other reinforcements prompted by social exclusion,
a coping strategy by individuals who have failed to nd a meaningful life, or rather,
a combination of these problems. We should also reformulate concepts such as vulner-
able individual, which for the neurobiological approach means someone with genetic
predisposition towards addiction, also as someone repressed by social taboo and
excluded from long-term bonds and life satisfaction,orsomeone lacking the basic
skills to cope with the horrors of life.
The neurobiological approach, in spite of having extensively documented the eect
on the brain of natural reinforcers (Kelley & Berridge, 2002; Noori, Linan, & Spanagel,
2016; Olsen, 2011) does not take them into account for the explanation of the onset of
addiction or for its therapy, or in the best of cases, vastly downplay them. It has been
proved how access to non-drug rewards like sugar and saccharin have a protective
eect against cocaine and heroin consumption in laboratory animals (Carroll, Howell, &
Kuhar, 1999; Lenoir & Ahmed, 2008), which is reminiscent of the eects observed in
Alexanders Rat Park environment. Therefore, these reinforcements cannot be taken out
of the equation: addicts often nd shelter in drug consumption due to rejection and
seclusion, which privates them from natural reinforcements. Furthermore, this also
privates them from meaning in life. Humans are complex beings and present needs
other than food, sleep and sex. For this reason, meaning in life and a sense of fulllment
might confer this kind of protection at a much higher degree. It is also for this reason
that rebuilding the world of the addict cannot just be an afterthought in the treatment,
but a priority.
In Aldous Huxleys(1932)Brave New World, all citizens consumed soma, a drug that
provided them with constant gratication, soothing of discomfort, and dissipation of any
motivation to change society, rules, or the situation in general, eventually hollowing it
out of meaning. Would a substitute pharmacological treatment improve things much?
By using this analogy, one can see how incomplete the pharmacological approach is in
COUNSELLING PSYCHOLOGY QUARTERLY 7
order to treat addiction and the shattered worlds it creates. The biological aspect of
addiction is actually much smaller than it is given credit for.
A clinical conception of addiction
We must clarify then the concept of addiction we use throughout this article. Addiction
cannot be considered exclusively in terms of physical dependence, withdrawal, toler-
ance and quantity of consumption of a substance, or time devoted to a particular
activity. For example, many people can use high doses of a substance during many
years, displaying high resilience to potential adverse eects of the drug, and still not
present a psychological problem. One can freely choose to regularly consume caeine or
cocaine, being aware of the consequences, because it provides one with enough energy
to carry out a loved job, or to sporadically make use of marihuana because it makes one
think more creatively (e.g., some brokers in Wall Street or entrepreneurs in Silicon
Valley). Drugs have been used practically from the beginning of human existence and
they are not a problem themselves.
However, addiction implies a clinically signicant impairment or distress. Substance
use disorders and other addictive disorders entail physical, psychological, and/or inter-
personal problems as a consequence of the substance use or activity the person is
addicted to (American Psychiatric Association, 2013). Addiction aects drastically the
quality of life of the addict and creates a strong disconnection between who one wants
to be and who one really is. Besides, addiction disorders often include withdrawal
complications (such as anxiety, irritability, restlessness, and sleep problems) in the
absence of a given substance or activity and unsuccessful attempts to cut it down
(American Psychological Association, 2018). When we speak of addiction or an addict in
this article, we refer to this clinical picture.
An existential perspective of addiction
What is the existential perspective? Wong (2017) provides this denition:
Existentialism is concerned with the inescapable aspects of human existence and addresses
the recurrent questions of human struggles: What am I doing here? What is the point of
striving toward a goal, when death is the inevitable end? How can I live a worthwhile life?
How can one nd happiness in a world full of suering? Because clients may raise existential
concerns during counseling, implicitly or explicitly, psychotherapists, regardless of their
therapeutic modality, need to be prepared to address these concerns. Unlike other
approaches to psychology and psychotherapy, the existential perspective focuses on the
role of meaning as a pathway to survive and thrive in a chaotic and meaningless world. (p.
1374)
For thousands of years, human beings have been aware of their existence, asking and
answering these questions about themselves and the meaning of their lives. According
to Frankl (1985), the quest for meaning in life is the manifestation of the spiritual drive of
human beings. Spirituality is expressed as the human propensity toward self-
transcendence, the striving for something beyond and bigger than the self (Wong,
2014). We know that psychological well-being and happiness depend to a great extent
on having solved these questions satisfactorily. But, while many people have developed
8D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
a coherent and worthy sense of themselves, linking their past, present, and future in
a meaningful way so that they feel connected to others (no matter whether they are
close to people, society, animals, or God), to what really matters in life for them, other
people have not developed an adequate existential framework to protect and sustain
them in times of personal crises.
People with addiction generally appear to live in a serious struggle with existential
challenges (Ford, 1996; Wiklund, 2008a). For example, perceiving oneself as alienated
from the self and others has been described as a motive for drug use (e.g., Boyd &
Mackey, 2000). Addiction has been also considered as a mechanism to escape from
suering and traumatic experiences (e.g., Nehls & Sallmann, 2005; Zakrzewski & Hector,
2004). According to a qualitative study by Wiklund (2008b), addiction presents conicts
such as meaninglessness, loneliness, death, guilt, and loss of control. Other authors have
conceived addiction as a narrow hedonistic way of existence (Kemp, 2011), and one of
the outcomes of existential vacuum (Frankl, 1969; Wong, 2011b) and societal malaise
(Alexander, 2001).
The dialectical perspective of PP2.0
However, addition cannot be exclusively approached either as a maladaptive seek of
hedonism or as an articial escape from suering and existential despair. The psycho-
logical study of addiction requires a more integrative approach that includes the
following two self-regulation procedures: the pursuit of the positive and the avoidance
of the negative. Wongs Dual-Systems Model gives an account of this self-regulation
duality in depth (Wong, 2012a). According to this model:
The approach and avoidance systems coexist and operate in an interdependent fashion.
The approach system represents appetitive behaviors, positive aects, goal striving, and
intrinsic motivations. The avoidance system represents defensive mechanisms against nox-
ious conditions, threats, and negative emotions. Both systems need to interact with each
other in order to optimize positive outcomes. (Wong, 2012a, pp. 6 and 7)
Wong claims that an adaptive interaction of these two motivational systems is
necessary to have an optimal life. For example, whereas positivity is linked to sub-
jective well-being, certain levels of negativity can be useful to develop resilience
(Wong, 2012a).
Based on these dialectical principles and the integration of humanistic existential
psychology with positive psychology, a new paradigm called existential positive psy-
chology(EPP; Wong, 2009), also labeled PP2.0(Wong, 2011a) and second wave of
positive psychology(Ivtzan, Lomas, Heeron, & Worth, 2015; Lomas & Ivtzan, 2016) has
emerged. PP2.0 is a development of the rst wave of positive psychology (PP; Seligman
& Csikszentmihalyi, 2000), a paradigm criticized for being excessively focused on posi-
tivity (e.g., Held, 2004; Wong & Roy, 2017). In addition to the positive qualities of human
functioning proposed in the PP research, PP2.0 claims that to bring out the best in
people it is necessary to embrace the dark side of life. In life, suering is inevitable but
also potentially benecial. According to this view, heartbreaking moments, traumas,
death, illness and existential abyss, among other challenges, although may instinctively
COUNSELLING PSYCHOLOGY QUARTERLY 9
be considered undesirable, can be promoters of personal and spiritual growth (Wong,
2011a).
In the following sections we oer a conceptualization of addiction under this exis-
tential positive perspective. Addiction can be interpreted as a maladaptive response to
the existential challenges from both the positive and the negative self-regulation
systems.
Relational problems in addiction
Many of the existential struggles in addiction are collected in the following narrative by
a client involved in drug abuse during his adolescence:
My drug addiction began after being rejected by the girl I had fallen in love with. By that
time, I was changing my group of friends since the previous one did not convince me at all.
The majority of my new friends were addicted to tobacco, and cannabis, drank a lot of
alcohol during the weekend, and used quite often hard drugs like cocaine or ecstasy.
Although they were seen as a conictive group in my town, for me they were just dierent,
good people rejected by a classist society. Many of them had dysfunctional families like
mine. . . The freedom I got in my new role, the intense emotions I was experiencing were
everything for me. . .I was overcoming my fears, breaking down limits. I even challenged
authorities quite often. Being the worstof the group made me feel good, a leader. . . Many
of the times I got high I had the courage to get closer to that girl, expressing my love for
her, always received with ambivalence or rejection. The relation with my mother became
worse and worse, my dream of enrolling at university was vanishing, and the chance of
dating that girl was practically null. I was falling behind the rest of people, distancing from
myself. . . Those friends were not the good friends I had imagined.
In the above case, we can see that the adolescent is striving to nd people with whom
he can feel connected and supported. This relational decit has been generally found in
people with addiction. For example, Hardie and Tee (2007) found that internet over-
users and addicts are characterised by being less extrovert as well as more socially
anxious and emotionally lonely than average internet users. Mothers recovering from
drug addiction reported aversive childhood experiences related to problematic parent-
ing, a current lack of social support, and decient parenting skills themselves (Harmer,
Sanderson, & Mertin, 1999). Other studies have also evidenced that drug addicts exhibit
lower perceived social support than those who do not use drugs (Dodge & Potocky-
Tripodi, 2001). Indeed, authors such as Kemp and Butler (2014) have even suggested
that at the heart of addiction are the issues of love and hate. According to these authors,
the addict seeks love but nds hate from others.
The problematic dual function of a wide variety of addictions regarding relationships
is that, on the one hand, it can serve as the means to seek connection with others, and
on the other hand, it can be the means to numb the pain of rejection or social isolation.
Firstly, the inhibitory eect of many drugs (like alcohol or opiates) can be a vehicle to
create emotional links with others by removing shame and facilitating emotional expres-
sion. Gambling and internet surng can be also a way to nd social interaction. Some of
the key activities in these types of addiction are online multiplayer gaming and chatting
which create virtual social spaces where the person interacts online with other people.
Secondly, in social isolation, the absence of the rich amalgam of stimulation and
emotions naturally produced by social reinforcers may lead to substance abuse or
10 D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
excessive indulgence in addictive activities. In this situation, the object of addiction
could be a poor articialsource of reinforcement that cannot be otherwise naturally
obtained from social life. Thirdly, in the case of having negative experiences such as
abuse or rejection from other people like family, friends, classmates, either before
developing the addiction or as a consequence of it, the addict can use the substance
or activity as a short-term way to escape from suering.
When ones life is full of attacks and snubs from others, one will likely develop
a negative sense of oneself: to the eyes of the self, one becomes a black sheep, an
outcast, someone inferior to the surrounding people. Drugs and addictive activities may
temporally relief such painful feelings. Taking into account that addicts often nd
rejection by society as well, as they can be considered to be irresponsible losers or
deviant and mad (Kemp & Butler, 2014), addictive behaviors can be the pathological
result of dissatisfaction with or rejection of the self (Das, 1998). Therefore, love and
empathy should be two of the central healing features in addiction recovery (Kemp &
Butler, 2014).
The proposal of a healing community for addiction recovery has been emphasized by
dierent institutions and authors such as Alcoholics Anonymous (1939/1990), Peck
(1978), Picucci (1996) and Wong (2011b). Being a member of a group of people,
comprised of either professionals, clients or both, which promotes an environment of
acceptance, care, and trust, provides many opportunities to experience psychosocial
integration and learn new social skills.
Guilt and responsibility in addiction
The disease concept of alcoholism has been spread during the last decades under the
pretext that it promotes humanitarian attitudes towards alcoholics (Crawford & Heather,
1987; Room, 1972). This disease analogy became the de facto explanation of addiction,
conning alcoholics within a victim role and reducing or even altogether removing their
sense of guilt and freedom of choice about their drug use (Robinson, 1972). Today,
although the inuence of psychosocial factors has been recognised, the disease model
remains the major explanation of substance addiction (e.g., American Psychiatric
Association, 2017).
However, the removal of a sense of guilt and responsibility about addiction can be
a double-edged sword. On one hand, reducing guilt about addictive behavior can help
one by preserving up to a point a sense of will, worthiness and control. In the words of
Ford (1996):
[People with addiction] frequently become depressed and hopeless in response to their
guilt they tell themselves that they could never hope to correct the wrongs that they have
done to others or make up for the years that they have wasted, so it is not worth attempting
to do so. Also, they believe that their past misbehaviour indicates that they are just badby
nature. This preoccupation with guilt often serves to impede the process of change. (p. 155)
But, on other hand, removing guilt about present decisions (be they passive or active)
can be a scapegoat from taking responsibility about ones misbehavior that perpetuates
addiction. Guilt is a signal that ones behavior is inconsistent with ones values (Ford,
1996). Although excessive guilt about the past can hinder the recovery process, a sense
COUNSELLING PSYCHOLOGY QUARTERLY 11
of responsibility oriented towards present and future actions is necessary to cease
addictive behavior.
We assume that regardless of whether humans are determined or not by their
facticity (the physical, biological, social, and cultural conditions in which they were
born and live), they are in a sense condemned to be free (Sartre, 1943/1956). Modern
western societies, inuenced mainly by the predominant deterministic discourse of
science, normally explain human behavior through factors such as biology, emotions,
cognitions, social context, etc. Most of these explanations encourage an external locus of
control and often underestimate the potential of an individual to make free decisions.
For example, we learn that one has depressionbecause of a neurochemical dysfunc-
tion, a lack of positive stimuli, a low self-esteem, a traumatic experience, or a relational
decit. Whatever the reason, they are rarely considered as a consequence of free choices
(active or passive) made by a person. However, even in situations of high levels of
suering, there is always some degree of freedom in the attitude we adopt toward that
suering (Frankl, 1985).
This escape from the degree of freedom we have as human beings is very present in
addiction. People with addiction tend to show an external locus of control (e.g., Drew,
1986; Iskender & Akin, 2010; Sheer et al., 2012). They normally consider their addiction
to be superior to their willpower, and that hence they cannot stop it. And, although
some people feel that they have control of their addictive behavior, they always post-
pone its interruption.
This external locus of control usually accompanies negative feelings such as guilt,
misery, impotence, and despair about their perceived inability (Ford, 1996). Such feelings
surface even more when there is a failure to cut the addiction down. Relapses can bring
more doubt about making a positive life change and submerge those with addiction
deeper and deeper inside avery dark place. The more problematic the life into which
one has introduced oneself is, the more dicult assuming responsibility about it is. If
one assumes that drug consumption can be interrupted in the present, one could also
assume that its cessation was possible in earlier stages, which can create a feeling of
guilt about the past.
Treatments should not be exclusively focused either on the reduction of the addictive
behavior like traditional psychological treatments, or on cultivating more positive emo-
tions that replace the object of addiction as proposed by the rst wave of positive
psychology treatments (see Krentzman, 2013). In line with PP2.0 (Wong, 2011a), deepen-
ing ones self-understanding and learning how to deal with the dark side of human
existence, in which we often observe feelings of guilt, misery, and inability, should be an
integral component of psychological programs for addiction. It is necessary to help
people with addictions forgive themselves for their reprehensiblepast and taking it
with acceptance, while encouraging responsibility for present and future choices and
actions. Therapies such as logotherapy (Frankl, 1985) and meaning-centered therapy
(Wong, 2012b) restore the human freedom of will and the imperative of personal
responsibility, accepting diculties as a strong motivation for transformation. Research
has shown that responsibility and a sense of coherence are important for addiction
recovery (Feigin & Sapir, 2011).
12 D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
Meaninglessness in life in addiction
We speak of meaninglessness in life when the core existential questions about ones life
(Wong, 2017) are not solved, when one does not have a clear purpose and motivation in
life, when one is disconnected from others, society, or an ultimate purpose (let us call it
humanity, greater good, nature, universe, God or whatever that is beyond the self),
when there is a huge inconsistency between who one would like to be and who one
really is (or perceives oneself to be), when there is a feeling that ones life is not worth
living. Addiction has been suggested to be the outcome of this existential vacuum,
a lack of meaning in life (Frankl, 1969; Wong, 2011b,2013).
Apart from substance use or engaging in addictive activities, people with addiction
seem to live deprived from a clear sense of meaning and purpose in life (e.g., Didelot,
Hollingsworth, & Buckenmeyer, 2012; Johnson, Grin-Shelley, & Sandler, 1987). There is
a need for them to create a new interpretation of their world, to experience coherence
in life, to restore dignity as well as a sense of community and attachment (Wiklund,
2008b). For people with addiction, terms like boring,dull,awful, and trappedare
common (Kemp, 2011). Addictsdaily life is usually repetitive, and they exhibit some of
the following features: (a) withdrawal from the world, (b) very little contact with others,
(c) low physical activity, (d) excessive hedonism and leisure activities like TV watching,
and (e) monotony. The lived space is often reduced to their homes. In this sense, people
with addiction seem to be living in an inner fantasy world (Kemp, 2011).
There is also a problematic dialectic function of addiction from a meaning perspec-
tive. Addiction may not only be the consequence of a hedonistic life (seeking constant
short-term stimulation), addiction can be also a way to escape from the responsibility
and suering that a meaningful prosocial life often demands.
A hedonist orientation, a change of moral norms, and overabundance in a society can
produce existential vacuum (Frankl, 1969). These three factors are very much present in
worldwide societies today. A predominance of short-term stimulation over long-term
goals prevents people from living a life with deep meaning and fulllment. The epi-
demic of addiction and the accompanying psychological and societal problems are
some of the outcomes of this hedonistic lifestyle in an excessively materialistic and
individualistic auent society. According to Frankl (1986), The feeling of meaningless-
ness. . .underlies the mass neurotic triad of today, i.e., depression-addiction-aggression
(p. 298).
However, when a life-threating illness is diagnosed, that worldview, lifestyle and
evasion of responsibility are challenged. In the example of tobacco addiction we have
seen how death awareness results in the cessation of consumption and the abandon-
ment of this passive style of living. The problem is that sometimes it is too late to
recover from the physical damage produced, and it eventually leads to death.
Treatments for addiction should develop techniques that produce a similar existential
awareness and the commitment to an addiction-free meaningful life.
The meaning-centered approach to addiction recovery
Previous studies have corroborated the ecacy of introducing the existential aspect of
meaning in life in treating addiction. For instance, Chen (2006) observed that the
COUNSELLING PSYCHOLOGY QUARTERLY 13
integration of spirituality (understood as connectedness to oneself, to the environment,
or to a higher power [Adams & Bezner, 2000]) with social support in a 12-step program
for addiction recovery produces a higher sense of coherence and meaning in life,
together with a reduction in the intensity of negative emotions in comparison with
exclusively social support interventions. Other proposals of incorporating meaning in life
elements in treatment for addiction and its ecacy can be seen in Giord et al. (2004),
Giord et al. (2011)), Krentzman (2013), and Somov (2007).
Throughout the text, we have argued based on evidence that an eective treatment
for addiction should address the existential struggles of the client (like social isolation
and relational problems, evasion of responsibility and meaninglessness in life) while
paying special attention not only to the positive motivation that leads people to use
drugs or to repeat the activity they are addicted to, but also to the negative reinforce-
ment of these behaviors via a relief of social rejection and traumas and an escape from
existential despair, guilt and responsibility. We believe that one paradigm for treating
addiction that covers these important issues is the eaning-centered approach (MCA;
Wong, 2011b,2013).
MCA or meaning-centered therapy (MCT) is rooted in existential positive psychology
(EPP; Wong, 2010)orPP2.0(Wong,2011a). While considering the positive aspects of human
functioning (such as positive aect, personal strengths, ow, engagement and purpose)
derived from the rst wave of positive psychology (Seligman & Csikszentmihalyi, 2000),
PP2.0 emphasizes the potential benet of negative factors and suering in life for optimal
functioning and personal growth. PP2.0 highlights the dynamic interplay between the
bright side and the dark side of life for human ourishing.
Derived from the principles of Frankls logotherapy (Frankl, 1985), at the heart of MCA
there is the focus on meaning in life and the centrality of spiritual needs for human
ourishing (Wong, 2011b). Thus, the MCA for treating addiction does not only include
goals of recovery from addiction but also seeks a restoration to fullness of life and
reintegration into society. The aim is to help the client to discover and choose a mission
in life, awaking their drive towards meaning and their capacity for freedom and respon-
sibility. The problem of addiction is not the drug use or the addictive activity, but the
person who keeps doing such actions until destroying their life. According to this
perspective, although complete abstinence may be the consequence of complete life
restoration, it is not necessary for it (Wong, 2011b).
Wong (2011a) provides the following overview of the MCA characteristics:
(1) Holistic: From a bio-psycho-social-spiritual model, it treats the whole person
rather than only addiction as a disease.
(2) Integrative and comprehensive: It can complement other evidence-based addic-
tion treatments. It makes use of all available resources to achieve treatment goals.
(3) Meaning-centered: Addiction is understood as the symptom of existential
vacuum; therefore, it helps clients to cope with the existential and spiritual
challenges.
(4) Relational: The therapist is the most important instrument in therapy. Relationship
with the client is an authentic here-and-now encounter that reaches a deep level
of intimacy, empathy and trust.
14 D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
(5) Community-oriented: MCA includes a healing community in which people with
addiction can feel socially integrated and learn new ways of relating and coming
together.
(6) Psycho-educational: An important part of the treatment is to teach clients the
underlying factors related to their addiction and the need for learning more
adaptive coping skills.
(7) Optimistic: Although it recognizes the darkness of reality, it uses the concept of
tragic optimism (Frankl, 1985) to make clients believe that no matter the circum-
stances, we can keep hope.
The PURE model
The ambivalence between being sober versus remaining an addict stems from the fact that the
gains of leading a drug-free life are not strong enough to compete with the intense pleasures
of being high (Wong, 2011b). In fact, during recovery, many addicts still experience a void in
their lives, which initially drove them to addiction. Since the eects of a substance or an
addictive activity have been normally the major source of reinforcement (positive and nega-
tive) in the addicts life, its removal must be necessarily supplied with other powerful reinfor-
cers. The goal of MCA is not only the cessation of addictive behavior, but also the switching
from a shallow hedonist existence into a deeper and more fullling meaningful life.
MCA helps clients with addiction restore meaning and passion for living under the frame-
work of the PURE model. According to the PURE model (Wong, 2012a), meaningful living is an
integration of four dierent elements: Purpose, Understanding, Responsible action, and
Enjoyment/Evaluation. Purpose is the motivational component of meaning; it is about having
goals, values, aspirations and directions, knowing what is important for one in life.
Understanding is the cognitive component of the model and is related to nding a sense of
coherence, making sense of the situations, understanding ones own identity and other
people. Responsible action is the moral and behavioral part of meaning, the commitment
through actions based on personal values, being responsible to do what one believes is
morally right. Enjoyment/Evaluation is the aective component; it is about assessing the
degree of satisfaction or dissatisfaction with the current situation and the life one is living.
Based on these four pillars for a meaningful life, MCA for addiction recovery proposes
dierent techniques such as the ABCDE strategy (Accept reality, Believe that life is worth living,
Commit to goals, Discover the meaning, Evaluate and Enjoy the outcomes) in order to over-
come negativity and cope with the suering associated with the recovery process. Other
strategies like Wongs 5 steps (acceptance, armation, courage, faith and self-transcendence)
are also used to restore hope during a relapse or a period of depression (for a detailed
description of these and other techniques used in MCA, see Wong, 2011b,2013).
Conclusions
Addiction is widely considered to be a chronic brain disease. Research over the last decades
has been heavily focused on laboratory studies addressing neurochemical dysfunctions in
rodents and chronic addicts. Convinced of the fundamentally biological character of addiction,
neuroscientists have strived to develop mostly pharmacological treatments to palliate
COUNSELLING PSYCHOLOGY QUARTERLY 15
addictive behavior. However, the brain disease model has failed to yield a rich and successful
accountofthecomplexphenomenonofaddiction.Someoftheweaknessesoftheneurobio-
logical model of addiction are poor external validity of laboratory studies (which fails to
account for elements present in natural contexts), the assumption of genetic vulnerabilities
and how it impairs prevention measures, and the low ecacy of pharmacological treatments
in practice, among others.
The neurobiological model can be contested in both epistemological and methodo-
logical grounds by criticizing the fundamentality of any level or approach over others
and the connement to a restricted set of methods that supposedly captures such
fundamentality.
Our critiques are in line with the work of Marc Lewis (2017), a neuroscientist who
defends that the brain changes observed in addiction share the same characteristics of
those generally observed in the development of deep habits, and therefore, they cannot
be attributed to a brain disease as usually conceived.
We believe that a pluralist approach to addiction which is more concerned about
practical results than ideals of fundamentality, purity and good scienceis a more
suitable approach to understand and treat this also societal, economic and spiritual
problem.
From a holistic perspective we observe that people with addiction often present existential
struggles that could account for the development and maintenance of addiction. Addiction
can be interpreted as a narrow hedonistic way of existence (Kemp, 2011), one of the outcomes
of existential vacuum (Frankl, 1969;Wong,2011b,2013) and societal malaise (Alexander, 2001).
existential positive psychology (or PP2.0) provides a pluralistic framework of addiction that can
explain the underlying maladaptive self-regulation when coping with existential challenges.
Based on the evidence at hand, we rstly discussed the existential struggle related to the social
disconnection experienced by this population.Inlinewiththedual-systemsmodel(Wong,
2012a), behind substance abuse and activities like excessive gambling or internet surng can
be a problematic way to nd human connection, a counterfeit substitute of emotional
stimulation that cannot be naturally obtained from social interaction, or a means to numb
the pain of rejection and interpersonal traumas.
Secondly, another underlying existential struggle in addiction is the evasion of guilt and
responsibility. The message that the problem behind addiction is not weakness of will but an
underlying physical illness can be a double-edged sword. Although it can preserve certain
sense of will and worth of the addict, it can also be a mechanism to escape from taking
responsibility about the own misbehavior that in turn perpetuates addiction. One may blame
ones genes, environment, relatives, or call it a disease. One may rightly confess onesutter
helplessness to get over the addiction. But ultimately, one still holds the key to recovery.
This lack of responsibility is also linked to a lack of meaning and purpose in life (e.g., Didelot
et al., 2012;Johnsonetal.,1987). Following a meaningful prosocial life requires coping with
suering and taking responsibility for personal actions, but over time fewer people accept this
lifestyle. Existential crises are frequent in modern societies characterized by a hedonistic-
sedentary style of living, materialistic, individualistic, with increasing depersonalization and
dehumanization due to global competition. Addiction is just one of the outcomes of this
existential vacuum.
Finally we proposed the meaning-centered approach (MCA) or meaning-centered therapy
(MCT) for addiction recovery (Wong, 2011b,2013). Rooted in PP2.0, MCA intends to help clients
16 D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
with existential struggles such as social isolation, traumas, rejection, guilt, evasion of respon-
sibility and lack of purpose in life behind their addiction. Its ultimate objectives are the
realization of clientsfull potential, full integration into society, and the restoration of purpose
and passion for living. Thus, MCA is characterized as being holistic, integrative, meaning-
centered, relational, community oriented, psycho-educational and optimistic. Because of this
existential emphasis, MCA can be an essential complement for mainstream addiction treat-
ments. The available evidence about the eectiveness of current treatments for addiction
shows that there is still much room for improvement. MCA has been recently developed with
the purpose of integrating and enhancing insights from the addiction literature. However, the
outcomes it promises must be still evidenced. We call for empirical studies assessing in depth
the virtues of this approach for treating addiction. Beating addiction is hard, especially when it
becomes chronic. However, recognising and dealing with the existential facet of addiction may
be a way to facilitate the process.
Disclosure statement
No potential conict of interest was reported by the authors.
Notes on contributors
David F. Carreno is a PhD candidate and lecturer at the Department of Psychology at University of
Almeria, Spain. He also works as a psychotherapist and counsellor.
José Antonio Pérez-Escobar is a PhD candidate in philosophy of science at ETH Zürich, Switzerland.
He has a formal academic background in psychology, neuroscience and philosophy.
References
Adams, T. B., & Bezner, J. R. (2000). Conceptualization and measurement of the spiritual and
psychological dimensions of wellness in a college population. Journal of American College
Health,48, 165170.
Alcoholics Anonymous. (1939/1990). Alcoholics anonymous. New York, NY: AA World Services.
Alexander, B. K. (2001). The roots of addiction in free market society. Vancouver, BC: Canadian Centre
for Policy Alternatives.
Alexander, B. K., Beyerstein, B. L., Hadaway, P. F., & Coambs, R. B. (1981). Eect of early and later
colony housing on oral ingestion of morphine in rats. Pharmacology Biochemistry and Behavior,
15(4), 571576.
Alexander, B. K., Coambs, R. B., & Hadaway, P. F. (1978). The eect of housing and gender on
morphine self-administration in rats. Psychopharmacology,58(2), 175179.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5). Washington DC, MD: Author.
American Psychiatric Association. (2017, January). What is addiction? Retrieved from https://www.
psychiatry.org/patients-families/addiction/what-is-addiction
American Psychological Association. (2018, March 14). Addictions. Retrieved from http://www.apa.
org/topics/addiction/index.aspx
Berridge, K. C., & Robinson, T. E. (2003). Parsing reward. Trends in Neurosciences,26(9), 507513.
Boyd, M. R., & Mackey, M. C. (2000). Alienation from self and others: The psychosocial problem of
rural alcoholic women. Archives of Psychiatric Nursing,14(3), 134141.
Brandon, T. H., Vidrine, J. I., & Litvin, E. B. (2007). Relapse and relapse prevention. Annual Review of
Clinical Psychology,3, 257284.
COUNSELLING PSYCHOLOGY QUARTERLY 17
Campbell, P. (2005). In praise of soft science. Nature,435(7045), 1003.
Carroll, F. I., Howell, L. L., & Kuhar, M. J. (1999). Pharmacotherapies for treatment of cocaine abuse:
Preclinical aspects. Journal of Medicinal Chemistry,42(15), 27212736.
Cartwright, N. (1983). How the laws of physics lie. Oxford: Oxford University Press.
Chen, G. (2006). Social support, spiritual program, and addiction recovery. International Journal of
Oender Therapy and Comparative Criminology,50(3), 306323.
Cooley, M. E., Sarna, L., Kotlerman, J., Lukanich, J. M., Jaklisch, M., Green, S. B., & Bueno, R. (2009).
Smoking cessation is challenging even for patients recovering from lung cancer surgery with
curative intent. Lung Cancer (Amsterdam, Netherlands),66(2), 218225.
Crawford, J., & Heather, N. (1987). Public attitudes to the disease concept of alcoholism.
International Journal of the Addictions,22(11), 11291138.
Das, A. (1998). Frankl and the realm of meaning. Journal of Humanistic Education & Development,36
(4), 199212.
Davey, K. (2003). Is mathematical rigor necessary in physics? The British Journal for the Philosophy
of Science,54(3), 439463.
Didelot, M. J., Hollingsworth, L., & Buckenmeyer, J. A. (2012). Internet addiction: A logotherapeutic
approach. Journal of Addictions & Oender Counseling,33(1), 1833.
Dodge, K., & Potocky-Tripodi, M. (2001). The eectiveness of three inpatient intervention strategies
for chemically dependent. Research on Social Work Practice,11(1), 2440.
Dresler, C. M., Bailey, M., Roper, C. R., Patterson, G. A., & Cooper, J. D. (1996). Smoking cessation and
lung cancer resection. Chest,110(5), 11991202.
Drew, L. R. H. (1986). Beyond the disease concept of addiction: drug use as a way of life leading to
predicaments. Journal of Drug Issues,16(2), 263274.
Feigin, R., & Sapir, Y. (2011). The relationship between sense of coherence and attribution of
responsibility for problems and their solutions, and cessation of substance abuse over time.
Journal of Psychoactive Drugs,37(1), 6373.
Feyerabend, P. K. (1962). Explanation, reduction, and empiricism. In H. Feigl & G. Maxwell (Eds.),
Minnesota studies in the philosophy of science (Vol. 3): Scientic explanation, space and time(pp.
28-97). Minneapolis, MN: University of Minnesota Press.
Ford, G. G. (1996). An existential Model for promoting life change: Confronting the disease
concept. Journal of Substance Abuse Treatment,13(2), 151158.
Frankl, V. E. (1969). The will to meaning. New York, NY: New American Library.
Frankl, V. E. (1985). Mans search for meaning. ((Revised & updated ed.)). New York, NY: Washington
Square Press.
Frankl, V. E. (1986). The doctor and the soul: From psychotherapy to logotherapy (Rev ed.). New York,
NY: Vintage.
Giord, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M., Rasmussen-Hall,
M. L., & Psalm, K. M. (2004). Acceptance-based treatment for smoking cessation. Behavior
Therapy,35(4), 689705.
Giord,E.V.,Kohlenberg,B.S.,Hayes,S.C.,Pierson,H.M.,Piasecki,M.P.,Antonuccio,D.O.,&Palm,K.M.
(2011). Does acceptance and relationship focused behavior therapy contribute to bupropion out-
comes? A randomized controlled trial of functional analytic psychotherapy and acceptance and
commitment therapy for smoking cessation. Behavior Therapy,42(4), 700715.
Gritz, E. R., Nisenbaum, R., Elasho, R. E., & Holmes, E. C. (1991). Smoking behaviors following
diagnosis of patients with stage I non-small cell lung cancer. Cancer Causes and Control,2(2),
105112.
Hardie, E., & Tee, M. Y. (2007). Excessive internet use: The role of personality, loneliness and social
support networks in internet addiction. Australian Journal of Emerging Technologies & Society,5
(1), 3447.
Harmer, A. L., Sanderson, J., & Mertin, P. (1999). Inuence of negative childhood experiences on
psychological functioning, social support, and parenting for mothers recovering from addiction.
Child Abuse & Neglect,23(5), 421433.
Hedges, L. V. (1987). How hard is hard science, how soft is soft science? The empirical cumula-
tiveness of research. American Psychologist,42(5), 443455.
18 D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
Held,B.S.(2004). The negative side of positive psychology. Journal of Humanistic Psychology,44(1), 946.
Holden, C. (2001). Behavioraladdictions: Do they exist? Science,294(5544), 980982.
Huxley, A. (1932). Brave new world. London, England: Chatto & Windus.
Iskender, M., & Akin, A. (2010). Social self-ecacy, academic locus of control, and internet
addiction. Computers & Education,54(4), 11011106.
Ivtzan, I., Lomas, T., Heeron, K., & Worth, P. (2015). Second wave of positive psychology: Embracing
the dark side of life. London, UK: Routledge.
Johnson, R. A., Grin-Shelley, E., & Sandler, K. R. (1987). Existential issues in psychotherapy with
alcoholics. Alcoholism Treatment Quarterly,4(1), 1525.
Jorenby, D. E., Hays, J., Rigotti, N. A., Azoulay, S., Watsky, E. J., Williams, K. E., . . . Reeves, K. R. (2006).
Ecacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs
placebo or sustained-release bupropion for smoking cessation: A randomized controlled trial.
JAMA,296(1), 5663.
Keller, E. F. (2007). A clash of two cultures. Nature,445(7128), 603.
Kelley, A. E., & Berridge, K. C. (2002). The neuroscience of natural rewards: Relevance to addictive
drugs. The Journal of Neuroscience,22(9), 33063311.
Kemp, R. (2011). The worlding of addiction. The Humanistic Psychologist,39(4), 338347.
Kemp, R., & Butler, A. (2014). Love, hate and the emergence of self in addiction recovery. Existential
Analysis,25(2), 257268.
Knight, C., Howard, P., Baker, C. L., & Marton, J. P. (2010). The cost-eectiveness of an extended
course (12 + 12 weeks) of varenicline compared with other available smoking cessation
strategies in the united states: An extension and update to the BENESCO model. Value in
Health,13(2), 209214.
Koob, G. F., & Le Moal, M. (1997). Drug abuse: Hedonic homeostatic dysregulation. Science,278
(5335), 5258.
Koob, G. F., & Le Moal, M. (2001). Drug addiction, dysregulation of reward, and allostasis.
Neuropsychopharmacology,24(2), 97129.
Koob,G.F.,&Volkow,N.D.(2010). Neurocircuitry of addiction. Neuropsychopharmacology,35(1), 217238.
Krentzman, A. R. (2013). Review of the application of positive psychology to substance use,
addiction, and recovery research. Psychology of Addictive Behaviors,27(1), 151165.
Lenoir, M., & Ahmed, S. H. (2008). Supply of a nondrug substitute reduces escalated heroin
consumption. Neuropsychopharmacology,33(9), 22722282.
Lewis, M. (2017). Addiction and the brain: Development, not disease. Neuroethics,10(1), 718.
Lomas, T., & Ivtzan, I. (2016). Second wave positive psychology: Exploring the positive-negative
dialectics of wellbeing. Journal of Happiness Studies, 17(4), 1753-17.
Nehls, N., & Sallmann, J. (2005). Women living with a history of physical and/or sexual abuse,
substance use, and mental health problems. Qualitative Health Research,15(3), 365381.
Noori, H. R., Linan, A. C., & Spanagel, R. (2016). Largely overlapping neuronal substrates of
reactivity to drug, gambling, food and sexual cues: A comprehensive meta-analysis. European
Neuropsychopharmacology,26(9), 14191430.
Olsen, C. M. (2011). Natural rewards, neuroplasticity, and non-drug addictions. Neuropharmacology,
61(7), 11091122.
Oostveen, R., van der Galien, O. P., Smeets, H. M., Hollinga, A. P., & Bosmans, J. E. (2014).
Eectiveness of pharmacotherapy in behavioural therapeutic smoking cessation programmes.
The European Journal of Public Health,25(2), 204209.
Park, E. R., Japuntich, S. J., Rigotti, N. A., Traeger, L., He, Y., Wallace, R. B., . . . Keating, N. L. (2012).
A snapshot of smokers after lung and colorectal cancer diagnosis. Cancer,118(12), 31533164.
Peck, M. S. (1978). The road less traveled: A new psychology of love, traditional values and spiritual
growth. New York, NY: Simon & Schuster.
Picucci, M. (1996). Complete recovery: An expanded model of community healing. New York, NY:
Mombaccus.
Platt, J. R. (1964). Strong inference. Science,146(3642), 347353.
Polivy, J., & Herman, C. P. (2000). The false-hope syndrome: Unfullled expectations of self-change.
Current Directions in Psychological Science,9(4), 128131.
COUNSELLING PSYCHOLOGY QUARTERLY 19
Robins, L. N. (1993). Vietnam veteransrapid recovery from heroin addiction: A uke or normal
expectation? Addiction,88(8), 10411054.
Robinson, D. (1972). The alcohologists addiction: Some implications of having lost control over
the disease concept of alcoholism. Quarterly Journal of Studies on Alcohol,33(4), 10281042.
Room,R.(1972). Drinking and disease. Comment on the alcohologistsaddiction..QuarterlyJournal of
Studies on Alcohol,33(4), 10491059.
Sartre, J. P. (1943/1956). Being and nothingness. (H. E. Barnes, Trans.). New Work, NY: Philosophical Library.
Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive Psychology: An Introduction. American
Psychologist,55(1), 514.
Sheer, C., MacKillop, J., McGeary, J., Landes, R., Carter, L., Yi, R., . . . Bickel, W. (2012). Delay
discounting, locus of control, and cognitive impulsiveness independently predict tobacco
dependence treatment outcomes in a highly dependent, lower socioeconomic group of
smokers. The American Journal on Addictions,21(3), 221232.
Somov, P. G. (2007). Meaning of life group: Group application of logotherapy for substance use
treatment. The Journal for Specialists in Group Work,32(4), 316345.
Stead, L. F., Koilpillai, P., Fanshawe, T. R., & Lancaster, T. (2016). Combined pharmacotherapy and
behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews,3.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008286.pub3/abstract
Storer, N. W. (1967). The hard sciences and the soft: Some sociological observations. Bulletin of the
Medical Library Association,55(1), 7584.
Sussman, S., Lisha, N., & Griths, M. (2011). Prevalence of the addictions: A problem of the majority
or the minority? Evaluation & the Health Professions,34(1), 356.
Twardella, D., Loew, M., Rothenbacher, D., Stegmaier, C., Ziegler, H., & Brenner, H. (2006). The
diagnosis of a smoking-related disease is a prominent trigger for smoking cessation in
a retrospective cohort study. Journal of Clinical Epidemiology,59(1), 8289.
VanLandingham, M. (2014). On the hard and soft sciences in public health. Public Health Reports,
129(2), 124126.
Volkow, N. D., Fowler, J. S., & Wang, G. J. (2003). The addicted human brain: Insights from imaging
studies. The Journal of Clinical Investigation,111(10), 14441451.
Volkow, N. D., Wang, G. J., Fowler, J. S., Tomasi, D., Telang, F., & Baler, R. (2010). Addiction:
Decreased reward sensitivity and increased expectation sensitivity conspire to overwhelm the
brains control circuit. Bioessays,32(9), 748755.
Wiklund, L. (2008a). Existential aspects of living with addiction - Part I: Meeting challenges. Journal
of Clinical Nursing,17(18), 24262434.
Wiklund, L. (2008b). Existential aspects of living with addiction - Part II: Caring needs.
A hermeneutic expansion of qualitative ndings. Journal of Clinical Nursing,17(18), 24352443.
Wong, P. T. P. (2009). Existential positive psychology. In S. J. Lopez (Ed.), Encyclopedia of positive
psychology (Vol. 1, pp. 361368). Oxford, UK: Wiley Blackwell.
Wong, P. T. P. (2010). Meaning therapy: An integrative and positive existential psychotherapy.
Journal of Contemporary Psychotherapy,40(2), 8599.
Wong, P. T. P. (2011a). Positive psychology 2.0: Towards a balanced interactive model of the good
life. Canadian Psychology,52(2), 6981.
Wong, P. T. P. (2011b). Meaning-centered counseling and therapy: An integrative and compre-
hensive approach to motivational counseling and addiction treatment. In W. M. Cox & E. Klinger
(Eds.), Handbook of motivational counseling: Goal-based approaches to assessment and interven-
tion with addiction and other problems (pp. 461487). West Sussex, UK: Wiley.
Wong, P. T. P. (2012a). Toward a dual-systems model of what makes life worth living. In
P. T. P. Wong (Ed.), The human quest for meaning: Theories, research, and applications (2nd ed.,
pp. 322). New York, NY: Routledge.
Wong, P. T. P. (2012b). From logotherapy to meaning-centered counseling and therapy. In
P. T. P. Wong (Ed.), The human quest for meaning: Theories, research, and applications (2nd ed.,
pp. 619647). New York, NY: Routledge.
20 D. F. CARRENO AND J. A. PÉREZ-ESCOBAR
Wong, P. T. P. (2013). A meaning-centered approach to addiction and recovery. In L. C. J. Wong,
G. R. Thompson, & P. T. P. Wong (Eds.), The positive psychology of meaning and addiction recovery
(pp. 181192). Birmingham, AL: Purpose Research.
Wong, P. T. P. (2014). Viktor Frankls meaning seeking model and positive psychology. In
A. Batthyany & P. Russo-Netzer (Eds.), Meaning in existential and positive psychology (pp.
149184). New York, NY: Springer.
Wong, P. T. P. (2017). Existential theoretical framework. In A. Wenzel (Ed.), The SAGE encyclopedia of
abnormal and clinical psychology (pp. 13751378). New York, NY: Sage.
Wong, P. T. P., & Roy, S. (2017). Critique of positive psychology and positive interventions. In
N. J. L. Brown, T. Lomas, & F. J. Eiroa-Orosa (Eds.), The Routledge international handbook of critical
positive psychology (pp. 142-160). London, UK: Routledge.
Zakrzewski, R. F., & Hector, M. A. (2004). The lived experiences of alcohol addiction: Men of
alcoholics anonymous. Issues in Mental Health Nursing,25(1), 6177.
Zernig, G., Wallner, R., Grohs, U., Kriechbaum, N., Kemmler, G., & Saria, A. (2008). A randomized trial
of short psychotherapy versus sustained-release bupropion for smoking cessation. Addiction,
103(12), 20242031.
COUNSELLING PSYCHOLOGY QUARTERLY 21
... 7-3.). It was argued that having a sense of ML would be a protective factor from addictive behaviors (Dursun et al., 2021), and overall, literature on ML determined that a high sense of ML would be generally associated with positive outcomes (e.g., greater satisfaction in life) whereas a lack of ML may be associated with negative health outcomes (e.g., addictive behaviors, cardiovascular disease, mortality, age-related cognitive decline, burnout, social appeal, psychological disorders, risk of physical disability, suicidal ideation) (Blau et al., 2019;Carreno & Pérez-Escobar, 2019;King & Hicks, 2021). Therefore, meaning-centered approaches to cope with existential challenges were introduced in treating substance-related addictions (such as existential positive psychology approaches) (Adams & Bezner, 2000;Bartram, 2020;Carreno & Pérez-Escobar, 2019;Chen, 2006;Krentzman, 2012;Wong, 2010Wong, , 2011. ...
... It was argued that having a sense of ML would be a protective factor from addictive behaviors (Dursun et al., 2021), and overall, literature on ML determined that a high sense of ML would be generally associated with positive outcomes (e.g., greater satisfaction in life) whereas a lack of ML may be associated with negative health outcomes (e.g., addictive behaviors, cardiovascular disease, mortality, age-related cognitive decline, burnout, social appeal, psychological disorders, risk of physical disability, suicidal ideation) (Blau et al., 2019;Carreno & Pérez-Escobar, 2019;King & Hicks, 2021). Therefore, meaning-centered approaches to cope with existential challenges were introduced in treating substance-related addictions (such as existential positive psychology approaches) (Adams & Bezner, 2000;Bartram, 2020;Carreno & Pérez-Escobar, 2019;Chen, 2006;Krentzman, 2012;Wong, 2010Wong, , 2011. ...
... Literature indicated that a lack of meaning was often associated with negative health outcomes (King & Hicks, 2021). More precisely, addictive behaviors were generally associated with existential struggles (Carreno & Pérez-Escobar, 2019), whereas having a sense of ML was argued to be a protective factor (Dursun et al., 2021). Internet was identified as a potential source of ML (Aydın, 2017;Blau et al., 2019;Dursun et al., 2021;Rammazi et al., 2018), and it was argued that momentary experience of ML was higher when individuals engage in daily routines (Heintzelman & King, 2019). ...
Article
Full-text available
Literature highlighted how beliefs and a lack of meaning in life may act as a motive for developing addictions. This present study investigated the relationship between addictive beliefs, core beliefs, meaning in life, generalized problematic Internet use (PIU), problematic Facebook use (PFU), and problematic Instagram use (PIgU). A sample of 573 French participants aged between 18 and 78 years old (M = 31.8, SD = 12.3), with 471 female participants (82%), responded to an online survey that assessed PIU, PFU, PIgU, addictive beliefs about Internet use, core beliefs about behavioral addictions and Internet addiction (IA), and meaning in life dimensions. Overall, Pearson’s correlations indicated that PIU, PFU, and PIgU were correlated with scores of meaning anxiety, meaning confusion, and three dimensions of core beliefs about behavioral addictions and Internet addiction. Multiple linear regressions indicated that PIU, PFU, and PIgU were positively impacted by scores of positive addictive beliefs about Internet use (believing Internet use brings gratification), and PIU was significantly impacted by scores of meaning confusion. This study found associations between addictive beliefs and PIU, PFU, and PIgU. Thus, it is important to investigate those beliefs in therapeutical settings. Results of this research may guide future studies aiming to investigate gratification and expectations towards Internet use. With certain meaning in life subscores correlating with PIU, PFU, and PIgU, further research should be dedicated to investigating other variables that may be involved in the relationship between meaning in life and Internet use. Implications for further research were discussed.
... Since 2011 existential positive psychology (PP2.0) has gained in importance, dealing with the questions how to lead a meaningful and a positive and constructive life at the same time (Wong, 2011;Passmore and Howell, 2014;Ivtzan et al., 2017;Carreno and Pérez-Escobar, 2019). Therefore, research in PP2.0 suggests that the dark and negative aspects of life, the suffering and the pain of existence need to be radically accepted, dealt with and transformed-if this is the case, mental health and well-being improves based on the lived-through experience (Wong, 2011(Wong, , 2016(Wong, , 2020Fowers et al., 2017;Turaniu et al., 2017;Vanderheiden and Mayer, 2017;Mayer and Vanderheiden, 2019;Van Tongeren and Showalter Van Tongeren, 2020). ...
... As described before (Mayer and Vanderheiden, 2019;Mayer et al., 2021), this research study points to the coping mechanisms to deal with shame constructively through different strategies which are influenced by individual and socio-cultural preferences. As shown in this study, participants strive for a meaningful, conscious, and positive life-as highlighted in the PP2.0 literature (Wong, 2011;Passmore and Howell, 2014;Ivtzan et al., 2017;Carreno and Pérez-Escobar, 2019). ...
Article
Full-text available
Shame is an unconscious, somehow unattended and neglected emotion and occurs when individual and socio-cultural norms are violated. It often impacts negatively on the self and others across cultures. During the Covid-19 crises, shame has become an important emotion with a powerful effect, depending on how it is experienced within the socio-cultural context. This article explores shame in international perspectives in the context of Covid-19 and addresses the question how shame is transformed from an existential positive psychology (PP2.0) perspective. The study uses a qualitative research paradigm and explores shame and its transformation during Covid-19. Purposeful and snowball sampling was used. The sample consisted of 24 individuals (16 female, 8 male), of 13 different nationalities. Data were collected from written interviews and analyzed through thematic analysis. Ethical considerations were followed; ethical approval was given by a university. Findings show that participants become very worried, anxious, scared, sad, and shocked when they or individuals in their close relationships contracted Covid-19. Shame plays an important role during the Covid-19 pandemic. However, the meaning and experience of shame during Covid-19 is strongly dependent on the socio-cultural background of the individual who is experiencing the disease. Individuals use different strategies and mechanisms to deal with and transform shame in the context of Covid-19.
... Based on a review of the clinical, existential, and relational approaches to addiction, meaning-centered approaches to addiction therapy have been proposed (Carreno & Pérez-Escobar, 2019). Specifically, that review highlighted the potential effectiveness of these approaches to helping clients with addictions deal with a variety of existential issues such as social isolation, evasion of responsibility, and lack of purpose. ...
... Meaning, as measured by purpose in life, has been found to be a significant contributor to sustained sobriety (Oakes, 2008). Logotherapy has been used to treat addictions, including substance abuse, as this theoretical framework perceives addictions to be a means of filling a void in meaning that in a manner that ends up being harmful to the person (Armstrong, 2018a;Carreno & Pérez-Escobar, 2019;Somov, 2007;Song et al., 2018). Having a sense of meaning in life, beyond a religious belief, has also been found to be protective against suicidal ideation in the homeless population (Testoni et al., 2018). ...
Thesis
Full-text available
In Canada there are an estimated 35,000 people experiencing homelessness on any given night and 235,000 people experiencing homelessness each year. The number of people in Ottawa using emergency overnight shelters in 2018 was 7937, an increase of 6.8% over 2017. In addition to experiencing a range of physical ailments, between 23% and 74% of homeless people report having some type of mental illness or problem. While community-based approaches to mental health interventions for homeless people are effective, many neither address nor explore the concept of “meaning” and its relevance to their lives. Meaning may be important for the experience of mental health, as well as substance use intervention, and has also been found to be linked to resilience, itself a contributor to positive mental health. Those programs that do address this topic have not engaged homeless people in the development of such programs, which can be detrimental to program use and effectiveness. By using a stakeholder-informed knowledge translation-integrated (KTI) model, the present study seeks to integrate learnings from research on mental health interventions with homeless people, community-based and participatory action principles, and the importance of meaning to well-being with the recommendations of the Mental Health Commission of Canada. Using a consensual qualitative research methodology, a needs assessment for the development of a meaning exploration session for clients of The Ottawa Mission’s Day Program was conducted based on KTI standards. Based on the stakeholder-generated general themes that emerged from the research, meaning exploration sessions can and should be created in Day Program, would likely be helpful and motivating to clients, and clients stated that they would attend such sessions. Keywords: homelessness, needs assessment, meaning, resiliency, knowledge translation, consensual qualitative research
... Irvine et al. (2014) sustains that when a thesis in philosophy of mind is vague, general and/or tries to fit rather than predict empirical data, chances are that it cannot be tested empirically. Carreno and Pérez-Escobar (2019) argue that empirical information is useful to tackle practical issues and make clinical decisions based on preliminary notions on the character of the (abnormal) mind and its brain bases but does not settle metaphysical issues. ...
Article
Full-text available
This work gives a new argument for ‘Empirical Philosophy of Mathematical Practice’. It analyses different modalities on how empirical information can influence philosophical endeavours. We evoke the classical dichotomy between “armchair” philosophy and empirical/experimental philosophy, and claim that the latter should in turn be subdivided in three distinct styles: Apostate speculator , Informed analyst , and Freeway explorer . This is a shift of focus from the source of the information towards its use by philosophers. We present several examples from philosophy of mind/science and ethics on one side and a case study from philosophy of mathematics on the other. We argue that empirically informed philosophy of mathematics is different from the rest in a way that encourages a Freeway explorer approach, because intuitions about mathematical objects are often unavailable for non-mathematicians (since they are sometimes hard to grasp even for mathematicians). This consideration is supported by a case study in set theory.
... Continuing care and wellbeing development treatment plan design will be personalized for the individual's unique personality, including consideration of socio-cultural influences. Scotton, 1996); existential (Carreno, 2019); humanistic (Rowan 2001;Serlin, 2011); spiritual; and energy psychologies. Frameworks of perspective guide individual counseling and group therapy, in facilitating understanding of mindbody connections, human nature, and the role of the individual determination in taking responsibility for outcome, self-actualization and mastery of potential (Kobau, 2011;Lambert 2015). ...
Article
Full-text available
In the new era of genomic medicine, the interactive effects of genetic and epigenetic influence upon the development of substance use disorder (SUD), behavioral process addiction (BPA) comorbid mental health disorder (CMHD), as well as upon the development of personality, need to be considered in the design of personalized addiction recovery treatment plans. Twenty-first century holistic addiction treatment planning will consider the individual patient-client’s genome in treatment planning of both neurological and psychological issues. The science of personality psychology will be utilized in the development and personalization of short term, mid-range and long term substance use disorder and addiction recovery plans, which take into consideration personality type, temperament and trait analysis, to predict potential areas of increased risk to sustained abstinence and cessation of self-medication re-instatement of drug use, and those personality strengths which could potentially increase resilience, adaptation and facilitate wellbeing. Keywords: addiction, substance use disorder, reconceptualizing addiction, reward deficiency syndrome and personality.
... The predominance of one type of strategy over another is determined, in part, by personal style and also by the type of stressful event. Maladaptive coping strategies, such as avoidance and minimization, have been associated with higher levels of distress (Theleritis et al., 2020) and significant number of psychological problems such as depression and anxiety (Blalock and Joiner, 2000), lower subjective well-being (Elliot et al., 2011), drug use (Carreno and Pérez-Escobar, 2019), and post-traumatic stress (Dempsey et al., 2000). ...
Article
Full-text available
Background: Coronavirus disease 2019 (COVID-19) has resulted in an increase in known risk factors for mental health problems. Mexico adopted lockdown and physical distancing as a containment strategy with potential consequences on day to day life, such as social isolation, loss of income and loneliness that can have important consequences in terms of mental health. Objective: We aimed to examine the effect of the initial phases of the COVID-19 pandemic on psychological distress, well-being and perceived physical health among Mexican-base respondents and to examine whether coping strategies would play a potential intermediating role in relation to these variables. Under the Existential Positive Psychology perspective, an emphasis was made on meaning-centered coping. Methods: A cross-sectional study was conducted between April 30 and June 16th 2020 among 604 Mexicans-base respondents of which 471 were women and 132 men. Data was collected by using online questionnaires. Psychological distress was measured using the Depression, Anxiety, and Stress Scale (DASS-21). The Brief COPE Inventory was used to assess problem-focused and emotion-focused coping strategies. We also used the Meaning-Centered Coping Scale (MCCS). PERMA-Profiler was used to assess well-being, perceived physical health, and loneliness. Profiler and Descriptive analyses and bivariate linear regression were performed to examine the association of variables. Results: 45.9% of the participants reported moderate to extremely severe psychological distress. Our results demonstrate that problem-focused and emotion-focused coping were positively related to psychological distress, whereas meaning-centered coping was negatively associated with distress. Furthermore, psychological distress played a potential negative role in the perceived physical health, while meaning-centered coping and well-being buffered the negative influence of psychological distress on perceived physical health (completely standardized indirect effect = –0.01, SE: 0.012, 95% CI [−0.065; −0.017]. Conclusion: Meaning-centered coping was found to suppress the negative influence of psychological distress on sensation of decreased physical health corroborating the critical role of meaning in life in promoting well-being. Future studies can further examine the value of the critical role of meaning in life in promoting well-being as a protective factor against severe distress during traumatic events. Findings of this study can be used to orient policies and interventions aimed to alleviate suffering in the midst of the COVID-19 pandemic.
... In particular, meaning in life seems to act as a buffer against psychological distress and foster resilience (e.g., Batthyany and Russo-Netzer, 2014;Gloria and Steinhardt, 2016). It also seems to play a transformative and rehabilitative role in disorders related to potentially traumatic events (Calhoun and Tedeschi, 2006;Khanna and Greyson, 2015) and substance abuse (Carreno and Pérez-Escobar, 2019). Especially, meaning in life has been shown to be negatively associated with depression both in cross-sectional studies (e.g., Steger et al., 2006;Carreno et al., 2020) and longitudinal ones (e.g., Disabato et al., 2017). ...
Article
Full-text available
The COVID-19 pandemic has subjected most of the world’s population to unprecedented situations, like national lockdowns, health hazards, social isolation and economic harm. Such a scenario calls for urgent measures not only to palliate it but also, to better cope with it. According to existential positive psychology, well-being does not simply represent a lack of stress and negative emotions but highlights their importance by incorporating an adaptive relationship with them. Thus, suffering can be mitigated (and transformed into growth) by, among other factors, adopting an attitude of positive reframing, maintaining hope, existential courage, life appreciation, engagement in meaningful activities, and prosociality. The conglomerate of these elements has been recently denominated as meaning-centered coping. In this study, we evaluated the protective role of this type of coping on mental health. A sample of 12,243 participants from 30 countries across all continents completed measures of Meaning-Centered Coping Scale (MCCS), depression, stress, anxiety and stressful COVID-19 related conditions they experienced. Results indicated that meaning-centered coping was strongly associated with diminished symptoms of stress, anxiety, and depression. Moreover, it moderated various relationships between vulnerability factors and markers of psychological distress, especially in the case of depression. These findings call for attention to meaning-centered coping approaches in the context of hardship, such as the current COVID-19 health crisis. In these difficult times, decision-makers and health organizations may integrate these approaches into their guidelines.
Article
Disordered eating can underpin a number of debilitating and prevalent chronic diseases, such as obesity. Broader advances in psychopharmacology and biology have motivated some neuroscientists to address diet-induced obesity through reductionist, pre-clinical eating investigations on the rodent brain. Specifically, chemogenetic and optogenetic methods developed in the 21st century allow neuroscientists to perform in vivo , region-specific/projection-specific/promoter-specific circuit manipulations and immediately assess the impact of these manipulations on rodent feeding. These studies are able to rigorously conclude whether a specific neuronal population regulates feeding behaviour in the hope of eventually developing a mechanistic neuroanatomical map of appetite regulation. However, an artificially stimulated/inhibited rodent neuronal population that changes feeding behaviour does not necessarily represent a pharmacological target for treating eating disorders in humans. Chemogenetic/optogenetic findings must therefore be triangulated with the array of theories that contribute to our understanding of appetite. The objective of this review is to provide a wide-ranging discussion of the limitations of chemogenetic/optogenetic circuit manipulation experiments in rodents that are used to investigate appetite. Stepping into and outside of medical science epistemologies, this paper draws on philosophy of science, nutrition, addiction biology and neurophilosophy to prompt more integrative, transdisciplinary interpretations of chemogenetic/optogenetic appetite data. Through discussing the various technical and epistemological limitations of these data, we provide both an overview of chemogenetics and optogenetics accessible to non-neuroscientist obesity researchers, as well as a resource for neuroscientists to expand the number of lenses through which they interpret their circuit manipulation findings.
Article
Full-text available
RESUMO: Este artigo científico sistematizou a concepção do psicólogo sino-canadense Paul T. P. Wong sobre as felicidades prudencial, eudaimonística e cairônica, no âmbito da sua proposta de Psicologia Positiva 2.0. A fim de contextualizar a sua visão da PP 2.0, teceram-se considerações propedêuticas sobre as facetas existencialista e indigenista da PP 2.0. Após, capítulos específicos se dedicaram a aprofundar a concepção de Wong acerca das felicidades autêntica, eudaimonística e cairônica, articulando esses constructos com a literatura contemporânea de PP 2.0, sejam as pesquisas científicas qualitativas, sejam as problematizações teoréticas, em diálogo com aportes do movimento transpessoal e do movimento existencial e humanista em Psicologia. ABSTRACT: This scientific article systematized the conception Sino-Canadian psychologist Paul T. P. Wong has of prudential, eudaimonic and chaironic happiness, within the scope of his proposal for Positive Psychology 2.0. In order to contextualize his vision of PP 2.0, propaedeutic considerations were made about the existentialist and indigenous facets of PP 2.0. Afterward, specific chapters were dedicated to deepening Wong's conception of authentic, eudaimonic, and chaironic happiness, articulating these constructs with contemporary PP 2.0 literature, be it qualitative scientific research or theoretical problems, in a dialogue with contributions from the transpersonal movement and the existential and humanist movement in Psychology.
Article
Social work and substance use research often neglect to make epistemological perspectives explicit in their studies, inadvertently embedding numerous assumptions that remain invisible and uncontested. Consequently, the unchallenged dominance of post-positivist epistemologies in Western European countries becomes (re)produced in social work and substance use education, policies and practices, limiting space for alternative viewpoints. This narrative review examines some of the social work and substance use literature, highlighting the value of making epistemology more explicit and the importance of applying critical epistemologies to counter dominant paradigms. This article makes a unique contribution to substance use literature by examining substance use from post-positivist, social constructivist and critical paradigms and by promoting a critical social work lens. A critical paradigm is particularly useful for questioning prevailing assumptions of substance use as a medical problem requiring professional treatment and for generating greater attention to structural policies that promote a more equitable society. Social work’s commitment to human rights and social justice effectively positions the discipline to apply a critical paradigm to the field of substance use studies. Keywords: Critical social work, epistemology, methodology, social justice, substance use, theoretical paradigms
Article
Full-text available
The authors argue that the formation of self is at the heart of many addiction issues. Likewise issues of love (sought) and hate (found) are central to both the formation of a self vulnerable to addiction and to fostering recovery. So the negative feelings towards addicts (hate) is not simple prejudice, but inherent to the condition itself. As such this needs careful reflection by therapists. The authors argue that love, as compassion, is the central healing feature in addiction recovery. This paper is written by two addiction professionals, one of whom (AB) has over thirty years of lived addiction experience. We hope therefore that the paper combines both theoretical and experiential rigour. As such the purpose of this paper is to explore the issues of love and hate as they manifest in the recovery process of individuals who are described as having addictions. By using the word 'addiction' we do not mean to denigrate these individuals or to create alienating labels which can hinder authentic living. However, based on our clinical and personal experience, we are convinced that there exists a commonality of suffered lived experience which can be called 'addiction'. With the caveat that addiction will manifest differently for each individual, and also for different cultures and groups, there does appear to be commonalities across various types of addictions. It is not possible however to explore this issue further here. Our intention is to briefly review the existential literature on addiction and then to more deeply explore the issue of relationships in addiction. Thus we will eventually explore how the relationship between skilled helper (therapist) and addict is impacted and how this can help or hinder the recovery process. Our argument is that love and hate are central issues in the development, maintenance and eventual transcendence of addiction. Addiction develops in some cases as a mechanism to deal with issues of self and identity. However addiction only serves to further alienate addicts
Article
Full-text available
I review the brain disease model of addiction promoted by medical, scientific, and clinical authorities in the US and elsewhere. I then show that the disease model is flawed because brain changes in addiction are similar to those generally observed when recurrent, highly motivated goal seeking results in the development of deep habits, Pavlovian learning, and prefrontal disengagement. This analysis relies on concepts of self-organization, neuroplasticity, personality development, and delay discounting. It also highlights neural and behavioral parallels between substance addictions, behavioral addictions, normative compulsive behaviors, and falling in love. I note that the short duration of addictive rewards leads to negative emotions that accelerate the learning cycle, but cortical reconfiguration in recovery should also inform our understanding of addiction. I end by showing that the ethos of the disease model makes it difficult to reconcile with a developmental-learning orientation.
Chapter
Full-text available
The main purpose of this chapter is to introduce Viktor Frankl’s logotherapy to the twenty-first century, especially to positive psychologists interested in meaning research and applications. Frankl’s radically positive message of re-humanizing psychotherapy is much needed in the current technological culture. More specifically, I explain the basic assumptions of logotherapy and translate them into a testable meaning-seeking model to facilitate meaning research and intervention. This model consists of five hypotheses: (1) The Self-Transcendence Hypothesis: The will to meaning is a spiritual and primary motivation for self-transcendence; thus, it predicts that spiritual pathways (e.g., spiritual care, self-transcendence) will enhance meaning in life and well-being, even when other pathways to well-being are not available. (2) The Ultimate Meaning Hypothesis: It predicts that belief in the intrinsic meaning and value of life, regardless of circumstances, is more functional than alternative global beliefs. It also predicts that belief in ultimate meaning facilitates the discovery of meaning of the moment. (3) The Meaning Mindset Hypothesis: A meaning mindset, as compared to the success mindset, leads to greater meaningfulness, compassion, moral excellence, eudaemonic happiness, and resilience. (4) The Freedom of Will Hypothesis: People who believe in the inherent human capacity for freedom and responsibility, regardless of circumstances, will show higher autonomy and authenticity than those without such beliefs. (5) The Value Hypothesis of Discovering Meaning: Meaning is more likely to be discovered through creative, experiential, and attitudinal values that are motivated by self-transcendence rather than by self-interest. Together, they capture the complexity and centrality of meaning seeking in healing and well-being. In sum, Viktor Frankl emphasizes the need for a radical shift from self-focus to meaning-focus as the most promising way to lift up individuals from the dark pit of despair to a higher ground of flourishing. This chapter outlines the differences between logotherapy and positive psychology and suggests future research to bridge these two parallel fields of study for the benefit of psychology and society.
Chapter
Full-text available
Rooted in logotherapy, meaning-centered counseling and therapy (MCCT) employs personal meaning as its central organizing construct, but it also provides a conceptual framework to assimilate other approaches of counseling and psychotherapy, such as cognitive-behavioral therapy, narrative therapy, multicultural counseling and positive psychotherapy. This chapter first describes the basic tenets of MCCT and then introduces it as an integrative and comprehensive approach to motivational counseling in treating substance abuse.
Article
Full-text available
Positive psychology has tended to be defined in terms of a concern with ‘positive’ psychological qualities and states. However, critics of the field have highlighted various problems inherent in classifying phenomena as either ‘positive’ or ‘negative.’ For instance, ostensibly positive qualities (e.g., optimism) can sometimes be detrimental to wellbeing, whereas apparently negative processes (like anxiety) may at times be conducive to it. As such, over recent years, a more nuanced ‘second wave’ of positive psychology has been germinating, which explores the philosophical and conceptual complexities of the very idea of the ‘positive.’ The current paper introduces this emergent second wave by examining the ways in which the field is developing a more subtle understanding of the ‘dialectical’ nature of flourishing (i.e., involving a complex and dynamic interplay of positive and negative experiences). The paper does so by problematizing the notions of positive and negative through seven case studies, including five salient dichotomies (such as optimism versus pessimism) and two complex processes (posttraumatic growth and love). These case studies serve to highlight the type of critical, dialectical thinking that characterises this second wave, thereby outlining the contours of the evolving field.
Article
Cue reactivity to natural and social rewards is essential for motivational behavior. However, cue reactivity to drug rewards can also elicit craving in addicted subjects. The degree to which drug and natural rewards share neural substrates is not known. The objective of this study is to conduct a comprehensive meta-analysis of neuroimaging studies on drug, gambling and natural stimuli (food and sex) to identify the common and distinct neural substrates of cue reactivity to drug and natural rewards. Neural cue reactivity studies were selected for the meta-analysis by means of activation likelihood estimations, followed by sensitivity and clustering analyses of averaged neuronal response patterns. Data from 176 studies (5573 individuals) suggests largely overlapping neural response patterns towards all tested reward modalities. Common cue reactivity to natural and drug rewards was expressed by bilateral neural responses within anterior cingulate gyrus, insula, caudate head, inferior frontal gyrus, middle frontal gyrus and cerebellum. However, drug cues also generated distinct activation patterns in medial frontal gyrus, middle temporal gyrus, posterior cingulate gyrus, caudate body and putamen. Natural (sexual) reward cues induced unique activation of the pulvinar in thalamus. Neural substrates of cue reactivity to alcohol, drugs of abuse, food, sex and gambling are largely overlapping and comprise a network that processes reward, emotional responses and habit formation. This suggests that cue-mediated craving involves mechanisms that are not exclusive for addictive disorders but rather resemble the intersection of information pathways for processing reward, emotional responses, non-declarative memory and obsessive-compulsive behavior.
Article
Understanding the neurobiological mechanisms of addiction requires an integration of basic neuroscience with social psychology, experimental psychology, and psychiatry. Addiction is presented as a cycle of spiralling dysregulation of brain reward systems that progressively increases, resulting in compulsive drug use and a loss of control over drug-taking. Sensitization and counteradaptation are hypothesized to contribute to this hedonic homeostatic dysregulation, and the neurobiological mechanisms involved, such as the mesolimbic dopamine system, opioid peptidergic systems, and brain and hormonal stress systems, are beginning to be characterized. This framework provides a realistic approach to identifying the neurobiological factors that produce vulnerability to addiction and to relapse in individuals with a history of addiction.
Article
Research results in the social and behavioral sciences are often conceded to be less replicable than research results in the physical sciences. However, direct empirical comparisons of the cumulativeness of research in the social and physical sciences have not been made to date. This article notes the parallels between methods used in the quantitative synthesis of research in the social and in the physical sciences. Essentially identical methods are used to test the consistency of research results in physics and in psychology. These methods can be used to compare the consistency of replicated research results in physics and in the social sciences. The methodology is illustrated with 13 exemplary reviews from each domain. The exemplary comparison suggests that the results of physical experiments may not be strikingly more consistent than those of social or behavioral experiments. The data suggest that even the results of physical experiments may not be cumulative in the absolute sense by statistical criteria. It is argued that the study of the actual cumulativeness found in physical data could inform social scientists about what to expect from replicated experiments under good conditions.