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Doing Recovery Work Together: Clients' and Counsellors' Social, Discursive, and Institutional Practices
Abstract
In this conceptual paper, we offer an alternative to traditional approaches to addictive behaviours and addictions counselling. We outline practice theory and tenets of an institutional ethnographic approach used to inquire into tacit or invisible practices of addictive behaviours, the work of recovery from them, and how counselling may (or may not) be helpful. We provide a conceptual alternative to working with clients who present for counselling with addiction concerns, using case examples as in invitation to practitioners to extend their work in new ways.
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This article offers a relational practice view to conceptualize natural recovery from addiction concerns. Through the lens of a social practice framework, the processes of natural recovery are seen as specific relational trajectories or transformative pathways involving relationships between humans, non-humans, communities, and philosophies, rather than as a process of symptom elimination. We argue that this kind of conceptualization of recovery acknowledges the many people who manage to recover without treatment or professional help, known as natural recovery. In addiction practices, we can see the dominance of pathologizing interpersonal patterns (PIPs) that maintain the addictive process. Over the course of recovery, we can see the dominance of healing interpersonal patterns (HIPs) that support the recovery process. To utilize this understanding as practitioners, we need to help nourish the platforms where the healing interactional patterns in daily life might be supported and maintained. While this reduces power from the position of “expert” in the biomedical model, it also provides more optimism, as members of the social network we can directly contribute to those healing interpersonal patterns—by the way we relate to, support, and engage with other people.
This article uses Marc Lewis’ work as a springboard to discuss the socio-political context of the brain disease model of addiction (BDMA). The claim that promotion of the BDMA is the only way the general public can be persuaded to withhold blame and punishment from addicts is critically examined. After a discussion of public understandings of the disease concept of addiction, it is pointed out that it is possible to develop a scientific account of addiction which is neither a disease nor a moral model but which the public could understand. Evidence is reviewed to suggest that public acceptance of the disease concept is largely lip-service and that the claim the BDMA removes stigma among the public and professionals is unsupported by evidence. Further, there is good evidence that biogenetic explanations of mental/behavioural disorders in general have been counterproductive in the attempt to ally stigma. A model of addiction as a disorder of choice may attract special problems in public-facing communications and risks being misunderstood. However, ways of presenting this model to the public are suggested that may avoid such risks. Lastly, the claim that the BDMA is the only way of ensuring access to treatment and of maintaining research funding for addiction is disputed and a way in which these benefits can be retained under a disorder-of-choice model proposed. The article concludes by enthusiastically endorsing Lewis’ call for a third stage in the governing image of addiction.
Background and aims
The use of mobile phones has become an integral part of everyday life. Young people in particular can be observed using their smartphones constantly, and they not only make or receive calls but also use different applications or just tap touch screens for several minutes at a time. The opportunities provided by smartphones are attractive, and the cumulative time of using smartphones per day is very high for many people, so the question arises whether we can really speak of a mobile phone addiction? In this study, our aim is to describe and analyze a possible case of smartphone addiction.
Methods
We present the case of Anette, an 18-year-old girl, who is characterized by excessive smartphone use. We compare Anette’s symptoms to Griffiths’s conception of technological addictions, Goodman’s criteria of behavioral addictions, and the DSM-5 criteria of gambling disorder.
Results
Anette fulfills almost all the criteria of Griffiths, Goodman, and the DSM-5, and she spends about 8 hr in a day using her smartphone.
Discussion
Anette’s excessive mobile phone usage includes different types of addictive behaviors: making selfies and editing them for hours, watching movies, surfing on the Internet, and, above all, visiting social sites. The cumulative time of these activities results in a very high level of smartphone use. The device in her case is a tool that provides these activities for her whole day. Most of Anette’s activities with a mobile phone are connected to community sites, so her main problem may be a community site addiction.
Background
Complexity has been linked to health interventions in two ways: first as a property of the intervention, and secondly as a property of the system into which the intervention is implemented. The former recognizes that interventions may consist of multiple components that act both independently and interdependently, making it difficult to identify the components or combinations of components (and their contexts) that are important mechanisms of change. The latter recognizes that interventions are implemented in complex adaptive systems comprised of intelligent agents who modify their behaviour (including any actions required to implement the intervention) in an effort to improve outcomes relative to their own perspective and objectives. Although an intervention may be intended to take a particular form, its implementation and impact within the system may deviate from its original intentions as a result of adaptation. Complexity highlights the challenge in developing interventions as effective health solutions. The UK Medical Research Council provides guidelines on the development and evaluation of complex interventions. While mathematical modelling is included in the guidelines, there is potential for mathematical modeling to play a greater role.
Discussion
The dynamic non-linear nature of complex adaptive systems makes mathematical modelling crucial. However, the tendency is for models of interventions to limit focus on the ecology of the system - the ‘real-time’ operation of the system and impacts of the intervention. These models are deficient by not modelling the way the system reacts to the intervention via agent adaptation. Complex intervention modelling needs to capture the consequences of adaptation through the inclusion of an evolutionary dynamic to describe the long-term emergent outcomes that result as agents respond to the ecological changes introduced by intervention in an effort to produce better outcomes for themselves. Mathematical approaches such as those found in economics in evolutionary game theory and mechanism design can inform the design and evaluation of health interventions. As an illustration, the introduction of a central screening clinic is modeled as an example of a health services delivery intervention.
Summary
Complexity necessitates a greater role for mathematical models, especially those that capture the dynamics of human actions and interactions.
Electronic supplementary material
The online version of this article (doi:10.1186/s12874-016-0149-8) contains supplementary material, which is available to authorized users.
Individuals with psychosocial problems such as social phobia or feelings of loneliness might be vulnerable to excessive use of cyber-technological devices, such as smartphones. We aimed to determine the relationship of smartphone addiction with social phobia and loneliness in a sample of university students in Istanbul, Turkey. Three hundred and sixty-seven students who owned smartphones were given the Smartphone Addiction Scale (SAS), UCLA Loneliness Scale (UCLA-LS), and Brief Social Phobia Scale (BSPS). A significant difference was found in the mean SAS scores (p < .001) between users who declared that their main purpose for smartphone use was to access social networking sites. The BSPS scores showed positive correlations with all six subscales and with the total SAS scores. The total UCLA-LS scores were positively correlated with daily life disturbance, positive anticipation, cyber-oriented relationship, and total scores on the SAS. In regression analyses, total BSPS scores were significant predictors for SAS total scores (β = 0.313, t = 5.992, p < .001). In addition, BSPS scores were significant predictors for all six SAS subscales, whereas UCLA-LS scores were significant predictors for only cyber-oriented relationship subscale scores on the SAS (β = 0.130, t = 2.416, p < .05). The results of this study indicate that social phobia was associated with the risk for smartphone addiction in young people. Younger individuals who primarily use their smartphones to access social networking sites also have an excessive pattern of smartphone use.
We explored the frequency and indices of smartphone addiction in a group of King Saud University students and investigated whether there were differences in smartphone addiction based on gender, social status, educational level, monthly income and hours of daily use. We developed a questionnaire probing smartphone addiction consisting of five dimensions: 1) overuse of smartphone, 2) the psychological-social dimension, 3) the health dimension, 4) preoccupation with smartphones, and 5) the technological dimension. After being validated, the questionnaire was administered to 416 students, both male and female, at King Saud University. Results revealed that addiction percentage among participants was 48%. The order of smartphone addiction indices were as follows: overuse of smartphone, the technological dimension, the psychological-social dimension, preoccupation with smartphones, and the health dimension. Significant gender differences were found in the degree of addiction on the whole questionnaire and all of its dimensions with the exception of the technological dimension in favor of males. Significant differences by social status were found in favor of the unmarried. Bachelor degree students were found to have the highest degree of addiction. Significant differences by hours of daily use were also detected in favor of participants using the smartphone for more than 4 h a day. As to the monthly income dimension, significant differences were found on the health dimension in favor of participants with lower monthly income.
This chapter presents a meaning-based framework for addressing substance abuse in psychotherapy. It demonstrates how narrative identity theory and narrative-based therapy can be combined with mindfulness techniques to treat a woman in her 30s who is abusing alcohol. It first presents some key principles of narrative identity theory, focusing specifically on the concept of narrative scripts that become repetitive maladaptive responses to interpersonal stress. It discusses the identification and treatment of these dysfunctional scripts in psychotherapy. It then presents a case study of a woman who engaged in self-destructive drinking binges after perceived rejection in relationships. Once the therapist assessed her maladaptive script connected to her drinking, he employed several mindfulness techniques to preempt the script and provide her with alternative cognitive attributions and coping strategies. © 2013 Springer Science+Business Media Dordrecht. All rights reserved.
Using a comprehensive personality model, this study is the first to examine the relationship between a full range of personality traits and cell phone addiction. 346 college students completed an online survey that asked respondents to complete measures of the Big-Five personality traits and measures of materialism and need for arousal, Barratt’s (1959) impulsiveness scale, and a four-item measure of cell phone addiction. Data were analyzed using structural equation modeling. Couched in Mowen’s (2000) 3M Hierarchical Model of Personality, the elemental traits of emotional instability and materialism were positively associated while introversion was negatively associated with cell phone addiction. The central trait of attention impulsiveness exhibited a direct and positive association with cell phone addiction. A significant negative relationship between conscientiousness and all three dimensions of Barratt’s impulsiveness scale (central trait) was found. Several additional relationships between the elemental traits of Mowen’s personality hierarchy and the three dimensions of impulsiveness (central trait) also were uncovered. Study implications and future research directions are discussed.
The addictions field continues to grow and is expanding beyond the area of substance abuse and substance dependence. Process addictions are now an integral aspect of addictions treatment, diagnosis, and assessment. There is a gap in the literature related to process addictions which impacts counselors and clients due to lack of literature and knowledge on this new area. It also is hypothesized that there is a gap in continued education for incorporating treatment and assessment measure into clinical practice. This initial study was conducted to initiate an understanding of levels of knowledge counselors have in diagnosing, assessing and treating clients suffering with process addictions, indicators of where and how they learned about process addictions, and how they integrate their level of the treatment of process addictions in to clinical practice. The authors provide a brief overview of process addictions, a summary of original research, implications of this study, discussion, and recommendations for future research.
Background
Behavioral addiction research has been particularly flourishing over the last two decades. However, recent publications have suggested that nearly all daily life activities might lead to a genuine addiction.
Methods and aim
In this article, we discuss how the use of atheoretical and confirmatory research approaches may result in the identification of an unlimited list of “new” behavioral addictions.
Results
Both methodological and theoretical shortcomings of these studies were discussed.
Conclusions
We suggested that studies overpathologizing daily life activities are likely to prompt a dismissive appraisal of behavioral addiction research. Consequently, we proposed several roadmaps for future research in the field, centrally highlighting the need for longer tenable behavioral addiction research that shifts from a mere criteria-based approach toward an approach focusing on the psychological processes involved.
Information technology use is typically assumed to have positive effects for users, yet information technology use may also lead to negative consequences with various degrees of gravity. In the current work, we build on dual-systems theories to investigate negative consequences associated with mobile phones use (MPU), defined as the extent to which the use of mobile phones is perceived to create problems in managing one's personal and social life. According to dual-system theories, human behaviour is guided by two systems: reflexive (automatic) and reflective (control), which most of the time work in harmony. But when the two systems come into conflict, they will both complete to exert their influences over behaviour. Thus, we view the negative consequences associated with MPU as an outcome of the tug-of-war between the two systems influencing our day-to-day behaviours, where reflexive system is represented in our study by MPU habits and reflective system is represented by self-regulation. We hypothesise that the influence of habit and self-regulation on these negative consequences will be mediated through MPU. A partial least square analysis of 266 responses was used to validate and test our model. The study results generally support our model. The theoretical and practical implications of our study are discussed.
Background:
Resolving the theoretical controversy on the labeling of an increasing number of excessive behaviors as behavioral addictions may also be facilitated by more empirical data on these behavioral problems. For instance, an essential issue to the classification of psychiatric disorders is information on their natural course. However, longitudinal research on the chronic vs. episodic nature of behavioral addictions is scarce. The aim of the present study, therefore, was to provide data on prevalence, substance use comorbidity, and five-year trajectories of six excessive behaviors-namely exercising, sexual behavior, shopping, online chatting, video gaming, and eating.
Methods:
Analyses were based on the data of the Quinte Longitudinal Study, where a cohort of 4,121 adults from Ontario, Canada was followed for 5 years (2006 to 2011). The response rate was 21.3%, while retention rate was 93.9%. To assess the occurrence of each problem behavior, a single self-diagnostic question asked people whether their over-involvement in the behavior had caused significant problems for them in the past 12 months. To assess the severity of each problem behavior reported, the Behavioral Addiction Measure was administered. A mixed design ANOVA was used to investigate symptom trajectories over time for each problem behavior and whether these symptom trajectories varied as a function of sex.
Results:
The large majority of people reported having problematic over-involvement for just one of these behaviors and just in a single time period. A main effect of time was found for each problem behavior, indicating a moderately strong decrease in symptom severity across time. The time x sex interaction was insignificant in each model indicating that the decreasing trend is similar for males and females. The data also showed that help seeking was very low in the case of excessive sexual behavior, shopping, online chatting, and video gaming but substantially more prevalent in the case of excessive eating and exercising.
Conclusions:
The present results indicate that self-identified excessive exercising, sexual behavior, shopping, online chatting, video gaming, and/or eating tend to be fairly transient for most people. This aspect of the results is inconsistent with conceptualizations of addictions as progressive in nature, unless treated.
Psychological understandings and individualistic theories of human behaviour and behaviour change have dominated both academic research and interventions at the ‘coalface’ of public health. Meanwhile, efforts to understand persistent inequalities in health point to structural factors, but fail to show exactly how these translate into the daily lives (and hence health) of different sectors of the population. In this paper, we suggest that social theories of practice provide an alternative paradigm to both approaches, informing significantly new ways of conceptualising and responding to some of the most pressing contemporary challenges in public health. We introduce and discuss the relevance of such an approach with reference to tobacco smoking, focusing on the life course of smoking as a practice, rather than on the characteristics of individual smokers or on broad social determinants of health. This move forces us to consider the material and symbolic elements of which smoking is comprised, and to follow the ways in which these elements have changed over time. Some of these developments have to do with the relation between smoking and other practices such as drinking alcohol, relaxing and socialising. We suggest that intervening in the future of smoking depends, in part, on understanding the nature of these alliances, and how sets of practices co-evolve. We conclude by reflecting on the implications of taking social practices as the central focus of public health policy, commenting on the benefits of such a paradigmatic turn, and on the challenges that this presents for established methods, policies and programmes.
Background: Addiction recovery is receiving increasing attention in policy, practice and research. However, the concept remains vague, and it is unclear how the perspectives of important stakeholders – such as individuals in recovery and family members – relate to each other. Therefore, this study aims to capture these perspectives to provide a better understanding of what recovery entails and how optimized support can be provided.
Method: To gain insight into these perspectives, 9 focus groups (6 with individuals in recovery, 3 with family members), focusing on what recovery means to the respondents, were conducted in both in- and outpatient treatment settings. The focus groups were audio-taped, transcribed and thematically analyzed.
Results: Several tensions between the perspectives of individuals in recovery and family members and differences in pace emerged with regard to the 2 main categories we found in the data: (1) recovery as an act of change, and (2) the relational nature of recovery. Perspectives differ in relation to the change (existential or behavioral) that was needed for recovery, the roles of family members in recovery processes (tendency to control versus support), and the need for involvement in support.
Conclusion: Differing perspectives on recovery lead to a different pace and different expectations of important stakeholders. Therefore, mutual understanding is essential to gain awareness and to better align mismatching perspectives. A supportive context can provide the needed support for both individuals in recovery and family members to go through their own recovery process, while accompanied and supported by others who proceed at their own speed.
Dr’s Gregory Cajete, John G. Hansen, Jay Hansford C. Vest, and John E. Charlton have expanded the breadth, depth and scope of Walking With Indigenous Philosophy: Justice and Addiction Recovery (3rd ed.) making it a multidisciplinary, international and cross-cultural examination of a restorative justice based approach, that at its heart draws upon the wisdom inherent within Indigenous cultures, in order to question hierarchical and heavily one-sided disease based understanding to addiction recovery. This third edition continues to advocate a model of restorative justice, saturated throughout by an Indigenous philosophy of holism and healing through inclusion and education, when working with those upon the margins, in order to appreciate and honour the whole person. Justice is understood as a concept that must be based upon, and within, the recognition of the other. It is from within this recognition of the other that accountability, as a healing endeavour, must find its grounding. The voices of Cree Elders indigenous to northern Manitoba, Indigenous Justice Workers, two American Indians (Cajete and Vest), one First Nation (Hansen), one addiction counselling professional (Charlton) and both Indigenous and non-Indigenous people in recovery are heard. this books contains considerable discussion on the topics noted below:
1. Colonial Domination and Institutional Racism
2. Indigenous Philosophy
3. The Story and Philosophy of Walking With
4. Methodology
5. Indigenous Elders and non-Indigenous Respondents
6. Opaskwayak Crime Prevention
7. Understanding Addictions Recovery with the Friendship Centre in Saskatoon
8. Sweating with the Trickster
9. The Spiritual Ecology of Indigenous Thought
10. Looking at the Data Holistically
11. Indigenous (Omushkegowuk) Worldview
12. The International and Cross-Cultural Applicability of Indigenous Philosophy
13. Conclusions and General Recommendations for Walking With
Background:
The social meanings, settings and habitual nature of health-related activities and their integration into our daily lives are often overlooked in quantitative public health research. This reflects an overly individualized approach to epidemiological surveillance and evaluations of public health interventions, based on models of behaviour that are rooted in social cognition and rational choice theories. This paper calls for a new approach to alcohol epidemiology and intervention research informed by theories of practice.
Argument:
Practices are conceptualized as routinized types of human activity that are made up of, and can be recognized by, the coming together of several interwoven elements in the same situation (e.g. materials, meanings, skills, locations, timings). Different practices are interconnected-they can occur simultaneously (e.g. drinking and eating), hold each other in place (e.g. after-work drinks) or compete for time (e.g. parenting versus socializing). Applying these principles to alcohol research means shifting attention away from individuals and their behaviours and instead making drinking practices an important unit of analysis. Studying how drinking practices emerge, persist and decay over time, how they spread through populations and local or social networks and how they relate to other activities of everyday life promises new insights into how, why, where, when and with whom drinking and getting drunk occur.
Conclusions:
Theories of practice provide a framework for generating new explanations of stability and change in alcohol consumption and other health behaviours. This framework offers potential for novel insights into the persistence of health inequalities, unanticipated consequences of policies and interventions and new interventions targets through understanding which elements of problematic practices are likely to be most modifiable. We hope this will generate novel insights into the emergence and decay of drinking practices over time and into the geographical and socio-demographic patterning of drinking. Theories of practice-informed research would consider how alcohol policies and population-level interventions might differentially affect different drinking practices.
Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range ofcommonbehavioursandleisureactivitiesaspossiblebehaviouraladdiction.Ifthisexpansiondoesnotend,boththerelevanceandthecredibilityofthe fieldofaddictivedisordersmightbequestioned,whichmaypromptadismissiveappraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework
Little is known about the mechanisms of smartphone features that are used in sealing relationships between psychopathology and problematic smartphone use. Our purpose was to investigate two specific smartphone usage types – process use and social use – for associations with depression and anxiety; and in accounting for relationships between anxiety/depression and problematic smartphone use. Social smartphone usage involves social feature engagement (e.g., social networking, messaging), while process usage involves non-social feature engagement (e.g., news consumption, entertainment, relaxation). 308 participants from Amazon’s Mechanical Turk internet labor market answered questionnaires about their depression and anxiety symptoms, and problematic smartphone use along with process and social smartphone use dimensions. Statistically adjusting for age and sex, we discovered the association between anxiety symptoms was stronger with process versus social smartphone use. Depression symptom severity was negatively associated with greater social smartphone use. Process smartphone was more strongly associated with problematic smartphone use. Finally, process smartphone use accounted for relationships between anxiety severity and problematic smartphone use.
Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n = 152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d = 0.39) and social anxiety (d = 0.70), but not panic symptoms (d = 0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and unguided interventions. We conclude that Internet-delivered ACT is appropriate for treating SAD and potentially PD. Smartphone applications may partially compensate for lack of therapist support.
Drug-related overdoses appear to be a major factor behind an historic pause or even a reversal in the predominant downward trend over time in U.S. mortality rates, a departure that is especially evident among non-Hispanic white females of middle age. The new geography of accidental poisoning deaths and their covariates suggests that we should reassess traditional policies and perspectives in order to combat this threat to public health.
Conceptualizing, diagnosing, and treating behavioral or process addictions (addictions to nondrug activities, such as gambling, sex, Internet use and gaming, eating, shopping, work, and exercise) have proven to be conceptually complex. As a means of addressing this complexity, we adopt a syndrome model of addiction, which views the disorder of addiction as a syndrome with multiple opportunistic expressions and multiple, interacting biological, psychological, and experiential elements. In this chapter we refine our focus to how the psychological factors of impairment of control, craving, motives and expectancies, and personality influence the addiction syndrome of excessive behaviors. We draw upon relevant research on these psychological factors as they relate to excessive behaviors, integrate these findings, and propose implications for treating excessive behaviors. A transdiagnostic treatment approach is suggested that recognizes the dynamic interaction between personality characteristics, emotional and cognitive states, interpersonal problems, and excessive behaviors but also uses a tailored case conceptualization to identify the optimal specific treatment focus and approach as relevant to specific individuals and types of behavioral problems.
The neurobiology of addiction is pointing the way to potential methods of disrupting the neurocircuitry with both pharmaceutical and behavioral tools. Altering the reward and emotional circuits may prevent and treat the problem.
Addiction exercises enormous power over all those who are touched by it. This book argues that power and powerlessness have been neglected in addiction studies and that they are a unifying theme that brings together different areas of research from the field including the disempowering nature of addiction; effects on family, community and the workplace; epidemiological and ethnographic work; studies of the legal and illegal supply; and theories of treatment and change. Examples of alcohol, drug and gambling addiction are used to discuss the evidence that addiction is most disempowering where social resources to resist it are weakest; the ways in which the dominant discourses about addictive behaviour encourage the attributing of responsibility for addiction to individuals and divert attention from the powerful who benefit from addiction; and the ways in which the voices of those whose interests are least well-served by addiction are silenced.
The concept of addiction is complex and shaped by a range of understandings including how the recipient of an addiction is interpreted. This paper examines how concepts of self and concepts of addiction interact. Two fundamentally different understandings of self are considered: one which focuses on the self as a bio-psychological individual, the ‘particle’ self, and another that focuses on the self as a nexus of relationships, the ‘social’ self. The effect these have on understandings of addiction is examined along with implications for service interventions. Particle-informed understandings of addiction are seen as dominating services and leading to intervention responses that focus on the individual and de-emphasize the role of family, community and culture. The absence of social understandings limits both the range and quality of services offered. Particle and social approaches to addiction could operate side-by-side in offering a broader range of effective service responses to addiction.
Throughout history social stigma suffered by individual addicts has often been extended to cover large segments of the society, first of all lower classes and ethnic minorities in order to discredit their claims for more social justice and to legitimise superior position of dominant classes. Social stigma reinforced by criminal justice system justifies harsh control measures imposed on individuals and social classes which apparently do not deserve social justice due to their moral inferiority manifested by their apparently excess use of psychoactive substances. Disease concept of addition failed to remove individual stigma as in public perception moral condemnation of addictions is reinforced by medical stigma of chronic disease with poor prospects for recovery. Addiction treatment including its patients and providers have very low social status followed by low investments which results in poor treatment outcomes, further stigmatisation and progressing marginalisation. Interference of criminal justice system reinforces this process.
Addiction professionals and the public are recognizing that certain nonsubstance behaviors-such as gambling, Internet use, video-game playing, sex, eating, and shopping-bear resemblance to alcohol and drug dependence. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or "behavioral" addictions and has led to the newly introduced diagnostic category "Substance-Related and Addictive Disorders" in DSM-5. At present, only gambling disorder has been placed in this category, with insufficient data for other proposed behavioral addictions to justify their inclusion. This review summarizes recent advances in our understanding of behavioral addictions, describes treatment considerations, and addresses future directions. Current evidence points to overlaps between behavioral and substance-related addictions in phenomenology, epidemiology, comorbidity, neurobiological mechanisms, genetic contributions, responses to treatments, and prevention efforts. Differences also exist. Recognizing behavioral addictions and developing appropriate diagnostic criteria are important in order to increase awareness of these disorders and to further prevention and treatment strategies.
Complexity-resulting from interactions among many component parts-is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic modeling, definitions of integrity and means of standardization, and evaluation. New metaphors and terminology are needed to capture the recognition that knowledge generation comes from the hands of practitioners/implementers as much as it comes from those usually playing the role of intervention researcher. Failure to acknowledge this may blind us to the very mechanisms we seek to understand. Researchers in clinical settings are documenting health improvement gains made as a consequence of complex systems thinking. Improvement science in clinical settings has much to offer researchers in population health Expected final online publication date for the Annual Review of Public Health Volume 36 is March 18, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
In this new book, Bruno Latour offers answers to questions raised in We Have Never Been Modern, a work that interrogated the connections between nature and culture. If not modern, he asked, what have we been, and what values should we inherit? Over the last twenty-five years, Latour has developed a research protocol different from the actor-network theory with which his name is now associated—a research protocol that follows the different types of connectors that provide specific truth conditions. These are the connectors that prompt a climate scientist challenged by a captain of industry to appeal to the institution of science, with its army of researchers and mountains of data, rather than to “capital-S Science” as a higher authority. Such modes of extension—or modes of existence, Latour argues here—account for the many differences between law, science, politics, and other domains of knowledge.Though scientific knowledge corresponds to only one of the many possible modes of existence Latour describes, an unrealistic vision of science has become the arbiter of reality and truth, seducing us into judging all values by a single standard. Latour implores us to recover other modes of existence in order to do justice to the plurality of truth conditions that Moderns have discovered throughout their history. This systematic effort of building a new philosophical anthropology presents a completely different view of what Moderns have been, and provides a new basis for opening diplomatic encounters with other societies at a time when all societies are coping with ecological crisis. (Publisher's abstract)
Feminist scholars developed the concept of “invisible work” in the 1980s to bring sociological attention to work that was unpaid, unrecognized, or undervalued. Since then, it has become clear that the “generous” concept of work can be applied more broadly and that bringing invisible work into view may help to advance projects of social justice and inclusion. Drawing on the example of healthcare access for deaf patients, this article explores strategies for deploying the generous concept of work in institutional analysis.
In this study, a previously evaluated guided Internet-based cognitive behavior therapy for social anxiety disorder (SAD) was adapted for mobile phone administration (mCBT). The treatment was compared with a guided self-help treatment based on interpersonal psychotherapy (mIPT). The treatment platform could be accessed through smartphones, tablet computers, and standard computers. A total of 52 participants were diagnosed with SAD and randomized to either mCBT (n = 27) or mIPT (n = 25). Measures were collected at pre-treatment, during the treatment, post-treatment and 3 month follow-up. On the primary outcome measure, the Liebowitz Social Anxiety Scale–self rated, both groups showed statistically significant improvements. However, mCBT performed significantly better than mIPT (between group Cohen's d =0.64 in favor of mCBT). A larger proportion of the mCBT group was classified as responders at post-treatment (55.6% versus 8.0% in the mIPT group). We conclude that CBT for SAD can be delivered using modern information technology. IPT delivered as a guided self-help treatment may be less effective in this format.
Neurobiological and clinical data indicate that maladaptive engagement in certain behaviors warrants consideration as “behavioral” or non-substance addictions. The present chapter reviews existing neurobiological and genetic/family history evidence for behavioral addictions involving gambling, Internet use, video-game play, sex, eating, and shopping. At a neurochemical level, behavioral addictions may involve dysregulation of serotoninergic, dopaminergic, noradrenergic, and opioidergic systems. At a neurocircuitry level, findings suggest dysfunction in brain regions associated with the mesolimbic dopaminergic pathway and frontal areas; disruption in these circuits could lead to disadvantageous decision-making, impaired inhibition, and increased cue-induced craving. While a genetic understanding is at an early stage, genetics/family history data support heritability for behavioral addictions and suggest genetic overlaps with other psychopathologies. As this represents an emerging area of research, data remain sparse in multiple domains. An improved understanding of behavioral addictions will help in establishing appropriate nomenclature and enhance the ability to recognize, prevent, and treat these disorders more effectively.
This article works out the main characteristics of `practice theory', a type of social theory which has been sketched by such authors as Bourdieu, Giddens, Taylor, late Foucault and others. Practice theory is presented as a conceptual alternative to other forms of social and cultural theory, above all to culturalist mentalism, textualism and intersubjectivism. The article shows how practice theory and the three other cultural-theoretical vocabularies differ in their localization of the social and in their conceptualization of the body, mind, things, knowledge, discourse, structure/process and the agent.
The experience of youth, the impact of technology, and the assumptions of gender are experienced as natural by most individuals—as if due solely to biology or progress. Yet, as scholars have effectively demonstrated, social processes that are culturally and historically relative have a critical role in shaping our lived experiences. This paper will continue to build upon the examination of social construction through a unique analysis of the use of cellular phones by teenage girls that incorporates both the idealization of use presented in advertising images and the lived experiences of teenage girls. The functioning of three primary discourses will be outlined: the media discourse that emphasizes image and independence; the parental discourse that focuses upon danger and safety; and the youth discourse that highlights self-determination and sociability. Current advertising, it will be shown, is picking up on what adolescents today want: style, friendships, and individuality. For the young women interviewed, however, the desire for independence is mitigated by their parents' rules, an acceptance that the public world is a dangerous place, and a desire to act as a responsible young woman. The cellular telephone thus exists at the intersection of these competing discourses of independence, safety and femininity. And at this intersection, it will be argued, the cellular phone functions as a part of the ‘technology of the self', as posited by Michel Foucault, through which these young women are reminded of what is desired of them and are encouraged to reflect upon their actions and identities.
For many, gambling is a recreational activity that is performed periodically without ill effects, but for some, gambling may interfere with life functioning. A diagnostic entity, pathological gambling (PG), is currently used to define a condition marked by excessive and problematic gambling. In this review, the current status of understanding of the neurobiologies of gambling and PG is described. Multiple neurotransmitter systems (norepinephrine, serotonin, dopamine, opioid and glutamate) and brain regions (ventral striatum, ventromedial prefrontal cortex, insula, among others) have been implicated in gambling and PG. Considerations for future directions in gambling research, with a view towards translating neurobiological advances into more effective prevention and treatment strategies, are discussed.
In this incisive book, Michel de Certeau considers the uses to which social representation and modes of social behavior are put by individuals and groups, describing the tactics available to the common man for reclaiming his own autonomy from the all-pervasive forces of commerce, politics, and culture. In exploring the public meaning of ingeniously defended private meanings, de Certeau draws brilliantly on an immense theoretical literature to speak of an apposite use of imaginative literature.
Debates about EBs (gambling, Internet use, shopping, working, exercising, eating, video game playing and sex) have gained momentum among researchers, clinicians, and the media. Controversy exists in the scientific literature about whether EBs are primary psychiatric disorders and, if so, where they fit into current and emerging diagnostic classification systems. The lack of consensus and associated confusion was the impetus for this systematic review. The key search terms were: abuse/misuse, dependence, addiction, impulse control, compulsivity, pathological, and excessive, in combination with: buying/shopping, work, gaming/video games, exercise, Internet, sex, eating, and gambling. 361 articles were analyzed according to their conceptualization. In total, 47% adopted an addiction conceptualization, 9% adopted an impulse control conceptualization, and 2% an obsessive compulsive spectrum conceptualization. Alternative or blended conceptualizations were utilized by 27% and 16% did not specify a particular conceptualization. The findings were also broken down by excessive behaviour. Almost half of the articles were review articles (49%), 34% were empirical articles, and the remaining 17% were commentaries. There was a general lack of agreement regarding conceptualization and a lack of consistency in nomenclature, definitions, and use of language. The addiction conceptualization was most prevalent consistent with the common use of the term behavioural addiction, and in line with proposed changes to the DSM-5.