Treatment of Compulsive and Addictive Behaviors

Group Addiction TX

Theory Selection

The Psychodynamic Model

The Behaviorists

The Cognitive Model

The Humanistic Model

Theory Analysis

Ethical and Cultural Considerations

Group Development

Personal Model

Psychology has a long tradition of interpreting human behavior across different paradigms. The current paper investigates a method of incorporating four main psychological paradigms: psychoanalytic, behaviorist, cognitive, and humanist, into group counseling treatment for addictions and compulsive behaviors. Each paradigm is briefly discussed then the integration of aspects from theoretical models that spring from the paradigms is examined. This integration is based on previous empirically-based findings that support the use of a specific facet or an approach to treatment and counseling. The integration of these paradigms is discussed in terms of the ethical and cultural considerations, the development of groups, and a model developed specifically to avoid recidivism in addictive or compulsive behaviors.

Psychology has a long tradition of interpreting human behavior across different paradigms. The specific paradigm used defines what methods, hypotheses, and explanations will be accepted in describing behavior. Thus, the same behavior can be explained differently depending of the core propositions of each paradigm (Mcleod, 2007). Counseling also follows this approach. The specific counseling methods are derived from the major psychological paradigms. The five major perspectives in psychology are: the psychodynamic perspective, the behaviorist perspective, the humanist perspective, the cognitive perspective, and the biological perspective (McGraw-Hill, 2008). As the biological perspective is most often associated with the use of medications and psychiatry there will be no discussion specifically of that model in this paper, although counseling interventions are believed to have neurobiological effects.

The other four paradigms have direct applications to therapy and counseling for a number of different conditions. Psychotherapy or counseling for addictions has often been considered a difficult enterprise (Wurmser, 1978), but if approached from an integrative manner counseling for addictions and compulsive behaviors in a group or individual format can be effective. The current paper examines some of the aspects of each of the four remaining paradigms that this writer believes can be helpful in a group counseling approach to these issues and to forming a holistic approach to treatment.

Theory Selection

The Psychodynamic Model

The psychodynamic paradigm was originated by Sigmund Freud and advanced by other famous psychologists, most from a clinical psychology or psychiatry background such as Carl Jung, Karen Horney, and Alfred Adler (Hall, Lindzey, & Campbell, 1998). In essence, the psychodynamic paradigm views the mind as a composite of three interacting and sometimes competing structures that were originally named by Freud as the id (the unconscious instinctual aspect composed of drives), the ego (the mostly conscious aspect that mediates reality with drives and rules), and the superego (the conscience, mostly unconscious but learned from parents). Most dynamically- oriented theorists/methods retain Freud’s structural motif, although differing emphasis was placed on the role and importance of the ego and of personal (object) relations with others by later theorists. In a dynamic model much of human behavior is attributed to instinctual drives (for Freud these were sexual or procreative drives) and much of motivation is unconscious in nature. Thus, the person often has little insight and little conscious control over many or most (if not all) of their actions. Behavior is fueled by drives and needs that are innate and psychological problems result when drives are blocked or when anxiety occurs as a result of unconscious conflicts that transpire due to the interactions of the three structures of the mind. Often the anxiety is blocked by defenses mechanisms such as repression that protects the ego from the anxiety associated with id impulses gone awry. For most of the psychodynamic theorists the crucial time in the development of one’s personality occur the first six or so years of life, although there are some exceptions such as the theories of Erik Erickson (Hall, Lindzey, & Campbell, 1998). Psychodynamic counseling relies on three main techniques: free association (the client just speaking what is on their mind at the time), transference (the projection of inner conflicts on the therapist), and interpretation (when the time is right the counselor provides limited insight into the meanings of associations and transference). Sometimes dream analysis can be used if appropriate.

Early psychoanalytic formulations of substance abuse and compulsive behaviors proposed that these behaviors stemmed from the unconscious self-destructive instincts of the id resulting in a “slow suicide” (Khantzian, 1980). These early dynamic treatments focused on these tendencies of the id as actions that were merely manifest symptoms of a repressed idea that leaks into consciousness. The actual repressed idea is unrecognizable, it appears on the surface as compulsive behavior or addiction but it is distorted by psychological defense mechanisms. Compulsive behaviors and addiction were initially thought of as a compromises resulting from the conflict of a repressed idea and the defenses against that idea (Morgenstern & Leeds, 1996). However, as psychoanalytic thought began to move away from drive reduction models of behavior and more towards the ego functions the conceptualization of psychodynamic models altered its focus. More contemporary psychodynamic approaches maintain that compulsive behaviors like addictions are the defense mechanism themselves (e.g., Khantzian, 2012). Addicts and those with other compulsive behaviors use those actions to protect themselves from depression, anxiety, shame, and other negative emotions. That is to say that these behaviors are attempts at “self-medication” (Khantzian, 1980). So in the more contemporary analytical thinking these negative affective states are not the consequences of addiction or compulsive behaviors, but instead are the causes of them (Khantzian, 2012). One of the early originators of this idea, Wurmser (1978) believed that the greater the legal penalties or social stigma associated with a specific drug or behavioral compulsion, the more severe the psychopathology that was involved in driving it. The logical conclusion would be that drug control laws or laws against certain compulsive acts and many forms of drug treatment miss the point because they merely focus on the acts themselves and not the underlying pathology. If indeed the self-medication hypothesis is true, then it would follow that different psychopathological states would result in different compulsions or dugs of choice. This also led to a large body of research aimed at being able to predict the type of drug addiction or compulsion one has or one will have as a result of their underlying psychopathology. There has been extensive research starting in the 1980’s up to the present time attempting to predict a specific drug of choice from psychological data. For example, Suh et al. (2008) attempted to predict specific drug addiction/abuse in a large sample of drug users and nonusers based on the Minnesota Multiphasic Personality Inventory-2 special scales using logistic regression analyses. The results indicated that repression directly and the depression subscales indirectly predicted membership in the alcoholic group, psychomotor acceleration was a predictor of the cocaine abuse group, and cynicism predicted preference for heroin, partially supporting the self-medication hypothesis.

Group psychodynamic therapy would still follow many of the same principles that individual therapy follows. By focusing group therapy on particular issues the clients are directed to introspect on specific events regarding their behaviors and feelings and are given insight about their interpersonal relationships and transferences in the group. By listening to each others’ introspections, conflicts, and transference behaviors the process of insight into psychodynamic therapy is can be significantly increased in the group process.

Behaviorism

Behaviorists, like psychodynamic theorists agree that much behavior occurs beneath ones’ conscious awareness, but in contrast the psychodynamic theorists, the behaviorists took a different approach to designing their theories. The bulk of early psychodynamic thought was derived from their observations and cases histories of clinical cases of people with psychological problems (in some instances very severe psychological problems) but the behaviorists developed their ideas initially from the experimental studies with animals (Hall, Lindzey, & Campbell, 1998). The early influential studies that formed the core theme of the behaviorists came from experiments by Pavlov, Thorndike, and Watson. Essentially the behaviorists took the view that what was externally observable was important and human behavior was based on the reinforcement or punishment of like behaviors in the past. In its most extreme form behaviorism viewed the mind as a “black box” from which little useful information could be derived (Skinner, 1966). In a sense then, behaviorism is the antithesis of the psychodynamic model in that it did not theorize about unconscious drives but instead relied on empirical evidence, measureable behaviors, and experimental models to derive their ideas B.F. Skinner, probably the most influential of all the behaviorists, took this notion to the extreme developing models of how schedules of reinforcement could be provided and offering a look at how behavioral theories could be applied to everything from education to psychotherapy to a model for developing society.

McAuliffe and Gordon (1980) proposed that addiction and compulsive behaviors are operantly conditioned responses that strengthen as a function of the quality, number, and size of the reinforces, which can be either positive (rewards like euphoria or peer acceptance) or negative (like anxiety reduction, pain management, or the reduction of withdrawal symptoms). For strict behaviorists addiction or compulsion are simply a terms for an operantly conditioned behavior. Other compulsive behaviors follow the same line of reasoning. The inability to refrain from using a drug or engaging in a compulsion merely indicates that a sufficient history of reinforcement has been acquired to drive a high rate of the behavior. Therefore, physical dependence, as in the DSM-IV-TR diagnostic criteria, is neither sufficient nor necessary to result in a diagnosis of an addiction (American Psychiatric Association [APA], 2000). Physical dependence is just a result of the overuse of certain drugs according to this view (McAuliffe & Gordon, 1980).

Behaviorists offer many different techniques that can applied to group counseling. Typically contingency management (CM) techniques are applicable behavioral for group counseling involved with addiction or compulsive behaviors (Higgins & Petry, 1999). CM initially begins with a functional analysis to determine antecedents and consequences of the behavior. By understanding the antecedent conditions and reinforcers for the behavior other more adaptive behaviors can be substituted for the addiction or the compulsion. In the early CM approaches Dustin and George (1973) specified three phases of CM that can be applied to group counseling. The first phase is problem specification which incorporates a functional analysis and defines terms as they have relevance for the client. The second phase is making a commitment to change. In addictions and compulsive behaviors the client is often in treatment at the bequest of others; the client needs to commit to change and believe that change is needed. Incentives to generate and maintain the clients’ motivation are crucial to identify. The third phase is specifying goals where the group and the client specify the client’s goals and the means to achieve them. The contingencies are delivered based on the client’s maintenance of abstinence and on their attendance. Some groups use vouchers or reinstatement of privileges, whereas other contingences can be more internalized. In some cases punishment may be used to maintain treatment adherence, but the preferred way is to use positive reinforcement.

The Cognitive Model

According to the strict behaviorists all learning was a result of reinforcement (or punishment); however, as might be clear from the above description of CM behavioral therapies benefit from the addition of the recognition of the importance of thoughts and attitudes. Cognitive models of behavior have been extremely influential in counseling. The cognitive paradigm got its start when in 1946 Edward Tolman, in order to discredit a pure behavioral explanation of behavior, performed an experiment where completely sated rats were allowed to explore a T-maze. At one end of the maze was water, at the other end food. Later when half the rats were deprived of food and the other half were deprived of water they returned to the spot in the maze that would allow then to satisfy their needs. According to behaviorist theory since the rats were never reinforced for learning they should not have been able to find food or water later; however, Tolman had argued that the rats had made “cognitive maps” of the maze and this is why they knew where the food (or water) was (Tolman, 1948). Tolman’s views would later be adopted by other psychologists such as Uric Neisser to develop the cognitive perspective of psychology (Neisser, 1967). The cognitive paradigm holds that people’s mental states, thoughts, perceptions, and beliefs shape and mold their behaviors. Modern cognitive psychological principles have likened humans to complex information processing systems that input, analyze, and manipulate information in order to make decisions. Thus, cognitive psychologists acknowledge the presence of inner mental states like the psychodynamic and humanist models and still adhere to the rigid empirical and methodological approach of the behaviorist school. Cognitive psychology principles have been applied to all areas of psychological applications and in other fields such as economics and decision making theory.

Bandura’s (1977) social learning theory (SLT) is an obvious cognitive application that fits in with group models of counseling. SLT indicates that learning (hence behavior) can occur via the modeling of another’s actions. This is an obvious advantage to the group counseling process whereas individuals learn, relate, and share from each other’s experiences. Motivational interviewing (Miller & Rollnick, 2002) is an empirically supported cognitive behavioral treatment for addiction, substance abuse, and compulsive behaviors. Motivational interviewing works by positively reinforcing treatment relevant cognitive behaviors such as “change talk” by means of an interpersonal process in the therapy session (e.g., the use of support, empathy and contingent feedback to the members of the group).

The Humanistic Model

The use of empathy, being able to take the client’s perspective, is often regarded as a key component in fostering change. This component was popularized by the “third force” in psychology, the humanistic movement. This movement was fueled primarily by Carl Rogers, although certain other theorists like Abram Maslow were also instrumental in promoting the humanist perspective (Mcleod, 2007). This perspective came about as a reaction to the mechanistic and deterministic stances of the psychodynamic and behavioral models, hence the third force tag. Humanists strongly believe in choice, free will, and self-determination (or self-actualization as characterized by Maslow) as the important determinants of behavior and personality. Their ideas are reaction to the psychodynamic notion that instincts direct behavior and the behaviorist notion that the environment shapes personality. Therefore the humanistic model sought to put the control of people’s lives back in their own hands and concentrated on issues such as the need to meet basic human needs such as food and shelter, but also the human need to strive for other more abstract goals such as a sense of belongingness, creativity, and becoming more in tune with the greater meanings of life. Motivation was then not also due to instincts or environmental pulls, but was also fueled by the need to become something more than a cog in a machine and a need to find deeper meanings to life and existence, something not well explained by the previous two paradigms. The humanistic paradigm was also extremely accomplished in the area of psychotherapy thanks to Carl Rogers being the first therapist to apply experimental methodologies to psychotherapy outcomes (Barry, 2002). Given their views the humanists are often considered to have the most positive outlook on behavior and personality compared to the previous paradigms.

Using the Rogerian ideals of therapist empathy, genuineness, and unconditional positive regard will enhance any group counseling format (Okiishi, Lambert, Nielsen, & Ogles, 2003). However, there are some other principles that Rogers explored that are also important in group counseling for compulsive behaviors or addictions. Rogers believed that every person had a drive towards self-actualization, but this drive was hindered by the “shoulds” which are attitudes people accept as being valid, but are actually based on false perceptions of what the person believes will validate them as a person (Rogers, 1965). We incorporate these values from others. In addiction and compulsive behaviors these “shoulds” can be important to identify and challenge.

Theoretical Analysis of the Paradigms

Which of the above paradigms is correct? There is no easy answer to that question; however, the most parsimonious answer is that all of the influences described by these paradigms play an important part in human behavior (Fava & Sonino, 2008).

The accomplished psychoanalyst Wurmser (1974) believed that addicts were not suitable clients for analysis. Moreover, the psychodynamic notion of addictive or compulsive behavior as a form of “self-medication” while long accepted in lay circles, has not stood up to empirical efforts to test its validity. Most of the research forecasting group membership by pathology is ad hoc, and not predictive. For example, even as far back as 1985 Cox found that those subjects who later developed addictions demonstrated the traits of independence, nonconformity, and impulsivity but no significantly difference levels of psychopathology than those who did not become abusers or addicts. In fact the opposite appears to be true: the comorbidity of depression, anxiety, etc. appears to result after significant abuse/addictive problems have occurred with the lone exception being personality disorders, but none of these predicted substance abuse problems better than the other (Grant et al., 2004). The self-medication hypothesis then may explain the maintenance and increasing intensity of compulsions or addictions, but not their etiology. Nonetheless the model can still be a useful consideration in treatment. The psychoanalytic notion of conscious and unconscious components of behavior has recently been popularized by models of social cognition that have divided cognition into automatic and controlled cognitive processes is relevant to understanding compulsive behaviors and addiction and can be applied in a cognitive behavioral model.

CM has solid empirical support to its effectiveness in the treatment of compulsive behaviors and addictions and meta-analyses of treatment studies indicate robust effect sizes (e.g., Dutra et al., 2008). However, the use of behavioral techniques is enhanced significantly by including cognitive therapy techniques. The principles of motivational interviewing have been empirically supported as valid methods to treat addictions and compulsive behaviors and are compatible in CM individual and group sessions (Moyers & Martin, 2006). Cognitive behavioral therapy has been used to treat a wide variety of issues and is often the preferred therapy for substance abuse, addiction, and compulsive behaviors (Miller & Rollinck, 2002; Moyers & Martin, 2006). However, all psychosocial interventions include common and unique factors in their conceptualization and implementation. There has been a long history of discussing the common factors in therapy and counseling which often include the educating clients, giving them a rationale for treatment, developing expectations of improvement, providing encouragement and support, and what is often considered crucial is the quality of the therapeutic relationship (Okiishi et al., 2002). The humanistic paradigm focuses on improving the therapeutic outcome via the therapeutic relationship. Moreover, the Rogerian notion of the “shoulds” and trying to conform to what we think others think we should is very similar to the cognitive model of counseling and implanting change. Therefore in group counseling the combination of these factors can bring together a viable counseling environment.

Ethical and Cultural Issues

There are several important issues to consider here (Pope & Vasquez, 2010):

1. Getting Informed Consent. Getting informed consent from clients for group therapy is of fundamental importance as it to assure the client’s independence in entering and following the guidelines of counseling as well as informing them of the group procedures including roles, rights and responsibilities of all parties.

2. Counselor Competence. Counselors have an ethical responsibility only to practice within the scope of their professional competence as judged by education, training, and experience. Moreover, counselors should base treatments on established methods backed by sound theory. The counselor should be able to describe the theoretical basis for providing a counseling service or using a particular method.

3. Confidentiality. Counselors need to carefully guard against the unauthorized disclosure of client information. This issue should be explained to the group and to new members. Several other concerns associated with this are: Counselors have a duty to warn/protect individuals whom a client places in imminent danger, such sharing of needles, STDs, relapses, etc. Counselors should know the statues relating to these situations. Minors in the groups need to have a clearly established understanding of the extent to which their parents will be informed of issues surfacing in sessions. Counselors should be familiar with state and federal laws regarding minors and substance abuse.

4. The maintenance of appropriate boundaries during the sessions and after the groups are over should be discussed with the group and new members.

Another important concern is the counselor’s and group’s need to honor diverse values. It can be a challenge to guide change in individuals without undermining their autonomy. It is inevitable that counselors with encounter views that are different from their own and that group members will also have such differences. When the counselor holds a fundamentally incompatible value with a client, it is up to the counselor to either refer the client out or to attempt to help the client achieve their goals within the context of their value system. However, some clients with alcohol issues and other substance abuse issues will attempt cling to their alcohol use as form of cultural expression. In these cases if the counselor finds it necessary to make an effort to modify these values, it should be done no more than is necessary to address the particular focus of the treatment.

It can be beneficial to discuss differing values in group as long as it is done respectfully. Of course this does not mean values regarding substance abuse and continued use while in treatment, as sobriety should be stressed, but instead related to personal and cultural differences. If a counselor cannot practice tolerance and respect for certain individuals then the counselor should refer them to another treatment provider. Group members who cannot demonstrate tolerance and respect for others or if they become too disruptive and will not attempt to change or demonstrate respect for others should also be referred to another provider.

Group Development

Tuckman’s (1965) model has been applied to the development of groups that can serve as a guideline for the development of the addiction counseling group. There are a few considerations however. First, Tuckman’s model applied to closed groups that basically were oriented towards a goal and would disband when the goal was achieved. Many counseling groups are open, continuing, and allow new members to join at anytime. Some of the dynamics of these groups will change slightly because members can be at different stages, but the main concepts of Tuckman’s model are still applicable.

Stage one (Forming) involves development of the group, briefing members as to the purpose, rules, ethics, etc. Many counseling groups are not static and new members may come in at anytime so this may be an ongoing or repetitive stage for the group. In substance abuse or compulsive behavior group there will be the need for self-disclosure and many members will feel uncomfortable at first. The stage can be comfortable and it is up to the counselor to provide the empathy and acceptance for all members so this is modeled across the group. This is also the best time for didactics and teaching, setting up CM plans for individuals, and working on the behavioral aspects of the treatment. In open groups newer members can benefit from the experience of more senior members and should be encouraged to listen closely to them, ask questions, and discuss issues with them.

In stage two (Storming) where different ideas, different needs, different views will start to compete. Individuals will experience difficulties in maintaining their sobriety or behavioral plan, or will have cravings and feel helpless. Here a counselor needs to be able to assist the different members in the development and maintenance of the CM plan that was originally agreed upon. Other group members should also be able to share and contribute. The counselor is responsible for trying to keep members focused and engaged in treatment. This is the phase where many relapses will occur (but relapse can occur at any stage) and the counselor should approach these as a learning experience for the client and not a failure. This is the stage where confidence in the ability to engage in treatment will begin to wane and the counselor is crucial in working with clients and using Rogerian principles to strengthen the therapeutic alliance and keep the client on track.

The third stage (Norming) occurs when the group has achieved a sense of purpose and can focus on the group goals. Counseling groups are often able to benefit from the flow of members in and out of groups as these groups are often open. Thus, there will be members at differing stages of development and those in the early stages can benefit from the experience of those that have been in the group. So there will always be some members in the storming phase and some in this phase some in the next two phases. The empathetic counselor will let the group benefit from this situation.

The fourth stage (Performing) is the stage where group can focus on the tasks and reach goals as a unit. Senior members of the group here learn by listening, sharing, and teaching; newer members learn mostly by listening, asking, and sharing. In an open group the newer members are able to move quicker through the stages than their predecessors as they have the benefit of experience. Members at this stage develop a string sense of group cohesiveness, the feeling of an awareness of belonging or being a member of the group. Members in this stage can go beyond simple behavioral interventions and CM and begin to explore an in-depth examination of their thinking processes, motivations, and focus on bringing desirable changes in behavior.

The fifth stage, adjourning, occurs after the client, the group, and the counselor concur that a member has “graduated” for lack of a better term is ready to function outside the group. The counseling group itself is likely to be ongoing, unlike the groups that Tuckman envisioned. However, closed groups may have a group adjournment. Twelve-step groups never formally acknowledge this step as adjourning and hard-core “12-steppers” consider group attendance a lifelong endeavor.

A good counselor would also plan for follow-up meetings with members that leave the group to allow for booster sessions and in cases of legal involvement for accountability purposes so that the members will continue their programs. Group members “graduating” should be encouraged to return to the group from time to time if they so desire.

Personal Model

This writer has come to believe that an integrative therapy/counseling approach is the best approach for the treatment of addictions and compulsive behaviors. The difference between integrative psychotherapy and eclectic psychotherapy is that integrative therapy ties together at least two different elements from at least two different schools of thought into a unified theoretical approach, whereas eclectic approaches combine different techniques from different schools on a case by case basis (Palmer & Woolfe, 1999). I do not believe that a competent counselor will just use a trial and error approach in much the same way the psychiatrists prescribe medications.

Using and integrative approach the client, counselor, and group should first identify the situations in which group members he/she may experience difficulty coping and increased desire to return to the addictive or compulsive behavior. Since most addicts and those with compulsions have tried to stop on their own reviewing past relapses and discussing fantasies of using would allow for identification of such situations. For clients who are still engaging in their behaviors a self-monitoring system that records situations, feelings, and interpersonal factors associated with urges could be developed (this could be useful for all clients).

Next, the members of the group need to learn to recognize the situations associated with relapse so risky situations can be addressed. Learning and practicing more effective coping skills in these situations should be undertaken. This allows for the development of motivation, self-efficacy, and strengthening of the ability to delay gratification and adopt more distal goals. For many of the clients in the group assessing and developing these last two aspects are very important.

For long-term success identifying individual aspects of addictive and compulsive behaviors, cognitive restructuring, and teaching would be important factors of successful treatment in several ways. These could follow some basic guidelines such as:

A. Reviewing the client’s expectations of their behaviors. Addictions and compulsions are driven by expectations of the client. Something is expected from the behavior. These clients concentrate on the immediate effects of their behavior and not the long-term effects. An effective treatment regime should include having them weigh their expectancies for both immediate and delayed consequences their behavior. This allows for the identification of the drive of the behavior and can help them to identify and strive for longer-term outcomes. Practice here is the key to learn to use higher-order mental processes (social cognition).

B. The group can jointly develop recovery maps which are analyses of high-risk situations that emphasize the different choices available to cope in these situations. A solid therapy system should actively address these issues.

C. As discussed above these behaviors are not just specific problems themselves but are often symptoms of bigger issues. Other needs often have to be addressed on many levels. By discussing mood, relationships, and occupational issues and using reframing strategies in these areas a person can achieve greater lifestyle balance and develop coping mechanisms for triggers of use and relapse.

D. Return to activities that were previously enjoyable or identifying new activities and goals can help establish more positive behaviors (so-called positive addictions).

E. Relapses are not uncommon in recovery, wanting to go out and return to one’s old ways is common. Counselors should be assisting in the reframing of such episodes. What is driving this desire and how else can the drive be addressed? This can help decrease the tendency of the person to view relapses as the result of a personal failing and reduce the potential of the notion that a slip will inevitably lead to relapse

F. Finally, other issues such as depression or other psychiatric problems should be addressed in their own right.

Table one displays the mechanics of the group:

By to adhering to these main points one can integrate the important paradigms and work towards a positive outcomes with these difficult clients. The style will be democratic, with the counselor’s role being less prominent as the group develops over time. In early sessions the counselor will provide didactics and structure; however, as the group develops more and more structure will be provided by the group members. The counselor will allow the group format to be determined by all of the members of the group. All individuals in the group will be able to participate and structure the group’s direction.

References

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Bandura, A. (1977). Social leaning theory. Englewood Cliffs, NJ: Prentice-Hall.

Barry, P. (2002). Mental health and mental illness. (7th Ed.) New York: Lippincott.

Cox, W.M. (1985). Personality correlates of substance abuse. In M. Galizio & S.A.

Maisto (Eds.), Determinants of substance abuse: Biological, psychological, and environmental factors (pp.209-246). New York: Plenum.

Dustin, R., & George, R.L. (1973). Action counseling for behavior change (2nd ed.). Cranston, RI: Carroll.

Dutra, L., Stathopoulou, G., Basden, S.L., Leyro, T.M., Powers, M.B., & Otto, M.W. (2008). A meta-analytic review of psychosocial interventions for substance use disorders. American Journal Psychiatry, 165 (2) 179-187.

Fava, G.A. & Sonino, N. (2008). The biopsychosocial model thirty years later. Psychotherapy and Psychosomatics, 77, 1 — 2.

Grant, B.F., Stinson, F.S., Dawson, D.A., Chou, S.P., Dufour, M.C., Compton, W., et al. (2004).

Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61, 807-816.

Hall, C.S., Lindzey, G., & Campbell, J.B. (1998). Theories of personality. New York:

John Wiley.

Higgins, S. & Petry, N. (1999). Contingency management: Incentives for sobriety. Alcohol Research and Health, 23, 122-127.

Khantzian, E.J. (1980). An ego/self theory of substance dependence: A contemporary psychoanalytic perspective. In D.J. Lettieri, M. Sayers & H.W. Pearson (Eds.), Theories on drug abuse: Selected contemporary perspectives (pp. 29-33). Washington, DC: National Institute of Drug Abuse.

Khantzian, E.J. (2012). Reflections on treating addictive disorders: A psychodynamic perspective. The American Journal on Addictions, 21 (3), 274-279.

McAuliffe, W.E. & Gordon, R.A. Reinforcement and the combination of effects: Summary of a theory of opiate addiction. In: D.J. Lettieri, M. Sayers, & H.W. Pearson (Eds.) Theories on drug abuse: Selected contemporary perspectives. Washington DC: National Institute of Drug Abuse.

McGraw-Hill. (2008). Introduction to psychology: Psychinteractive online. In Five perspectives on psychology. Retrieved June 7, 2012, from http://highered.mcgraw-

hill.com/sites/0073382736/student_view0/perspectives_in_psychology/five_persp

Mcleod, S. (2007). Psychology perspectives. In Simply psychology. Retrieved June 7,

2012, from http://www.simplypsychology.org/perspective.html.

Miller, W. & Rollnick, S. (2002). Motivational interviewing: Preparing people for change, (2nd ed.). New York: Guilford Press.

Morgenstern, J., & Leeds, J. (1996). Contemporary psychoanalytic theories of substance abuse: A disorder in search of a paradigm. Psychotherapy, 30, 194-206.

Moyers, T. & Martin, T. (2006). Therapist influence on client language during motivational interviewing sessions. Journal of Substance Abuse Treatment, 30, 245-251.

Neisser, U. (1967). Cognitive psychology. New York: Meredith.

Okiishi, J., Lambert, M.J., Nielsen, S.L., & Ogles, B.M. (2003). Waiting for supershrink: An empirical analysis of therapist effects. Journal of Clinical Psychology and Psychotherapy, 10, 361 — 373.

Palmer, S. & Woolfe, R. (1999). Integrative and eclectic counselling and psychotherapy. Thousand Oaks: Sage Publications.

Pope, K. And Vasquez, M. (2010). Ethics in psychotherapy and counseling: A practical guide (4th ed.). San Francisco: Jossey-Bass.

Rogers, C.R. (1965). The place of the person in the new world of the behavioral sciences. In F.T. Severin (Ed.), Humanistic viewpoints in psychology: A book of readings (pp. 387- 407). New York: McGraw-Hill.

Skinner, B.F. (1966). The phylogeny and ontogeny of behavior. Science, 153, 1204 — 1213.

Suh, J.J., Ruffins, S., Robins, C.E., Albanese, M.J., & Khantzian, E.J. (2008). Self- medication hypothesis: Connecting affective experience and drug choice. Psychoanalytic Psychology, 25, 518-532.

Tolman, E.C. (1948). Cognitive maps in rats and men. Psychological Review, 55, 189-208.

Tuckman, B. 1965). Developmental sequence in small groups. Psychological Bulletin 63 (6), 384-399.

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Aronson.

Table One. Components of Democratic Style of the Group.

Group Leadership-Democratic

Group Centered Theory f or Addictions and Compulsive Behavior

Group Counseling Dynamics

Ethical Issues:

Informed consent

Confidentiality

Counselor Competence

Respecting Boundaries

Multicultural Issues

ACA codes

A.2.a

A. 8. A

C.2.a

A.5

A.6.

Tolerance and Respect for other

s.

Viewpoints.

Psychodynamic (Self-medication)

Behaviorist (CM)

Cognitive (Restructuring)

Humanistic (Therapist variables)

ACA codes

B.1.a


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Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!

Psychology

While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.

Engineering

Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.

Nursing

In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.

Sociology

Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.

Business

We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!

Statistics

We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.

Law

Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

  • When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
  • We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

  • The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
  • We will have a different writer write the paper from scratch.
  • Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment  Help Service Works

1.      Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2.      Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3.      Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4.      Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

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