Theories of Addiction-Choice Theory PowerPoint
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This document discusses theories of addiction and how choice theory can be applied to addiction treatment in social work practice. It defines addiction according to the American Society of Addiction Medicine and outlines key concepts of choice theory such as basic human needs, the quality world, perceived world, and total behavior. The document argues that choice theory encourages empowerment of clients and self-determination, which aligns well with social work ethics. It also explores how choice theory can be used in various treatment settings and integrated with other social work skills and interventions.
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- 1. THEORIES OF ADDICTION Kristine Gordon-Kendig, BSW, AA Jennifer Laubenstein, BS, CSAC, IDP-AT Kimberly Smith, LSW, SW Walden University
- 2. WHY THEORIES OF ADDICTION? • Several of our group members have experienced substance abuse, with and without dependency, within their families or in their personal lives. • Some of us have experience working with clients in various settings and found that it is rare to come across a client that did not have a substance abuse issue to some degree. We anticipate the same findings when we become social work practitioners. This implored us to educate ourselves on addiction theories we may not have worked with yet to bring about positive change in the lives of our future and current clients. • We believe that addiction is not addressed enough in society. We plan to use this presentation to bring about social change in our respective communities.
- 3. DEFINITION OF ADDICTION The American Society of Addiction Medicine defines addiction as: “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death” (2011). “Noclinical clients aremoredifficult tosuccessfully treat than those whoarechemically dependent orwell along the path toaddictions” (Coombs, 2001, p.xi).
- 4. CHOICE THEORY ASSERTIONS • We are internally motivated by a never ending quest to fulfill our Basic Human Needs: survival (food, shelter, safety), love and belonging (relationships, social connections, affection), power (self-determination, recognition of achievements, self worth), freedom (independence, autonomy, have choices), and fun (leisure, pleasure, play, and laugh) (Glasser, 1998; Davenport, n.d.). • When our basic needs are not satisfied, we have a continuous urge to behave in ways we believe will satisfy our needs (Glasser, 1998). • We are responsible for our own choices, decisions, goals, and the general degree of happiness in our lives (Glasser, 1998). • We always have a choice regarding how we behave. This does not mean that we have unlimited choices of behaviors or that external information is unrelated to our behavior choices. It simply means we have more control over our behaviors than most people believe and that we are responsible for any choices we make (Glasser, 1998).
- 5. OUR QUALITY WORLD • Our Quality World is comprised of a “personal picture album” containing the people, things, thoughts, and enjoyable moments of our life (Davenport, n.d.; Glasser, 2003). • The pictures in our Quality World meet at least one of our Basic Human Needs, are ever changing, are unique to us, at times clash with each other, fluctuate in degree of intensity, and fluctuate in degree of attainability (Davenport, n.d.; Glasser, 2003). • Our Quality World is the specific motivation for all human behavior (Glasser, 2003). • We satisfy our needs by repeating past behaviors from our Quality World (Glasser, 2003). • Perceptions from our Quality World become the standard for our behavioral choices (Glasser, 2003). • We behave differently from others because of the differences in our Quality Worlds (Glasser, 2003). • When we integrate the knowledge of our Quality World into our every day life, it helps us to be effective in controlling our behaviors (Glasser, 2003).
- 6. OUR PERCEIVED WORLD • “…we experience the world through our perceptual system…first through our sensory system: eyes, ears, nose, mouth, and skin…beginning with our total knowledge filter, which represents everything we know or have experienced” (Davenport, n.d.). • When information passes through our knowledge filter we either: decide the information is not useful and discard it; don’t recognize the information, but decide it may become useful, so we attempt to gather more information; or the information is meaningful to us, and moves on through the valuing filter (Davenport, n.d.). • We assign values to information that passes through our valuing filter: if it satisfies our needs, we assign it a positive value, if it stifles our needs, we assign it a negative value; and if it neither satisfies or stifles our needs, we assign it no value (Davenport, n.d.). • Our Perceived World is based on our culture, education, experience, gender, age, etc; is unique to only us; constantly evolving; and inaccurate much of the time (Davenport, n.d.). • It is beneficial for us to choose which perception is best for us to hold, as we can choose to perceive people, places, and situations in a variety of ways (Davenport, n.d.).
- 7. TOTAL BEHAVIOR • Total Behavior is composed of four components: • Acting (example: walking, talking) • Thinking (example: reasoning, fantasizing, analyzing) • Feeling (example: angering, depressing, irritating) • Physiology (example: sweating, headaching, trembling) • All four components are continually present, when we change one component, it results in the other three changing (Davenport, n.d.). • When there is a difference between what we have and what we want, we behave in such a way to attempt to get what we want (Sullo, n.d.). • Feeling is typically the first component that we notice. We behave based on our feelings while ignoring the other components (Sullo, n.d.). • Changing Total Behavior is directly affected by changing the ‘acting’ and ‘thinking’ components (Sullo, n.d.). • “A choice of action that results in greater control will be accompanied by better feelings, more pleasant thoughts, and greater physical comfort” (Glasser, 1998. p. 51).
- 8. INFLUENCES ON SOCIAL WORK PRACTICE • Choice theory is easy to understand and can be applied in day-to-day functions for both the social worker and the client (Sullo, n.d.). • Choice theory helps social workers to impress upon the client that they have the power to choose to stop their addiction (Sullo, n.d.). • Choice theory encourages empowerment of the client; a major goal in social work practice (Robbins, Chatterjee & Canda, 2012). • Choice theory insists that the social worker and client collaborate continuously to monitor accomplishments and adjust the action plan as needed (Berger, 2005). • Choice theory can be used in inpatient and outpatient settings and compliments other social work skills and interventions, such as motivational interviewing and individual or group counseling (Howatt, 2003). • Choice theory model is flexible, allowing for it’s use during any stage of treatment or recovery (Howatt, 2003).
- 9. CONGRUENCY WITH SOCIAL WORK ETHICS AND VALUES Choice Theory • Encourages self-determination to make behavioral choices for improvements in well-being (Glasser, 1998). • Respects cultural differences and includes cultural considerations in the client’s action plan (Glasser, 1998). • Insists that therapists have a positive view of human nature and the belief that everyone has the ability to change (Glasser, 1998). • Supports empowerment of the client (Berger, 2005). • Is easily evaluated and researchable by social workers to assess applicability to their practice and client base. Congruency with Ethics and Values • “Social workers respect and promote the right of clients to self-determination ….” (NASW, 2008, 1.02). • “Social workers should have a knowledge base of their clients’ cultures …that are sensitive to clients’ cultures….” (NASW, 2008, 1.05(b)). • “Social workers seek to enhance clients’ capacity and opportunity to change and to address their own needs” (NASW, 2008, p. 3). • “Empowerment is highly consistent with social work values….” (Robbins, Chatterjee & Canda, 2012, p. 104). • “Social workers should promote and facilitate evaluation and research to contribute to the development of knowledge” (NASW, 2008, 5.02(b)).
- 10. REFERENCES American Society of Addiction Medicine. (2011). Definition of addiction. Retrieved on October 10, 2015 from http://www.asam.org/for-the-public/definition-of-addiction Berger, V. (2005). Reality therapy. Retrieved on October 23, 2015 from http://www.psychologistanywhereanytime.com/treatment_and_therapy_psychologist/psychologist_reality_ therapy.htm Code of Ethics of the National Association of Social Workers (NASW). (2008). Retrieved from http://www.socialworkers.org/pubs/code/code/asp Coombs, R.H. (Eds). (2001). Addiction recovery tool. Thousand Oaks, CA: Sage Publications. Davenport, B. (n.d.) Choice theory. Retrieved on October 23, 2015 from http://www.brucedavenport.com Glasser, W. (1998). Choice theory: A new psychology of personal freedom. New York, NY: HarperCollins. Howatt, W.A. (2003). Choice theory: A core addiction recovery tool. International Journal of Reality Therapy. 22(2), 12-14. Robbins, Chatterjee & Canda. (2012). Contemporary human behavior theory: A critical perspective for social work (3rd Ed.). Upper Saddle River, NJ: Allyn & Bacon. Sullo, B. (n.d.). Choice theory. Retrieved on October 10, 2015 from http://www.choicetheory.com/ct.htm
Editor's Notes
- Choice Theory: A Core Addiction Recovery Tool Article Summary Jennifer Laubenstein In his article, “Choice Theory: A Core Addiction Recovery Tool”, Howatt (2003) contends that using Choice Theory to treat clients with addictive disorders is extremely effective. He emphasizes the need for counselors and therapists to have an array of interventions available for use with clients challenged with addiction, and believes that Choice Theory should be one of those interventions (Howatt, 2003). Choice Theory is appropriate for use in inpatient or outpatient settings as well as with individual or group counseling. Howatt (2003) argues that Choice Theory promotes the general principle that clients with addictive disorders have to make the choice to stop their addictive behavior to be successful in treatment. Many clients with addictive disorders are unaware that they can make different choices to take control of their life. Successful recovery depends upon clients understanding and accepting their internal locus of control, the impact of their total behavior on their lives, the difference between their wants and their needs, and the feedback they receive (Howatt, 2003). The biggest impact of Choice Theory is educating clients that they have choices and how to implement choices into their daily lives (Howatt, 2003). According to Howatt (2003), counselors and therapists need to possess a thorough understanding of Choice Theory, how to apply the theory to recovery from addiction, and considerable knowledge of the Ten-Step Choice Theory Addiction Recovery Tool. The steps of the tool do not need to follow a specific order, but the client will not move onto the next step unless the client and therapist agree that the client has accomplished the goals of each step. To start off, the client makes a list of “have to dos” that they believe they need to complete before being able to enter into recovery (Howatt, 2003). Secondly, the client identifies on paper why they believe their life is out of control, which indicates to the worker the client’s present thinking (Howatt, 2003). Next, the client and worker take a detailed inventory of the client’s strengths, weaknesses, talents, skills, and available resources that will help them make better choices for positive change (Howatt, 2003). Then the client works on identifying precursors and triggers of their addiction to give them insight into their using patterns and develop counter-triggers (Howatt, 2003). The worker then focuses on educating the client about internal locus of control, which helps the client recognize the distortions of their perceived sense of control (Howatt, 2003). The next step is to assess the client’s total behavior and determine which behaviors are healthy and which are harmful to connect choices with behavior and self-control (Howatt, 2003). The client then discovers new behaviors that will sustain their recovery long-term (Howatt, 2003). The client then uses all of the information they learned in previous steps to create motivational anchors of what they really want out of life to help them get through challenging situations without relapsing (Howatt, 2003). Finally, the client develops a detailed and goal-orientated action plan for the next twelve months that includes micro and macro levels of doing what is necessary to be successful in their recovery (Howatt, 2003). Choice Theory approaches addiction somewhat differently than other approaches by challenging the client to analyze and assess their actions, behaviors, and choices instead of having their worker tell them what behaviors they need to change and choices they should be making. The majority of the work involved in this intervention is completed by the client between sessions. Sessions are used to examine and discuss the homework assigned at the previous session and for the worker to educate the client about choices made based on internal locus of control. By using Choice Theory as an addiction recovery tool, clients can meet their basic needs by making different choices that influence their use of positive behaviors and using their internal locus of control to avoid relapsing back to their ambiguous and superficial sense of control (Howatt, 2003). Reference Howatt, W. A. (2003). Choice theory: A core addiction recovery tool. International Journal of Reality Therapy, 22(2), 12-14.
- Losing Control vs. Not Exercising Control Article Summary Kristine Gordon-Kendig Depending on how the addictive disease is conceptualized, such as if addiction is a disease or not, this creates opposing views in using theories in treating addictive behavior. Skog (2000) believes that choice is the theory that stands behind prolonged addictive behaviors. In his theory, the person has the choice to be an addict and lose control, or to control their consumption amount and their behaviors. Abstaining is also an individual’s choice. Even factoring in long-term use and buildup of the tolerance to the substance, it is a person’s choice to alleviate an unpleasant symptoms of their dependency. In using his earlier theory of fluctuating choice (Skog, 1997), current and future factors, as well as consequences, are considered prior to the individual using. However, as sometimes it happens to be, plans fall through due to weakness in will power and a person makes the choice to use. For example, while a person may believe that only having a few drinks will not lead to continued use, realistically, the individual is less motivated to exercise control because the consequences of their addictive behavior are reduced after each continued drink. Applying this logic, this still holds the individual in control of their choice because people are constant planners and able to foresee the short and long term consequences due to not maintaining control of their substance use. Stog (2000) went on to state that it is unreasonable to believe that internal compulsions, such as having the inability to control their actions, is due to a lack of control to abstain. There is an absence of scientific evidence to support this idea because the “inability to choose” to use, or not, is missing from research. Therefore, the question remains: Is the person just exercising their right not to control their addiction, or are they losing control because of their addiction? Exercising choice theory when it comes to addictions suggests that the person could have behaved differently and made other choices based on self-determination if presented with future consequences. Hence, consequences can be scientifically measured. Since many consequences occur after the behavior has been displayed – such as using – assumptions can be made that if the person is exposed to disagreeable outcomes prior to displaying the behavior, they will not engage in the behavioral. This, too, proves that addiction is based on choice. Another argument shared with many theorists is if individuals do not have the ability to control their addictive behavior, we then accept the fact that people do not realistically have a choice in their behavior. In this understanding, this would also mean that individuals also have no ability to improve their behavior when sober. The treatment option would be to force the person to stop the addiction, and would consequently would take away the person’s right to choose since they cannot wield their behavior on their own. Additionally, this would also imply that since the person cannot be morally responsible for their behaviors after they use and abuse because they have no control over themselves, then the person cannot be held accountable for their actions when they are sober, either. Applying another logic, if the addict is unable to abstain from use, it allows reduces the person to be seen as “a robot – a helpless spectator to his own body’s movements.” While abstaining from use is called self-control, the choice to use or not to be able to stop is called “loss of control” (p. 1310), yet, the motives to either use or not still fall under the choices individuals make. From a behaviorist perspective, observing addictive behaviors may lead to conclusions and predictions about this behavior that may be erroneous. In the flawed description that individuals have no control over their addiction, we are also aware of the fact that individuals make plans, have desires, and with those factors, have the ability of choice. While many previous approaches in addictions were based on observational methodical studies, Skog (2000) believes that the individual, both sober and while abusing the substance, is complete guided by choice, where helplessness and losing control is accurately believed not to be the true problem. One last consideration is that the addict has their own beliefs about what will work and wont in order to kick the addiction. Yet, if and when an addict needs to see a practitioner because of the “loss of control” of their addiction, what theories and treatment options are offered to the client are based on the practitioner’s beliefs about how they conceptualize the addiction. Once the theory to “cure” the addiction, the addict is then expected to conform to the appropriate intervention that is chosen. However, if the addict does not conform to the treatment available, thus, does not follow to expected norms and behavior while in treatment, then the addict may be labeled as a person that may have illogical thoughts and behaviors, such as additional mental health issues. When this occurs, we than assign the addict as unable to control their addiction, therefore, is not responsible for their behavior. References Skog, O. J. (1997). The strength of weak will. Rationality and Society, 9, 245-271. Skog, O. J. (2000). Addicts' choice. Addiction, 95(9), 1309-1314.
- A New Vision for Counseling Article Summary Kimberly Smith In the article, “A New Vision for Counseling” William Glasser explains choice theory that he added to Reality Therapy that does not include the use of any type of drugs (Glasser, 2004). Glasser’s Choice Theory can be explained as the belief that there is “no valid research to confirm the fact that there is pathology in your brain or brain chemistry” (Glasser, 2004, pg. 339). Glasser surmised that the symptoms an individual was encountering were not caused by a brain pathology (Glasser, 2004). He explained that because there is no brain pathology linked to symptoms, there is no need for medications that are possibly mind-altering and potentially harmful (Glasser, 2004). The article addresses that the client can be taught to be mentally healthy without medications by implementing this new idea of, Choice Theory, the client improving his or her own mental health (Glasser, 2004). “A New Vision for Counseling” (Glasser, 2004) addresses the use of coercion and external control in relationships (Glasser, 2004). Choice theory provides an alternative perspective (Glasser, 2004). An illustration of Choice Theory is that of a phone ringing. When a phone rings, we answer it. Not because we have to but because it is a choice. In other words, “We choose what we do or what we do not do” (Glasser, 2004, pg. 340). Glasser (2004) advocates for replacing external control with Choice Theory. He further explains that all living creatures are driven by basic needs: survival, love and belonging, freedom, and fun (Glasser, 2004). Glasser states that human beings are the only creatures who have a fifth need: power (Glasser, 2004). It is through this need for power that external control is developed (Glasser, 2004). Mental health can then be developed through replacing external control with choice theory (Glasser, 2004). Glasser also explains that clients are diagnosed by psychiatrists because they cannot conceive that individuals can behave as they do without pathology in their brains (2004). He continues to explain that when working with a client, a counselor, implementing Choice Theory, can teach that there are two kinds of pleasure (Glasser, 2004). One pleasure is being with others, and the other is being without others (Glasser, 2004). Glasser explains that the pleasure obtained without others is addiction (2004). “Drugs and gambling are the most common, but no addiction is mentally healthy” (Glasser, 2004, pg. 341). In regards to counseling, Glasser states that the professional must develop the skill to form a positive, strong rapport with clients (2004). He explains that individuals must implement Choice Theory in therapy to advance through any mental health issue, including addiction (Glasser, 2004). From the article, Glasser would have it appear as if having a mental health issue is a choice, and this choice can be overcome by persistence and willingness not to use drugs or pharmaceuticals (2004). References Glasser, W. (2004). A new vision for counseling. The Family Journal, 12(4), 339-341.