medicate depression; men use cocaine when they feel OK but want to
feel better. Women tend to smoke cigarettes to control their mood and
appetite; men smoke to reduce aggression and stress. Nicotine
replacement treatment works better with men; anti-depressants and
support groups help women more.
The psychological view (Peele, 1998), opposing the disease model,
is that addictions are behavioral adaptations to one's environment.
This doesn't deny the possible long-term physical addictive qualities of
substances, like cocaine, nicotine or alcohol, but the emphasis is on
this being a behavior that is acquired and changed like other habits,
not a disease, like cancer, or a brain disorder, like schizophrenia. From
this perspective, it is believed by many therapists that an addictive
habit often serves the purpose of relieving pain or distracting the
victim from some stressful emotion, such as feeling inadequate, being
depressed, being consumed with anger, shame, or guilt, etc. In short,
addictions try to help us cope with and cover up emotions that trigger
the addiction. So, the solution for many therapists is to get your
emotions under control. See Clancy (1997), Dodes (2002)--
powerlessness & anger, Santoro & Cohen (1997)--anger, Black
(1998)--shame, Birkedahl (1991)--better habits, Ellis (1998)--
upsetting thoughts, Hirschmann & Munter (1995)--poor body image,
Twerski, (1997)--self-deception, and Washton & Boundy (1989)--self-
misunderstanding, who take this approach.
Addictions are commonly broken into several types, such as
alcohol, drugs, eating, gambling, sex, internet and so on. Then when
books, therapists, treatment centers, self-help groups, and book
chapters (including this one) are organized into these specific
addictions, it gives the impression that an addict usually has only one
particular need or "fix." That is misleading. Experienced counselors,
such as Julian Taber (http://www.thecheers.org/) believe that addicts
have tendencies towards several addictions, often in the form of an
addictive personality. So, if and when one addiction is stopped,
another addiction soon replaces it. Thinking of the disorder in this way
leads to the notion of a generalized "Addictive Response Syndrome"
which probably results from basic personality weaknesses and coping
skills deficiencies, not just from an overriding need to drink, eat,
gamble or whatever. New research also supports the general addictive
personality notion (Holden, 2001; Helmath, 2001). This goes counter
to the common belief that just stopping the addict's one troublesome
behavior will automatically result in a normal, wholesome adjustment.
Adequate treatment or self-help will almost certainly involve more
than just curtailing one out-of-control habit.
The disease oriented approach, i.e. Alcoholic Anonymous (AA), has
been essentially the only treatment available since the 1930's until this
decade. Even now, AA is the treatment commonly recommended,
especially by medical institutions. AA and the 12-step programs have,
indeed, helped millions, but there are a lot of people they don't help
(Kasl, 1992). The relapse rate of AA members is over 70%. Recently,
many specialists in the area of addiction have come to believe that lots