Hidden Addictions: Assessment Practices for Psychotherapists, Counselors, and Health Care Providers Book

Preface ix

Part I

1 What Is an Addiction? 3

DSM-IV and Addictions 3

DSM-IV: Defining Substance Abuse and Dependence 5

Distinguishing Addictions from Compulsions 10

Excessive Behaviors: Addiction or Compulsion? 13

The Addiction Construct 14

Addictive Disorder 15

Summary 17

2 Lessons Learned from a Brief History of Addiction Treatment 19

The Twelve-Step Approach 19

Contributions from Psychotherapists and Researchers 22

Psychotherapy as a Place to Treat Addictions 23

Summary 26

3 The Need for Addiction Assessment in Health Care Settings 27

Prevalence of Addiction in Psychotherapy Patients 27

Behaviors at Risk for Addiction 29

The Underdiagnosis of Addiction 31

The Benefits of Accurate Addiction Assessment 33

4 Impediments to Accurate Addiction Assessment 37

Why Education Is Not a Solution to Underdiagnosis of Addictions 39

Stereotypes 41

Denial and Undetected Addictions 47

Diagnostic Ambiguities 53

Summary 59

5 Standardized Assessment Approaches to Substance-Related Disorders 61

Toxicology Screening 62

Standardized Screening Tools 64

Validity of Self-Report Measures 71

Self-Administered Screens with Low Face Validity 72

Other Scales for Assessing Alcohol and Drug Use 73

6 Assessment of Process Addictions 75

Exercise 76

Buying/Shopping 79

Gambling 81

Computer Addiction 84

Sex and Cybersex Addiction 88

Assessment of Multiple Addictive Behaviors 92

Summary 93

7 Interview-Based Approaches to Assessment 95

Subtle Signs of Addiction 96

Subtle Interviewing Techniques 102

Face-Valid Approaches to Interviewing 105

Validity Techniques 107

Summary 110

8 Addiction Assessment with Diverse Populations111

Gender Differences 111

Addiction Assessment at Different Life Stages 117

Racial and Economic Factors 135

Summary 139

9 The Nature of Addiction: A Further Source of Camouflage 141

Cross Tolerance, Polysubstance Use, and Cross Addictions 142

Substance Effects Mimicking Psychological Symptoms 147

Summary 154

10 Transforming the Assessment Process into Treatment 155

The Assessment Process in Light of Stages of Change 156

Screening: Identifying a Potential Problem 158

From Screening to Diagnosis 160

The Role of Input from Significant Others: Collateral Reports 169

Concluding the Assessment: Developing a Shared Definition of the Problem 171

Summary 175

Part II

11 Assessing Hidden Addictions in Psychotherapy: Case Illustrations 179

The Case of Sarah 180

The Case of Tom 187

The Case of George 199

The Case of Jacob 207

The Case of Tracy 216

The Case of Aida: Facilitating Treatment for an Addicted Significant Other 221

12 Autobiographies of Addiction 227

SaveKaryn: One Shopaholic's Journey to Debt and Back Karyn Bosnak 227

Dry Augusten Burroughs 228

Note Found in a Bottle: My Life as a Drinker Susan Cheever 229

A Million Little Pieces James Frey 230

A Drinking Life: A Memoir Pete Hamill 231

Rachel's Holiday Marian Keyes 231

Drinking: A Love Story Caroline Knapp 233

Poker Face: A Girlhood among Gamblers Katy Lederer 234

How to Stop Time: Heroin from A to Z Ann Marlowe 235

Liquid Lover: A Memoir John Moriarty 236

More, Now, Again Elizabeth Wurtzel 237

Appendix 239

References 243

Index 257

About the Author 269