Fragmented intimacy: Addiction in a social world

Fragmented Intimacy: Addiction in a Social World

Volumn , Issue , 2008, Pages 1-339

  Adams, Peter J ^a  

^a UNIVERSITY OF AUCKLAND   (New Zealand)

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EID: 84889989717     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.1007/978-0-387-72661-8     Document Type: Book

References (376)

1. This poem was attributed to Edgar Allan Poe by Thomas Ollive Mabbott in 1939, and again in 1969. The original manuscript supposedly hung on the wall of the Washington Tavern in Lowell, Massachusetts, for many years. It was apparently last seen around 1892 It was recalled from memory by a former bartender there about 1939. Although of questionable origin, the attribution has some merit and has not been seriously opposed. See www.eapoe.org/works/poems/ alea.htm (accessed March 2007).
2. C. Kasl, Women, Sex and Addiction: A Search for Love and Power (Ticknor & Fields, 1989)
3. B. Killinger, Workaholics: The Respectable Addicts (Simon and Schuster, 1992)
4. P. Mellody and A. Miller, Facing Love Addiction: Giving Yourself the Power to Change the Way Yo u Love (Harper, 1992). A helpful bibliography on codependency is available on: www.projectcork.org/bibliographies/data/ Bibliography-Co-Dependency (accessed March 2007).
5. These estimates are usually reported as "current prevalence," which refers to the percentage of people who respond positively to questions about their use "over the last year" or sometimes "over the last 6 months." These figures are taken from J. Welte, G. Barnes, et al. (2001) "Alcohol and gambling pathology among U.S. adults: prevalence, demographic patterns and comorbidity" Journal of Studies on Alcohol, 62(5), 706-712
6. (the figures exclude addictions to tobacco). Prevalence estimates outside the U.S. can vary; for example, European studies indicate lower prevalence of around 0.5 percent for addictions to drugs; see C. Furr-Holden and J. Anthony (2003) "Epidemiologic differences in drug dependence - a US-UK cross-national comparison" Social Psychiatry and Psychiatric Epidemiology, 38(4), 165-172
7. and L. Kraus, R. Augustin, et al. (2003) "Estimating prevalence of problem drug use at national level in countries of the European Union and Norway" Addiction, 98(4), 471-485.
8. See reviews of gambling prevalence studies in H. Shaffer, M. Hall, et al. Estimating the Prevalence of Disordered Gambling Behaviour in the United States and Canada: A Meta-Analysis (Presidents and Fellows of Harvard College, 1997). In these studies addictions to gambling have been conservatively interpreted as "pathological" rather than the broader category of "problem gambling."
9. The Australian Productivity Commission's report Australia's Gambling Industries: Final Report (Productivity Commission, 1999, p. 7.33) examined the evidence of how many people can be significantly affected by one problem gambler and concluded that it could vary between 7 and 10 people.
10. Mariana Valverde in Diseases of the Will: Alcohol and the Dilemmas of Freedom (Cambridge University Press, 1998, pp. 50-51) traces the origins of the concept of addiction back to 1887 when a Dr. Norman Kerr of the British Society for the Scientific Study of Inebriety referred to habitual inebriates as "alcoholics."
11. Marc Schuckit, Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment, 4th ed. (Plenum Medical, 1995, p. 5).
12. From R. Morse and D. Flavin (1992) "The definition of alcoholism." Journal of the American Medical Association, 268, p. 1013
13. Also adopted and quoted in H. Doweiko, Concepts of Chemical Dependency, 5th ed. (Brooks/Cole, 2002, p. 13).
14. World Health Organization (1952). Technical Report, Series No. 48 (Expert Committee on Mental Health, 1952)
15. quoted in J. Orford, Excessive Appetites: A Psychological View of Addictions (Wiley, 1985, p. 12).
16. As presented in A. Blume (2005) Treating Drug Problems (Wiley, 2005, pp. 5-11).
17. As described in their main book Narcotics Anonymous, 5th ed. (NA World Service Office, 1988, pp. 3-4).
18. Cognitive behavioral therapy approaches to treating addictions are the best example of a widely used approach that focuses on the capacity of thinking to influence changes in behavior. For a review see J. Morgenstern and R. Longabaugh (2000) "Cognitivebehavioral treatment for alcohol dependence: a review of evidence for its hypothesized mechanisms of action" Addiction, 95(10), 1475-1490.
19. From a public health perspective the impact of alcohol and other dangerous consumptions incorporates a wide range of harms that are not necessarily linked to addictions. For example, in P. Davies and D. Walsh, Alcohol Problems and Alcohol Control in Europe (Croom Helm, 1983), they stated "even fairly moderate levels of drinking may be transformed into alcohol problems if combined with the exacting demands of driving a car, handling machinery at work, or maintaining normal family and social relations" (pp. 19-20)
20. See also G. Edwards, P. Anderson, et al., Alcohol Policy and the Public Good (Oxford University Press, 1994)
21. T. Babor, R. Caetano, et al., Alcohol: No Ordinary Commodity. Research and Public Policy (Oxford University Press, 2003).
22. To cite a few who adopt a broad brush approach, see R. Coombs (ed.), Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment (Wiley, 2004)
23. H. Shaffer (1997) "The most important unresolved issue in the addictions: conceptual chaos" Substance Use & Misuse, 32(11), 153-158
24. J. Orford, Excessive Appetites: A Psychological View of Addictions (Wiley, 1985).
25. This widening of the term addiction to apply to consumptions that may only have minimal negative impacts has been criticized by a range of writers, who include M. Valverde, Diseases of the Will (Cambridge University Press, 1998)
26. C. DiClemente, Addiction and Change: How Addictions Develop and Addicted People Recover (Guilford, 2003)
27. Helen Keane, What's Wrong with Addiction (Melbourne University Press, 2002).
28. From P. Carnes, R. Murray, et al (2004) "Addiction interaction disorder".. In R. Coombs (Ed.), Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment (Wiley, 2004, pp. 57-58).
29. From Miller (1999), cited in H. Doweiko, Concepts of Chemical Dependency, 5th ed. (Brooks/Cole, 2002, p. 8).
30. From George DuWors, White Knuckles and Wishful Thinking: Breaking the Chain of Compulsive Reaction in Alcoholism and Other Addictions (Hogrefe & Huber, 1992, p. 3).
31. From Jean Francois Lyotard (1993) Political Writings. (University College London, 1993, p33)
32. In compiling this chapter, I am strongly indebted to Lyotard's writings, particularly his book The Postmodern Condition: A Report on Knowledge (Minnesota University Press, 1984[1979])
33. as well as Thomas Kuhn's seminal work in The Structure of Scientific Revolutions (University of Chicago, 1970)
34. along with my early exposures to lectures by Paul Feyerabend and his wonderful book Against Method: Outline of an Anarchistic Theory of Knowledge (Verso, 1970).
35. Quoted in A. Salmond The Trial of the Cannibal Dog: Captain Cook in the South Seas (Allen Lane/Penguin 2003, p41). Although as master of the Dolphin William Robertson arrived in Tahiti shortly before Captain Cook, his reaction is typical of the strong impression these earlier visitors had to the bounteous nature of life on these islands.
36. The impact of Cook's voyages on the European imagination is discussed in A. Frost "New geographical perspectives and the emergence of the romantic imagination". In R. Fisher and H. Johnston (Eds.) Captain Cook and His Times (Australian National University Press, 1979, 5-20).
37. Paul Feyerabend in Against Method (Verso, 1970) provides an excellent account of the irrationality of this paradigm switch.
38. One important philosopher of science Imre Lakatos "Falsification and the methodology of scientific research programmes" in I. Lakatos and A. Musgrave Criticism and the Growth of Knowledge (Cambridge University, 1970), argued that research based on one paradigm can run its course and eventually run out of steam (or "positive heuristic"). New paradigms can then attract adherents because they offer new territories for discovery.
39. Thomas Kuhn The Structure of Scientific Revolutions (University of Chicago, 1970, p158).
40. Classic periods of pluralism, such as classical Athens, Moorish Spain and Vienna in the 1900s, were transitory phenomenon. For discussions of the pluralism of these periods see A. Janik and S. Toulmin's Wittgenstein's Viena. (Simon & Schuster, 1973)
41. R. Fletcher Moorish Spain (University of California Press, 1993)
42. S. Pomeroy Ancient Greece: A Political, Social, and Cultural History (Oxford University Press, 1999).
43. A critical literature on the wholesale application of illness metaphors to mental wellbeing is available and exemplified in books such as Thomas Szasz's The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (Harper & Row, 1974)
44. Michel Foucault's Madness and Civilization (Pantheon, 1965).
45. This total form of dominance is often referred to as "hegemony" and is a critical concept for many post-modern thinkers including Derrida, Lyotard, Foucault, Bourdieu etc., see I. Burkitt Bodies of Thought: Embodiment, Identity and Modernity (Sage 1999).
46. See Mariana Valverde's excellent book on Diseases of the Will: Alcohol and the Dilemmas of Freedom (Cambridge University, 1998).
47. Provided by the WHO Expert Committee on Mental Health (1957) on Addiction Producing Drugs, pp17-25.
48. World Health Organisation Expert Committee on Mental Health (1957). Addiction Producing Drugs: 7th Report of the WHO Expert Committee. Geneva, World Health Organisation: 17-25.
49. For example, see discussions in S. Shaw "The disease concept of dependence". In N. Heather, I. Robertson, et al. (Eds.) The Misuse of Alcohol: Crucial Issues in Dependence, Treatment, and Prevention (University Press, 1985)
50. N. Heather and I. Robertson Problem Drinking: Third Edition (Oxford Medical Publications, 1997).
51. The increasing recognition of social influences such as culture, class and community environments are explored.. In books such as Mac Marshall (Ed.) Beliefs, Behaviors and Alcoholic Beverages in Cross Cultural Survey. (University of Michigan, 1979)
52. Stan Einstein's (Ed.) The Community's Response to Drug Use (Pergamon 1980)
53. John Davies' The Myth of Addiction (Harwood Academic, 1992).
54. For example, applications of the biopsychosocial model can be found in D. Lende and E. Smith (2002). "Evolution meets biopsychosociality: an analysis of addictive behaviour, Addiction, 97(4), 470-1
55. P. Rogers and H. Smit (2000) "Food craving and food "addiction,": a critical review of the evidence from a biopsychosocial perspective" Pharmacology, Biochemistry and Behavior, 66(1), 3-14.
56. See this discussed in A. Blume Treating Drug Problems (Wiley, 2005, p21)
57. The biopsychosocial model is also championed by Marlatt and VandenBos's (Eds.) "Introduction" in Addictive Behaviours: Readings on Etiology, Prevention and Treatment (American Psychological Association, 1997).
58. C. DiClemente (2003). Addiction and Change: How Addictions Develop and Addicted People Recover (Guilford Press, 2003, p18).
59. Translated by Gilmour in F. Nietzsche (1989 [1873]) "On Truth and Lying in an Extramoral Sense" in Friedrich Nietzsche on Rhetoric and Language (Harper & Row, 1989).
60. For excellent summaries of post-modernism see D. R. Dickens and A. Fontana (Eds.) Postmodernism & Social Inquiry (Guilford 1994)
61. H. Bertens and J. Natoli (Eds.) Postmodernism: Key Figures (Blackwell, 2002).
62. Since 2003 I and a group of colleagues began hosting an annual two day Dangerous Consumptions Colloquium for academics in Australia and New Zealand interested in applications of social theory to alcohol, drugs, gambling and other dangerous consumptions. In November 2006 we held our fourth event ("DC4"). In Canberra, and we plan to continue running them for the foreseeable future. For an overview see P. Adams, J. Fitzgerald, et al., (Eds.) (2005) "Special Issue: Dangerous Consumptions" Addiction Research and Theory, 13(6).
63. For example, some of his most well known students include Helmut Wagner, Peter Berger and Thomas Luckmann, and he had a profound influence on the ethnomethodology of Harold Garfinkel. For more detail see G. Psathas (2004). "Alfred Schutz's influence on American sociologists and sociology." Human Studies, 27(1), 1-35.
64. Alfred Schutz The Phenomenology of the Social World (Heinemann Educational, 1972).
65. R. Wilkinson and M. Marmot Social determinants of health: The solid facts (WHO European Office, 2003).
66. See D. Fergusson and M. Lynskey (1996). "Adolescent resiliency to family adversity." Journal of child psychiatry, 37(3), 281-292
67. C. Olsson, L. Bond, et al. (2003). "Adolescent resilience: a concept analysis." Journal of Adolescence, 26, 1-11
68. In an article by S. Fergus and M. Zimmerman (2005). "Adolescent resilience: A framework for understanding healthy development in the face of risk." Annual Review of Public Health, 26, 399-419 they discuss three models of resilience: compensatory, protective and challenge models, where each involves a different type of research strategy.
69. Ron Labonte (1990). "Empowerment: Notes on Professional and Community Dimensions." Canadian Review of Social Policy, 26, 64-75
70. G. Laverack (2001). "An identification and interpretation of the organisational aspects of community empowerment." Community Development Journal, 36(2), 40-50.
71. See K. Rubin, K. Dwyer, et al (2004). "Attachment, friendship, and psychosocial functioning in early adolescence." Journal of Early Adolescence, 24(4), 326-356.
72. See discussions of the effectiveness in of community capacity building approaches in G. Laverack Health Promotion Practice: Power and Empowerment (Sage, 2004)
73. and demonstrated in the large community development projects led by Barbara Israel and colleagues (2006) in "Challenges and facilitating factors in sustaining community-based participatory research partnerships: lessons learned from the Detroit, New York City and Seattle Urban Research Centers" Journal of Urban Health, 83(6), 1022-40.
74. Summaries of the various practice applications of systems theory can be found in Lynn Hoffman's Family Therapy: An Intimate History (Norton & Co, 2001)
75. P. C. Rosenblatt's Metaphors of Family Systems Theory: Toward New Constructions (Guilford, 1997).
76. Te Taniwha in Whitianga describing her first sighting of Cook and his crew as cited by Anne Salmond in Two Worlds: First Meetings between Maori and Europeans 1642-1772 (Penguin/Viking, 1991, p87)
77. The complexities of the varying interpretations of civilization and savagery are contrasted in G. Obeyesekere The Apotheosis of Captain Cook: European Mythmaking in the Pacific (Princeton University Press, 1992).
78. Quoted in A. Salmond Between Worlds: Early Exchanges Between Maori and Europeans 1773-1815 (Viking, 1997, p78).
79. As argued by T. Kuhn The Structure of Scientific Revolutions (University of Chicago, 1970, p115)
80. and by I. Lakatos "Falsification and the methodology of scientific research programmes". In I. Lakatos and A. Musgrave (Eds.) Criticism and the Growth of Knowledge (Cambridge University, 1970, pp91-196).
81. Quoted in A Salmond Two Worlds (Penguin/Viking, 1991, p112).
82. Quoted in A. Salmond The Trial of the Cannibal Dog (Allen Lane/Penguin, 2003, p385).
83. Jack London John Barleycorn of Alcoholic Memoirs (Arco, 1967, p. 15). The book tells the tale of London's own addictive relationship to alcohol, with "John Barleycorn" named as a person but in reality representing alcohol.
84. There is an expanding literature on social connection, particularly in the human development literature on its contribution to resiliency. An overview is provided by H. Kaplan, "Toward an understanding of resilience" in M. Glantz and J. Johnson, Resilience and Development: Positive Life Adaptations (Kluwer/Plenum, 1999, pp. 17-83)
85. C. Olsson, L. Bond, et al. (2003), "Adolescent resilience: a concept analysis." Journal of Adolescence, 26, 1-11
86. K. Rubin, K. Dwyer, et al. (2004) "Attachment, friendship, and psychosocial functioning in early adolescence." Journal of Early Adolescence, 24(4), 326-356.
87. George Lakoff has discussed the processes involved in forming categories and argues they do not function like Venn diagrams, or pigeonholes, but are conceptually based on what he calls "idealised cognitive models". See his book Women, Fire, and Dangerous Things: What Categories Reveal about the Mind (University of Chicago, 1987).
88. This is discussed in more detail in Chapter 2, but briefly it has emerged from the related disciplines of sociology, social anthropology, and critical social psychology. Key works in its emergence include Gregory Bateson, Steps in an Ecology of Mind (Granada, 1972)
89. Alfred Schutz, The Phenomenology of the Social World (Heinemann, 1972)
90. Elizabeth Bott, Family and Social Network, 2nd ed (Basic Books, 1971).
91. In his book on addictions, Jim Orford Excessive Appetites: A Psychological View of Addictions (Wiley, 1985)
92. also includes what we have termed process addictions, including gambling, eating, and sexuality. Applying the concept of addictions beyond substance addictions is controversial and has generated considerable debate. For example, see coverage of the debate over gambling in Howard Shaffer (1999), "Strange bedfellows: a critical view of pathological gambling and addiction." Addiction, 94(10), 1445-1448.
93. There is a sizable literature on aspects in which alcohol is embedded.. In European, indigenous and other cultures. For a summary of these, see D. Heath (Ed.), International Handbook on Alcohol and Culture (Greenwood, 1995).
94. Gerda Reith's revealing book, The Age of Chance: Gambling in Western Culture (Routledge, 1999), explores in detail the evolution of cultural meanings around gambling within European culture, tracing it back to early civilizations such as Mesopotamian and Egyptian cultures.
95. The sociocultural dynamics of illicit drug use has received less attention than alcohol, but ethnographic and discourse work is emerging in works such as N. Zinberg, Drug, Set, and Setting: The Basis for Controlled Intoxicant Use (Yale University, 1984)
96. J. B. Davies, Drugspeak: the Analysis of Drug Discourse (Harwood, 1997).
97. The main North American manual used for diagnosing mental disorders, the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV; American Psychiatric Association, 1994), identifies "dependent substance use" with one of its seven key criteria involving "a great deal of time... spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain smoking), or recover from its effect."
98. In their book The Alcoholic Marriage: Alternative Perspectives (Grune & Stratton, 1977), T. Paolino and B. McCrady point out that for every excessive drinker there are at least five others who suffer directly or indirectly from this involvement.
99. The links between trauma and addictions are well documented. For example, for a summary on sexual abuse, see the introductory chapter to B. Veysey and C. Clark (Eds.), Sexual Abuse in Women with Alcohol and Other Drug and Mental Disorders: Program Building (Haworth, 2004, pp. 1-39).
100. The impacts of colonization and subsequent oppression is most acutely observed by the elevated levels of addictive relationships formed by rapidly colonized indigenous populations, such as Australian aboriginal, Maori and North American Indian. For a summary on gambling, see V. McGowan, J. Droessler, et al. Recent Research in the Socio-Cultural Domain Of Gaming and Gambling: An Annotated Bibliography And Critical Overview (Alberta Gaming Research Institute, 2000)
101. and for substance use, see F. Beauvais, E. Oetting, et al. (1989), "American Indian youth and drugs, 1976-87: a continuing problem." American Journal of Public Health, 79, 634-636.
102. First verse of a poem "The Cold Hub" by the New Zealand poet James K. Baxter from his collection, The Rock Woman: Selected Poems (Oxford University Press, 1969, p. 52).
103. In George Vaillant, The Natural History of Alcoholism Revisited (Harvard University, 1995), he provides an interesting account of the long-term progression with addictive relationships to alcohol. In long-term studies of cohorts of people with addictive relationships to alcohol, he identified the difficulties faced in achieving long-term change and the threats of premature death. He provides a summary of alcoholism and morbidity and mortality (pp. 200-215).
104. Otto Neurath's stated his metaphor as, "We are like sailors who must rebuild their ship on the open sea, never able to dismantle it in dry dock, and to reconstruct it there out of the best materials," quoted on p. 205 in P. Roth (1984), "On missing Neurath's Boat," Synthese, 61, 205-231.
105. See George DuWors, White Knuckles and Wishful Thinking: Breaking the Chain of Compulsive Reaction in Alcoholism and Other Addictions (Hogrefe & Huber, 1992) for a more detailed discussion of the nature of "white-knuckling," particularly his discussion of it in the context of relapse (reversion) (pp. 53-80).
106. In fact, the research evidence suggests that the majority of those attending programs are unlikely to succeed in maintaining abstinence for over 1 year, as discussed in M. Berglund, S. Thelander, et al. (2003), "Treatment of alcohol abuse: An evidence-based review," Alcoholism: Clinical and Experimental Research, 27(10), 1645-1656.
107. Stephanie Brown in her model of recovery from alcoholism identifies "transition" as key phase in what she describes as "the alcohol axis" leading onto the phase of "early recovery". See her book, Treating the Alcoholic: A Development Model of Recovery (Wiley, 1985) pp. 37-54.
108. Vaillant argues that the first years of attempting change are difficult to discern from fluctuations in the relationship. In the natural history of addictive relationships with alcohol a short time frame may dupe people into seeing a fluctuation as evidence of change. See discussions in his article (1988), "What can long-term follow-up teach us about relapse and prevention of relapse in addiction?" British Journal of Addiction, 83, 1147-1157
109. as well as in his book The Natural History of Alcoholism Revisited (Harvard University, 1995).
110. The range of therapies currently employed by addiction practitioners vary widely from body and process oriented approaches (e.g., psychodrama and gestalt therapy), to thinking therapies (e.g., rational emotive therapy and cognitive behavioural therapy) to social approaches (e.g., family therapy and networking therapy). An overview of these is provided in A. Blume, Treating Drug Problems (Wiley, 2005)
111. T. Jarvis, J. Tebbutt, et al. Treatment Approaches for Alcohol and Drug Dependence, 2nd ed. (Wiley, 2005).
112. Many countries have shifted their prescribing of opioid substitution from specialist addiction services to primary health. This is aimed to provide improved access, more personalized care and less stigmatization. For discussion of this switch, see M. Weinrich and M. Stuart (2000), "Provision of methadone treatment in primary care medical practices: a review of the Scottish experience and implications for US Policy," Journal of the American Medical Association, 283(10), 1343-1348.
113. V. Dole and M. Nyswander (1965), "Medical treatment for diacetylmorphine (heroin) addiction," Ibid. 193, 645-656.
114. For comprehensive coverage, see J. Ward, R. Mattick, et al. (eds.), Methadone Maintenance Treatment and Other Opioid Replacement Therapies (Harwood Academic, 2000).
115. There remains considerable debate regarding whether methadone maintenance merely maintains the status quo or whether it genuinely provides a pathway to reintegration. One group argues that it enables engagement in a process of change; others argue it merely substitutes an illegal with a legal drug. The issues are discussed in N. Seivewright, and J. Greenwood (1996), "What is important in drug misuse treatment?" Lancet, 347, 373-376
116. H. Doweiko Concepts of Chemical Dependency, 5th ed. (Brooks/Cole, 2002, p. 396).
117. The results of Project Match have been published in a variety of papers, but a good summary can be found in F. Glaser, N. Heather, et al. (1999), "Comments on Project Match: matching alcohol treatments to client heterogeneity" Addiction, 94(1), 31-70.
118. Reviews of controlled studies find similarly that improvements of up to a third of people attending well-structured therapeutic interventions will change but this leaves the large proportion of them reverting back. See W. Miller and P. Wilbourne (2002), "Review: Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders" Addiction, 97, 265-277
119. M. Berglund, S. Thelander, et al. (2003), "Treatment of alcohol abuse: an evidence-based review," Alcoholism: Clinical and Experimental Research, 27(10), 1645-1656.
120. In their influential book, Motivational Interviewing: Preparing People to Change Addictive Behaviour (Guilford, 1991), William Miller and Steve Rollnick identified reversion (or "relapse") as a common part of what they refer to as the "cycle of change." For example, while giving up smoking, people frequently relapse because they are inadequately prepared for maintenance of the change, mainly because they have underestimated what it might involve to continue and need to be better prepared next time round.
121. The term recovery is more commonly used, both for rehabilitation from addictions and from mental health issues. In mental health it is being increasingly linked to a resiliency or strength building approach to mental health concerns, with emphasis particularly on raising quality of life by building a network of strong connections. See wider discussion of this in J. Russo, Applying a Strengths Based Approach in Working with People with Developmental Disabilities and their Families (Manticore, 1998). However, since the term recovery emphasizes the psychological rather than the social dimensions of this process, it is better described as "reintegration."
122. M. Stanton, T. Todd, et al, The Family Therapy of Drug Abuse and Addiction (Guilford, 1982), the authors point out that for adults with addictive relationships to illicit drugs, contrary to what their disorderly and transient lifestyles suggest, "there is a preponderance of evidence... that, despite their protestations of independence, the majority of addicts maintain close family ties" (p. 9).
123. F. Scott Fitzgerald's novel (1934) Tender Is the Night: A Romance (Charles Scribner, 1934, p389). This novel is relevant to Fitzgerald's own troubled history with alcohol and depicts the ongoing deterioration in relationships for someone with a similar involvement with intoxication.
124. I have searched the literature on intimacy and addiction for a suitable framework for this book. While there is some relevant and important pieces (such as Anthony Gidden, The Transformation of Intimacy: Sexuality, Love, and Eroticism in Modern Societies (Polity, 1992)
125. Helen Keane, (2004) "Disorders of desire: addiction and problems of intimacy," Journal of Medical Humanities, 25(3), 189-204), I found little available that would support the type of analysis being undertaken in this book. For that reason this chapter uses an original and relatively simple framework for talking about the link between intimate relationships and addictive relationships.
126. Wittgenstein's influential theory of "language as use" and "family resemblances" is developed in his Philosophical Investigations (Blackwell, 1974[1953]).
127. George Lakoff, in Women, Fire, and Dangerous Things: What Categories Reveal About the Mind (University of Chicago Press, 1987), has explored Wittgenstein's ideas further in arguing that most words we use refer to categories rather than things and that in turn these categories require imaginative reference to concepts (which he calls "idealized cognitive models") that in turn call on social and cultural associations.
128. Wittgenstein's Philosophical Investigations (Blackwell, 1974[1953], p. 32).
129. The extensive literature on the effectiveness of counseling and psychotherapy has consistently indicated that the qualities of the practitioner and the relationship with the client matter more that the type of psychotherapeutic methods. For example, Bruce Wampold, in The Great Psychotherapy Debate: Models, Methods, and Findings (Lawrence Erlbaum, 2001), summarizes this issue by concluding that psychotherapy can be more effective than placebo, that no particular approach can claim consistently greater effectiveness than another, and that key factors relate to whether or not the therapist has established a positive working alliance with the client, and that this accounts for much more of the variance in outcomes than specific approaches.
130. The key importance of a "continuum of risk" perspective in thinking about risks to health was championed by Geoffrey Rose in The Strategy of Preventive Medicine (Oxford University Press, 1992) and has been used in a variety of areas in addiction studies where binary conceptions have limited options (such as normal/ dependent drinking, social/pathological gambling, and ethical/unethical funding)
131. J. Gerevich (2005) "Binarisms, regressive outcomes and biases in the drug policy interventions: a theoretical approach," Substance Use and Misuse, 40(4), 451-472
132. S. Ioannou (2005) "Health logic and health-related behaviours" Critical Public Health, 15(3), 263-273
133. P. J. Adams (1997) "Assessing whether to receive funding support from tobacco, alcohol, gambling and other dangerous consumption industries," Addiction 102, 1027-1033.
134. From Anne Bronte's novel The Tenant of Wildfell Hall (Oxford University Press, 1993[1848] p. 245). It is based on her experiences of her brother Branwell's addictive relationship to alcohol and centers on Helen's marriage to Arthur and how his addiction led her and her son to leave him - an unusual response by women in those times.
135. People in addictive relationships have a high likelihood of experiencing anxiety as well as a broad range of other mental health concerns. For example, F. Lotufo-Neto and V. Gentil (1994), "Alcoholism and phobic anxiety: a clinical-demographic comparison," Addiction, 89(4), 447-453 examined the effects of phobic anxiety between people both in and not in addictive relationships to alcohol and found that those with more phobic anxiety tended to have more intense addictive relationships with a lower likelihood of change
136. Also S. Maynard (1997), "Growing up in an alcoholic family system: The effect on anxiety and differentiation of self," Journal of Substance Abuse, 9(1), 161-170, examined the interactions between anxiety and growing up in an addictive system.
137. High rates for people in addictive relationships also experiencing severe depression have been reported in studies of both the general population and with people who present to services, see R. Kessler, C. Nelson, et al. (1996), "The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization," American Journal of Orthopsychiatry, 66(1), 17-31
138. N. Miller, D. Klamen, et al. (1996), "Prevalence of depression and alcohol and other drug dependence in addictions treatment populations," Journal of Psychoactive Drugs, 28(2), 111-124.
139. Several of these emotions are described in a study of the lived experience of men attending Alcoholics Anonymous, R. Zakrzewski and M. Hector (2004), "The lived experiences of alcohol addiction: men of Alcoholics Anonymous" Issues in Mental Health Nursing, 25: 61-77
140. Examinations of specific emotions include: on fear, F. Thorberg and M. Lyvers (2006), "Attachment, fear of intimacy and differentiation of self among clients in substance disorder treatment facilities," Addictive Behaviors, 31(4), 732-737
141. and for shame, R. Potter-Efron and D. Efron (1993), "Three models of shame and their relation to the addictive process," Alcoholism Treatment Quarterly, 10(1-2), 23-48.
142. P. Steinglass, L. Bennett, et al The Alcoholic Family (Basic Books, 1987), they point out how addictive systems can attain their own character and equilibrium, which enables them to continue for long periods of time (see discussion later in the chapter).
143. The influence of social norms and their relationship to social surveillance are central to Michelle Foucault's concept of "disciplinary power" as discussed in M. Foucault, Discipline and Punish: The Birth of the Prison (Pantheon, 1977). Here norms of belief and behavior become internalized to the extent that a person monitors their own behavior in relation to those norms, so in a sense they become their own jailer.
144. Attachment theory is a central approach in developmental psychology that looks at the family processes that influence emergence of personal identity and behavior patterns. It has been applied in many ways to understanding addictive relationships, particularly in the formation and responses by younger people to addictive systems; see R. Finzi-Dottan, Cohen, et al. (2003), "The drug-user husband and his wife: attachment styles, family cohesion, and adaptability." Substance Use and Misuse 38(2): 271-292
145. A. McNally, T. Palfai, et al. (2003), "Attachment dimensions and drinking-related problems among young adults: the mediational role of coping motives" Addictive Behaviors, 28(6), 1115-1127.
146. P. Steinglass, L. Bennett, et al The Alcoholic Family (Basic Books, 1987).
147. Mark Twain's Huckleberry Finn (Whitman, 1955[1890]) p. 38.
148. The impacts of a systematic program of violence typically lead to global effects on the recipients with effects that include impacts on their physical well-being (through stress, neglect of health care), impacts on their mental well-being (high anxiety, depression, posttraumatic effects), impacts on their emotional functioning (low self-esteem, hyperreactivity), and impacts on their social functioning (isolation, low social confidence, deceptive practices). See L.E.A. Walker, The Battered Woman Syndrome (Springer, 1984)
149. M. Bograd, "Power, gender and the family: feminist perspectives on family systems theory,". In M. Dutton-Douglas and L. Walker (Eds.) Feminist Psychotherapies: Integration of Therapeutic and Feminist Systems (Ablex, 1988, pp. 118-133).
150. See H. Johnson, Dangerous Domains: Violence Against Women in Canada (Nelson, 1996)
151. K.E. Leonard, "Alcohol use and marital aggression in newlywed couples,". In X. Arriaga and S. Oskamp (Eds.), Violence in Intimate Relationships (Sage, 1999, pp. 113-135).
152. As described in various papers.. In J. J. Collins Jr (Ed.), Drinking and Crime: Perspectives on the Relationship between Alcohol Consumption and Criminal Behavior (Tavistock, 1982)
153. Also see D. G. Saunders, Violence Against women: Synthesis of Research on Offender Interventions (National Institute of Justice, 2003).
154. In the ten years I was a facilitator in stopping violence programs, at least half of the participants in our programs admit alcohol and drug abuse is associated with their violence, and similar high rates have been reported in other programs, such as F. Fitch and A. Papantonio (1983), "Men who batter: some pertinent characteristics," Journal of Nervous and Mental Disease, 171(3), 190-192
155. P. Kivel, Men's Work: How to Stop the Violence that Tears Our Lives Apart (Ballantine, 1992)
156. M. Testa (2004), "The role of substance use in male-to-female physical and sexual violence: a brief review and recommendations for future research," Journal of Interpersonal Violence, 19(12), 1494-1505
157. Further evidence of a link between substance misuse and male partner in many controlled studies, see E. Gondolf (1995), "Alcohol abuse, wife assault and power needs," Social Service Review, 69(2), 274-284
158. T. O'Farrell and C. Murphy (1995), "Marital violence before and after alcoholism treatment," Journal of Consulting and Clinical Psychology, 63, 256-262
159. S. Boles and K. Miotto (2003), "Substance abuse and violence: a review of the literature." Aggression and Violent Behavior, 8(2), 155-174.
160. Summaries of research can be found in R. Ackerman (1988), "Complexities of alcohol and abusive families," Focus on Chemically Dependent Families, 11(3), 15
161. J. Smith (2000), "Addiction medicine and domestic violence," Journal of Substance Abuse Treatment, 19(4), 329-338
162. For example S. Stith, R. Crossman, et al. (1991), "Alcoholism and marital violence: a comparative study of men in alcohol treatment programs and batterer treatment programs," Alcoholism Treatment Quarterly, 8(2), 3-20, compared men attending violence intervention programs with those attending alcohol treatment programs and found very little difference between them, and thus they recommended screening men who are both violent and addicted for tailored interventions.
163. For example, Jerry Flanzer states in "Alcohol and other drugs are key causal agents of violence" in R. Gelles and D. Loseke, Current Controversies on Family Violence (Sage, p. 178), "An individual harboring intense underlying anger that has been contained by psychological defence mechanisms can become physically aggressive and intimidating as a result of the of the disinhibiting effects of alcohol".
164. The literature on the biological processes associated with alcohol and violence is quite large. For fuller discussion, see S. Boles and K. Miotto (2003), "Substance abuse and violence: a review of the literature," Aggression and Violent Behavior, 8(2), 155-174
165. P. Hoaken and S. Stewart (2003), "Drugs of abuse and the elicitation of human aggressive behavior," Addictive Behaviors, 28(9), 1533-1554.
166. See an overview in A. Badawy (2003), "Alcohol and violence and the possible role of serotonin," Criminal Behaviour and Mental Health, 13(1), 31-44.
167. Richared Gelles challenges the relevance of the notion of disinhibition with respect to violence and supports this with reference to research on culture, laboratory experiments, blood tests on men arrested, and survey research. See R. Gelles, "Alcohol and other drugs are associated with violence: they are not its cause." Current Controversies on Family Violence (Sage, 1993, pp. 182-196)
168. Kai Pernanen (1997), "Uses of 'disinhibition' in the explanation of intoxicated behavior," Contemporary Drug Problems, 24, 703-729
169. examines the various senses of "disinhibition" and concludes that while in some formal senses alcohol acts as a disinhibitor, this is different than claiming a causal link. Along similar lines, Sarah Galvani (2004), "Responsible disinhibition: alcohol, men and violence to women," Addiction Research and Theory, 12(4), 357-371, argues for the notion of "responsible disinhibition" where the intoxicated man is still held accountable for his violent behavior.
170. In considering the relationship between alcohol and violence against women, R. Tolman and L. Bennett (1990), "A review of quantitative research on men who batter," Journal of Interpersonal Violence, 5(1), state: "The widely held belief that drinking directly causes woman abuse is questionable. In the light of experimental evidence that expectancy of alcohol-related aggression is a better predictor of aggressive behaviour than is the consumption of alcohol... Although acute alcohol intoxication has proven to be a better predictor of general crimes of violence... it is chronic alcohol abuse that better predicts woman abuse" (p. 90).
171. The significance of the closeness of intoxication is hotly contested. See the introduction by C. Wekerle and A. Wall (Eds.) in The Violence and Addiction Equation: Theoretical and Clinical Issues in Substance Abuse and Relationship Violence (Brunner/Mazel, 2002)
172. See also discussion of the complexities in C. Humphreys, L. Regan, et al. (2005). "Domestic violence and substance use: Tackling complexity" British Journal of Social Work, 35(8), 1303-1320.
173. For example, the relationship of cannabis to violence is well documented. Summaries of the literature are in T. Brown, A. Werk, et al. (1999), "Violent substance abusers in domestic violence treatment," Violence and Victims, 14, 179-190
174. T. Moore and G. Stuart (2005), "A review of the literature on marijuana and interpersonal violence," Aggression and Violent Behavior, 10(2), 171-192.
175. The literature here is relatively new, but research is beginning to appear on gambling: V. Lorenz and R. Yaffee (1988), "Pathological gambling and psychosomatic, emotional and mental difficulties as reported by the spouse," Journal of Gambling Behavior, 4, 13-26
176. R. Muelleman, T. DenOtter, et al. (2002), "Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence," Journal of Emergency Medicine, 23(3), 307-312
177. On work, B. Robinson and P. Post (1997), "Risk of addiction to work and family functioning," Psychological Reports, 81(1), 91-95
178. The research on addictive relationships to sex has yet to get underway, but a number of practitioner and self-help books have been published such as E. Griffin-Shelley, Sex and Love: Addiction Treatment and Recovery (Praeger/ Greenwood, 1997).
179. See C. MacAndrew and R. Edgerton, Drunken Comportment: A Social Explanation (Aldine, 1969).
180. This perspective also connects with the "alcohol expectancies" literature in psychology, which argues that if people believe they will be violent when they drink, then they will probably act violently; see J. Collins and P. Messerschmidt (1993), "Epidemiology of alcohol-related violence," Alcohol Health and Research World, 17(2), 93-99
181. In a survey of over 1000 students, R. Lindman and A. Lang (1994), "The alcohol-aggression stereotype: a cross-cultural comparison of beliefs," International Journal of the Addictions, 29(1), 1-13
182. found student expectations of what intoxicated aggression meant varied according to different cultural backgrounds. Furthermore, Holly Johnson (2000), "The role of alcohol in male partners' assaults on wives," Journal of Drug Issues, 30(4), 725-740, analyzed a large Canadian sample (12, 300) of woman and found that once negative attitudes to women were factored out, the relationship between alcohol and violence became nonsignificant.
183. See R. L. Sexton, "Ritualized inebriation, violence, and social control in Cajun Mardi Gras," Anthropological Quarterly, 74(1), 37.
184. A feminist interpretation of violence is sometimes referred to as "profeminist" as a way of including men who support the primary assumptions of feminism. For discussion of this, see E. Gondolf (1985), "Anger and oppression in men who batter: empiricist and feminist perspectives and their implications for research," Victimology: An International Journal, 10, 311-324
185. E. Pence and M. Paymar, Education Groups for Men Who Batter: The Duluth Model (Springer, 1993)
186. Alternatively it is referred to as a "sociological" approach, see R. Dobash, R. Dobash, et al., "Confronting violent men,". In J. Hanmer and C. Itzin (Eds.), Home Truths About Domestic Violence: Feminist Influences on Policy and Practice: A Reader (Routledge, 2000)
187. In this approach male partner violence is interpreted as a sociopolitical problem as described by D. Adams, "Feminist based interventions for battering men," in P. Caesar and L. Hamberger, Treating Men Who Batter: Theory, Practice and Programs (Springer, 1989, p. 3)
188. where controlling behavior needs to be understood in the context of the whole social ecology that provides support for violence. As also described in J. Edleson and R. Tolman, Intervention for Men Who Batter: An Ecological Approach (Sage, 1992).
189. Further examination of the social and political utility of violence can be found in Z. Eisikovits and J. Edleson (1989), "Intervening with men who batter: a critical review of the literature," Social Services Review, (September), 384-414
190. K. Yllö, "Through a feminist lens: gender, power, and violence," in R. Gelles and D. Loseke, Current Controversies on Family Violence (Sage, 1993, pp. 47-60).
191. The broader social supports have been tracked back to male entitlement beliefs, see P. Adams, A. Towns, et al., "Dominance and entitlement: the rhetoric men use to discuss their violence towards women," in M. Talbot et al. Language and Power in the Modern World (Edinburgh University, 2003, pp. 184-198)
192. Violence supporting beliefs based on male privilege are described in M. Russell, "Wife assault theory, research, and treatment: a literature review," Journal of Family Violence, 3, 193-208
193. and institutional beliefs on the overriding importance of protecting marriages in N. Robertson (1999), "Stopping violence programmes: enhancing the safety of battered women or producing better-educated batterers?" New Zealand Journal of Psychology, 28(2), 88-78, which also points out how stopping violence programs themselves can be used as a means of furthering the repertoire of justifications and potentially up-skilling abusers.
194. Key works in this area include: on responsibility, see A. Jenkins, Invitations to Responsibility: The Therapeutic Engagement of Men Who Are Violent and Abusive (Dulwich Centre Publications, 1990)
195. On beliefs that support violence, see E. Pence and M. Paymar, Education Groups for Men Who Batter: The Duluth Model (Springer, 1993)
196. and on broader supports, see S. Schechter and L. Gary, "A framework for understanding and empowering battered women," in M. Straus, Abuse and Victimization Across the Lifespan (John Hopkins, 1988, pp. 240-253).
197. In a series of articles, my colleagues and I have argued that feminist approaches move beyond particle interpretations and include the social and political dynamics of abuse. See Adams, P. J. (in press), "Interventions with men who are violent to their partners: strategies for early engagement," Journal of Marital and Family Therapy
198. A. Towns and P. Adams (2000), "'If I really loved him enough, he would be okay': Women's accounts of male partner violence," Violence Against Woman, 6(6), 558-585.
199. For instance, in a U.K. interview study with 2027 participants, K Graham, M. Plant, et al. (2004), "Alcohol, gender and partner aggression: a general population study of British adults," Addiction Research and Theory, 12(4), 385-401, reported that heavier alcohol use increased the level of reported interpersonal violence and that in these circumstances slightly more women than men admitted to being violent
200. For a comprehensive discussion on silencing, see the editor's introduction.. In L. Thiesmeyer (Ed.), Discourse and Silencing: Representation and the Language of Displacement (John Benjamins, 2003), and the chapter in the same book by my colleagues and I entitled "Silencing Talk of Men's Violence Towards Women."
201. This is, of course, the central idea behind Foucault's notion of "disciplinary power," where surveillance strategies lead people to become in a sense their own jailer, monitoring their own behavior with regard to imposed or evolved societal norms. For broader discussions of this in relation to violence, see N. Gavey, Just Sex? The Cultural Scaffolding of Rape (Routledge, 2004)
202. A. Towns and P. Adams (2000), "'If I really loved him enough, he would be okay': women's accounts of male partner violence," Violence Against Woman, 6(6), 558-585.
203. From Frank McCourt's autobiographical account of his early childhood, Angela's Ashes: A Memoir of a Childhood (Flamingo, 1997, p. 207).
204. The surprising paucity of research in this area is highlighted in reviews such as R. Velleman and J. Orford, Risk and Resilience: Adults Who Were the Children of Problem Drinkers (Harwood Academic, 1999)
205. S. Harter (2000), "Psychosocial adjustment of adult children of alcoholics: a review of the recent empirical literature," Clinical Psychology Review, 20(3), 311-337.
206. See K. Sher, K. Walitzer, et al (1991), "Characteristics of children of alcoholics: Putative risk factors, substance use and abuse, and psychopathology," Journal of Abnormal Psychology, 100, 427-448.
207. See R. Mathew, W. Wilson, et al (1993), "Psychiatric disorders in adult children of alcoholics: Data from the Epidemiologic Catchment Area project," American Journal of Psychiatry, 150, 793-800.
208. See P. Steinglass, L. Bennett, et al, The Alcoholic Family (Basic Books, 1987, p. 18).
209. For example, S. Harter (2000), "Psychosocial adjustment of adult children of alcoholics: a review of the recent empirical literature" Clinical Psychology Review, 20(3), 311-337, argues that the research is inadequate as yet to draw conclusions; methodological weaknesses include small sample sizes and lack of comparison groups.
210. These factors are covered in reviews by J. Ritter, M. Stewart, et al. (2002), "Effects of childhood exposure to familial alcoholism and family violence on adolescent substance use, conduct problems, and self-esteem," Journal of Traumatic Stress, 15(2), 113-122
211. and A. Barrett and R. Turner (2006), "Family structure and substance use problems in adolescence and early adulthood: examining explanations for the relationship," Addiction, 101(1), 109-120.
212. For example, using a general measure of mental health concerns, A. Fulton and W. Yates (1990), "Adult children of alcoholics: a valid diagnostic group?" Journal of Nervous and Mental Disease, 178, 505-508, failed to find significant differences in the frequency of mental disorders for people in addictive relationships than for other populations. These included depressive and anxiety disorders.
213. In a long-term study of 500 heavy drinkers in the English West Midlands, J. Orford, and S. Dalton (2005), "A four-year follow-up of close family members of Birmingham untreated heavy drinkers," Addiction Research and Theory, 13(2), 155-170, they followed 25 close family members over 4 years and found, surprisingly, that as time went on, the family members considered the drinking in more benign terms.
214. As resilience research has established itself more strongly in studying risks to youth well-being, the approach is becoming more frequently applied to dangerous consumptions as illustrated in K. Griffin, G. Botvin, et al. (2003), "Effectiveness of a universal drug abuse prevention approach for youth at high risk for substance use initiation," Preventive Medicine, 36(1), 1-7
215. C. Olsson, L. Bond, et al. (2003), "Adolescent resilience: a concept analysis," Journal of Adolescence, 26, 1-11
216. A. Carle and L. Chassin (2004), "Resilience in a community sample of children of alcoholics: its prevalence and relation to internalizing symptomatology and positive affect," Applied Developmental Psychology, 25, 577-595.
217. For example, J. Ritter, M. Stewart, et al (2002), "Effects of childhood exposure to familial alcoholism and family violence on adolescent substance use, conduct problems, and self-esteem," Journal of Traumatic Stress, 15(2), 113-122, examined three domains of adolescent functioning in a high-risk community sample of 109 families and found that the combination of childhood exposure to addictive family systems plus exposure to family violence were associated with their psychosocial functioning as adolescents.
218. For example, S. Harter and T. Taylor (2000), "Parental alcoholism, child abuse, and adult adjustment," Journal of Substance Abuse, 11(1), 31-44, explored exposures to parents in addictive relationships to alcohol and abuse for 333 college students. They found that symptom distress and social maladjustment was more pronounced for those who had experienced both addictive home contexts and abuse.
219. A range of factors can play a role, for example, the age for intimates when the addictive relationship emerged, their developmental stage, the nature of the way they left home, the stage at which they try to reform their own intimacies; see R. Ackerman and E. Gondolf (1991), "Adult children of alcoholics: the effects of background and treatment on ACOA symptoms," International Journal of Addictions, 26, 1159-1171.
220. The processes of early parental attachments have a strong influence over how intimacy is approached in later life. Developmental literature on attachment is extensive. A good overview is provided by R. Karen, Becoming Attached: First Relationships and How they Shape our Capacity to Love (Oxford University Press, 1998).
221. These issues in addictive family systems are explored in M. Stanton, T. Todd, et al., The Family Therapy of Drug Abuse and Addiction (Guilford, 1982).
222. In their review M. West and R. Prinz (1987), "Parental alcoholism and childhood psychopathology," Psychological Bulletin, 102(2), 204-218, the authors outlined how children in addictive systems, particularly boys, display outwardly hostile behaviors that can develop into conduct disorders and other behavioral problems.
223. The research on the long-term impacts of childhood exposure to addictive family systems is still emergent and is coming up with inconsistent findings. Until research methods improve, all we can say generally is that many such children grow up with issues associated with antisocial behavior, mental health issues (such as anxiety and depression), and relationship difficulties. See the review by S. Harter and T. Taylor (2000), "Parental alcoholism, child abuse, and adult adjustment," Journal of Substance Abuse, 11(1), 31-44.
224. While attachment theory has found applications to understanding the effects of growing up in an addictive system, such as N. El-Guebaly, M. West, et al. (1993), "Attachment among adult children of alcoholics," Addiction, 88, 1405-1411
225. a specific focus on adolescents has yet to be fully explored. See also J. Ritter, M. Stewart, et al. (2002), "Effects of childhood exposure to familial alcoholism and family violence on adolescent substance use, conduct problems, and self-esteem," Journal of Traumatic Stress, 15(2), 113-122.
226. Resilience theory has been extensively applied to a wide range of issues associated with adolescent development. For instance, in S. Fergus and M. Zimmerman (2005), "Adolescent resilience: a framework for understanding healthy development in the face of risk," Annual Review of Public Health, 26, 399-419
227. the authors identify three models of resilience - compensatory, protective, and challenge - with each involving different types of research. The approach has been applied to adolescent substance use, violence, and sexual risk, and this is discussed in A. Carle and L. Chassin (2004), "Resilience in a community sample of children of alcoholics: its prevalence and relation to inter nalizing symptomatolog y and positive affect," Journal of Applied Developmental Psychology, 25, 577-595. In this article the authors stated that "resilience has not been adequately studied in the children of alcoholic parents literature and little information exists regarding this group" (p. 579). It is a promising area for future research.
228. Proactive employee assistance programs (EAPs) develop workplace systems where a potentially troubled employee is identified via documented evidence of impaired job performance and then referred to peer referral officers who assist them in accessing appropriate counseling, which, in the case of troubles associated with addictive substances/processes might involve brief motivational counseling or constructive confrontation. Descriptions of these approaches are provided in T. Blum and P. Roman (1992), "A description of clients using employment assistance programs," Alcohol Health & Research World, 16, 120-127
229. S. Milne, T. Blum, et al. (1994), "Factors influencing employees' propensity to use an employee assistance program," Personnel Psychology, 47, 123-145.
230. A World Health Organization (WHO)-sponsored analysis of alcohol and public health mainly in European countries, G. Edwards, P. Anderson, et al., Alcohol Policy and the Public Good (Oxford University Press, 1994, p. 35), outlines how countries such as Spain and France, which consume high amounts of alcohol, also had to contend with high health, justice system, and social costs.
231. The reluctance of medical practitioners to enter into discussions about addictive relationships with people affected is well documented with people in addictive relationships. For example, in the United States a national survey of 648 primary care physicians found 94 percent failed to include substance abuse among five diagnoses they offered when presented with early symptoms of alcohol abuse in an adult patient. See CASA National Center on Addiction and Substance Abuse, Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse (Columbia University, 2000)
232. Similar concerning findings are noted in M. Fleming (2004), "Screening and brief intervention in primary care settings," Alcohol Research and Health, 28(2), 57-62
233. and in our own work with WHO, P. Adams, A. Powell, et al. (1997), "Incentives for general practitioners to provide brief interventions for alcohol problems," New Zealand Medical Journal, 110, 291-294.
234. This is also undoubtedly related to privileges enjoyed by men in terms of higher access (customary and economic) to most dangerous consumptions. For example, in a comparison of addictive relationships to drugs between the U.S. and U.K., in both countries higher prevalence was associated with "being male, non-married, of a low socio-economic status (SES), and living in an urban setting," in C. Furr-Holden and J. Anthony (2003), "Epidemiologic differences in drug dependence - a US-UK crossnational comparison," Social Psychiatry and Psychiatric Epidemiology, 38(4), 165-172.
235. Various studies have found varying impacts on a child depending on whether the parent is the father or the mother. For example, in a long-term study of 85, 000 children in Denmark, M. Christoffersena, and K. Soothill (2003), "The long-term consequences of parental alcohol abuse: a cohort study of children in Denmark," Journal of Substance Abuse Treatment, 25, 107-116, the authors found that the range of negative effects were worse when the mother rather than the father was in the addictive relationship. They concluded, "A mother's alcohol abuse may have somewhat different consequences from a father's alcohol abuse" (p. 115) and that future research needs to improve our understanding of these gender relationships.
236. S. Greenfield, A. Brooks, et al (2007), "Substance abuse treatment entry, retention, and outcome in women," Drug and Alcohol Dependence, 86, 1-21
237. the authors reviewed the literature examining characteristics associated with treatment outcome in women with substance use disorders, and concluded that while gender specific treatment programs do not necessarily improve treatment retention or outcome, they are better suited for women with specific issues (such as co-occurring issues with sexual abuse or eating disorders). Other reviews of gender dynamics include D. Heath (1991), "Women and alcohol: cross-cultural perspectives," Journal of Substance Abuse 3(2): 175-185
238. D. Gefou-Madianou (ed.), Alcohol, Gender and Culture (Routledge, 1992).
239. Prior to the modern proliferation of gambling in Western-style democracies, traditional forms of gambling such as track betting and poker were dominated by men. With the rise of continuous forms of gambling (e.g., electronic gambling machines and casino tables), the participation of women and their levels of problem gambling have quickly risen and are approaching male rates, see J. Hraba and G. Lee (1996), "Gender, gambling and problem gambling," Journal of Gambling Studies, 12(1), 83-101
240. R. Desai, P. Maciejewski, et al. (2006), "Gender differences among recreational gamblers: association with the frequency of alcohol use," Psychology of Addictive Behaviors, 20(2), 145-153.
241. An overview of the diverse ways alcohol is incorporated into cultural practices is provided in D. Heath, Drinking Occasions: Comparative Perspectives on Alcohol and Culture (Brunner/Mazel, 2000).
242. See essay collections by D. Gefou-Madianou (ed.), Alcohol, Gender and Culture (Routledge, 1992)
243. D. Heath, Drinking Occasions: Comparative Perspectives on Alcohol and Culture (Brunner/Mazel, 2000)
244. and a special issue edited by M. Marshall, G. Ames, et al. (2001), "Anthropological perspectives on alcohol and drugs at the turn of the new millennium," Social Science and Medicine, 53(2), 153-64.
245. A description of this sequence is provided in S. Tse, J. Wong, et al. (2004), "A public health approach for Asian people with problem gambling in foreign countries," Journal of Gambling Issues, 12, 1-15
246. C. Jiacheng (1995), "China,".. In D. Heath (Ed.), International Handbook on Alcohol and Culture (Greenwood, 1995, pp. 42-50).
247. Mac Marshall's most influential work on drinking and Pacific culture is his Weekend Warriors: Alcohol in Micronesian Culture (Mayfield, 1979)
248. His notion of "weekend warriors" could also be extended into understanding customary drinking practices in modern Western societies. Also his edited book, Beliefs, Behaviors and Alcoholic Beverages in Cross Cultural Survey (University of Michigan Press, 1979), provides another detailed look into the interrelationships between alcohol use and changes in Pacific culture.
249. In a detailed study of Niuean men in Auckland, Vili Nosa interviewed them about their changes in their drinking practices since migrating to New Zealand. While binge drinking was a common pattern, he found many of their practices differentiated strongly from their heavy drinking European contemporaries. V. Nosa, The Perceptions and Use of Alcohol Among Niuean Men Living in Auckland (Unpublished PhD dissertation, University of Auckland, 2005).
250. The interactions between colonization and addiction issues is summarized in M. Gracey (1998), "Substance misuse in Aboriginal Australians," Addiction Biology, 3, 29-46
251. L. French (2004), "Alcohol and other drug addictions among Native Americans: the movement toward tribal-centric treatment programs," Alcoholism Treatment Quarterly, 22(1), 81-91.
252. D. Heath, "An anthropological view of alcohol and culture in international perspective," in his International Handbook on Alcohol and Culture (Greenwood 1995, pp. 328-347), he provides an overview of using anthropological methods in understanding the interactions of alcohol use with culture.
253. Quoted in A. Sinclair, Dylan Thomas: No Man More Magical (Holt, Rinehart & Winston, 1975, p.172) from letters from Laugharne in early 1950s shortly before his death.
254. The importance of the concept of empowerment for community development is reviewed by N. Wallerstein (2006) for the World Health Organization in What Is the Evidence on Effectiveness of Empowerment to Improve Health? (WHO Regional Office for Europe's Health Evidence Network, 2006)
255. The review highlights how empowering initiatives can lead to positive health outcomes and reduce disparities in health. Also the thinking on community empowerment is outlined by Ron Labonte. (1990), "Empowerment: Notes on Professional and Community Dimensions," Canadian Review of Social Policy, 26, 64-75.
256. For a review of how the health of communities can be improved using the principles of community empowerment, see G. Laverack, Health Promotion Practice: Power and Empowerment (Sage, 2004, pp. 60-72).
257. Community development literature in both developed and developing countries provides many examples where organizations in positions of power (governments, aid agencies, international bodies) impose their ideas of how a particular community should develop. Their efforts often falter because communities have difficulties owning the initiatives. For critical discussion of this, see N. Wallerstein (1992), "Powerlessness, empowerment, and health: implications for health promotion program," American Journal of Health Promotion, 6, 197-205
258. R. Labonte and G. Laverack (2001), "Capacity building in health promotion, Part 1: for whom? And for what purpose?" Critical Public Health, 11(2), 111-127.
259. Considerable research on youth has focused on the various ways in which social connectedness (connectedness to school, parents, and peers) contributes to strength and resilience. For discussion on this literature, see R. Baumeister, and M. Leary (1995), "The need to belong: desire for interpersonal attachments as a fundamental human motivation," Psychological Bulletin, 117(3), 497-529
260. A. Masten, H. Gest, et al. (1999), "Competence in the context of adversity: pathways to resilience and maladaptation from childhood to late adolescence," Development and Psychopathology, 11, 143-169.
261. The relationship between resilience and social involvement with alcohol issues is outlined in R. Velleman, and J. Orford, Risk and Resilience: Adults Who Were the Children of Problem Drinkers (Harwood Academic, 1999)
262. A. Carle and L. Chassin (2004), "Resilience in a community sample of children of alcoholics: its prevalence and relation to internalizing symptomatology and positive affect," Applied Developmental Psychology, 25, 577-595.
263. The different experiences between men and women in addictive systems and accessing services are being increasingly researched. See T. Brown, M. Kokin, et al. (1995), "The role of spouses of substance abusers in treatment: gender differences," Journal of Psychoactive Drugs 27(3): 223-229
264. S. Greenfield, A. Brooks, et al. (2007), "Substance abuse treatment entry, retention, and outcome in women: a review of the literature," Drug and Alcohol Dependence, 86, 1-21.
265. The concept of "community" is complex and multidimensional, as illustrated in B. Israel, B. Checkoway, et al. (1994), "Health education and community empowerment: conceptualizing and measuring perceptions of individual, organisational and community control," Health Education Quarterly, 21(2), 149-170.
266. As will be discussed more fully in Chapter 11, several current interventions aim to engage family members as a means of later engaging the person in the addictive relationship. For example, J. Barber, and B. Crisp (1995), "The 'pressures to change' approach to working with the partners of heavy drinkers," Addiction, 90, 269-276, developed procedures for engaging family members as a means of putting pressure on the person in the addictive relationship to change
267. A summary of these strategies is provided in A. Copello, R. Velleman, et al. (2005), "Family interventions in the treatment of alcohol and drug problems," Drug and Alcohol Review, 24, 369-385.
268. From The Collected Poems of Theodore Roethke (Faber & Faber, 1966, p. 19). Roethke faced his own ongoing struggles with an addictive relationship to alcohol.
269. See the excellent discussion of this in G. Lakoff and M. Johnson, Metaphors We Live By (University of Chicago Press, 1979).
270. In a detailed exploration of the rhetoric used in modern economics, Don (Dierdre) McCloskey in The Rhetoric of Economics (Harvester Press, 1985) explores how heavily rhetorical devices are used in academic literature to generate a sense of neutrality and objectivity.
271. See this discussed in D. Massaro (1986), "The computer as a metaphor for psychological inquiry: considerations and recommendations," Behaviour Research Methods, Instruments and Computers, 18, 73-92
272. This type of metaphor is also discussed by J. Searle, Minds, Brains and Science (Harvard University Press, 1984).
273. Together AA, NA and Al-Anon have generated a vast number of self-help brochures, booklets, and books. For example, a GSO archive of brochures, books, and other material is available at: http://www.alcoholics-anonymous.org/en-gso- archives.cfm (accessed Feb 2007).
274. Books written as self-help guides for reintegrating families and couples include C. Patterson-Sterling, Rebuilding Relationships in Recovery: A Guide to Healing Relationships Impacted by Addiction (Xlibris, 2004)
275. C. Nakken, Reclaim Your Family from Addiction: How Couples and Families Recover Love and Meaning (Hazelden, 2000).
276. The importance of the body and spatiality is increasingly seen as playing a role in social identity and social relating. Summaries of this literature can be found in I. Burkitt, Bodies of Thought: Embodiment, Identity and Modernity (Sage, 1999)
277. C. Shilling (2003), The Body and Social Theory (Sage, 1999).
278. Self-help guide books on recovery provide strong emphasis on attention to physical wellbeing, relaxation strategies, and reducing stress. See N. Denzin, The Alcoholic Society: Addiction and Recovery of the Self (Transaction, 1993)
279. B. Ley-Jacobs, Nature's Road to Recovery: Nutritional Supplements for the Recovering Alcoholic, Chemical-dependent and the Social Drinker: A Health Learning Handbook (BL Publications, 1999).
280. Discussions of AA and spirituality can be found in Alcoholics Anonymous, 4th ed. (AA World Services, 1976)
281. and also summaries in C. Cook (2004), "Addiction and spirituality," Addiction, 99(5), 539-551
282. A. Morjaria and J. Orford (2002), "The role of religion and spirituality in recovery from drink problems: a qualitative study of Alcoholics Anonymous members and South Asian men," Addiction Research and Theory, 10(3), 225-256.
283. I have completed a detail study of these experiences and how they communicate them in A Rhetoric of Mysticism (unpublished PhD dissertation, University of Auckland, 1991).
284. From Marian Keyes's novel, Rachel's Holiday (Penguin 1997, p. 578), about a woman's reluctant experiences in an addiction rehabilitation program.
285. There are also more drug specific groups such as Marijuana Anonymous and Cocaine Anonymous. See discussion in R. Room and T. Greenfield (1993), "Alcoholics anonymous, other 12-step movements and psychotherapy in the US population, 1990," Addiction, 88(4), 555-562
286. M. Peyrot (1985), "Narcotics anonymous: its history, structure, and approach" International Journal of Addictions, 20(10), 1509-1522.
287. For example, the concept of codependency has been criticized for the way it overextends understanding of addiction and pathologizes women. See articles by S. Anderson (1994), "A critical analysis of the concept of codependency," Social Work, 39(6), 677-685
288. L. Stafford (2001), "Is codependency a meaningful concept?" Issues in Mental Health Nursing, 22(3), 273-286.
289. Mariana Valverde's (1998), Diseases of the Will: Alcohol and the Dilemmas of Freedom (Cambridge University Press, 1998, p. 122).
290. See, for example, overviews provided by C. Whitfield (1989), "Co-dependence: our most common addiction - some physical, mental, emotional and spiritual perspectives," Alcoholism Treatment Quarterly, 6, 19-36
291. M. Hands and G. Dear (1994), "Co-dependency: a critical review," Drug and Alcohol Review, 13, 437-445.
292. The publications are many, but leading books include M. Beattie, Codependent No More (Collins Dove, 1989)
293. R. Norwood, Women Who Love Too Much (Arrow Books, 1990)
294. P. Mellody, Facing Codependence (Harper & Row, 1989).
295. This view is echoed in criticisms by Eve Sedgewick in her influential essay "Epidemics of the Will" in Tendencies (Duke University Press, 1998, 130-142)
296. M. Valverde, Diseases of the Will (Cambridge University Press, 1998, pp. 34-35, 128).
297. The literature on the effectiveness of family approaches has been summarized in A. Copello, R. Velleman, et al. (2005), "Family interventions in the treatment of alcohol and drug problems," Drug and Alcohol Review, 24, 369-385
298. as well as in W. Miller and P. Wilbourne (2002), "Review: Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders," Addiction, 97, 265-277.
299. Ibid., p. 276, and quoted by A. Copello, R. Velleman, et al. (2005), "Family interventions in the treatment of alcohol and drug problems," Drug and Alcohol Review, 24, 369-385.
300. Pauline O'Flaherty, Being Strong: An Exploration of Discourses Concerning Transition to Life Beyond Residential Drug and Alcohol Treatment (unpublished thesis, University of Auckland, 1999).
301. The Johnson intervention, named after the Johnson Institute, is described in detail in G. Loneck, J. Garret, et al. (1996), "The Johnson intervention and relapse during outpatient treatment," American Journal of Drug and Alcohol Abuse, 22, 233-246.
302. See M. Liepman, "Using family influence to motivate resistant alcoholics to enter treatment: the Johnson Institute approach," in T. O'Farrell, Treating Alcohol Problems: Marital and Family Interventions (Guilford Press, 1993, pp. 54-77).
303. Outlined in J. Garrett, J. Landau, et al. (1998), "The ARISE intervention-using family and network links to engage addicted persons in treatment," Journal of Substance Abuse Treatment, 15, 333-343.
304. Described in detail. In their book, R. Meyers and W. Miller (Eds.), A Community Reinforcement Approach to Addiction Treatment (Cambridge University Press, 2001).
305. As outlined by G. Hunt, and N. Azrin (1973), "A community- reinforcement approach to alcoholism," Behavior Research and Therapy, 11, 91-104. The approach was originally developed. In Illinois as a treatment package involving a range of treatment strategies that included job-finding, marital therapy, social/leisure counseling, and social clubs.
306. R. Meyers and W. Miller (Eds.), A Community Reinforcement Approach to Addiction Treatment (Cambridge University Press, 2001, pp. 46-61).
307. In a randomized controlled trial comparing CRA alone with CRAFT, R. Sisson and N. Azrin (1986), "Family-member involvement to initiate and promote treatment of problem drinkers," Journal of Behavior Therapy and Experimental Psychiatry, 17, 15-21, found the family component of craft led to more improved outcomes.
308. R. Meyers, W. Miller, et al, "Community Reinforcement and Family Training (CRAFT)" in their A Community Reinforcement Approach to Addiction Treatment (Cambridge University Press, 2001, p. 150).
309. Ibid. A lay version of this approach is provided in R. Meyers and B. Wolfe, Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening (Hazelden, 2004).
310. The focus on the person in the addictive relationship rather than the potential in the family system is clear in their book, J. Smith and R. Meyers, Motivating Substance Abusers to Enter Treatment: Working with Family Members (Guilford Press, 2004).
311. Recent reviews on family oriented interventions (including family therapy) are available in articles such as H. Liddle (2004), "Family-based therapies for adolescent alcohol and drug use: research contributions and future research needs," Addiction, 99(suppl 2), 76-92
312. A. Copello, L. Templeton, et al. (2006), "Family interventions for drug and alcohol misuse: Is there a best practice?" Current Opinion in Psychiatry, 19(3), 271-276.
313. See M. Stanton, T. Todd, et al, The Family Therapy of Drug Abuse and Addiction (Guilford, 1982).
314. As described in Marc Galanter, Network Therapy for Alcohol and Drug Abuse (Guilford, 1993)
315. M. Galanter and D. Brook (2001), "Network therapy for addiction: bringing family and peer support into office practice," International Journal of Group Psychotherapy, 51(1), 101-122.
316. As described in J. Combs and G. Freedman, Narrative Therapy: The Social Construction of Preferred Realities (Norton, 1996).
317. Colleagues and I have attempted for over 20 years to incorporate family approaches into addiction services. Early on we used standard family therapy practices that included oneway mirrors, videos telephones, and letter writing. We adopted theories and approaches based on strategic, structural, conjoint, psychoanalytic, cybernetic, and narrative understandings. We set up couples groups, multiple family groups, family education days, and family session times. We developed staff training in family approaches, we set up community liaison initiatives, and we developed guidelines and other materials for practitioners on family inclusion. What was both disheartening and fascinating was how little impact these efforts had in shifting the focus of services in favor of families. In effect, family approaches have been more consistently adopted in situations in which an adolescent in an addictive relationship, as illustrated in J. Szapocznik, A. Perez-Vidal, et al. (1988), "Engaging adolescent drug abusers and their families in treatment: a strategic structural systems approach," Journal of Consulting and Clinical Psychology, 56, 552-557.
318. P. Steinglass, L. Bennett, et al, The Alcoholic Family (Basic Books, 1987, p.47).
319. See review by B. Brook, "Adolescents who abuse substances,"
320. P. Kymissis and D. Halperin (1996), Group Therapy with Children and Adolescents (American Psychiatric Press, 1996, pp. 243-264).
321. See R. Cronkite, J. Finney, et al, "Remission among alcoholic patients and family adaption to alcoholism: a stress and coping perspective," in R. Collins, K. Leonard, and J. Searles, Alcohol and the Family: Research and Clinical Perspectives (Guilford, 1990, pp. 309-337).
322. See R. Moos, J. Finney, et al, Alcoholism Treatment: Context, Process and Outcome (Oxford University Press, 1990).
323. See R. Cronkite, J. Finney, et al, "Remission among alcoholic patients and family adaption to alcoholism: a stress and coping perspective," in R. Collins, K. Leonard, and J. Searles, Alcohol and the Family: Research and Clinical Perspectives (Guilford, 1990, p. 327).
324. Barbara McCrady, in "The marital relationship and alcoholism treatment". In R. L. Collins, K. E. Leonard & J. S. Searles (Eds.), Alcohol and the Family: Research and Clinical Perspectives (Guildford, 1190, pp. 338-355)
325. looked at three different models of marital relationship and treatment; family disease, family systems and social learning. She advocated a combination of systems and social learning approaches. Other couple approaches are discussed in Jim Orford, "The coping perspective," in R. Velleman, A. Copello and J. Maslin, Living with Drink: Women Who Live with Problem Drinkers (Longman, 1998, pp. 128-149)
326. E. Epstein, B. McCrady, et al., "Couple therapy in the treatment of alcohol problems," in A. Gurman and N. Jacobson, Clinical Handbook of Marital Therapy, 3rd ed. (Guilford, 2002, pp. 597-628).
327. For example as described in J. Dittrich (1993), "Group programs for wives of alcoholics," in T. O'Farrell, Treating Alcohol Problems: Marital and Family Interventions (Guilford, 1993, pp. 78-114).
328. See R. Velleman and L. Templeton (2003), "Alcohol, drugs and the family: a UK research programme," European Addiction Research, 9, 103-112.
329. The willingness to engage with others also included involvement with the person in the addictive relationship and with other associates such as GPs as described by A. Copello, J. Orford, et al. (2000), "Methods for reducing alcohol and drug related family harm in non-specialist settings," Journal of Mental Health, 9, 319-333
330. and in a primary care package of treatment involving brief psycho-social interventions described in A. Copello, L. Templeton, et al. (2000), "A treatment package to improve primary care services for relatives of people with alcohol and drug problems," Addiction Research, 8(5), 471-484.
331. This approach was developed into a manual for a controlled trial the UK Alcohol Treatment Trial (UKATT) comparing this approach with motivational enhancement therapy, A. Copello, J. Orford, et al. (2002), "Social behavior and network therapy: basic principles and early experiences," Addictive Behaviors, 27, 345-366.
332. Sources of information vary enormously. More socially oriented material can be found in books such as R. Meyers and B. Wolfe, Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening (Hazelden, 2004)
333. C. Patterson-Sterling, Rebuilding Relationships in Recovery: A Guide to Healing Relationships Impacted by Addiction (Xlibris Corporation, 2004), or on Web sites such as Kina Families and Addiction Trust www.kinatrust.org.nz, or Addiction and Family Resource Group, www.addictionandfamily. org
334. The importance of writing as a means of processing difficult and traumatic experiences has been highlighted in the work of James Pennebaker, whose research has spawned a wide variety of other research programs looking at the effects of traumatic writing on both psychological and physical well-being. See reviews in B. Esterling, L. L'Abate, et al., (1999) "Empirical foundations for writing in prevention and psychotherapy: mental and physical health outcomes," Clinical Psychology Review, 19(1), 79-96
335. J. Pennebaker (1999), "The effects of traumatic disclosure on physical and mental health: the values of writing and talking about upsetting events," International Journal of Emergency Mental Health, 1(1), 9-18.
336. Quoted in K. Tamasese, C. Peteru, et al., O le Taeao Afua The New Morning: A Qualitative Investigation into Samoan Perspectives on Mental Health and Culturally Appropriate Services (The Family Centre and New Zealand Health Research Council, 1997).
337. In a book translated into English on the clubs, V. Hüdolin, P. Gosparini, et al. (Eds.), Clubs of Treated Alcoholics: A Guide for the Work in the Clubs of Treated Alcoholics (SocialEcological Approach) (European School of Alcohology and Ecologica Psychiatry, 2001), the authors have opted consistently for the term treated alcoholics. My impression is that the terms treated and alcoholic may for them have different connotations and less medicalized overtones than in Anglo-American contexts. For that reason I have chosen to refer to them here simply and more neutrally as "clubs."
338. See V. Hüdolin, P. Gosparini, et al. (Eds.), Club of Treated Alcoholics: A Guide for the Work in the Clubs of Treated Alcoholics (European School of Alcohology and Ecological Psychiatry, 2001).
339. Based on material in L. Musso, Handbook for Setting Up a Local Introductory Course: How to Do It? (Turin, Clubs of Treated Alcoholics, 2001, p. 53).
340. In V. Hüdolin, P. Gosparini, et al. (Eds.), Club of Treated Alcoholics: A Guide for the Work in the Clubs of Treated Alcoholics (European School of Alcohology and Ecological Psychiatry, 2001, p. 223). The left box has been abbreviated from "The area of alcohology programmes (Area alcohology schools, Interclub, Congresses etc.)" to "The Club Network."
341. L. Musso, Handbook for Setting Up a Local Introductory Course: How to Do It? (Clubs of Treated Alcoholics, 2001, p.38) the handbook describes the concept of the net as needing to be "fine mesh," "dynamic," and all inclusive.
342. In Croatia the numbers have dropped to about 140 clubs, a response to more basic priorities following the physical and social devastation of 1991; see discussion. In V. Hüdolin, P. Gosparini, et al. (Eds.), Club of Treated Alcoholics (European School of Alcohology and Ecological Psychiatry, 2001, pp. 42-49).
343. Asian colleagues emphasize the importance of collective unity over the individualism they observe in Western contexts. See discussion in S. Tse., J. Wong, et al. (2004), "A public health approach for Asian people with problem gambling in foreign countries," Journal of Gambling Issues, 12, 1-15.
344. This is discussed more fully in Steven Fischer, A History of the Pacific Islands (Palgrave, 2002).
345. As described by Michael King in his overview in The Penguin History of New Zealand (Penguin, 2003).
346. James Bellich in his landmark Making Peoples: A History of the New Zealanders from Polynesian Settlement to the End of the Nineteenth Century (Penguin, 1996) describes in detail how in the early years up until the 1850s Māori and European relationships were fairly intertwined, with Māori vastly outnumbering the settlers. Then as emigration from the British Isles increased on a more systematic basis and with Māori deaths from European diseases, European settlers soon outnumbered Māori and land confiscations became widespread.
347. From a presentation by Pam Armstrong on The Dynamics of Whanaungatanga (Ngati Wai, 2003, slide 4).
348. Stated by Pa (Father) Henare Tate and quoted in Pam Armstrong, The Dynamics of Whanaungatanga (unpublished report, 2003, p. 9).
349. Michael Shirres quoted in Pam Armstrong The Dynamics of Whanaungatanga (unpublished report, 2003, p. 12).
350. From Michael Shirres, Te Tangata: The Human Person. (Auckland, Accent, 1997 pp. 44-45).
351. From Mason Durie, Maui Ora: The Dynamics of Maori Health. (Oxford University Press, 2001, p. 203).
352. Described in Pam Armstrong, The Dynamics of Whanaungatanga (unpublished report, 2003, p. 13).
353. A range of different Maori health models have been used to support the development of physical, social, psychological, and spiritual connectedness, and their use has been extended to work with mental health issues including addictive relationships; see T. Huriwai, P. Armstrong, et al. (2001), "Whanaungatanga: A process in the treatment of Mâori with alcohol and drug problems," Substance Use and Misuse, 36(8), 1033-1052
354. M. Durie, Mauri Ora: The Dynamics of Maori Health (Oxford University Press, 2001).
355. H. Moewaka-Barnes (2000), "Collaboration in community action: a successful partnership between indigenous communities and researchers," Health Promotion International 15(1): 17-25, the author argues that unlocking the power of connectedness is more likely to occur in a Māori cultural framework than in European contexts.
356. As outlined in Wendy Henwood's process evaluation of the early stages of the project in Evaluation of "He Ope Awhina Ia Tatou" (Unpublished report, Nga Manga Puriri, 2000).
357. As outlined in K. Conway, M. Tunks, et al. (2000), "Te Whanau Cadillac - a Waka for change," Health Education & Behavior, 27, 339-350.
358. The cultural independence of Maori services is identified as a significant issue by P. Robertson, T Haitana, et al. (2006), "A review of work-force development literature for the Maori addiction treatment field in Aotearoa/New Zealand," Drug & Alcohol Review, 25, 233-239. They point out how kaupapa Maori services provide the opportunity for individuals and whanau (family/extended family) to work with ethnically matched health workers in ways that increase service accessibility and improve treatment outcomes.
359. As described in a booklet produced by the Kina Families and Addiction Trust, Family Inclusive Practice in the Addiction Field: A Guide for Practitioners Working with Couples, Families and Whanau. (Napier, NZ, Kina Families and Addiction Trust, 2005), p. 60.
360. This quotation comes from an important editorial in the leading journal on addiction in which the case was made for a stronger focus on family. A. Copello and J. Orford (2002), "Editorial: addiction and the family: Is it time for services to take notice of the evidence?," Addiction, 97, p. 1362.
361. For example, even recent texts place a heavy emphasis on primarily psychological and to some extent biological dimensions of addiction. This is clear in Carlos DiClemente, Addiction and Change: How Addictions Develop and Addicted People Recover (Guilford, 2005)
362. Arthur Blume, Treating Drug Problems (Wiley, 2005).
363. The best studies of service counseling interventions indicate that only one third of clients improve, and since the interventions' effectiveness is typically only tracked for 18 months to 3 years, the studies may not address the long-term outcomes. George Vaillant argues that the effect of these interventions should be monitored for 5 to 10 years; see G. Vaillant (1988), "What can long-term follow-up teach us about relapse and prevention of relapse in addiction?," British Journal of Addiction, 83, 1147-1157.
364. The colonization of women's experience in violent relationships is a topic that my colleagues and I have examined for some time. For example, see A. Towns and P. Adams (2000), "'If I really loved him enough, he would be okay': women's accounts of male partner violence," Violence Against Woman, 6(6), 558-585
365. P. Adams, A. Towns, and N. Gavey, "Dominance and entitlement: the rhetoric men use to discuss their violence towards women,". In M. Talbot, K. Atkinson and D. Atkinson (Eds.), Language and Power in the Modern World (Edinburgh University Press, 2003) pp. 184-198
366. A. Towns, P. Adams, & N. Gavey (2003), "Silencing talk of men's violence towards women,". In L. Theismeyer (Ed.), Discourse and Silencing: Representation and the Language of Displacement (John Benjamins, 2003).
367. The work of postmodern writers is placing increasing emphasis on the symbolic importance of how people interact with space and how the body plays an instrumental role in identity and social meaning. For summaries of this literature, see I. Burkitt, Bodies of Thought: Embodiment, Identity and Modernity (Sage, 1999)
368. C. Shilling, The Body and Social Theory (Sage, 2003).
369. In my doctoral dissertation I researched the various rhetorical strategies people without religious affiliations use to convey their mystical and religious experiences. See P. Adams, A Rhetoric of Mysticism (Unpublished dissertation, University of Auckland, 1991).
370. From William Burroughs' Naked Lunch (Flamingo, 1993, p. 174).
371. For example, the importance of coexistent concerns is summarized in a review article by P. Buckley (2006), "Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness," Journal of Clinical Psychiatry, 67(suppl 7), 5-9; the authors found that one quarter of people with severe mental illness have issues with addictive relationships and half of those in addictive relationships also struggle with major mental health concerns.
372. Research suggests the presence of abuse may be a critical factor. See summaries in J. Ritter, M. Stewart, et al. (2002), "Effects of childhood exposure to familial alcoholism and family violence on adolescent substance use, conduct problems, and self-esteem," Journal of Traumatic Stress, 15(2), 113-122
373. C. Humphreys, L. Regan, et al. (2005), "Domestic violence and substance use: tackling complexity," British Journal of Social Work, 35(8), 1303-1320.
374. Alex Copello in particular has been pointing this out as described in A. Copello and J. Orford (2002), "Editorial: addiction and the family: is it time for services to take notice of the evidence?," Addiction, 97, 1361-1363
375. A. Copello, R. Velleman, et al (2005), "Family interventions in the treatment of alcohol and drug problems," Drug and Alcohol Review, 24, 369-385.
376. See N. Wallerstein (2006), What is the Evidence on Effectiveness of Empowerment to Improve Health? (WHO Health Evidence Network, 2006).