Alcohol & Alcoholism Vol. 39, No. 1, pp. 72, 2004
© Medical Council on Alcohol 2004; all rights reserved
BOOK REVIEW
Addiction and Change: How Addictions Develop and Addicted People Recover
Addiction and Change: How Addictions Develop and Addicted People Recover. By Carlo C. Di Clemente. The Guildford Press, New York, 2003, 318 pp., £26.95. ISBN 1-572030-057-4.This book describes the trans theoretical model of intentional behaviour change, presenting it as an integrative framework for understanding addictive behaviour.
Addiction is viewed from a predominantly psychological perspective, emphasizing its appetitive, i.e. its pleasurable and reinforcing aspects; dependence seen as characterized by poor self-regulatory control; and resistance to change. The author makes the pertinent comment that change is the antithesis of addiction.
Single factor models such as the social/environment, genetic/physiological, personality/intrapsychic models are briefly summarized and viewed as only partially explanatory. Their limitations are delineated to make a case for a more integrative model. Interestingly in the summary of the genetic/physiological model, craving is mentioned as a physical reaction and feature of ‘a clear withdrawal syndrome’, and nicotine is listed along with alcohol and heroin as apparently producing physiological dependence. There is little mention of the moral model, although worldwide it arguably remains a prevalent one. The author states, ‘without a pathway that can lead to real integration, the biopsychosocial model represents only a semantic linking of terms or at best a partial integration’.
In the trans theoretical model, intentional human behaviour change is taken as the integrating construct. Its stages of changes must be now familiar to virtually every worker in specialist addiction services, certainly for relinquishing addiction. Fewer will be aware of their application to the development and maintenance of addiction. For instance, the Action stage may be viewed as applicable to those with substance abuse until self-regulation is sufficiently impaired for dependence and a shift into the Maintenance stage.
A relatively coherent psychological model for the development, maintenance and quitting of addiction is cogently presented. There is, however, little consideration of lifestyle change and the role of adherence to Alcoholics Anonymous or related organizations. Physiological mechanisms are acknowledged but not described in any detail in this book. Some of the psychological terminology may require more explanation for those without specialist psychology training.
All in all this is an excellent exposition of an already widely adopted model for understanding addictive behaviour. I recommend it to all students of addictive behaviour and all involved in helping or treating addicts.
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