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Addiction |
3 |
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Table of Contents |
7 |
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List of Contributors |
13 |
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Foreword |
15 |
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Preface |
19 |
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Notes on Contributors |
21 |
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PART 1 Understanding the Psychology and Treatment of Addictions |
27 |
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CHAPTER 1 Addiction: A Comprehensive Approach |
29 |
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1.1 Introduction |
30 |
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1.2 Existing theories |
31 |
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1.2.1 Choice Theories |
31 |
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1.2.2 Compulsion and Self-Control Theories |
32 |
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1.2.3 Theories Focusing on the Neural Basis of Reward and Punishment |
32 |
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1.2.4 Integrated Theories |
33 |
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1.2.5 The Need for a Synthetic Theory |
34 |
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1.3 The human motivational system |
34 |
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1.3.1 Structure of the Motivational System |
35 |
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1.4 Internal and external sources of influence |
37 |
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1.4.1 Drives, Emotional States and Arousal |
37 |
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1.4.2 Self-Control and Identity |
38 |
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1.5 The dynamics of the system |
38 |
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1.5.1 The Moment-to-Moment Control of Behaviour |
38 |
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1.5.2 The Unstable Mind and Chreods |
39 |
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1.6 Changing dispositions |
40 |
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1.7 Testing the theory |
41 |
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Suggestions for further reading |
42 |
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References |
42 |
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CHAPTER 2 An Attachment-Informed Approach to Working with Addiction |
46 |
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2.1 Introduction to attachment |
47 |
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2.2 Attachment and psychopathology |
49 |
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2.2.1 Parenting |
50 |
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2.2.2 Trauma |
51 |
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2.3 Attachment and addiction |
51 |
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2.3.1 Emotion Regulation |
52 |
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2.3.2 Alexithymia |
53 |
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2.3.3 Interpersonal Difficulties |
53 |
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2.3.4 Co-Morbid Mental Health Problems |
54 |
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2.4 Attachment styles in clinical samples |
54 |
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2.5 Assessment and formulation through an attachment lens |
55 |
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2.5.1 The Clinical Interview |
56 |
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2.5.2 Psychometric Approaches |
57 |
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2.5.3 Transference and Counter-Transference |
57 |
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2.6 Treatment implications |
58 |
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2.6.1 Therapeutic Alliance |
58 |
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2.6.2 Enhancing Skills |
59 |
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2.6.3 Addressing Issues of Loss |
61 |
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2.7 Conclusion |
61 |
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Suggestions for further reading |
61 |
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References |
62 |
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CHAPTER 3 Families, Friends and Addiction: Impacts, Psychological Models and Interventions |
68 |
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3.1 Introduction |
69 |
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3.2 The composition of alcohol and drug users’ social networks |
69 |
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3.3 Impacts of addictions on others |
70 |
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3.4 Theoretical models of addiction and the family: stress-strain-coping-support |
73 |
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3.5 From models to interventions |
74 |
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3.5.1 Supporting Family Members in Their Own Right: The 5-Step Method |
75 |
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3.5.2 Involving Families and Wider Social Networks in Treatment to Support Alcohol- and Drug-Users |
77 |
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3.6 Conclusion |
78 |
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Suggestions for further reading |
79 |
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References |
80 |
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CHAPTER 4 Working Systemically with Alcohol Misuse |
83 |
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4.1 Introduction |
84 |
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4.2 Family life |
85 |
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4.3 Family systems approaches |
86 |
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4.3.1 Patterns in Communication |
87 |
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4.3.2 Patterns in Relationships |
87 |
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4.3.3 Patterns over Time and Life Cycle Issues |
88 |
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4.4 Working therapeutically with violence and abuse |
90 |
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4.5 Engagement and the therapeutic relationship |
91 |
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4.6 Conclusion |
92 |
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Suggestions for further reading |
92 |
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References |
93 |
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CHAPTER 5 ‘Dangerous Desires and Inanimate Attachments’: Modern Psychodynamic Approaches to Substance Misuse |
94 |
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5.1 Introduction |
95 |
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5.2 Primitive emotional states: Kleinian views |
96 |
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5.3 Comforting self-objects: Kohutian views |
98 |
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5.4 Inanimate attachments: Bowlbian views |
100 |
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5.5 Bringing it together: addiction as a disorder of self-regulation |
102 |
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5.6 Reflective practice |
104 |
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5.7 Internal recovery |
105 |
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5.8 Conclusion |
107 |
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Suggestions for further reading |
108 |
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References |
108 |
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CHAPTER 6 Mindfulness, Acceptance and Values in Substance Misuse Services |
110 |
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6.1 Introduction: what are the principles and methods of mindfulness, acceptance and values? |
111 |
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6.1.1 Mindfulness |
111 |
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6.1.2 Acceptance |
112 |
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6.1.3 Values |
113 |
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6.2 How does ACT integrate with other approaches? |
113 |
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6.3 How does the service use these principles and methods of ACT? |
116 |
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6.4 How do mindfulness, acceptance and values support the resilience of staff in the face of seemingly relentless relapse and other behaviours? |
118 |
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6.4.1 Mindfulness, Acceptance, Values and the Therapeutic Alliance |
118 |
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6.4.2 Increasing Openness and Flexibility |
119 |
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6.4.3 Building and Maintaining Personal Strengths and Resources |
119 |
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6.5 What are the experiences of staff working with ACT? |
120 |
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6.5.1 Mindfulness, Acceptance and Values |
120 |
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6.5.2 Impact on Client Work |
121 |
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6.5.3 Team Impact |
121 |
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6.5.4 Concerns |
122 |
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6.6 What are the experiences of clients working this way? |
122 |
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6.7 Our experience of ACT |
123 |
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Suggestions for further reading |
124 |
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References |
124 |
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PART 2 Clinical Applications of Addiction Psychology |
129 |
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CHAPTER 7 The Role of Clinical Psychology within Alcohol Related Brain Damage |
131 |
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7.1 Introduction |
132 |
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7.2 Clinical definition of alcohol-related brain damage and related syndromes |
132 |
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7.3 Epidemiology of ARBD and related syndromes |
133 |
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7.4 Cognitive function in ARBD |
134 |
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7.4.1 Cognitive Deficits in ARBD |
134 |
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7.4.2 Neuropsychological Assessment in ARBD |
135 |
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7.4.3 Recovery of Cognitive Function in ARBD |
136 |
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7.5 Psychosocial and cognitive rehabilitation |
137 |
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7.5.1 Impact of Cognitive Deficits in ARBD and Rationale for Treatment |
137 |
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7.5.2 Adaptations to Alcohol Treatment Programmes |
139 |
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7.5.3 Cognitive Rehabilitation from Both ARBD and Brain Injury Settings |
140 |
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7.5.4 Holistic Rehabilitation for ARBD |
142 |
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7.5.5 Conclusion |
142 |
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7.6 Legal framework: mental capacity |
143 |
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7.6.1 Assessment of Capacity |
144 |
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7.7 Recovery |
144 |
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Suggestions for further reading |
145 |
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References |
145 |
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CHAPTER 8 Trauma and Addiction |
150 |
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8.1 Psychological trauma and PTSD |
151 |
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8.2 The relationship between addiction and psychological trauma |
153 |
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8.3 Assessment |
155 |
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8.3.1 The Clinical Interview |
156 |
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8.3.2 Self-Report Measures |
156 |
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8.4 Treatment of co-existing trauma and substance use disorders |
157 |
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8.4.1 Sequential Versus Parallel Treatment |
159 |
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8.4.2 Trauma-Focused Versus Non-Trauma-Focused Interventions |
159 |
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8.5 Clinical implications |
161 |
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8.5.1 Attending to the Therapeutic Relationship |
161 |
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8.5.2 Identifying Treatment Goals |
161 |
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8.5.3 Treatment Retention |
162 |
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8.5.4 Exploring Trauma |
163 |
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8.5.5 Emotional Reactivity |
163 |
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8.5.6 Training |
164 |
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8.6 Conclusion |
165 |
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Suggestions for further reading |
165 |
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References |
165 |
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CHAPTER 9 Narrative Identity and Change: Addiction and Recovery |
170 |
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9.1 Narrative theory |
171 |
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9.2 Narrative therapy |
171 |
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9.3 Narrative theory and addiction |
172 |
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9.4 Client talk |
173 |
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9.5 Generating narrative |
175 |
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9.5.1 Letters |
176 |
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9.5.2 Chapters |
176 |
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9.5.3 Evocative Questions |
177 |
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9.5.4 Poems, Books, Stories |
177 |
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9.6 Narratives of recovery |
178 |
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9.7 Varieties of recovery story |
178 |
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9.8 Conclusion |
180 |
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Acknowledgements |
181 |
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Notes |
181 |
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Suggestions for further reading |
181 |
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References |
182 |
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CHAPTER 10 Addiction and Mental Health |
184 |
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10.1 Introduction |
185 |
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10.2 Association between substance misuse and psychosis |
186 |
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10.3 Prevalence and epidemiology |
188 |
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10.4 Outcomes associated with co-occurring disorders |
189 |
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10.5 Treatment approach and effectiveness |
189 |
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10.6 Evidence for effectiveness |
190 |
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10.7 Conclusion |
192 |
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Suggestions for further reading |
193 |
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References |
193 |
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CHAPTER 11 Substance Misuse in Older Adults |
198 |
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11.1 Introduction |
199 |
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11.2 Definition of older adult |
199 |
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11.3 Alcohol |
199 |
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11.3.1 Extent and Nature of Alcohol Use and Misuse |
199 |
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11.3.2 Onset of Alcohol Misuse |
201 |
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11.3.3 Circumstances that Can Lead to Increased Alcohol Use and Misuse |
201 |
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11.4 Illicit drug use |
202 |
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11.4.1 Extent and Nature of Illicit Drug Use |
202 |
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11.4.2 Onset of Illicit Drug Use |
203 |
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11.4.3 Circumstances that Can Lead to Late-Onset Drug Use |
203 |
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11.5 Medication misuse |
204 |
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11.5.1 Extent and Nature of Medication Misuse |
204 |
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11.5.2 Onset of Medication Misuse |
205 |
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11.5.3 Risk Factors for Medication Misuse in Older Adults |
205 |
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11.6 Assessment of older people with substance misuse |
205 |
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11.6.1 Principles of Assessment |
205 |
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11.6.2 Systematic Assessment |
206 |
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11.6.3 Identifying Substance Misuse |
206 |
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11.6.4 Screening and Identification |
208 |
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11.6.5 Mental State Examination |
208 |
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11.6.6 Physical Examination |
209 |
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11.6.7 Referral to Other Services |
209 |
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11.7 Psychosocial interventions |
210 |
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11.7.1 Brief Advice |
210 |
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11.7.2 Motivational Interviewing |
210 |
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11.7.3 Supporting Families and Carers |
211 |
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11.8 Legal and ethical considerations |
211 |
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11.8.1 Mental Capacity |
211 |
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11.8.2 Elder Abuse |
212 |
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11.8.3 Mental Health Act |
212 |
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11.9 Using and evaluating health and social outcomes |
212 |
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11.10 Conclusion |
213 |
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Suggestions for further reading |
214 |
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References |
214 |
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CHAPTER 12 Issues Arising in Hepatitis C Work: The Role of the Clinical Psychologist |
219 |
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12.1 Introduction |
220 |
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12.2 Hepatitis C background: the virus and treatment |
220 |
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12.3 Social and clinical characteristics of the HCV patient population |
221 |
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12.4 HCV treatment challenges |
222 |
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12.5 Pegylated Interferon-related adverse psychiatric side-effects |
223 |
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12.6 HCV-infected mental health populations |
224 |
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12.7 So what is the role of the psychologist? |
226 |
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12.7.1 Promoting Treatment Access for People with ‘Severe Psychiatric Condition’ |
228 |
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12.7.2 Systematic Identification of Mental Health Problems |
229 |
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12.7.3 Intensive Case Management Approach |
230 |
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12.7.4 Promoting Resilience |
231 |
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12.8 Psychological stepped-care model in HCV treatment |
232 |
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12.9 Future challenge |
234 |
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12.10 Conclusion |
234 |
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Suggestions for further reading |
235 |
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References |
235 |
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CHAPTER 13 The Psychology and Treatment of Gambling Disorders |
239 |
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13.1 Introduction |
240 |
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13.2 Definition |
240 |
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13.3 Prevalence |
241 |
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13.4 Demographic risk factors |
242 |
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13.4.1 The Pathways Model of Problem Gambling |
242 |
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13.4.2 The ‘Behavioural Conditioned’ Group |
242 |
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13.4.3 The ‘Emotionally Vulnerable’ Group |
245 |
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13.4.4 The ‘Antisocial Impulsivist’ Group |
246 |
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13.4.5 Conclusion |
248 |
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13.5 Treatment of gambling disorders |
248 |
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13.5.1 Cognitive-Behavioural Interventions |
248 |
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13.5.2 Brief Interventions |
249 |
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13.5.3 Fellowship and Self-Help |
249 |
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13.5.4 Family Therapy and Concerned Significant Others |
249 |
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13.5.5 Pharmacological Interventions |
249 |
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13.6 Personal comment and reflections |
250 |
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13.7 Conclusion |
250 |
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Suggestions for further reading |
251 |
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References |
251 |
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CHAPTER 14 Alcoholics Anonymous and 12 Step Therapy: A Psychologist’s View |
256 |
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14.1 Introduction: personal context |
257 |
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14.2 History |
258 |
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14.3 Philosophy |
259 |
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14.4 How does it work? |
261 |
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14.4.1 AA: Group Therapy |
261 |
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14.4.2 AA: Psychosocial Change |
262 |
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14.4.3 AA: Narrative Change |
263 |
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14.4.4 AA: Structure of Care and Regulation |
265 |
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14.5 What can psychologist and helping professionals do? |
265 |
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14.6 Criticisms of AA |
266 |
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14.7 Postscript |
267 |
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Notes |
267 |
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Suggestions for further reading |
268 |
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References |
268 |
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CHAPTER 15 Relapse Prevention: Underlying Assumptions and Current Thinking |
271 |
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15.1 Introduction |
272 |
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15.2 What is relapse prevention? |
272 |
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15.2.1 Relapse Prevention Is the Sufficient Effect |
273 |
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15.2.2 Reoccurrence of the Original Behaviour: A Philosophical Conundrum |
273 |
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15.3 Models of relapse prevention |
276 |
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15.3.1 The Original Model of Relapse Prevention (Marlatt & Gordon, 1985) |
276 |
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15.3.2 The Dynamic Model of Relapse (Witkiewitz & Marlatt, 2004) |
278 |
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15.3.3 Mindfulness-Based Relapse Prevention (MBRP |
279 |
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15.4 Addressing co-existing mental health |
280 |
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15.5 Neuropsychological and associated difficulties when undertaking RP |
281 |
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15.6 Conclusion |
283 |
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Suggestions for further reading |
284 |
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References |
285 |
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CHAPTER 16 Working with Ambivalence about Change: Motivational Interviewing |
288 |
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16.1 Introduction |
289 |
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16.2 Definition |
289 |
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16.3 Historical perspective |
290 |
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16.4 Theoretical influences |
291 |
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16.5 The spirit of MI |
292 |
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16.6 Change talk, sustain talk and discord |
292 |
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16.7 The four MI processes |
293 |
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16.7.1 Engaging |
294 |
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16.7.2 Focusing |
294 |
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16.7.3 Evoking |
294 |
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16.7.4 Planning |
294 |
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16.8 Core MI skills |
295 |
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16.8.1 OARS: Open-Ended Questioning |
295 |
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16.8.2 OARS: Affirming |
295 |
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16.8.3 OARS: Reflections |
296 |
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16.8.4 OARS: Summarizing |
296 |
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16.8.5 Providing Advice and Information with Permission |
297 |
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16.8.6 Exploring Values and Goals |
297 |
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16.9 MI strategies more specific to particular processes |
297 |
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16.10 Evidence for the efficacy of MI |
298 |
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16.11 Integrating MI with other approaches |
300 |
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16.12 Using MI in groups |
301 |
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16.12.1 Clinical Example of an MI Group |
301 |
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16.13 Learning MI |
303 |
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16.14 Conclusion |
304 |
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Suggestions for further reading |
305 |
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References |
305 |
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CHAPTER 17 ‘Beyond Workshops’: Turning Evidence for Psychosocial Interventions into Embedded Practice |
310 |
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17.1 Introduction |
311 |
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17.2 What is implementation? |
311 |
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17.2.1 Implementation as a Process |
312 |
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17.2.2 Implementation in a Context |
312 |
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17.3 Implementation science |
313 |
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17.4 Consolidated Framework for Implementation Research (CFIR |
313 |
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17.4.1 Intervention Characteristics |
314 |
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17.4.2 Outer Setting |
314 |
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17.4.3 Inner Setting |
314 |
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17.4.4 Individuals Involved |
315 |
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17.4.5 The Implementation Process |
316 |
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17.5 Implement what? Evidence-based interventions versus evidence-based practices |
318 |
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17.6 Case studies in Motivational Interviewing and treatment effectiveness (Mapping) |
320 |
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17.6.1 Motivational Interviewing |
320 |
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17.6.2 Beyond Workshops |
321 |
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17.6.3 International Treatment Effectiveness (Mapping) |
322 |
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17.7 Conclusion |
324 |
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Notes |
326 |
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Suggestions for further reading |
326 |
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References |
326 |
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Index |
329 |
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EULA |
338 |
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