CHAPTER 11: Adlerian Therapy in the Treatment of Substance Abuse and Addiction

1. CHAPTER 11: Adlerian Therapy in the Treatment of Substance Abuse and Addiction Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory First Edition Todd F. Lewis Developed by Katie A. Wachtel, University of North Carolina at Greensboro

2. Introduction • Brief and time limited, present and future oriented, directive, flexible, integrative, and eclectic • This chapter discusses the major principles of Adlerian theory, how a thorough lifestyle assessment can provide cues for substance abuse intervention, ways of effectively applying the theory to substance abuse populations, and provides an explanation for Adler’s beliefs about how substance addiction develops

3. The Major Tenets of Adlerian Theory • All behavior is purposive and goal directed (teleological) • Individuals strive to move from perceived inferiority to perceived superiority • Maladjustment occurs when one’s personal goals are inconsistent with social interest • Lifestyle is one’s ways of perceiving self, others and the world and determines how he or she strives toward goals in life

4. Lifestyle • Self, ego, individuality, attitude toward life, personality • A series of conclusions individuals create about themselves, others, and the world that help move them through life • A roadmap based on one’s philosophy of life that develops early in life and remains relatively stable

5. Lifestyle Continued • Lifestyle development • Occurs between birth and 5 years • A complex interaction between biological factors, social experiences, and interpretations of these • Examining an individual’s childhood can provide insight into their lifestyle • Family interactions and perceptions of these interactions affect the development of lifestyle • Family constellation - the influences of family structure, dynamics and values • Sibling relationships and birth order are emphasized

6. Lifestyle Continued • Lifestyle convictions • A collection of strongly held beliefs, which assist one in finding a place in the world • Fictional images about what is needed to be safe, superior and to belong • Private logic - rules and assumptions that form an underlying lifestyle philosophy • Common sense-the ability to think in common with others • Basic mistakes-when convictions from private logic are inconsistent with common sense • “I am…The world is…Therefore…”

7. Lifestyle Continued • Lifestyle goals • Goals lead individuals through their life paths • Goal-directed movements lead one from perceived minus situation to a perceived plus situation • Four goals of misbehavior-attention, power, revenge, and display of inadequacy • Life Tasks • Work • Friendship • Love

8. Social Interest • The major key to healthy human functioning • A genuine concern for others, a cooperative approach to life, and striving for a healthy community • Those with high social interest progress through life in ways that are useful to self and others and accept responsibility for self and others • Substance abuse can be viewed as stemming from a lack of social interest or tackling life tasks in selfish ways (private intelligence) • Empathy is necessary for high social interest

9. Social Interest Continued • Individuals with high social interest demonstrate a concern for themselves as well as others • The interests of addicts are not consistent with those of the larger community • Addicted individuals may lack social interest due to poor preparation for life tasks in the early stages of life • Addicted individuals may develop their personalities in a situation of excessive pampering (the pampered lifestyle)

10. Application of Adlerian Therapy with Substance Abuse Problems • Adlerian principles applicable to substance abuse: • Social interest • Teleology • Holism • Self-determination • Phenomenology • Understanding the client • Goal alignment vs. denial • Life task emphasis • Self • Cosmos

11. Goals of Adlerian Therapy • Building the relationship • Empathy and encouragement help develop rapport • Understanding and Investigation • Lifestyle assessment explores childhood experiences that provide insight into lifestyle patterns • Family atmosphere-the emotional tone of the family • Family constellation- family structure, values, and dynamics when the client was a child • Early Recollections-Selected memories from childhood (before age 8) reflect current behaviors and beliefs

12. Goals of Alderian Therapy Continued • Making sense of the lifestyle assessment • Look for themes, methods of striving, levels of social interest, approaches to accomplish life tasks, purposes of behaviors, and one goal upon which the lifestyle is based • Interpretation • Many meanings can be found in client data, each an approximation of the truth. Interpretations should be given as hypotheses • Reorientation and change • Education, reorientation, and strategies to promote change

13. Adlerian Based Techniques • Lifestyle assessment • Miracle question • Increase social interest • Encouragement • Catching oneself • Acting “as if” • Pushbutton technique • Finding the purpose of the symptoms

14. Empirical Evidence • Research has found positive associations between social interest and mental health and negative associations between social interest and substance abuse • Lifestyle themes strong in social interest were significant predictors of substance use (immediate gratification, escape from reality, display of deep-seated denial patterns, engaging in an everlasting struggle for fulfillment) • Research supports a relationship between family functioning, birth order, and substance abuse • Early recollections have been shown to be helpful in interpreting personal dynamics behind substance abuse

15. Adlerian Therapy in the Treatment of Diverse Populations • Alder was one of the first theorists to acknowledge multicultural issues • The belief in developing a sense of community fits well with Asian, Native American, Mexican American, and African American values • The theory focuses on the person in a social context • The theory of change, definition of the family, and early childhood experiences may not be culturally sensitive notions

16. Running Case Study: Michael • The clinician conducts a lifestyle assessment to garner information about Michael’s family structure, family interactions, and family dynamics during early childhood. The clinician also encourages Michael to identify early recollections • The clinician uses the information gathered during the lifestyle assessment to interpret possible themes that play a role in his lifestyle and ways of approaching the life tasks • The clinician uses this information to work collaboratively with Michael to help him develop knew attitudes toward living more effectively

17. Strengths, Limitations and Ethical Issues Related to Adlerian Therapy • Strengths • Flexible and integrative • Lifestyle assessment is comprehensive • Has promise for working with diverse clientele • Can be brief and time-limited • Views individuals as purposive, self-determining, and striving for growth • Has a strong educational component

18. Strengths, Limitations and Ethical Issues Related to Adlerian Therapy • Limitations • Can be difficult to understand or follow • Some in the addictions field may not see the importance of early childhood experiences • Lifestyle assessment can take up to 3 sessions • More research is needed with diverse populations and substance abuse populations • Ethical Issues • Some components may not seem relevant to addictions • Many aspects of addictions may not be addressed • Adlerian therapists may hold differing goals for clients than what the client wants