Concept Of Addiction Research Articles

L’addiction à l’alimentation : définition, mesure et limites du concept, facteurs associés et implications cliniques et thérapeutiques

Addictions, which are characterized by the inability to control a behavior despite existence of physical or psychological consequences, have biological, psychological and social determinants. Although the possibility of developing an addiction to some psychoactive substances (e.g. alcohol, tobacco, cannabis) and to gambling (i.e., gambling disorder) is now well demonstrated, the possibility to develop a non-drug addiction (i.e., behavioral addiction) to certain behaviors which provide pleasure (e.g. eating, having sex, buying things) is still in debate. The concept of food addiction, which refers to people who exhibit substance dependence criteria in relation to some high-fat and high-sugar foods, was recently proposed by applying substance dependence DSM criteria to eating behavior. To assess food addiction, the Yale Food Addiction Scale is now the only self-administered questionnaire (diagnosis and estimate of the number of symptoms of food addiction). Prevalence for food addiction is higher in overweight and obese patients, and in patients with certain psychopathological characteristics (i.e., depression, Attention Deficit Hyperactivity Disorder, high impulsivity), in patients who are single and in patients with neurobiological alterations in the reward system. However, it is still unclear whether food addiction is necessary associated with subsequent increase in body weight and/or obesity. An increasing number of studies demonstrated that drug addiction and food addiction shares some similar clinical, neurobiological and psychopathological and sociocultural risk factors. To test the pertinence to include food addiction as an addiction, it would be interesting to conduct future studies in patients who may experience harms related to their food addiction, including not only patients with obesity, but also patients with metabolic syndrome, type 2diabetes, hypertension, dyslipidemia, atherosclerosis, stroke, or coronary heart disease. Food addiction is a clinical and multidimensional concept which requires integrated care with psychotherapy, pharmacological and social lines of approach. This concept has also practical implications in terms of prevention and public health (e.g., prevention, brief interventions, possible law enforcement regarding some kinds of food which could present some addictive properties).

Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic noncancer pain: do different measures identify the same patients?

The International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM) are routinely used in diagnosing illicit substance use disorders, but for people taking prescribed opioids they remain controversial. In pain medicine, the concept of "Addiction" is preferred with reduced emphasis on tolerance and withdrawal. This article examines the prevalence and characteristics of pharmaceutical opioid dependence/disorder according to ICD, DSM, and the pain medicine concept of "Addiction," among chronic noncancer pain (CNCP) patients prescribed opioids. In the current study, we used data from a national sample of 1134 people prescribed opioids for CNCP. Past 12-month "Addiction" (based on Pain Medicine definition), DSM, and ICD dependence definitions were assessed using the Composite International Diagnostic Interview. Twenty-four percent of the cohort met the criteria for "Addiction," 18% for DSM-5 use disorder and 19% for ICD-11 dependence. There was "substantial" concordance between "Addiction" and both DSM-5 use disorder and ICD-11 dependence, although concordance was much greater with ICD-11 dependence (kappa = 0.63 and 0.79, respectively). Participants meeting the criteria for "Addiction" only were older, less likely to engage in nonadherent behaviours, self-reported fewer problems or concerns with their medication, and had lower rates of psychological distress than those who also met the DSM-5 and ICD-11 criteria. The definition of "Addiction" captures a larger group of patients than other classification systems and includes people with fewer "risk" behaviours. Despite removal of tolerance and withdrawal for prescribed opioid use for DSM-5, we found that "Addiction" was more closely related to an ICD-11 diagnosis of pharmaceutical opioid dependence.

A typology of user liability to IT addiction

AbstractTo date, information systems (IS) research mainly has provided a monolithic view of information technology (IT) use, considering it to be a desired behaviour with positive outcomes. However, given the dramatic increase in the use of technology during the last few years, susceptibility to IT addiction is increasingly becoming an important issue for technology users and IS researchers. In this paper, we report the results of a study that focuses on identifying variations in user liability to IT addiction, which reflects the susceptibility of individual users to develop IT addiction. First, a review of the literature in different disciplines (e.g. health, psychology and IS) allows us to better understand the concepts of IT addiction and liability to addiction. The literature review also provides an overview of the antecedents and consequences associated with IT addiction. Then, building on the analysis of 15 in‐depth interviews and 182 exploratory open‐ended surveys collected from smartphone users, we apply the concept of liability to addiction in the IT use context and propose a typological theory of user liability to IT addiction. Our typology reveals five ideal types; each can be associated to a user profile (addict, fanatic, highly engaged, regular and thoughtful). Building upon both the extant literature and our results, we put forth propositions to extend the theoretical contributions of the study. We finally discuss the contributions and implications of our paper for research and practice.

L'interazione sociale nella web society tra Internet disorder e ruolo dei servizi delle dipendenze

The concept of new addiction meant as a phenomenon in which there is a risk of nonsubstances dependence. After an analysis and a definition of the concept, we will focus on Internet addiction disorder, as a social phenomenon increasingly relevant, and the changes into the relationship between the individual and the technologies in the era of the web society. They finally suggest possible institutional contrast strategies for services of the dependencies.

Ontological Addiction: Classification, Etiology, and Treatment

Despite the fact that there is increasing integration of Buddhist principles and practices into Western mental health and applied psychological disciplines, there appears to be limited understanding in Western psychology of the assumptions that underlie a Buddhist model of mental illness. The concept of ontological addiction was introduced and formulated in order to narrow some of the disconnect between Buddhist and Western models of mental illness and to foster effective assimilation of Buddhist practices and principles into mental health research and practice. Ontological addiction refers to the maladaptive condition whereby an individual is addicted to the belief that they inherently exist. The purposes of the present paper are to (i) classify ontological addiction in terms of its definition, symptoms, prevalence, and functional consequences, (ii) examine the etiology of the condition, and (iii) appraise both the traditional Buddhist and contemporary empirical literature in order to outline effective treatment strategies. An assessment of the extent to which ontological addiction meets the clinical criteria for addiction suggests that ontological addiction is a chronic and valid—albeit functionally distinct (i.e., when compared to chemical and behavioral addictions)—form of addiction. However, despite the protracted and pervasive nature of the condition, recent empirical findings add support to ancient Buddhist teachings and suggest that addiction to selfhood can be overcome by a treatment process involving phases of (i) becoming aware of the imputed self, (ii) deconstructing the imputed self, and (iii) reconstructing a dynamic and non-dual self.

Internet addiction: reappraisal of an increasingly inadequate concept.

This article re-examines the popular concept of Internet addiction, discusses the key problems associated with it, and proposes possible alternatives. The concept of Internet addiction is inadequate for several reasons. Addiction may be a correct designation only for the minority of individuals who meet the general criteria for addiction, and it needs to be better demarcated from various patterns of excessive or abnormal use. Addiction to the Internet as a medium does not exist, although the Internet as a medium may play an important role in making some behaviors addictive. The Internet can no longer be separated from other potentially overused media, such as text messaging and gaming platforms. Internet addiction is conceptually too heterogeneous because it pertains to a variety of very different behaviors. Internet addiction should be replaced by terms that refer to the specific behaviors (eg, gaming, gambling, or sexual activity), regardless of whether these are performed online or offline.

Validity, Reliability and Psychometric Evaluation of Persian Version of Young Internet Addiction Questionnaire For Tabriz University and Tabriz University of Medical Sciences Students

Introduction: The concept of addiction has developed enough to be used outside of areas such as drugs and alcohol and is being generally applied to many other behaviors such as internet use. The aim of this study is to evaluate the validity and reliability of the Persian version of the Young Internet Addiction Questionnaire (YIAQ) in university students in Tabriz. Methods: Initially, YIAQ was translated from English to Persian by someone with expert English skills, and then the Persian version was translated to English by another person. After that, a specialist in the field of psychiatry with acceptable skills in the field of English compared these two versions and suggested needed changes. In this methodological (mixed method) study, the Delphi method was used in the qualitative part and a cross-sectional design was used in the quantitative part. The Persian version was evaluated using the Delphi method by ten specialists in the field of internet use and they mentioned changes needed to evaluate face and content validity. For the evaluation of the Cronbach’s alpha coefficient, 200 students with different majors at Tabriz University were selected randomly and filled out the Persian version of YIAQ. Reliability was confirmed by clinical interview. Results: The reliability of the questionnaire was acceptable for 20 questions with Cronbach’s alpha coefficient of 0.93. The face and content validity were determined by the Delphi method and application of opinions of specialists in the field of internet use. Conclusion: The Persian version of YIAQ is valid and reliable for the evaluation of internet addiction

The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior.

Behavioral addictions such as gambling, sun-tanning, shopping, Internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse). Recent literature suggests that both non-suicidal self-injury (NSSI) and suicidal behavior (SB) can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors. This is a narrative review. The authors performed literature searches in PubMed and Google for suicidal behavior, self-harming, addiction, and "major repeaters." Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts) represent a distinctive suicidal phenotype and are the individuals at risk of developing an addiction to SB. The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as "addictions," and the putative mechanisms underlying them. Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual's self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction.

Concept Creep: Psychology's Expanding Concepts of Harm and Pathology

Many of psychology's concepts have undergone semantic shifts in recent years. These conceptual changes follow a consistent trend. Concepts that refer to the negative aspects of human experience and behavior have expanded their meanings so that they now encompass a much broader range of phenomena than before. This expansion takes “horizontal” and “vertical” forms: concepts extend outward to capture qualitatively new phenomena and downward to capture quantitatively less extreme phenomena. The concepts of abuse, bullying, trauma, mental disorder, addiction, and prejudice are examined to illustrate these historical changes. In each case, the concept's boundary has stretched and its meaning has dilated. A variety of explanations for this pattern of “concept creep” are considered and its implications are explored. I contend that the expansion primarily reflects an ever-increasing sensitivity to harm, reflecting a liberal moral agenda. Its implications are ambivalent, however. Although conceptual change is inevitable and often well motivated, concept creep runs the risk of pathologizing everyday experience and encouraging a sense of virtuous but impotent victimhood.

A mobilization against health? How alcohol producers dealt with the concept of addiction

A mobilization against health? How alcohol producers dealt with the concept of addiction

Views of alcoholic patients' about the concept of alcohol addiction in Ibn Rushed Hospital in Baghdad City

Views of alcoholic patients' about the concept of alcohol addiction in Ibn Rushed Hospital in Baghdad City

INDIVIDUAL PSYCHOLOGICAL CHARACTERISTICS OF HOUSEWIVES WITH DIFFERENT LEVELS OF COMMUNICATIVE ADDICTION

This article reveals the problem of communicative addiction in terms of its membership of a particular category of the population and gender - namely, housewives. The urgency of the research for this problem has been proven; the analysis of recent studies has been carried out, which includes the beginning of the problem solution. Summarizing the opinions of modern scholars about this phenomenon, the article clarifies the concept of communicative addiction as a form of interpersonal addiction of women- housewives. The article presents the study’s results of individual psychological characteristics of women, affecting the expression of communicative addiction on interpersonal relationships. Based on the empirical study the level of individual psychological characteristics of housewives has been analyzed (self-esteem, sociability, emotional stability, subordination, conformity), taking into account the general indicators of the communicative relationship. Comparative analysis of the communicative-addicted and not addictive housewives showed significant differences in such factors as «self-esteem», «communication», «subordination», and «conformity».Using correlation analysis a connection between the level of housewives` communicative addiction and their individual psychological characteristics, such as self-esteem, sociability, subordination, and the conformism has been revealed.

Exploring Legitimacy and Authority in the Construction of Truth Regarding Personal Experiences of Drug Use

Objectives: This research explored drug use from the perspectives of individuals who recreationally used one or more substances on a daily basis and had never attended addiction-related counselling or a mutual support group. The purpose of the research was to identify the ways that narrative accounts were discursively structured to enact, confirm, legitimate, reproduce, or challenge the concept of addiction. Methods: The methodology involved a critical analysis of discourse, drawing on personal accounts of drug use that were elicited using discursive narrative strategies. Results: The finding demonstrated that narrative accounts were constructed in relation to dominant discourses in the North American context. Efforts to refute dominant discourses can be viewed as a response to risks associated with self-disclosure of subjugated positions. The findings presented in this paper pertain to the ways in which research participants adopted indirect discursive practices that challenged distinctions between legal, socially sanctioned drug use (namely, medications) and illegal, socially unsanctioned drug use. Drawing in particular discursive strategies, the research participants blur the lines between categorization of drugs and drug-related practices as healthy or unhealthy, moral or immoral, socially acceptable or socially acceptable. Overall, the findings demonstrate that the research participants challenged dominant discourses that position illicit drug use and distribution as being socially unacceptable. Conclusion: This research uncovers discursive practices of power, authority, legitimacy, dominance, and inequality in relation to drug-related policy, research, and education. The findings offer an alternative interpretation to narrative accounts that might otherwise be interpreted as ego defense mechanisms.

Book Review: Debating Cancer: The Paradox in Cancer Research

Cancer arises as a result of accumulation of genetic changes in a single cell. This is the basis of gene mutation theory of cancer. A small number of gene mutations drive cancer, and cancer cells are addicted to these oncogenes. Cancer cell dies when there is no continued oncogene expression. This oncogene addiction concept is the basis for the development of molecularly targeted agents. We have a number of success history such as imatinib in chronic myelogenous leukemia CML or crizotinib in ALK-positive lung cancer. However, these are not common at all. Why not? We expected that cancer genome sequencing (CGS) project will reveal all gene mutations in tumors resulting in the development of precise medicine in each patient. In reality, CGS has produced massive genetic data, however, we failed to identify commonly shared gene mutations. Why not? This book introduces a new concept of genome theory of cancer evolution, in an attempt to solve these challenges and paradoxes. By critically analyzing the currently available data, the author compared gene- and genome-based theories. This book will serve as an excellent resource for cancer researchers.

Compulsivity in obsessive–compulsive disorder and addictions

Compulsive behaviors are driven by repetitive urges and typically involve the experience of limited voluntary control over these urges, a diminished ability to delay or inhibit these behaviors, and a tendency to perform repetitive acts in a habitual or stereotyped manner. Compulsivity is not only a central characteristic of obsessive–compulsive disorder (OCD) but is also crucial to addiction. Based on this analogy, OCD has been proposed to be part of the concept of behavioral addiction along with other non-drug-related disorders that share compulsivity, such as pathological gambling, skin-picking, trichotillomania and compulsive eating. In this review, we investigate the neurobiological overlap between compulsivity in substance-use disorders, OCD and behavioral addictions as a validation for the construct of compulsivity that could be adopted in the Research Domain Criteria (RDoC). The reviewed data suggest that compulsivity in OCD and addictions is related to impaired reward and punishment processing with attenuated dopamine release in the ventral striatum, negative reinforcement in limbic systems, cognitive and behavioral inflexibility with diminished serotonergic prefrontal control, and habitual responding with imbalances between ventral and dorsal frontostriatal recruitment. Frontostriatal abnormalities of compulsivity are promising targets for neuromodulation and other interventions for OCD and addictions. We conclude that compulsivity encompasses many of the RDoC constructs in a trans-diagnostic fashion with a common brain circuit dysfunction that can help identifying appropriate prevention and treatment targets.

Clinical Response to Idasanutlin (RG7388) in Acute Myeloid Leukemia Patients Is Associated with Pre-Treatment MDM2 Protein Expression in Leukemic Blasts and Leukemic Stem Cells

Introduction. Despite years of translational research and discovery, outcomes in Acute Myeloid Leukemia remain poor. The MDM2 antagonist idasanutlin has shown promising clinical activity in solid tumors and acute leukemias. Idasanutlin enhances the activity of the tumor suppressor, p53, through antagonism of MDM2:p53 interaction. Such protein:protein disruption abolishes MDM2 targeting of p53 for ubiquitination and degradation. Subsequent stabilization of the p53 protein allows it to exert tumor suppressor transcriptional regulation and induction of apoptotic pathways. Identification of patients in whom functional p53 activation drives efficacy may translate into improved outcomes for patients treated with idasanutlin.Patients and Methods. Trial NP28679 (NCT01773408) is a Phase 1/1b study evaluating idasanutlin (as monotherapy or in combination with cytarabine) in relapsed or refractory AML patients, with clinical response as the primary endpoint. To identify biomarkers of response, patients' pre-treatment peripheral blood specimens were evaluated for MDM2 protein expression levels in leukemic blasts and leukemic stem cells. Association of MDM2 percent cell positivity with clinical outcomes was evaluated using intracellular flow cytometry gated on CD45dim leukemic blasts and CD45dim/CD117+/CD34+ leukemic stem cells.Results. We observed in a proof-of-principle training data set that MDM2 expression in leukemic blasts was associated with patients more likely to exhibit Complete Remission (CR, CRp, CRi) versus Progressive Disease (PD, HI, PR) [n=61; Wilcoxon p = .0041 (AUC = .74; 95%CI[.57, .91])] TP53 mutational status alone was not tightly associated with patient response (Fisher's Exact Test p = .19 [AUC = .60; 95%CI [.52,.67.])] When MDM2 protein expression and TP53 mutational status were analyzed as co-variates, an enhanced association with patient CR was observed (AUC = .76; 95% CI [.59, .93.]) A separate group of patients treated with an optimized idasanutlin formulation was utilized as a validation set. Association of CR with MDM2 expression in blasts was also shown in this separate patient population [n=24; Wilcoxon p = .0052 (AUC = .82; 95% CI [.64, 1.00.]) Comparable results were observed for proof-of-principle and validation set analyses of response association with MDM2 protein expression in AML patients CD45dim/CD117+/CD34+ stem cell subpopulations.Conclusions. In summary, training and validation sets reveal that MDM2 protein expression in leukemic blasts and stem cells are associated with idasanutlin-induced CR in patients with AML. We will continue to monitor this potentially predictive biomarker in future randomized clinical studies of idasanutlin. On a broader level, the data presented here support the concept that leukemic blasts may be "oncogene-addicted" to MDM2 in AML, i.e. that AML tumor cells may rely on a dominant oncogene for growth and survival, such that inhibition of the function of this specific oncogene is sufficient to halt the neoplastic phenotype. Thus, the concept of oncogene addiction may apply not only to mutated kinases but also to ubiquitin ligases such as MDM2. DisclosuresReis:Roche Pharma: Employment, Equity Ownership. Jukofsky:Roche Pharma: Employment, Equity Ownership. Chen:Roche Pharma: Employment, Equity Ownership. Martinelli:BMS: Speakers Bureau; MSD: Consultancy; Roche: Consultancy; ARIAD: Consultancy; Novartis: Speakers Bureau; Pfizer: Consultancy. Zhong:Roche Pharma: Employment, Equity Ownership. So:Roche Pharma: Employment, Equity Ownership. Drummond:Baxalta: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead: Membership on an entity's Board of Directors or advisory committees. Assouline:Pfizer: Consultancy; BMS: Consultancy; Novartis: Consultancy. Hashemyan:Roche Pharma: Employment, Equity Ownership. Theron:Roche Pharma: Employment, Equity Ownership. Blotner:Roche Pharma: Employment, Equity Ownership. Rueger:Roche Pharma: Employment, Equity Ownership. Middleton:Roche Pharma: Employment, Equity Ownership. Vey:Celgene: Honoraria; Roche: Honoraria; Janssen: Honoraria. Nichols:Roche Pharma: Employment, Equity Ownership. Chen:Roche Pharma: Employment, Equity Ownership. Pierceall:Roche Pharma: Employment, Equity Ownership.

History of the Concept of Addiction.

Our distant forebears wrestled with concepts of alcohol addiction not unlike those of today: Is addiction a sin or a disease? Is addiction caused by the gods, the substance, the individual's vulnerability, or psychological or social factors? Luther, Calvin, and Catholic Church leaders viewed moderate alcohol use as God's gift; used intemperately, it was a moral transgression. The founders of modern scientific psychiatry rejected moral explanations for addiction in favor of an early biological model. The first two versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I and DSM-II) stigmatized addiction by listing it with other societally disapproved disorders stemming from personality disorder. DSM-III espoused atheoretical, descriptive diagnoses but required tolerance or withdrawal to diagnose dependence. Substance dependence in DSM-III-R included physiological and behavioral symptoms and reflected the substance dependence syndrome. DSM-IV's emphasis on biology in its concept of dependence was unchanged from its immediate predecessors. DSM-5 declared that all drugs taken in excess have in common the direct activation of the brain reward system. This article examines evolving concepts of alcohol addiction through 12,000 years of recorded human history, from the first mention of alcohol consumption in China more than 12,000 years ago to alcohol use and abuse in the DSM era, 1952 to the present.

Articulating addiction in alcohol and other drug policy: A multiverse of habits

Concepts of addiction differ across time and place. This article is based on an international research project currently exploring this variation and change in concepts of addiction, in particular in the field of alcohol and other drug (AOD) use. Taking AOD policy in Australia and Canada as its empirical focus, and in-depth interviews with policy makers, service providers and advocates in each country as its key method (N=60), the article compares the addiction concepts articulated by professionals working in each setting. Drawing on Bruno Latour's theoretical work on the body and his proposal for a better science based on the ‘articulation of differences’, it explores the accounts of addiction offered across the Australian and Canadian project sites, identifying a shared dynamic in all: the juggling of difference and unity in discussions of the nature of addiction, its composite parts and how best to respond to it. The article maps two simultaneous trajectories in the data – one moving towards difference in participants’ insistence on the multitude and diversity of factors that make up addiction problems and solutions, and the other towards unity in their tendency to return to narrow disease models of addiction in uncomfortable, sometimes dissonant, strategic choices. As I will argue, the AOD professionals interviewed for my project operate in two modes treated as distinct in Latour's proposal: in turning to reifying disease labels of addiction they take for granted, and work within, a ‘universe of essences’, but in articulating the multiplicity and diversity of addiction, they grope towards a vision of a ‘multiverse of habits’. The article concludes by addressing this tension directly, scrutinising its practical implications for the development of policy and delivery of services in the future, asking how new thinking, and therefore new opportunities, might be allowed to emerge.

Academic education in addictology (addiction science) in the Czech Republic: Analysis of the (pre-1989) historical origins

Background In the Czech Republic, education in addiction science consists of a distinctive and interconnected system of non-medical healthcare education on the Bachelor's (Bc) and Master's (MA) levels, followed by a doctoral study programme (PhD). Addictology (addiction science) as a new term is defined as a distinct and independent field of scientific inquiry on addictive behaviours and the risk environment of substance use, aiming at scientific and professional excellence relevant to society. Aims This case study seeks to identify, describe and explain important events in shaping the historical context of the Czech education and research programmes in addictology. Design The historical review is based on qualitative content analysis of central written documents. Results In the 19th century Czech territory, problematic alcohol use was addressed through self-help activities in the second half of the nineteenth century. During the 1950s and 1960s, a new generation of Czech psychiatrists emerged with an interest in alcohol treatment and in research of hallucinogenic drugs. A patient education bulletin Apolinářský zápisník [Apolinar Diary] was launched in 1951 and was later also used for education of treatment professionals in connection with other self-help and quasi-self-help activities. The monographs Alkoholism (1957) and Toxicomany (1973) conceptualised the core of abstinence-oriented historical traditions and developments. A separation of approaches to legal and illegal drugs can be observed in the 1970s. In 1967, a new and intensive training model was introduced for psychiatrists and psychotherapists, leading into specialisation in psychotherapy and addiction. Because of the Iron Curtain, Czech practitioners had to develop their own concept of addiction and ideas on training psychotherapists so they could not be labelled western or anti-state, or be subject to intense state control. Conclusions The final profile of the study programmes is the outcome of a long-term process that commenced in the 1950s but with roots in the interwar years, when addictology in the Czech Republic reflected traditional healthcare-oriented models of training and education. In this context the historical development in Czecholovakia and later Czech Relpublic can be characterized as a combination of early interest in self-help activities followed by the development of specialized treatment programmes both affected by a futher 40 years behind the “iron curtain” and intensively confrontated with harm and risk reducation interventions after the Velvet revolution.

Switching to a Social Approach to Addiction: Implications for Theory and Practice

The concept of addiction is complex and shaped by a range of understandings including how the recipient of an addiction is interpreted. This paper examines how concepts of self and concepts of addiction interact. Two fundamentally different understandings of self are considered: one which focuses on the self as a bio-psychological individual, the ‘particle’ self, and another that focuses on the self as a nexus of relationships, the ‘social’ self. The effect these have on understandings of addiction is examined along with implications for service interventions. Particle-informed understandings of addiction are seen as dominating services and leading to intervention responses that focus on the individual and de-emphasize the role of family, community and culture. The absence of social understandings limits both the range and quality of services offered. Particle and social approaches to addiction could operate side-by-side in offering a broader range of effective service responses to addiction.