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DETAILED CONTENTS
Preface xvi
About the Editors xviii
About the Contributors xix
1. F
rom Treatment Lore to Theory Application:
An Introduction to Addiction Theory and Practice 1
John R. Culbreth, Pamela S. Lassiter
Treatment Lore 2
Overview of Book Sections and Chapters 6
Addiction Counseling Case Study 10
Appendix: National Association of Alcohol and Drug Abuse
Counselors: Code of Ethics 13
2. H
istorical Perspectives and the Moral Model 27
Pamela S. Lassiter, Michael S. Spivey
Colonial Era (1492–1763) 27
American Revolution and Young Republic (1763–1820s) 28
Temperance Movement (1826–1919) 28
Prohibition (1919–1933) 31
World War II Era (1939–1945) 32
Nixon Era (1969–1974) 33
Carter Era (1977–1981) 34
Reagan Era (1981–1989) 35
The 1990s and 2000s 36
Cultural Views of Addiction 38
Basic Tenets of the Moral Model 39
Strengths and Weaknesses of the Theory 40
Influences on Social Policy 41
Influences on Clinicians 42
Case Study Responses 43
Summary 45
3. Biological Theory: Genetics and Brain Chemistry 47
Kathleen Brown-Rice, Regina R. Moro
Overview of Empirical Research Findings on the Addictive Process 47
Neurotransmitters 47
Brain Reward Pathway 48
Cycle of Addiction 49
Basic Tenets of the Theory 50
Philosophical Underpinnings and Key Concepts of the Theory 51
Dispositional Model 51
Neurobiological Model 52
Hijacked Brain Theory 53
Addictive Substances 53
Depressants 53
Stimulants 58
Latest Trends 60
Polysubstance Use 62
How the Theoretical Approach Is Used by Practitioners 62
Conceptualization 62
Psychoeducation 63
Assessment and Prevention Implications 65
Strengths 66
Weaknesses 67
Summary 70
4. Psychoanalytic Theory of Addiction 76

Leigh F. Holman
Summary 99
5. S
elf-Psychology Theory: Addiction and the Wounded Self 101
Joseph B. Cooper
Development of Self 102
Selfobject Needs 102
Transmuting Internalization 103
Development of Addictive Behavior 104
Early Stage Treatment Issues 106
Individual Counseling 107
Development of New Psychic Structure 107
Group Counseling 107
Guidelines for Group 108
Internalization of Recovery 111
Shame 112
Affect Regulation 113
Empathic Attunement and Transmuting Internalization 113
Outcome 114
Summary 115
6. A Developmental Approach to Addiction Theory and Treatment 117

Amy E. Williams, Charles F. Gressard
Common Elements of Developmental Theories 117
Basic Tenets 117
Philosophical Underpinnings and Key Concepts 118
Overview of Selected Developmental Theories 120
Erikson’s Psychosocial Development 120
Loevinger’s Ego Development 120
Kohlberg’s Moral Development 125
Fowler’s Faith Development 127
Brown’s Developmental Model of Recovery 129
Practitioner Uses and Applications to Addiction Counseling 132
Relationship Between Development and Substance Use 132
Relationship Between Substance Use and Development 133
Development and Recovery Processes 134
Applications and Implications for Prevention, Assessment,
and Treatment of Substance Use Disorders 135
Strengths and Weaknesses of Developmental Theories 137
Summary 139
7. Attachment Theory 141

Leigh F. Holman, Rebecca G. Scherer
Attachment Styles 146
Reflective Function and Emotion Regulation 147
Summary 158
8. Sociological Theory 161

Katie A. Lamberson
Brief History of Sociological/Cultural Influences on Addiction,
Including Differences Between the United States and Other
Parts of the World 161
Facilitation of Social Interaction 164
To Provide Release From Social Obligations 164
Promotion of Group Solidarity 165
Repudiation of Middle-Class Values 166
Adolescent Drug Subculture 167
Public Health Model of Addiction 167
Social Control 168
Social Learning Theory 168
Social Conflict Theory 169
Summary 175
9. Family Systems Theory 177

Simone F. Lambert, Heidi Unterberg, Marsha Riggio
Philosophical Underpinnings and Key Concepts of
the Theory 180
Systemic and Behavioral Theoretical Approach 180
Key Concepts 180
Stages in Family Recovery 183
Children and Adolescents 188
Trauma 190
Summary 195
10. Transtheoretical Model for Change 199

Daniel Gutierrez, Astra B. Czerny
Precontemplation 200
Contemplation 200
Preparation 201
Action 201
Maintenance 201
Termination 202
How the Approach Is Used by Practitioners 205
Termination 209
Counselor’s Stance 209
Summary 215
11. Motivational Interviewing in the Treatment of Substance

Abuse and Dependence 217
Todd F. Lewis
Importance of Ambivalence 218
Goals of MI 218
Ways to Implement MI 219
MI Spirit 219
Principles of MI 220
Importance and Confidence 222
Four Processes of MI 226
Planning 228
Summary 233
12. H
arm Reduction: Meeting Clients Where They Are 235
Regina R. Moro, Jana Burson
Key Concepts 237
Philosophical Underpinnings 238
Comparison With Other Approaches 240
Influences on Social Policy 240
Outcomes Associated With a Harm Reduction Approach 241
Needle Exchange and Injection Education 242
Naloxone Kits 243
Medication-Assisted Treatment (MAT) 243
Case Conceptualization 244
The Great Debate 246
Biological/Medical Concerns 250
Psychological Concerns 251
Sociological Concerns 251
Working With Gabriel 252
Key Techniques and Strategies 252
Summary 255
13. Cognitive Behavioral Approaches to Addiction Treatment 258

Edward Wahesh
Behavior Therapy 260
Cognitive Therapy 261
Rational Emotive Behavioral Therapy 264
Collaborative Therapeutic Relationship 265
Case Conceptualization 266
Cognitive and Behavioral Skills Training 267
Assessment 272
Prevention 272
Summary 277
14. T
welve-Step Facilitation 281
Jeremy M. Linton
Research on 12-Step Mutual-Help Group Attendance 283
Issues With Diversity 283
Recovery and the 12 Steps 285
Twelve-Step Facilitation 289
Effectiveness of 12-Step Counseling 291
Summary 296
15. C
onstructivist Approaches to Addiction Counseling:
Feminist, Womanist, and Narrative Theories 299
Pamela S. Lassiter, Anneliese A. Singh, Taryne M. Mingo
Philosophical Underpinnings and Key Concepts of Feminist and Womanist
Theories 299
Feminist Theory 300
Womanist Theory 301
Feminist Counseling Practices 303
Womanist Counseling Practices 304
Feminist 305
Womanist 306
Strengths and Weaknesses of the Feminist and Womanist
Theories 307
Philosophical Underpinnings and Key Concepts of
Narrative Theory 308
Dominant Narratives 309
Goal of Narrative Counseling 309
Externalizing Conversations 310
Deconstructive Listening 310
Unique Outcomes 311
Thickening the Plot and Spreading the News 312
Reflective Practices 313
Assessment and Prevention Implications of Narrative
Theory 313
Strengths and Weaknesses of Narrative Theory 314
Feminist Theory Case Study Response 314
Womanist Theory Case Study Response 315
Narrative Theory Case Study Response 317
Summary 318
16. Behavioral Addictions 320

Craig S. Cashwell, Paula J. Swindle
Behavioral Addictions 320
Gambling 323
Sex 324
Food 326
Exercise 327
Internet 328
Gaming 329
Shopping 331
Work 332
Cultural Issues in Behavioral Addictions 333
Summary 335
17. Theory and Practice of Group Work With Addictions 341

Melanie M. Iarussi
A Brief History of Group Work in Addictions Treatment 341
Key Concepts and Theoretical Underpinnings of Group Work in Addiction
Treatment 342
Therapeutic Factors in Group Work 343
Stages of the Group 345
Group Work in Practice 346
Effective Group Leader 346
Creating and Maintaining the Group 347
Building a Group Culture 349
Types of Group Treatment 352
Motivational Interviewing 354
Cognitive Behavioral Group Therapy 354
Strengths and Weaknesses of Group Work With Addictions 355
Strengths 355
Weaknesses 355
Type of Group 356
Application 357
Advantages and Disadvantages 357
Summary 359
18. Approaches to Relapse Prevention 362
Amanda L. Giordano, Elliott S. Woehler
Basic Tenets of Approaches to Relapse Prevention 362
A Definition of Relapse 362
Understanding Relapse From a Biopsychosocial Perspective 363
Defining Relapse Prevention 364
Philosophical Underpinnings and Key Concepts of Relapse Prevention 364
Relapse Prevention Model 365
Mindfulness-Based Relapse Prevention 367
Gorski’s CENAPS Model of Relapse Prevention 369
How Approaches to Relapse Prevention Are Used by Practitioners 370
Initial Responses to Client Relapse 370
Integrating Relapse Exploration Into the Counseling Process 371
Assessment and Prevention Implications of Relapse Prevention 373
Formal Assessments in Relapse Prevention 374
Informal Assessments in Relapse Prevention 375
Strengths and Weaknesses of Approaches to Relapse Prevention 376
Summary 379
Index 383
PREFACE
Nearly one in four Americans will face an addiction problem in their lifetime. This
widespread problem has reached alarming heights. Likewise, nearly all the clients a
professional counselor will serve have, in some way, been affected by addiction. Addiction
impacts families, the workplace, friendships, and nearly all aspects of daily living. Because
so many clients are impacted by addiction, all counselors, regardless of the setting, need to
have skills to work effectively with addiction issues.
Addiction is a multifaceted problem supported and maintained by interpersonal,
intrapersonal, social, psychological, spiritual, and biological factors. It is almost impossible
to effectively understand and treat addiction issues as an isolated problem because of the
complexity of its epistemology. For a given client, addiction may be a way of coping with
childhood trauma such as physical or sexual abuse (psychological factors), or it may be a way
of dealing with societal oppression and discrimination (sociological factors). Or biologically,
a client may be more likely to become addicted due to a genetic predisposition (biological
factors).
Effective counselors need a biopsychosocial perspective that examines and understands
addiction and its maintenance in the lives of clients as an interaction between complex
factors before they can prescribe appropriate treatment. A thorough understanding of
multiple approaches to theory and practice can prepare counselors to address individualized
issues that can enhance the likelihood of recovery and long-term relapse prevention.
Addiction counselors must understand the theoretical epistemology of addiction before
they can select the appropriate approach to treatment. Current theories such as medical,
psychological, sociological, and harm-reduction models all prescribe treatment in a different
way. The theory a counselor practices from will determine which type of treatment the client
receives. This book is intended to be a review of existing theories of addiction that then helps
counselors connect those theories to practice.
There are very few books related to addiction that focus solely on the theories of
addiction. To date, most of the textbooks for this area are more survey oriented. That is,
they provide a brief overview of typically four or five broad theoretical categories, such as
psychological, sociological, and medical models, and only briefly mention different aspects
of those theories in the chapter. They do not connect theory of addiction to practice. These
survey books then go on to provide an overview of assessment issues, family issues, and
12-step approaches, with one or two chapters focused on different treatment approaches or
issues. By contrast, when examining theory textbooks for the general counseling field, you
find that these texts are typically focused only on counseling theories. For addictions courses,
what has been lacking is a book that presents addiction theory as a focal point, similar to
counseling theory texts. Currently, professors teaching a theory course must put together a
collection of textbooks, book chapters, journal articles, and such to create a working group
of readings for students. This book provides all the information for an addiction theories
course in one location.
xvi
Preface • x v ii
We have provided an in-depth review of the current theories of addiction treatment,

with each chapter devoted to a specific theory. Each chapter includes a thorough
description of the basic tenets of the theory, the philosophical underpinnings and key
concepts of the theory, how the theoretical approach is used by practitioners, strengths
and weaknesses of the theory, and application to practice through case study responses.
The authors have provided responses to a common case study that intentionally includes
a multicultural focus in order to assist students in exploration of the impact of multiple
identities on addiction causality, maintenance, and treatment. Our authors have been
asked to respond to a common set of questions based on the theoretical perspective of
their chapter’s focus and the tenets of the theory. These case study responses can be
used to provide readers with an opportunity to compare how the different theoretical
approaches are applied to client situations. Additionally, each chapter includes boxes
with classroom discussion questions or classroom activities that assist students in further
exploration of the theory. Each chapter concludes with a list of resources to encourage
continued learning.
The audience for this book is students taking course work in addiction counseling.
There has been solid growth in these types of courses over the past 10 years. Also, with the
expansion of the CACREP specialization areas into addictions counseling, there is a need
for this type of textbook for programs that would like to provide training specifically for
addictions counselors as a specialty track. An addictions theory course serves as a foundation
for addiction counseling programs, assisting students in examining a variety of theoretical
influences on addiction etiology and its influence on treatment prescription.
ACKNOWLEDGMENTS
We would first like to thank our editors, Abbie Rickard and Kassie Graves, who believed in
this project, saw its potential, and worked hard to help us succeed. Editing a textbook is a
difficult and time-consuming process. It could not have come to fruition without the help of
the whole production team at Sage. We would also like to thank all our contributing authors
for sharing their experience, knowledge, and wisdom in advancing the addiction counseling
profession. Finally, we would like to thank the following reviewers for their thoughtful
recommendations: Chaniece Winfield, Old Dominion University; Kathryn Dziekan, New
Mexico Highlands University; Lia Willis, Columbia College; Ozietta D. Taylor, Coppin
State University; Tiffany L. W. Bates, Louisiana Tech University; Tracy R. Whitaker, Howard
University School of Social Work; Nancy E. Sherman, Bradley University; Tammara P.
Thomas, Winston-Salem University; William J. Elenchin, St. Bonaventure University; An-
Pyng Sun, University of Nevada Las Vegas; Diane Michaelsen, Southern Connecticut State
University; and Jody Huntington, Regis University.
We would like to thank the mentors and teachers who have taught us about counseling
and working with addicted families. Many of them have gone now, but their words and
wisdom live on in us as counselors and counselor educators. Some, but certainly not all,
of these educators include Al Greene, Bette Ann Weinstein, Katherine Townsend, David
Powell, Bettie Dibrell, Patti Mitchell, and John Edwards. Their words reverberate in our
teaching and remind us every day how fortunate we were to have been their students.
ABOUT THE EDITORS
Dr. Pamela S. Lassiter is an associate professor in the Department of Counseling at the

University of North Carolina at Charlotte. She has more than 30 years of work experience
as a counselor, clinical supervisor, and administrator in substance abuse treatment and
community mental health. Pam continues her clinical work in private practice in Charlotte,
North Carolina, and holds credentials as a licensed professional counselor, a licensed
marriage and family therapist, and a licensed clinical addiction specialist. She serves as
director of the Substance Abuse Certificate Program and Addictions Program at UNC
Charlotte. Dr. Lassiter is also the director of the annual Jonnie McLeod Institute on Addiction
at UNC Charlotte. Her areas of research include multicultural counseling and supervision,
gay and lesbian issues in counseling, addictions counseling, and women’s issues. She is past
president of the International Association of Addictions and Offender Counseling (IAAOC)
and currently the associate editor of the Journal of Addiction and Offender Counseling. She
is a past recipient of the Addictions/Offender Education Excellence Award from IAAOC;
the Dr. Mary Thomas Burke Mentoring Award given by the North Carolina Association
of Spiritual, Ethical, and Religious Values in Counseling; and the JoAnna White Founder’s
Award given by the Chi Epsilon Chapter of Chi Sigma Iota International. She enjoys
camping, playing golf, gardening, and hanging out with the best four-legged children a
person could ask for, Nola, Ellie, and Gracie.
Dr. John R. Culbreth is a professor in the Counseling Department at the University of

North Carolina Charlotte. His research interests are in clinical supervision, addiction
counseling, role stress among counselors, and international counselor preparation, resulting
in numerous journal articles, book chapters, and two books. Jack’s clinical experience includes
work in treatment settings as a mental health counselor, chemical dependency treatment
counselor, and substance abuse prevention counselor and in the school setting as a student
assistance program coordinator and intervention counselor. In addition to his teaching, Jack
maintains a small counseling and supervision private practice. Jack is a nationally certified
counselor, approved clinical supervisor, and master addictions counselor and is recognized
by the state of North Carolina as a licensed professional counselor supervisor, licensed
clinical addiction specialist, and certified clinical supervisor. Jack is an active member in
the American Counseling Association, the Association for Counselor Education and
Supervision, the International Association of Addiction and Offender Counseling, and Chi
Sigma Iota. He has served on two journal editorial review boards, The Journal of Addiction
and Offender Counseling and The Clinical Supervisor, and is an ad hoc reviewer for The
Journal of Counseling and Development and Counselor Education and Supervision. During
most of the year, he is in a constant internal battle between showing up for classes and
teaching (the adult choice) versus hitting the road on his motorcycle or chasing good snow
at the ski slopes (the good choice).
x v iii
ABOUT THE CONTRIBUTORS
Dr. Kathleen Brown-Rice is a licensed professional counselor (SD, NE, and NC), licensed
mental health provider (NE), certified addiction counselor (SD), licensed clinical addiction
counselor (NC), qualified mental health provider (SD), approved clinical supervisor, and
national certified counselor. Her research efforts are on developing and enhancing ethical
and competent services to clients. She has completed several projects and published in the
area of risky substance use. To further understand emotional regulation, resilience, and
risky substance use, she also incorporates neural imaging and epigenetics into her research.
She has worked as a professional counselor in various clinical mental health and addiction
settings and continues to practice part-time.
Dr. Jana Burson earned a BS degree in zoology and microbiology from Ohio University in
Athens, Ohio, and got her medical degree from Ohio State University College of Medicine.
She completed a residency in internal medicine at Carolinas Medical Center and worked
for a decade in primary care. She became interested in addiction medicine in 2001 and has
worked full-time in this field since 2004. She is an active member of the American Society
of Addiction Medicine and is board certified by the American Board of Addiction Medicine.
Her special interest is treating opioid use disorder with medication-assisted therapies.
She won the Fredrick B. Glaser Award in 2015, awarded by the Governor’s Institute on
Substance Abuse, for outstanding work in the field of addiction medicine in the state of
North Carolina. When not at work, she enjoys hiking the Appalachian foothills with her
fiancé and her two dogs. She also relaxes by making quilts and weaving rugs.
Dr. Craig S. Cashwell is professor in the Department of Counseling and Educational Development
at the University of North Carolina at Greensboro. Dr. Cashwell focuses his scholarship on the
competent and ethical integration of spirituality and religion into the counseling process and
behavioral addictions. Dr. Cashwell maintains a part-time private practice focusing on couples
counseling and addictions counseling. He has received numerous awards for teaching, research,
and service. Dr. Cashwell is a fellow in the American Counseling Association and a past chair
of the Council for Accreditation of Counseling and Related Educational Programs (CACREP).
He has served as the Association for Counselor Education and Supervision (ACES) Governing
Council representative to ACA and president of Chi Sigma Iota, the international honor society
for the counseling profession. He lives in Winston-Salem with his wife Dr. Tammy Cashwell,
who is also a counselor educator, and their daughter, Samantha.
Dr. Joseph B. Cooper is chair of the Department of Counseling at Marymount University

and former chair and current faculty member of the Intensive Short-Term Dynamic
Psychotherapy training program at the Washington School of Psychiatry in Washington, DC. He
is also a board member of the International Experiential Dynamic Psychotherapy Association.
He has more than 22 years of clinical experience and maintains a private practice in
Washington, DC, specializing in the treatment of trauma, addictions, and personality
xix
xx Theory and Practice of Addiction Counseling
disorders. In addition to teaching and conducting psychotherapy, he has been an active

presenter at national and international conferences and has published scholarly articles and
book chapters on clinical supervision, play therapy, counseling skills, and the importance
of emotions. For fun he likes hiking and traveling and is an avid guitar player who likes to
write, record, and play music. Prior to becoming a counselor educator, he toured with a
band playing original music until he ran out of money.
Dr. Astra B. Czerny currently works as an assistant professor in the Community & Trauma
Counseling program at Philadelphia University. Her scholarly work reflects her interest
and passion in women’s issues and empowerment. Her clinical work is focused on trauma,
women’s issues, and addictions. In addition to teaching classes at PhilaU, Dr. Czerny
has a private practice in Jenkintown, Pennsylvania, where she specializes in EMDR and
neurofeedback. In her spare time, Dr. Czerny enjoys crocheting millions of lace doilies, all
of which will be inherited by her loving children, much to their dismay.
Dr. Amanda L. Giordano, LPC, NCC, is an assistant professor at the University of North
Texas. She specializes in addictions counseling, including both substance and process
addictions and religious/spiritual issues in counseling. Giordano received the American
Counseling Association’s Ralph F. Berdie Memorial Award in recognition of her work with
collegiate substance abuse. She founded and cofacilitates an addictions counseling research
team in her department and serves on the editorial board of the Journal of Addiction and
Offender Counseling. Giordano is an avid fan of The Walking Dead.
Dr. Charles F. Gressard is a chancellor professor in the Counseling Program at the College
of William & Mary and is coordinator of the addictions specialty and faculty director of
the New Leaf Clinic. He received his PhD from the University of Iowa and has taught
at the University of Virginia and the College of William & Mary for the past 36 years.
He has served as chair of the Virginia Board of Counseling, chair of the National Board
for Certified Counselors, vice chair of CACREP, and chair of the Virginia Department
of Health Professions’ Impaired Professionals Committee. He currently chairs CACREP’s
International Registry for Counselor Education Programs (IRCEP). His licenses and
certifications include licensed professional counselor, licensed substance abuse treatment
professional (both in Virginia), national certified counselor, and master addiction counselor
certification. In 2007 he received the Virginia Summer Institute for Addiction Studies’
Visionary Leadership Award; in 2008 he received Chi Sigma Iota’s Thomas J. Sweeney
National Professional Leadership Award; and in 2009, along with the CACREP staff and the
other members of the 2009 Standards Revision Committee, he received the ACES Robert
O. Stripling Award for Excellence in Standards.
Dr. Daniel Gutierrez is an assistant professor of counseling at the University of North

Carolina at Charlotte and a licensed professional counselor in North Carolina and Florida.
His research agenda focuses on evidence-based treatment strategies for individuals and
couples, increasing preventative resources for coping with stress, and the use of meditative
practices in counseling. He lives in Charlotte, North Carolina, with his wife, two daughters,
About the Contributors • x xi
and their dog Duchess. He spends much of his free time reading, thinking about superheroes,
and watching movies.
Dr. Leigh F. Holman has worked as a mental health professional for more than 20 years
in private practice, hospitals, IOP, PHP, dual diagnosis units, impaired professionals units,
residential treatment, community agency, prison, and private practice settings. She has
taught for 10 years. Dr. Holman is licensed as a LPC-MHSP supervisor and certified as
a registered play therapy supervisor. She has earned the AMHCA diplomate credential in
substance abuse and co-occurring disorders, trauma counseling, and child and adolescent
counseling. She is the past president of IAAOC and was recognized as the Outstanding
Counseling Professional in 2013 for her contributions to the field of process addictions.
She conducts research in prison and community agency settings and has published and
presented nationally and internationally on addiction and offender topics.
Dr. Melanie M. Iarussi is an associate professor and the coordinator of the Counselor
Education Doctoral Program at Auburn University. She earned her PhD in counselor
education and supervision from Kent State University. Her clinical background is in
substance abuse counseling, college counseling, and private practice. She is a licensed
professional counselor and a certified substance abuse counselor. She is also a member of
the Motivational Interviewing Network of Trainers. Melanie’s research interests include
counselor training in substance use and addiction counseling, college student substance use
and recovery, and applications of motivational interviewing. Melanie enjoys life in Auburn
with her husband, two daughters, and black lab Angel.
Dr. Katie A. Lamberson received her master’s of rehabilitation counseling in 2010 and
worked for several years as a counselor for youth and families struggling with addiction.
She then went on to receive her doctorate in counseling and counselor education at the
University of North Carolina at Greensboro. In her current position, Katie teaches courses
for master’s students in the addictions track, as well as ethics in counseling and theories
of family counseling. Her area of research interest includes examining family dynamics
and substance use, specifically, how family influences either promote or deter continued
use of substances in adolescents. Katie lives in North Carolina with her husband, dog,
and cats.
Dr. Simone F. Lambert is an associate professor in counseling at Argosy University,

Washington, DC. She is a licensed professional counselor and national certified counselor,
serving as a counselor and supervisor over the past two decades. Dr. Lambert’s research
interests include addiction prevention; counselor wellness; sensory processing disorder;
and issues related to children, adolescents, and families. Dr. Lambert was the recipient
of the 2010 International Association of Addictions and Offenders Counselors (IAAOC)
Addictions/Offender Educator Excellence Award. She is a past president of IAAOC, a
division of the American Counseling Association. Her current professional leadership
includes serving as the IAAOC representative to the American Counseling Association
Governing Council. Additionally, she has served as the editor of ACAeNews. Dr. Lambert
x xii Theory and Practice of Addiction Counseling
has published numerous book chapters and articles primarily focused on issues related to
addiction, youth, and families.
Dr. Todd F. Lewis is an associate professor of counseling and counselor education at North
Dakota State University. He is a licensed professional counselor and a national certified
counselor. Dr. Lewis is past treasurer and president of the International Association of
Addictions and Offender Counselors (IAAOC), a subdivision of the American Counseling
Association. He recently served as the IAAOC representative on the Governing Council of
the American Counseling Association. Throughout his career, he has taught graduate-level
students in motivational interviewing, substance abuse counseling, assessment, diagnosis,
and treatment planning. He has presented on these topics at numerous local, state, national,
and international venues. Dr. Lewis has published numerous research articles related to
substance abuse, collegiate drinking, and theoretical approaches to addictions treatment. He
has twice received the Exemplary Research Award from IAAOC for his research and was
the 2012 recipient of the Teaching Excellence Award from the University of North Carolina
at Greensboro School of Education. In 2014, he published his first textbook, Substance
Abuse and Addiction Treatment: Practical Application of Counseling Theory, published by
Pearson Education. Dr. Lewis is a member of the Motivational Interviewing Network of
Trainers (MINT). He has secured internal and external funding for his work in motivational
interviewing, primarily using the approach to address health disparities within surrounding
communities. In addition to his full-time faculty work, Dr. Lewis has garnered significant
clinical experience where he has coordinated substance abuse clinical research and treatment
services with clients struggling with a range of substance abuse and mental health issues. In
his spare time, Dr. Lewis enjoys reading, hiking, being outdoors, and spending time with his
family.
Dr. Jeremy M. Linton is an associate professor of counseling and human services and
director of the Student Counselor Training Clinic at Indiana University South Bend. He
is also the counseling director at Collaborative Family Solutions in South Bend, Indiana.
Jeremy earned a bachelor’s degree in psychology from the University of Michigan, a master’s
degree in counseling from Valparaiso University, and a PhD in counselor education and
supervision from Western Michigan University. He is a licensed clinical addictions counselor
and licensed mental health counselor in the state of Indiana and a licensed professional
counselor in the state of Michigan. Jeremy is the author of the book Overcoming Problematic
Alcohol and Drug Use published by Routledge and more than 20 other journal articles and
book chapters. When he is not working, Jeremy enjoys reading, skateboarding, and spending
time with his wife, four kids, and two loyal golden retrievers.
Dr. Taryne M. Mingo is an assistant professor at Missouri State University and has a
career background as an elementary professional school counselor for rural populations in
Georgia. Her research interests include advocating for marginalized student populations
across P–16 settings, using intersectionality theory to support marginalized student
populations, womanist theory and supervision, and incorporating a social justice lens
within school counseling programs. Dr. Mingo serves as a member on the Department
of Elementary and Secondary Education (DESE) Writing Team for Missouri school
About the Contributors • x xiii
counselors and was invited to participate in the White House convening for school
counselors as part of the Reach Higher Initiative in 2014. Dr. Mingo identifies as a social
justice change agent who seeks to find new and innovative methods toward accessing
education, to support student learning, and to promote every student reaching his or her
highest potential.
Dr. Regina R. Moro serves as an assistant professor in counselor education at Boise State
University in Boise, Idaho. She received her PhD in counseling from the University of
North Carolina at Charlotte with an emphasis in multicultural counseling, received a
graduate certificate from UNC Charlotte in substance abuse counseling, and earned an
MS in community counseling from Syracuse University. Regina is a licensed mental health
counselor (FL), a licensed clinical addictions specialist (NC), and a national certified
counselor. Her clinical passion involves work with crisis and trauma, including a focus on
addiction with individuals and families. She enjoys spending her free time enjoying the great
outdoors with her partner and their dog, Barkley.
Dr. Marsha Riggio is chairperson and associate professor with the Counseling Department
at Argosy University, Washington, DC, where she recently received the 2016 Faculty
Mentor Award. Dr. Riggio received her PhD in counselor education and supervision, and
her background includes 20 years of teaching and mental health experience that involves 15
years in the U.S. Army as a behavioral science specialist/mental health officer and several
years as a licensed professional counselor/supervisor and national certified counselor. She has
a private counseling and supervision practice. Dr. Riggio is also the executive director of the
Maryland Counseling Association, president of the Maryland Association for Marriage and
Family Counseling, and a member of the board of directors for the William V.S. Tubman
University Foundation in Liberia. When not working, Dr. Riggio spends time with her
husband, six children, two cats, and one fish.
Dr. Rebecca G. Scherer joined the Counseling and Educational Psychology program at
the University of Nevada, Reno, in the fall of 2014. She is a licensed professional counselor
(LPC) in North Carolina, an approved clinical supervisor (ACS), and a nationally certified
counselor (NCC). Her professional interests include multiculturalism and social justice
in counseling, attachment theory/therapy, and clinical supervision. She has presented at
numerous workshops at state, regional, national, and international conferences. In her free
time, Rebecca enjoys hiking in the summer and skiing in the winter in the Lake Tahoe area.
Dr. Anneliese A. Singh is an associate professor and associate dean for diversity, equity,
and inclusion in the College of Education at the University of Georgia. Dr. Singh is a past
president of the Association for Lesbian, Gay, Bisexual & Transgender Issues in Counseling,
where she developed transgender counseling competencies and queer and trans people
of color initiatives. She cofounded the Georgia Safe Schools Coalition to work on the
intersection of heterosexism, racism, sexism, and other oppressions in Georgia schools. She
founded the Trans Resilience Project to translate findings from her 15 years of research
on the resilience that transgender people develop across the life span and across multiple
identities to navigate societal oppression. She passionately believes in and strives to live by
x xi v Theory and Practice of Addiction Counseling
the ideals of Dr. King’s beloved community, as well as Audre Lorde’s reminder that “without
community, there is no liberation.”
Michael S. Spivey holds bachelor of arts degrees in Spanish and history from the University
of North Carolina at Charlotte and a master of arts in education and human development
from the George Washington University. After working as a senior facilitator and consultant
for 25 years in the financial and manufacturing arenas, Michael is currently pursuing a
master of arts in counseling with a concentration in clinical mental health at the University
of North Carolina at Charlotte. He is a member of the American Counseling Association
and the North Carolina Counseling Association. He is also a current member and past board
member of the International Association of Facilitators, having served two terms in the role
of global director of professional development. Michael is also a member of the Chi Sigma
Iota and Kappa Delta Pi honor societies. In his spare time, he enjoys traveling, hiking, and
gardening.
Paula J. Swindle, MA, NCC, LPCS, is a doctoral student at the University of North
Carolina at Greensboro. She returned to pursue her PhD after 15 years in the counseling
profession, including designing and implementing mental health programming for cardiac
and cancer services in a hospital setting. Paula plans to go into counselor education, and
her research interests include counseling and spirituality, religious abuse, process addictions,
counselor self-care, and counseling in medical settings. Raised in the beautiful Blue Ridge
Mountains of North Carolina, Paula and her husband Dustin currently live in Winston-
Salem, North Carolina.
Heidi Unterberg is a doctoral student at Argosy University, Washington, DC, and has
worked as a teaching assistant (TA) in the Master’s Level Counseling Department for 2
years. She has presented at the International Association of Marriage and Family Counselors
(IAMFC) World Conference, sponsored by the International Association of Addictions
and Offender Counseling (IAAOC), on addictions and the family system: systems theory
with families affected by addiction. She also presented at the Association for Specialists
in Group Work (ASGW) National Conference, on criminogenic juveniles: morality
development using a restorative justice model. She is a member of the Restorative Justice
Committee in the division of IAAOC working with cohorts toward increasing knowledge
and counselor skills in restorative justice practices. She is a mental health therapist with
Valley Youth House, in Allentown, Pennsylvania, working toward certification in eco-
systemic family therapy (ESFT) with the Philadelphia Child Guidance Center (PCGC)
and toward certification in trauma focused–cognitive behavioral therapy (TF–CBT). She
lives in the Great Pocono Mountains with her supportive husband, David, of 19 years,
and her two amazing children, Samuel and Stephanie. The family enjoys spending time
outdoors together taking care of their five English mastiffs, four horses, ten chickens, and
duck Sparky. Oh, and their pig, Kevin.
Dr. Edward Wahesh is an assistant professor in the Department of Education and

Counseling at Villanova University, where he teaches courses in prevention, substance
abuse, and cognitive-behavioral approaches to counseling. He has published and presented
About the Contributors • xxv
in the areas of college student drinking prevention, addiction treatment, counselor training,
and clinical supervision. Dr. Wahesh earned his doctorate in counseling and counselor
education from the University of North Carolina at Greensboro. He is a member of the
Motivational Interviewing Network of Trainers and is an approved clinical supervisor (ACS)
and national certified counselor (NCC). In 2015, he received the New Professional Award
from the North Atlantic Region Association for Counselor Education and Supervision
(NARACES). Originally from Brooklyn, New York, Dr. Wahesh loves pizza, water ice, and
the New York Yankees.
Dr. Amy E. Williams is an assistant professor in the Department of Counseling, Special

Education, and School Psychology at Youngstown State University. Amy earned both her
M.Ed. in community and addiction counseling and her PhD in counselor education from
the College of William & Mary. Amy’s research focuses on substance use disorders (SUDs)
and their treatment, SUDs and family systems, and SUD counselor training and supervision.
Amy also engages in research related to assessment development for problematic substance
use patterns. Amy’s clinical experience includes individual, group, couple, and family
counseling in residential and outpatient settings with a focus on substance-related concerns
and SUDs. Amy has two feline research assistants, Katy and Franklin.
Elliott S. Woehler is a second-year doctoral student in the counseling PhD program at

the University of North Texas. He has served as a teaching assistant and research assistant
in the counseling program at UNT and has guest lectured for addictions, theories, ethics,
and counseling adolescents classes. His research interests include attachment styles, social
justice, and addictions. He has served on research teams assessing mental health symptoms,
substance use, trauma, and spirituality in qualitative and quantitative paradigms. He is a
member of the Texas Counseling Association and serves as the community liaison for the
UNT Counselors for Social Justice chapter. He has a cat named Casey and is a socially
acceptable tennis addict in the precontemplation stage of change. Elliott loves to travel and
has lived abroad in Austria, Israel, and Hungary.
FROM TREATMENT LORE
1 TO THEORY APPLICATION
An Introduction to Addiction Theory
and Practice
John R. Culbreth
Pamela S. Lassiter
T
his text explores multiple theoretical approaches to both the epistemology of addiction
and its treatment. It is important for the reader to understand our perspectives as editors
because who we are and what we believe ultimately defines the lens through which we
have edited this book. Both editors subscribe to a biopsychosocial and spiritual theoretical
perspective regarding the causes and maintenance of addiction. We believe that there are
crucial biological, psychological, sociological, and spiritual factors at play in the creation of
addiction and in the maintenance of that addiction once it has begun. We also both believe that
the treatment of addiction must necessarily include all of those aspects in order to adequately
address the disease of addiction.
Additionally, we base our work on several underlying assumptions about addiction
counseling. These include the following:
• Theories or models are underlying guides in clinical practice that include our beliefs
about what causes problems in our lives and about how and why people change in
response to those problems. In counseling, our theories reflect who we are as much as
they reflect our beliefs about change. In other words, our adopted counseling theories
are selected based on our own developmental process and our resulting worldview.
• We assume that counselors should be engaged in an ongoing, reflective practice con-
cerning their biases about addiction and addicted people. Most of us have been im-
pacted by addiction in some way. Personally speaking, after 30-plus years of practice
and a strong belief that addiction is a disease that literally hijacks the person’s brain,
it is still difficult not to fall into moral model beliefs when a young college student
is killed by a drunk driver with eight previous convictions of driving while impaired.
We have to understand those judgements, accept that we will always have them (just
as racism and sexism will always reside within us), and choose consciously not to act
out of that place when we provide treatment.
• There is a strong connection between what a counselor believes about the causes and
maintenance of addiction and how that counselor will go about treating the addicted
client. Likewise, we assume that the chosen theory of counseling determines the type
of treatment approach a counselor will choose to take with a client. For example, if
1
2 Theory and Practice of Addiction Counseling
a counselor believes family distress is a major contributing factor to a client’s addic-

tion, then the counselor may choose family therapy or a systemic approach as a pri-
mary treatment modality. If psychological issues are seen as the underlying cause of
the addiction, remedies such as stress reduction techniques or anxiety or depression
medication may be sought. Regardless of the counseling theory applied to work with
addicted clients, the onus is on the counselor to explore his or her own biases about
addiction, addicted people, and proper treatment.
• We also assume that best practices in addiction counseling are supported by a sound
theoretical approach that is evidence-based in terms of effectiveness. Whereas not all
aspects of theory are “proven” to be effective, our general approaches to treatment
ought to be based on empirical support for those practices.
TREATMENT LORE
Training to be a substance abuse counselor during the 1980s, when we came through our
own counselor training programs, was quite different from addiction counseling training
today. And yet there are many aspects of that early training that remain in today’s addiction
counseling curriculum. Much of this can be called treatment lore. This lore for working
with addicted clients has its history within the development of the field through the 20th
century. It is connected to Alcoholics Anonymous and the disease model in many ways. The
concepts of treatment lore have been handed down in a way similar to an oral history. With
this in mind, please note that we are not taking credit for these concepts and ideas. This is
merely a presentation of accumulated lore that we have learned through the years by way of
in-service training, our own clinical supervision as counselors, treatment program curricula,
and psychoeducational materials used by counselors with clients. And our use of the word
lore does not suggest that these concepts are untrue. They are simply a part of the accepted
culture of addiction counseling, impacting the ways in which addiction counselors perceive
and work with clients.
The use of treatment lore continues today, although we believe that in the classroom
there has been a significant shift in focus toward empirically based approaches and theories
that have solid foundations in the larger counseling and psychotherapy fields. Where
treatment lore persists is in the multitude of professional development trainings, workshops,
addiction counseling training institutes, and the addiction treatment agencies. Graduates of
counseling programs obtain positions in treatment programs that work from this treatment
lore approach. Granted, more and more programs are being required to demonstrate that
treatment provided is theoretically and empirically grounded. However, this requirement
is not universal, resulting in many treatment center and program addiction counselors
mashing together ideas, beliefs, and personal experiences into how they work with clients
on a day-to-day basis.
Although we do not advocate using treatment lore as the foundation for how counselors
work with addicted clients, we believe it is important to present some of these concepts
for two reasons. First, it is important that new counseling professionals entering the field
understand some of the culture of their intended work environments. Many of these
concepts are held to by working addiction counselors at almost a visceral level. We believe
Chapter 1 • From Treatment Lore to Theory Application 3
this is due to some of these counselors having either come through their own recovery
process or having a close family member in recovery. The result is that these beliefs are
directly related to the fact that this professional is still alive and breathing today. Personally
speaking, were it not for some or all of these ideas, some of our own family members would
be dead due to their addiction. This belief makes for a “true believer” in those who have
gone through this experience. And sometimes a true believer can be less open to alternative
ways to conceptualize addiction and work with addicted clients.
The second reason for presenting this information is that much of it makes sense and can
accurately describe some of the experiences and issues that addicted clients have to address
in their process of recovery. This piece of lore helps counseling professionals understand
these issues as well, allowing for a better understanding of their client experiences. If some
of these ideas are accurate, which we believe is the case, then addiction counselors will be
able to teach these ideas to clients and help them progress in their recovery.
In looking at what we consider to be common treatment lore, there are several groups of
concepts, including a definition of addiction, descriptors of the illness and how it manifests
in clients, and things to consider when working with an addicted client. We briefly discuss
these concepts and provide examples of how they are used.
A common issue when beginning work with addicted clients is a resistance to the
term alcoholic or drug addict. Both terms carry many negative connotations and negative
stereotypical views. Often clients openly and defiantly state that they are neither one of
these types. Our response is to agree with the client, stating that it is not our job to make
that determination; it is the client’s right to decide what levels of difficulty he or she has with
chemical use. We provide a common definition in individual, group, or psychoeducational
counseling, stating that addiction is the compulsive use of a mood-altering substance or
behavior, which continues even in the face of adverse consequences. One of the best known
advocates of this definition has been Father Martin, who has taught this concept in his
well renowned video Chalk Talks (Kelly Productions, 1972). An important corollary to
this definition is that it is important for counselors and clients both to understand that the
chemical itself (or behavior in a process addiction) is not the primary problem. Rather, it
is the behaviors, cognitions, and emotions surrounding the use and abuse of the chemical
(or process) that are important. In other words, it is not the alcohol that is important in
alcoholism; it is the “ism” that has to be addressed. Alcoholism, cocainism, workaholism,
hypersexism, gamblingism, and perfectionism are all about the “ism.” Each one of these
“isms” is merely a different way for a person to alter his or her mood. Put another way, “A
drug is a drug is a drug.”
Another treatment lore relates to how the nature of addiction is explained to clients so
that they can understand what they are experiencing as they move through recovery. This
description is commonly referred to as 3 Ps and a T. This name stands for addiction being a
primary illness that is progressive and persistent and if left unchecked is terminal. A primary
illness is one that requires treatment before any other issues or concerns are addressed. In
addiction counseling, this is related to clients who may focus on other psychological or
emotional problems, bypassing dealing with their addiction problem, thus never addressing
this issue. As counseling on the other problem progresses, often a client may begin self-
medicating the pain that arises with chemicals or processes, rather than developing more
appropriate and healthy coping strategies. Progress is limited at best and often very temporary.
Eventually the counselor may uncover what is actually happening with the client and try
to address the chemical use, with varying levels of success. Thus, a successful outcome for
the client is blocked due to the primary illness overshadowing any efforts by the client or
counselor to make positive changes.
Addiction as a progressive problem refers to the series of negative consequences
associated with compulsive unchecked use. These consequences follow a sequence from
mild to moderate to severe in nature. Examples of mild consequences include an increase
in tolerance to alcohol, onset of memory blackouts, and an inability to stop drinking even
once others have done so. Moderate consequences include failed efforts to control intake
amount or quit altogether; negative impact on work, finances, and family and friends; and
the development of tremors. Severe consequences include physical and moral deterioration,
lengthy episodes of intoxication, and a decrease in tolerance to alcohol, also known as
reverse tolerance. Each of these levels of severity coincide with viewing addiction through a
three-stage model of progression. Jellinek (1960) created a diagram called the Jellinek Curve
that displays how clients progress downward through the early, middle, and late stages of
addiction. The opposite side of the curve represents steps and progress markers for clients
who are working up toward recovery. The two sides create the curve, or U shape, of the
progression of addiction and the progression through recovery.
The concept of persistence explains the fact that this problem cannot be ignored with the
hope that it will eventually go away or resolve itself. Addiction must be addressed directly,
head-on, through active participation in a treatment process. Clients must understand
that their work toward recovery cannot become complacent. The idea of persistence is
especially difficult for parents to accept, especially when they say to a counselor that the
using behavior of a child is just a phase and that the child will grow out of it. Many times
this can happen. But more often, once someone’s use and abuse of chemicals comes to the
attention of professionals, it is well beyond the experimentation stage or phase. At this point,
the addiction is present and persistent and will not go away on its own.
The final descriptor, T, refers to addiction being a terminal condition. If it is left unchecked,
due to its persistent nature and the progression through increasingly severe consequences,
then the final outcome is likely to be death. Death may come about in a variety of ways. It can
be over the course of time through the physical deterioration of the body (although time here
is relative based on the quantity and frequency of individual use). Or death can be a result
of participating in risky behaviors due to impaired thinking, such as a traffic fatality. Many
addicted people struggle with depression and so are at significant risk of chemically induced
suicidal ideation and behaviors, sometimes resulting in a successful suicide.
A second group of descriptors about addicted clients are the three Ds of addiction: denial,
delusion, and dishonesty. Denial is probably the most commonly known of these three,
although the other two appear obvious once considered by the addiction counseling student.
As clients progress through addiction, they begin to deny the impact of their behaviors
and subsequent consequences. Often they will look to place the blame for any negative
consequences on any number of other areas rather than their use and abuse of chemicals.
It is common to hear clients refer to getting arrested for driving while impaired as merely
having to fill a law enforcement officer’s quota of citations. Disregard the fact that the client
was actually driving while impaired. Other clients will attribute their abuse of chemicals to
negative or dysfunctional relationships. All of this is denial.
As the denial increases with the progression of addiction, clients will begin to develop
patterns of impaired thinking, or delusions, surrounding their chemical abuse. This may
include unreasonable resentments toward family and friends. As the chemical or process
obsession grows, these can lead to delusional thinking. Often, this delusional thinking
supports a delusional belief of persecution by people in the lives of clients.
The third characteristic, dishonesty, is connected to the first two, in that clients will
often go to great lengths to avoid the truth of their addiction. This includes the dishonesty
toward the self through denial and delusional thinking, as well as dishonesty in everyday
interactions with the people they interact with. A system of lies is created that insulates
clients from the negative consequences of their behavior. Many people close to the addicted
person either openly support this dishonesty through enabling behavior or covertly support
the dishonesty by creating their own “reasons” for the abusive behavior and associated
consequences. Both of these compensation approaches by friends and family members share
a common characteristic of not directly and honestly confronting the inappropriate abuse
behavior, thus resulting in shielding, either intentionally or unintentionally, the addicted
person from the appropriate negative consequences of his or her behavior. The end result of
this complex level of dishonesty is usually a collapse of the delicate system of lies and alibis
for the addictive behavior.
Several other treatment lore concepts should be mentioned. One of these is the idea
that immediate and complete abstinence from all chemicals is the only way for a person to
achieve recovery from addiction. Whereas there may be theoretical approaches that support
this, and many addiction counselors who profess this as true, it should not be considered
an absolute. It is hard to address all of the variance in people through the use of absolute
thinking. Many clients have worked through their own recovery process and rebuilt their
lives successfully by way of treatment approaches that do not require abstinence.
Another piece of lore is that group counseling is the only way for clients to experience
any confrontation of their behaviors and that the group process needs to break through the
barrier of denial for addicted clients to finally see what they have done. This is not the case
and in fact has a level of paternalistic thinking that could be quite harmful to some clients. It
is important for addiction counselors to develop their other awareness of their clients and of
their clients’ individual circumstances. Some of this paternal thinking can be linked to some
counselors bringing their own recovery experiences, or family recovery experiences, into the
counseling process and assuming that if it worked for them, then it should work for their
clients. This can be a very Eurocentric viewpoint that does not work well in today’s diverse
society. In addition, it tends to lead counselors toward their own use of the term denial.
Some counselors will resort to labeling client resistance behaviors as client denial. The client
is just not ready to listen, or admit defeat, or acknowledge his or her problem, or admit
that others have been harmed. This belief releases the counselor from any responsibility in
adjusting his or her approach to more readily meet clients where they are and to create a
safe and accepting counseling relationship/environment that fosters honest disclosure and
examination of client motivations and behavior. Clients carry enough shame on their own.
They do not need more piled on them from their counselors.
There are many more aspects of treatment lore that have not been presented in this brief
discussion. We are only trying to give the reader an idea of a few of the concepts and belief
systems embedded in the culture of the addiction treatment community. It is important that
this information not be taken as an indictment of the many substance abuse professionals
and programs. It is not that at all. It is merely provided as information to help new addiction
counseling professionals understand the environment that they will be working in, allowing
them to integrate some of these concepts into their thinking as they work toward developing
a theoretical approach to addiction treatment, similar to any other counseling professional
integrating any of the more general counseling theoretical approaches into his or her own
personal theoretical framework.
OVERVIEW OF BOOK SECTIONS AND CHAPTERS

In this text, we have organized the chapters into a biopsychosocial framework, and in the
final two sections we discuss theoretical approaches to interventions or change strategies
and additional issues related to addiction treatment. We begin with a historical overview
of the evolution of conceptualizations of addiction and addicted people. This discussion
focuses mostly on the development of the moral model, which is not an accepted theory of
addiction among counseling professionals today but is rather a societal force that underlies
policies and biases that may affect treatment. In this chapter, the reader will understand how
Western cultures have shifted from relatively lax positions about substance use and addiction
to morally condemning positions. The evolution of addiction as sin is explored, as well as
its impact on treatment providers and public policy associated with laws governing drug
use. Readers are invited to explore how the moral model and dominant cultural views of
addiction have influenced their beliefs. Readers are also encouraged to use this awareness
to become reflective and conscious addiction counselors. This discussion is followed by
Chapter 3, which presents biological and genetic theories that conceptualize addiction as
a product of biology. It focuses on changes in the brain and central nervous system, issues
of tolerance and withdrawal, and the body’s reaction to different types of drugs, including
gender differences in physiological effects. Primary to the discussion is information
about pharmacology, neurophysiology, and heredity. The chapter frames addiction as a
disease, supporting this perspective with the latest empirical evidence. Information about
innovations and uses of medication in addiction treatment are briefly discussed.
The second section of the book presents psychological theories related to the onset,
maintenance, and treatment of addiction. Chapter 4 on psychoanalytic theory describes
how theorists and clinicians from various points on the psychoanalytic spectrum have
understood addiction and its treatment, including historical perspectives. Psychoanalytic
theory generally seeks to understand the motivation or the “why” behind addictive
behavior. Addiction is seen as a symptom of internal conflict, and the goal is to bring those
intrapsychic conflicts into awareness, to make the unconscious conscious. Identifying the
underlying cause is key to the removal of the symptom. Contemporary psychoanalytic
conceptualizations and applications to treatment of addiction are presented.
Also within the psychological factors section is Chapter 5, “Self-Psychology Theory,”
which presents views of addiction as a developmental failure to adequately integrate certain
qualities that lead to a cohesive self-structure. These qualities are crucial to later development
and can be obtained through a structured experience that helps the addicted person
internalize those qualities not received from earlier selfobjects. Information about the impact
of trauma related to this theory is also discussed. Recovery, therefore, is conceptualized as a
process of self-restoration. Next, Chapter 6 discusses the developmental nature of addiction.
This perspective assumes that as people mature or develop, they also mature in their ability
to cope with the addictive process and find ways to cope with tendencies toward relapse.
The chapter describes the etiology and maintenance of addiction through a developmental
lens. It also explores how developmental shifts toward higher levels of consciousness impact
addiction across the life span and discusses how these shifts may relate to recovery from
addiction.
Also from a psychological perspective, Chapter 7 presents attachment theory as a lens
to examine the relationship between attachment style and its impact on one’s ability to
self-regulate. Addiction is viewed as a disorder of self-regulation (emotions, self-esteem,
relationships) and is perceived as a misguided attempt to self-repair. This chapter discusses
attachment theory, research, and clinical applications for addicted populations. Information
about the impact of trauma related to this theory is also discussed. The ways in which
attachment theory is similar and dissimilar to traditional theories of addiction and how
existing mechanisms in addiction treatment may be used to increase attachment style
growth are explored.
The third section of the book focuses on various sociological factors related to the
epistemology and maintenance of addiction. First, Chapter 8 presents addiction through
the lens of external, cultural, and contextual factors. From this viewpoint, social influences
determine substance use issues, and cultural attitudes toward substances influence individual
behavior. Addicted individuals are links in society that are seen as part of a problem related
to the whole. Sociological functions of substance use include facilitation of social interaction,
release from normal social obligations, and promotion of cohesion among members of
a social or ethnic group and may be used as repudiation of “establishment” values. This
chapter explores various historical and contemporary sociocultural influences on the
epistemology and maintenance of addiction, including sociocultural differences between
the United States and other parts of the world. A second chapter in this section, Chapter
9, presents addiction through a family systems lens. This chapter examines the function of
addiction within the family system and different approaches to treating the addicted family.
Some approaches view addiction as a disease and encourage family members to examine
their own issues. Concepts such as codependency, enabling, and family roles are discussed.
Other approaches take more of a family systems approach by focusing on how the addiction
functions in the family, exploring rules, boundaries, communication, problem solving, and
roles. A behavioral family model looks at behaviors of the family that precede and reinforce
use, tries to change what occurs before and after use, and addresses relationships in terms of
themes, communication styles, and how drug use keeps the relationship stable.
A fourth section of the book explores various theoretical approaches to interventions
and change strategies including the transtheoretical model, motivational interviewing, harm
reduction, cognitive-behavioral approaches, 12-step facilitation, and postmodern approaches
to addiction treatment. The transtheoretical model, including the stages of change, assumes
that change happens when the right process happens at the right time. From this perspective,
change is both external and internal and may be viewed as transtheoretical in nature. In
Chapter 10, the transtheoretical model theory is presented and discussed in detail, including
how the counselor may use change process interventions (experiences and activities) that
help the client move from one stage to another. The chapter shows how clients spiral in and
out of these stages and how change behavior needs to be viewed within the cultural context.
Motivational interviewing is a client-centered method for enhancing internal motivation
for change by exploring and resolving ambivalence within the client. In Chapter 11,
motivational interviewing is presented as a style of therapeutic intervention that focuses
on developing a collaborative relationship with clients, helping the counselor to roll with
client resistance and enhancing client self-efficacy. This chapter is theoretical and practice
focused, helping the counselor integrate the stages of change with appropriate motivational
interviewing approaches.
Chapter 12 discusses harm reduction models as an approach to addiction treatment.
Harm reduction is based on the notion that lifelong abstinence from substances is extremely
difficult for addicted populations and that setting incremental goals toward abstinence may
be more realistic. Although complete abstinence from mood-altering chemicals or behaviors
may be preferred, it may not be attainable for all clients. Examples of harm reduction models
are discussed as well as client presentations where it may be preferred over other approaches.
An integration of a harm reduction approach with other theoretical models is also explored.
Chapter 13 reviews empirical support of cognitive behavioral theory (CBT) and surveys
its application to substance use disorders and treatment. The basic assumptions of CBT are
outlined as well as its assumptions about etiology and maintenance of addiction. The goals
and tasks of CBT treatment are discussed along with examples of techniques that might be
used in counseling.
The history of the 12-step movement is briefly explored in Chapter 14 followed by a
description of its conception of the etiology and maintenance of addiction, its integration
with other theoretical models (biopsychosocial/spiritual dimensions), empirical evidence
of its usefulness, and a discussion of central concepts (e.g., powerlessness, acceptance,
denial, spiritual dis-ease, fellowship, time binding, sponsorship, working the steps). The
chapter also discusses the use of 12-step groups as an ancillary support in conjunction with
counseling and treatment.
Chapter 15 describes three constructivist or postmodern approaches to addiction treatment.
Postmodern approaches such as narrative, feminist, and womanist therapy share a common
philosophical stance around issues of power, justice, and advocacy. They may, however, look
different in clinical application. Problem-saturated stories are common among people struggling
with addictions. Narrative approaches view people as separate from their problems and assume
people have many competencies, beliefs, values, and skills that will help them reduce the amount
of influence problems have over their lives. Narrative concepts such as deconstructive listening,
externalizing conversations, unique outcomes, thickening the plot, spreading the news, and
mining for hope guide this exploration toward creating alternative stories and preferred realities
in therapeutic work. Feminist and womanist approaches to addiction counseling emphasize
concepts such as the intersections of personal experience and political realities, the importance
of egalitarian relationships, and explorations of voice and resilience.
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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Counseling – Ebook PDF Version

4. Psychoanalytic Theory of Addiction 76

6. A Developmental Approach to Addiction Theory and Treatment 117

7. Attachment Theory 141

8. Sociological Theory 161

9. Family Systems Theory 177

10. Transtheoretical Model for Change 199

11. Motivational Interviewing in the Treatment of Substance

13. Cognitive Behavioral Approaches to Addiction Treatment 258

16. Behavioral Addictions 320

17. Theory and Practice of Group Work With Addictions 341

We have provided an in-depth review of the current theories of addiction treatment,

Dr. Pamela S. Lassiter is an associate professor in the Department of Counseling at the

Dr. John R. Culbreth is a professor in the Counseling Department at the University of

Dr. Joseph B. Cooper is chair of the Department of Counseling at Marymount University

disorders. In addition to teaching and conducting psychotherapy, he has been an active

Dr. Daniel Gutierrez is an assistant professor of counseling at the University of North

Dr. Simone F. Lambert is an associate professor in counseling at Argosy University,

Dr. Edward Wahesh is an assistant professor in the Department of Education and

Dr. Amy E. Williams is an assistant professor in the Department of Counseling, Special

Elliott S. Woehler is a second-year doctoral student in the counseling PhD program at

a counselor believes family distress is a major contributing factor to a client’s addic-

OVERVIEW OF BOOK SECTIONS AND CHAPTERS

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

LAST SMOOTHING BEFORE

FIRING THE BRUSH-PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

MANUFACTURE OF BARK-CLOTH AT NEWALA

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6. A Developmental Approach to Addiction Theory and Treatment 117

10. Transtheoretical Model for Change 199

11. Motivational Interviewing in the Treatment of Substance

13. Cognitive Behavioral Approaches to Addiction Treatment 258

16. Behavioral Addictions 320

17. Theory and Practice of Group Work With Addictions 341