Beyond Addiction is a book written by therapists associated with the Center for Motivation & Change. It largely rejects old twelve step approaches and old myths about addiction, replacing them with evidence-based approaches.  While it sometimes is a little overenthusiastic about the extent to which its methods have been proven, rather than just having some supporting evidence, it is a welcome resource as a reasonable approach to understanding and treating addiction. It is aimed mostly at those who live with addicts and are trying to help them. The fundamental assumption of the book is that addiction is most helpfully addressed psychologically: addicts keep on their addictive behavior because they want to. They haven’t lost control, and they are open to reason and incentive. They will decrease their addictive behavior when it stops being so rewarding. At the same time, this approach does not assume that people can “just stop.” It takes time to change acquired habits and ways of thinking, and there will be many setbacks along the way. People have bad days or longer periods, when they have much more difficulty sticking to their plans to reduce or stop their addictive behavior. There are all sorts of ways to help people give up their addictions, including various medications and changes in lifestyle, and late in the book, the authors discuss these. But they spend the bulk of the book discussing how to motivate a friend or family member to change their behavior. Chapters address the nature of addiction, what makes people change, coping with your situation living with an addict, and several on how to help. Helping is based on forming goals, communicating positively, reinforcing good change and creating consequences for negative behavior, what kinds of treatment are available and how to get the person with an addiction to enter treatment.

The authors have little time for notions such as addiction as a disease or co-dependency, although they acknowledge they may be meaningful to some.  They avoid using “addict” as a way to refer to a person with a behavior problem, and they encourage reframing problems so that they appear more susceptible to change. They reject many ideas long held about addiction, such as that addicts need to “hit bottom” before they can change, or that families cannot help their loved one unless the person wants to be helped. Their approach is much more open to gradual, non-linear change, where families are direct with the person with the problem about what they want, but choose their moments carefully, and express their ideas lovingly as much as possible.  The book is clear that family members are not therapists, and their job is not to completely negate their own needs. Rather, their goal is for the people reading the book to get what they want by helping their loved ones.  The book is especially good on showing how this kind of approach means that family members are not manipulating their loved one by helping them; far from it, they are expressing their feelings and needs directly.  But that’s different from expressing every angry thought, which is not really spontaneous behavior, but instead of often long repeated and unhelpful behavior. So Beyond Addiction is conceptually rich as well as being based on good science. It will be extremely useful to anyone who lives with someone with addictive behavior.

© 2016 Christian Perring

Christian Perring, Professor of Philosophy, Dowling College, New York