BPS Textbooks in Psychology
BPS Wiley presents a comprehensive and authoritative series covering everything a student needs in order to complete an undergraduate degree in psychology. Refreshingly written to consider more than North American research, this series is the first to give a truly international perspective. Written by the very best names in the field, the series offers an extensive range of titles from introductory level through to final year optional modules, and every text fully complies with the BPS syllabus in the topic. No other series bears the BPS seal of approval!
Many of the books are supported by a companion website, featuring additional resource materials for both instructors and students, designed to encourage critical thinking, and providing for all your course lecturing and testing needs.
For other titles in this series, please go to http://psychsource.bps.org.uk.
EDITED BY
This edition first published 2018
© 2018 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Paul Davis, Robert Patton and Sue Jackson to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
Registered Offices
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Office
The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print-on-demand. Some content that appears in standard print versions of this book may not be available in other formats.
Limit of Liability/Disclaimer of Warranty
While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging-in-Publication Data
hardback: 9781118489741
paperback: 9781118489758
Cover image: © Max Krasnov/Shutterstock
Cover design by Wiley
Paul Davis, Department of Psychology, University of Surrey, Guildford, UK
Sue Jackson, Psychology Department, University of the West of England, Bristol, UK
Bob Patton, Department of Psychology, University of Surrey, Guildford, UK
Jim Orford, School of Psychology, University of Birmingham, UK
Jamie Brown, Cancer Research UK Health Behaviour Research Centre, University College London, UK
Alex Copello, School of Psychology, University of Birmingham, UK; and the Addiction Service, Birmingham and Solihull Mental Health NHS Foundation Trust, UK
David Curran, School of Psychology, Queens University, Belfast, Northern Ireland; and the NHSCT Addiction Service, Northern Ireland, UK
Rudi Dallos, Department of Psychology, Plymouth University, Plymouth, UK
Lisa Dutheil, Camden and Islington NHS Foundation Trust, London, UK
Rebecca Fisher, Camden and Islington NHS Foundation Trust, London, UK
Alina Galis, Camden and Islington NHS Foundation Trust, London, UK
Andre Geel, Addictions Service, Central and North West London NHS Foundation Trust, London, UK
Jennifer Harris, Addictions Clinical and Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
Robert Hill, Addictions Clinical and Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
Adam Huxley, Change Grow Live, London, UK
Edward J. Khantzian, Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
Aska Matsunaga, Central and North West London NHS Foundation Trust, London, UK
Liz McGrath, Camden and Islington NHS Foundation Trust, London, UK
Mani Mehdikhani, Specialist Services Network, Greater Manchester West Trust, Manchester, UK
Luke Mitcheson, Addictions Services, South London and Maudsley NHS Foundation Trust, London, UK; and Alcohol, Drugs & Tobacco Division, Public Health England, London, UK
Fraser Morrison, NHS Lanarkshire, Scotland, UK
Jo M. Nicholson, Sheffield Teaching Hospitals, Sheffield, UK
Dominic O'Ryan, Camden and Islington NHS Foundation Trust, London, UK
Tony Rao, Psychiatry Department, South London and Maudsley NHS Foundation Trust, London, UK
Jenny Svanberg, Substance Misuse Department, NHS Forth Valley, Falkirk, UK
Arlene Vetere, VID Specialized University, Oslo, Norway
Sarah Wadd, Substance Misuse and Ageing Research Team (SMART), University of Bedfordshire, Luton, UK
Kathryn Walsh, Psychology Department, University of Birmingham, Birmingham, UK
Martin Weegmann, NHS; and Independent Practice London, UK
Robert West, Cancer Research UK Health Behaviour Research Centre, University College London, UK
Christopher Whiteley, Psychology Department, South London and Maudsley NHS Foundation Trust, London, UK
Addiction is highly prevalent. The World Health Organization (WHO) estimates that the number of people globally who suffer from an alcohol or drug use disorder annually is in the region of 100 million. Harmful and hazardous alcohol use, like tobacco, is considered by WHO to be a major preventable contributor to the global burden of disease and disability. There is no estimate, to my knowledge, of the worldwide prevalence of gambling disorder, but in Britain alone the adult annual prevalence is in the region of a third to a half million, which is very similar to the prevalence of disorders associated with illicit drug use. So prevalent is addiction that it can reasonably be thought of, along with anxiety and/or depression, as one of the two most common forms of psychological disorder. Yet in most relevant professions and disciplines, including psychology, it remains strangely marginalized. In Chapter 14 in this volume, on AA and 12 Step programmes, Martin Weegmann admits that when he first worked in the area of the addictions he had had virtually no experience of this client group, and minimal training in the area during his clinical psychology course. My experience was even worse. I led two clinical psychology training courses, in Exeter for 17 years in the 1970s and 1980s, and then in Birmingham for five years in the 1990s. Despite my passionate interest in the addictions, the British Psychological Society requirements for a training course, plus the lack of availability of supervised practice, plus I suspect a lot of prejudice about the topic, meant that my success in giving trainees a better grounding in the subject than Martin and I had had was only minimally successful. Perhaps everything has changed. I hope so, but suspect not. That is one of the main reasons why this book is so important.
Judging by the enthusiasm shown by all the authors of the chapters of this book, it seems their experience of finding themselves working in the addiction field – like me, often by accident, I suspect – was of entering a field that is endlessly rewarding and fascinating. Large numbers of people overcome their addictions, often with our help and sometimes even without it, and when they do, their recoveries are frequently impressive, given the depths to which their lives have been harmed. Addiction has more than its share of sadness and despair, but it is also replete with hope and inspiration.
For all that we have learned about addiction and its treatment – including so much that is included in these chapters – there remains a great deal that is mysterious about it, and about recovery from it. The scope for researching and theorizing about addiction, for developing and evaluating forms of treatment, for applying knowledge and methods for understanding and treating such complications of addiction as brain damage or Hepatitis C – both topics accorded chapters here – is endless. In fact, no one book can explore anything like all the intriguing issues that surround addiction. How do gender roles influence the prevalence of the different forms of addiction? What insights does psychology offer about how we might prevent addiction? What has psychology to say about what our relationships should be, if any, with the suppliers of the products to which people can become addicted – the commercial suppliers of alcohol, tobacco and gambling products and the legal and illegal suppliers of other substances? These are among the questions that must wait for a second edition.
This book treads dangerous ground in a number of ways, departing often from dominant thinking in the field. The latter is under the sway of a bio-psychological model of addiction which privileges diagnosis (very little mention of DSM can be found in this book), a rather limited approach to evidence-based treatment, and a greater emphasis on aggregated statistics than on a detailed understanding of the experiences of people who suffer from addiction and those others who are affected by it. Certain vital issues are neglected because of that dominant model of addiction, but they get proper attention here. One, which is repeatedly mentioned, is the importance for addiction of emotions and emotional regulation. This receives some attention in the dominant paradigm – the idea of self-medication, for example – but is rarely explored in any detail. Cognition tends to rule and emotion sits in second place. Emotions and emotional regulation have the great strength of being something that unites sub-topic areas such as attachment, psychodynamic and systemic approaches, and relapse prevention and mindfulness, albeit dealt with differently under those various headings.
There are chapters in this book which reach other parts of the mystery and despair of addiction which the dominant paradigm does not reach. One feature of addiction, rarely addressed elsewhere, is its effect on a person's ability to relate to others, variously described in different chapters as the replacement of affectional bonds by ‘addictional bonds', empathic blunting, and the way addiction can interfere with sensitivities and capacities (see Nussbaum, 2000, a favourite book of mine, for an explication of the capabilities approach). Family members affected by their relatives' addictions, who are equally as numerous as those who experience addiction at first hand, and probably more so, often talk of how their relatives have ceased to be the people they knew and loved and how addiction seems to have robbed their relatives of the capacity to care for the family. For family members, addiction is truly a mystery –
how can this person they knew be investing so much in something that seems so pointless and so damaging, and relatively less in what really matters? It is good, therefore, to see families highlighted early on in the book, and in more than one token chapter, as is often the case.
Another central feature, infrequently given the attention it deserves but properly addressed here, is the ambivalence and fragmentation that come with addiction (Adams, 2008). This can be seen as a surface phenomenon, as in the instability of motivation to change (an idea that West derives from PRIME theory), or the ambivalence which is central to motivational interviewing theory, or the conflict which is central to my Excessive Appetites model (Orford, 2001). But it can also be seen, as it is in a number of chapters, as a deeper fragmentation of the self. Rarely dealt with in psychology, one otherwise needs to go to the philosopher Levy (2011) for an appreciation of fragmentation of self as being close to the essence of addiction. His key idea was that an addicted person's preferences are inconsistent: the ability to make judgements about action is not impaired, but judgements shift from time to time. What characterizes addiction, therefore, is the fragmentation of agency, an inability to consistently exert will across time, and the loss of full capacity to effectively make plans and put in place long-term projects. I see this as a form of disempowerment, and I found it extremely helpful in developing my attempt to use the concept of power to integrate otherwise disparate areas of addiction studies (Orford, 2013).
Yet another topic which it is good to see given attention is the importance for change and recovery of the relationship with helpers or therapists. As I put it in my article, ‘Asking the right questions in the right way' (Orford, 2008):
The prevailing model of psychological treatment for addiction can be described, aptly, as a technology model. It is likened to a technique which, supported by a manual and good training and supervision, can be delivered to a high standard so that ‘therapist differences' cease to be important. The therapist is the medium through which a standard technique is applied at a high level of fidelity. Some have referred to this as the ‘drug metaphor', implying that treatment is seen, like a medication, as a piece of technology that requires only therapist skill and efficiency and patient compliance in order to be delivered effectively.
Like the authors of some of the chapters in this book I have always been suspicious of that model, and our experiences in the UK Alcohol Treatment Trial (UKATT) confirmed my suspicions. When clients were asked at follow-up to what factors they attributed any positive changes they had made, the most popular attributions were characteristics of the therapist and of the client's relationship with the therapist, more so than social-type attributions for Social Behaviour and Network Therapy clients or motivational-type attributions for Motivational Enhancement Therapy clients (Orford et al., 2009).
I could go on listing the aspects of addiction which the conventional wisdom downplays or dismisses but which are not avoided in this highly thoughtful volume. The importance of narratives and story-telling, of personal and social identity, of one's life values, of the very meaning of life are among them. The experience of trauma and the high frequency of addiction problems combined with other mental health problems are recurring themes in the book.
However, clinical psychology faces a number of problems – although they are by no means confined to clinical psychology. One is the question of evidence. Like all professions, it is required to demonstrate that its treatments ‘work'. That can be problematic, not just because showing that something works can be costly, time-consuming and fraught with methodological and interpretive difficulties – research evidence is often so complex that it is difficult to draw clear conclusions – but
also because what constitutes main outcomes may be debatable. Is the main aim symptom relief or adjustment to symptoms; abstinence or harm minimization? It is also problematic if a treatment method is comparatively new and innovative. Acceptance and Commitment Therapy (ACT) is an example, as McGrath and O'Ryan's Chapter 6 makes clear. Is ACT an example of running ahead of the evidence, they ask, or is it even, as they say one client put it, just ‘hocus-pocus'? Even if it can be demonstrated that a treatment works, there is the all-important question, addressed in the final chapter, of translating evidence into practice. This is a book about psychology being used to innovate, to push forward at the frontier of a subject that needs new thinking and fresh solutions. It therefore takes us well beyond the safe and secure domain of cognitive behaviour therapy (although the point is made a number of times in this volume that new treatments can complement rather than replace existing ones).
There is, finally, another problem for psychological applications to the addictions, and that is the need to develop methods that can be applied to large numbers. Psychology has often been criticized on this score in the past. If its methods remain specialized, requiring lengthy training or specialized institutional infrastructure, then good will be done for small numbers but the impact on the huge problem of addiction will be limited. I have always agreed with the principle that psychology must be ‘given away' if it is to be effective. We must think of training others who can deliver psychosocial treatments in non-specialized settings, or working remotely using modern communication technology. We must aim to make contact with hard-to-reach groups in our own countries, and the large numbers who might benefit from psychological methods in other countries, where specialized services and trained professionals are much thinner on the ground.
Adams, P. (2008). Fragmented intimacy: Addiction in a social world. Sydney, Australia: Springer.
Levy, N. (2011). Addiction, responsibility, and ego depletion. In J. Poland & G. Graham (Eds.), Addiction and responsibility. Cambridge, MA: MIT Press.
Nussbaum, M. C. (2000). Women and human development: The capabilities approach. Cambridge: Cambridge University Press.
Orford, J. (2001). Excessive appetites: A psychological view of addictions (2nd ed.). Chichester: John Wiley & Sons, Ltd.
Orford, J. (2008). Asking the right questions in the right way: The need for a shift in research on psychological treatments for addiction. Addiction, 103, 875–885. doi:10.1111/j.1360-0443.2007.02092.x
Orford, J. (2013). Power, powerlessness and addiction. Cambridge: Cambridge University Press.
Orford, J., Hodgson, R., Copello, A., Wilton, S., & Slegg, G. on behalf of the UKATT Research Team (2009). To what factors do clients attribute change? Content analysis of follow-up interviews with clients of the UK Alcohol Treatment Trial. Journal of Substance Abuse Treatment, 36, 49–58. doi:10.1016/j.jsat.2008.04.005
Like many other complex health problems, addictions are probably best viewed within a biopsychosocial model (see, e.g. Ogden, 2012). It is, however, possibly a truism to say that the treatment of addiction is about changing behaviours, beliefs and feelings; something that psychology is likely to contribute to in a significant way. Understanding these processes from a psychological perspective, including using psychological approaches to recovery, is something academics and practitioners from all disciplines, professions and training backgrounds can benefit from. This book is intended to provide such an understanding and present an overview of the applications of psychology to addictive behaviours. The book is not written solely for psychologists, but rather is intended for all clinicians, practitioners and academics working in the addictions field, as well as those outside specialist services who may encounter addiction in their generic work. It brings together contributions from leading practitioners and academics in the addictions specialty, and provides in one volume a synthesis of psychological models and approaches used in this complex area.
Part 1 gives an overview of theories and models used to understand the aetiology and development of addictions and includes consideration of the psychological models used in the intervention approaches. Part 2 contains chapters on specific applications of psychology across selected addictive behaviour problems with a variety of service user groups, as well as practical guides to the implementation of addiction psychology in health and community care settings.
Many internationally recognized scientists, practitioners and experienced clinicians have contributed to this book, and we would like to thank them all. Gratitude is also expressed to the numerous service users who have informed the individual chapters; thank you.
Paul Davis is a Teaching Fellow in Clinical Psychology at the University of Surrey, Guildford, UK. He worked as a Consultant Clinical Psychologist and Specialist Lead for many years in several NHS mental health services in London, providing treatments for addiction problems and continues to practise as an independent consultant. His publications, research and academic work have focused on the psychology of addictions, and he provides training courses both in the United Kingdom and abroad on treatment interventions. He has held a number of national advisory roles within health and criminal justice bodies working on policy and guidelines development.
Sue Jackson is a chartered psychologist specializing in the psychosocial impact and treatment of chronic health conditions. In addition to managing an extensive research portfolio, she is a visiting lecturer at a number of UK universities. Dr Jackson supports a number of patient support charities, and is the first psychologist to serve on the Medical Advisory Committee for the Pituitary Foundation.
Robert Patton is a lecturer in Clinical Psychology based at the University of Surrey and a Visiting Research Fellow in Addiction at King's College London. He has run a research consultancy since 1993. During the 1990s he worked as a consultant for the Home Office Drugs Prevention Initiative and as research associate in health promotion for the University of Northumbria. Now based in London, he has worked for Royal Holloway, LSHTM, Imperial College, the Institute of Psychiatry and the Maudsley Hospital.
Jim Orford. In his time as a clinical, and later clinical-cum-community, psychologist working in NHS and university settings in London, Exeter and for the last 20 years in Birmingham, Jim Orford has researched and written extensively about substance and gambling problems and particularly about their impact on the family. His best-known work is Excessive Appetites: A Psychological View of Addictions (2nd ed., 2001) and his most recent book is Power, Powerlessness and Addiction (2013).
Jamie Brown is a Principal Research Fellow of the Society for Study of Addiction at University College London. He co-leads a programme of research to evaluate digital behaviour change interventions and runs the Smoking and Alcohol Toolkit Studies. In over 80 publications on a variety of topics, his focus has been on tobacco control, including e-cigarettes, harm reduction and the real-world effectiveness of smoking cessation treatments. He has been invited to present his work on e-cigarettes at international conferences, to the UK regulatory authorities for medicines, and has co-authored a briefing to the UK all-party parliamentary pharmacy group. He is a co-author of Theory of Addiction (2nd ed.) and ABC of Behaviour Change Theories, and is an Assistant Editor of the journal Addiction.
Alex Copello is Professor of Addiction Research at the School of Psychology, University of Birmingham, and Consultant Clinical Psychologist with the Birmingham and Solihull Mental Health NHS Foundation Trust addiction services, where he leads the addictions research and innovation programme. His career has combined clinical, service management and academic work. Alex has researched extensively on the impact of addictions upon families and family-based interventions and publishes regularly in scientific journals.
David Curran is a consultant clinical psychologist working for an Addiction Service in Northern Ireland, and Assistant Course Director with the Doctorate in Clinical Psychology training programme at Queens University Belfast. Areas of clinical and research interest include early adversity, attachment, trauma and co-morbid presenting problems.
Rudi Dallos is Professor of Clinical Psychology at Plymouth University, UK. Rudi is a clinical psychologist and systemic family therapist. Professors Vetere and Dallos have co-authored many articles and three books: Systemic Therapy and Attachment Narratives: Applications across a Range of Clinical Settings (2009, Routledge), is most relevant to their chapter in this book.
Lisa Dutheil trained as a clinical psychologist at the Institute of Psychiatry, Psychology and Neuroscience (King's College London). She has a long-standing interest in addictions, and worked for several years pre-qualification as a practitioner and manager within third sector substance misuse services. Since 2011, she has practised as a clinical psychologist in the alcohol services at Camden and Islington NHS Foundation Trust. She works with individuals and groups, primarily using CBT, Mindfulness Based Approaches and Motivational Interviewing.
Rebecca Fisher is a clinical psychologist who has worked with the National Problem Gambling Clinic. She has worked with problem gamblers in individual and group formats, assessing and treating them as part of the therapeutic programme at the clinic. She is now working in offender care in a London NHS Trust.
Alina Galis is a clinical psychologist who has worked in substance misuse services since 2007; in NHS Fife, in Camden & Islington Foundation Trust and in the South Westminster Drug & Alcohol Service, in partnership with the third sector. She completed her training as a clinical psychologist at the University of Edinburgh and has previously worked a part of a research group within the Centre for Addiction Research & Education Scotland, University of Dundee. Clinically, she works with individual and group interventions for substance misuse and dual diagnosis.
André Geel is a consultant clinical psychologist in Addictions for Central and North West London NHS Foundation Trust. He has considerable experience working in the NHS, specializing in community, general mental health and addictions. He has been a management and clinical lead for a number of services, as well as contributing to a variety of psychology training courses in London and the South-East of England. He has held Project Lead positions for Addictions for the British Psychological Society, has acted as Chair of Substance Misuse Management in General Practice and is on the Executive of the Skills Consortium. He was one of the psychology contributors to the NICE Guidelines on Substance Misuse Services.
Jennifer Harris is a clinical psychologist working in inpatient and community addictions services at South London and Maudsley NHS Foundation Trust. She has a particular interest in working with trauma and is also an EMDR Therapist. Prior to this, she worked as a researcher in the field of addictions and holds an MSc in Health Psychology.
Robert Hill is a consultant clinical psychologist. His area of speciality is addictive behaviours, along with co-morbid psychological difficulties and neuropsychological functioning. He has previously worked as a Senior Lecturer at Middlesex University, focusing on the reduction of stress and burnout among community and inpatient mental health staff. He has a particular interest in philosophy and holds an MA in Modern European Philosophy. His most recent publication is Principles and Practice of Group Work in Addictions, published by Routledge, with his colleague Dr Jennifer Harris.
Adam Huxley is a consultant clinical forensic psychologist. He is currently the national psychology lead for Crime Reduction Initiatives, a leading charity providing support to vulnerable people facing addiction, homelessness and domestic abuse. His research and clinical interests include the impact of substance misuse on marginalized groups.
Edward J. Khantzian is Clinical Professor of Psychiatry, Harvard Medical School, and a founding member of the Department of Psychiatry at The Cambridge Hospital, MA, USA. He has spent more than 40 years studying psychological factors associated with drug and alcohol abuse. Dr Khantzian is a practising psychiatrist and psychoanalyst, a participant in numerous clinical research studies on substance abuse, and a lecturer and writer on psychiatry, psychoanalysis, and substance abuse problems. His studies, publications, and teaching have gained him recognition for his contributions on self-medication factors and self-care deficits in substance use disorders and the importance of modified techniques in group therapy for substance abusers. He is a founding member of the American Academy of Addiction Psychiatry (AAAP) and is a Past-President of this national organization. AAAP honoured him in 2000 by making him the recipient of its Founders Award and Keynote speaker for the annual scientific meeting in recognition of his ‘courage in changing the ways we think of and understand addictions'.
Aska Matsunaga completed her BSc Applied Psychology degree at the University of Kent as part of her career path to become a clinical psychologist, and has worked in London treatment services in addictions and adult mental health. She has delivered CBT in group settings and carried out research on methadone maintenance treatment as well as research into cross-cultural anger rumination and aggressive behaviour.
Liz McGrath qualified as a clinical psychologist from University College London, and has over 16 years experience of work in addiction services in Central London. She completed her training in clinical neuropsychology at the Institute of Psychiatry, London, before going on to train in mindfulness-based approaches at the Centre for Mindfulness Research and Practice in Bangor, Wales. Liz has applied mindfulness-based approaches at the individual, group, team and organizational levels in an inner-London NHS substance misuse service.
Mani Mehdikhani is a principal clinical psychologist and currently works for Greater Manchester West Trust's Specialist Services Network. Mani has worked as both a clinician and as a researcher in the field of addictions and substance misuse. He is a member of the British Psychological Society (BPS) and is also registered with the Health & Care Professions Council (HCPC). Mani regularly teaches on the Addiction modules at both Manchester and Liverpool Universities' Clinical Psychology training courses, and he has an interest in addiction, attachment, evolutionary psychology and personality disorders.
Luke Mitcheson, consultant clinical psychologist, is the Lead Psychologist for the addictions services in the South London and Maudsley NHS Foundation Trust and a consultant working in Lambeth community drug and alcohol services. He is also seconded as a clinical advisor to Public Health England in the Alcohol, Drugs and Tobacco Division.
Fraser Morrison is a clinical psychologist working in the field of Alcohol Related Brain Damage (ARBD). He has significant experience of substance misuse services and has specialized in the area of ARBD in recent years. He is currently completing the British Psychological Society Qualification in Clinical Neuropsychology and has published research specifically in this field of adapting existing therapeutic approaches and investigation of outcome.
Jo M. Nicholson completed her Doctorate of Clinical Psychology in 1997 and worked for 12 years in adult mental health services, mostly within acute psychiatric care settings. She currently specializes in working with people with Hepatitis C at Sheffield Teaching Hospitals. Dr Nicholson has an enduring interest in working with ‘hard to reach/hard to engage' groups, and she has a special interest in working with dual diagnosis, personality and substance misuse populations. In addition, she has an interest in service development and change process in NHS settings.
Dominic O'Ryan trained as a clinical psychologist at University College London and has worked as a practitioner and developer of clinical approaches in addiction services in Central London for over 15 years. In addition, he qualified in CBT from the Institute of Psychiatry, London, and in CBT Supervision from Royal Holloway University of London. Dominic has trained and practised in mindfulness-based cognitive therapy and offers mindfulness, acceptance and resilience-based approaches to service users and staff in an inner-London NHS substance misuse service.
Tony Rao is consultant old age psychiatrist at South London and Maudsley NHS Foundation Trust, working in an inner-city area of London with high rates of alcohol misuse in older people. As well as a Visiting Researcher at the Institute of Psychiatry, Tony is Chair of the Royal College of Psychiatrists Working Group on Older People and Substance Misuse. He is involved in policy change for older people with dual diagnosis and provides expertise to advisory bodies and voluntary organizations on substance misuse in older people.
Jenny Svanberg is a consultant clinical psychologist and Lead Psychologist for Substance Misuse in NHS Forth Valley. Her research and clinical interests include the prevention, assessment and treatment of complex difficulties relating to substance use and addiction.
Arlene Vetere is Professor of Family Therapy and Systemic Practice at VID Specialized University, Oslo, Norway. Arlene is a clinical psychologist and systemic family therapist. Professors Vetere and Dallos have co-authored many articles and three books: Systemic Therapy and Attachment Narratives: Applications across a Range of Clinical Settings (2009, Routledge), is most relevant to their chapter in this book.
Sarah Wadd is programme director of the Substance Misuse and Ageing Research Team (SMART) at the University of Bedfordshire and is one of the UK's leading experts on substance misuse in older people. Her seminal ‘Working with Older Drinkers Study' identified best practice in this area, based on interviews with alcohol practitioners who specialize in working with older people and older people receiving alcohol treatment. She is an expert advisor on substance misuse in older people for the Welsh Government and the UK's Advisory Council on Drug Misuse. Sarah is the academic lead for the £25m Big Lottery-funded ‘Drink Wise Age Well' Programme which aims to reduce alcohol-related harm in people aged 50 and over. Her other research studies have included alcohol misuse that co-exists with cognitive impairment in older people and illicit drug and medication misuse in older people, and she has contributed to studies on alcohol-related elder abuse and sight loss. Sarah is a cofounder of the Coalition of Older Adults Affected by Substance Misuse (COAASM), whose members work to reduce discrimination and improve prevention, services and treatment for older adults and families affected by substance misuse.
Kathryn Walsh is currently pursuing clinical psychology doctoral training at the University of Birmingham. Kathryn previously worked as a Research Associate at the School of Psychology, University of Birmingham, in a Brief Intervention National Institute of Health Research funded randomized controlled trial for people with addictions and severe mental health problems. She has published in the area of addictions and mental health and was awarded the first prize in the mental-health and substance-use essay competition 2012 by the Mental Health and Substance Use academic journal, where the essay was subsequently published.
Martin Weegmann is a consultant clinical psychologist and group analyst, with 20 years experience in the field of substance misuse. He is a well-known trainer, having delivered workshops and keynote lectures to a range of organizations through the United Kingdom, including organizing seven annual conferences on the theme ‘Psychotherapy of Addiction'. Martin has co-edited two books, Psychodynamics of Addiction (2002, Wiley) and Group Psychotherapy and Addiction (2004, Wiley) and published many chapters and papers. His latest book, The World within the Group: Developing Theory for Group Analysis (London, Karnac) was published in 2014. In 2011, he joined the General Services Board of Alcoholics Anonymous, as a ‘non-alcoholic trustee'.
Robert West is Professor of Health Psychology and Director of Tobacco Studies at the Cancer Research UK Health Behaviour Research Centre, University College London, UK. Professor West is also Editor-in-Chief of the journal Addiction. He has authored more than 500 scientific articles, books and book chapters. He was co-founder of the NHS stop-smoking services. His research includes evaluations of methods of helping smokers to stop and population surveys of smoking and smoking cessation patterns. He is author of The SmokeFreeFormula (Orion), which aims to bring the science of stopping to smokers. For more information, see www.rjwest.co.uk.
Christopher Whiteley, consultant clinical psychologist, is the Trust Deputy Head of Psychology for South London and Maudsley NHS Foundation Trust. His clinical work is with the Trust's specialist HIV Mental Health Team. He previously worked for over 10 years in drug and alcohol treatment services and more recently as a seconded clinical advisor to Public Health England in the Alcohol, Drugs and Tobacco Division.