ADDICTION AND ITS SCIENCES doi:10.1111/j.1360-0443.2006.01706.

The psychological science of addiction

Elizabeth Gifford & Keith Humphreys

Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA, USA

ABSTRACT

Aim To discuss the contributions and future course of the psychological science of addiction. Background The
psychology of addiction includes a tremendous range of scientific activity, from the basic experimental laboratory
through increasingly broad relational contexts, including patient–practitioner interactions, families, social networks,
institutional settings, economics and culture. Some of the contributions discussed here include applications of behav-
ioral principles, cognitive and behavioral neuroscience and the development and evaluation of addiction treatment.
Psychology has at times been guilty of proliferating theories with relatively little pruning, and of overemphasizing
intrapersonal explanations for human behavior. However, at its best, defined as the science of the individual in context,
psychology is an integrated discipline using diverse methods well-suited to capture the multi-dimensional nature of
addictive behavior. Conclusions Psychology has a unique ability to integrate basic experimental and applied clinical
science and to apply the knowledge gained from multiple levels of analysis to the pragmatic goal of reducing the
prevalence of addiction.

Keywords Addiction, behavior, psychology, substance use disorder intervention.

Correspondence to: Elizabeth Gifford, Program Evaluation and Resource Center (152-MPD), 795 Willow Road, Menlo Park, CA 94025, USA.
E-mail: elizabeth.gifford@va.gov
Submitted 7 July 2006; initial review completed 20 September 2006; final version accepted 16 October 2006

INTRODUCTION defined in the traditional sense as a ‘a rule or law con-

Psychology is the study of the individual in context, and
as such is fundamental to the clinical and research aspi-
rations of the addiction field. ‘Addiction’ is a hypothesis,
namely that a cluster of correlated phenomena are linked
by an underlying process (or as Gertrude Stein might
have put it, that there ‘really is a there, there’). Without
the behavior of persistent, destructive substance use, the
environmental availability of the substance itself, and the
environmental effects on the behavior, it would be diffi-
cult from a scientific viewpoint (and meaningless from a
clinical viewpoint) to verify the hypothesis that addiction
really exists. This does not limit addiction to observable
behaviors but does identify behavior–environment inter-
action as the central concern.
Throughout this paper we argue for attending to the
dynamic multi-dimensional adaptations involved in
person–environment interactions. We describe several
domains in which psychology, as a focused and flexible
science, is making contributions to understanding the
development, maintenance and recovery from addiction.
From this knowledge base we derive some principles
cerning the functioning of natural phenomena [emphasis
added]’ [1]. We emphasize how a functional approach
provides a useful means of orienting scientific efforts,
integrating basic and applied domains and leading trans-
disciplinary or interdisciplinary research efforts. We close
by illustrating how the functional principles derived from
this knowledge base contribute to a progressive, incre-
mental science of addiction.
Before proceeding to our review of psychology’s sub-
stantive and conceptual contributions to the field, we
would acknowledge all too briefly psychology’s far-
reaching contributions to methods. Graduate psychology
training programs typically place substantial emphasis
on measure development and assessment. One dividend
from this investment is many widely used instruments
designed by psychologists to assess individuals, families,
treatment programs and environments; for example,
Moos’ coping responses inventory [2] and social ecology
scales [3], Halstead & Reitan’s neuropsychological test
battery [4] and McLellan and colleagues’ [5] Addiction
Severity Index. Psychologists have also been leaders in
the development and application of quantitative

© 2007 Society for the Study of Addiction. No claim to original US government works Addiction, 102, 352–361

methods, including accounting for regression to the
mean [6], establishing construct validation [7,8] and
improving quasi-experimental and experimental treat-
ment evaluations using mediational modeling [9] and
meta-analysis [10]. Indeed, experimental studies with
human participants in addiction are almost entirely the
province of psychologists, including but not limited to
many of the methods used to evaluate learning. All these
methodological contributions made possible the
advances on which we focus in this essay, as well as innu-
merable advances that space limitations will prevent us
from discussing here.
ADDICTION AND MOTIVATION
The best scientific evidence for addiction is provided
by persistent substance use in the face of cumulative
costs, such as psychological distress, social conflict
and physical harm to health.
Addiction is not simply a physiological process, but the
action of multi-dimensional individuals behaving in a
particular fashion in certain contexts. Although many
professional and lay individuals speak of addiction as if
it were synonymous with tolerance and withdrawal,
both of these phenomena can occur without addictive
behavior [11]. Indeed, even if we developed a blood test
that could measure precisely the degree of an individu-
al’s physical tolerance to a drug, it would be hard to
convince ourselves or that person that they were
addicted without the evidence of drug-seeking and
using, i.e. a particular behavior–environment interac-
tion. In addition to making psychology of central rel-
evance to understanding addiction, this distinction also
aids in the interpretation of research findings. It may
explain, for example, why an episode of sustained absti-
nence in out-patient treatment predicts subsequent
abstinence when detoxification alone does not. The
change in the persistent behavior, not the absence of the
chemical alone, improves the likelihood of future absti-
nence [12].
Descriptions of addiction often use terms such as
‘overwhelming desire’ or ‘out of control’ to describe the
persistence of substance use in the face of damaging con-
sequences [13]. Yet behavior that looks ‘out of control’ to
the observer is in fact an individual’s response to their
environment and perceived options at the time. Models of
motivation attempt to characterize the processes under-
lying these seemingly irrational choices. These models
posit a range of motivations. Stated generally, people use
drugs because drugs feel good (positive reinforcement
[14], because drugs reduce or remove the experience of
feeling bad (negative reinforcement [15]), because brain
processes enhance the reward value of substances over
time to the point that automatic addictive behaviors
© 2007 Society for the Study of Addiction. No claim to original US government works
Psychology of addiction 353
occur without thinking (a combination of the effects of
drugs on the brain’s reward systems, particularly dopam-
ine signaling in the nucleus accumbens, respondent con-
ditioning and incentive sensitization [16–18]) and
because of other cognitive processes (e.g. expectancies,
beliefs, mental representations, self-efficacy and coping
[19]. More recent models synthesize these various
dynamic motivations [13,20]). Notably, all the above
models are concerned with understanding how and why
addicted individuals persistently respond to certain
immediate rewards [13].
SOCIAL CONTEXT
Addictive behavior occurs within a social context,
which can serve as a risk or protective factor. Social
contexts and individuals influence one another.
What are the contexts that influence the above-
described motivations? Psychology has led the field in
identifying the importance of social connection in
addiction, including the conceptualization and measure-
ment of the social ecology in which addicted people
receive care and in which they live [21,22]. Social
context serves as both a risk factor and protective factor
for substance use, playing an important role in addic-
tion’s initiation, escalation, maintenance and relapse;
and conversely in its prevention, treatment and long-
term resolution. Relevant social contexts include the
family, provider–patient relationships, treatment envi-
ronment, peer groups and friendship networks, work
settings, self-help organizations, neighborhoods and cul-
tural groups, including religious/spiritual communities.
As just a few examples, research in which psychologists
have been involved has shown that association with
substance-using peers is a major risk factor for initia-
tion, escalation and relapse [23]; that the quality of
provider–patient relationships contributes to patient
retention in substance use disorder treatment [24]; that
participation in a 12-Step community after treatment
facilitates ongoing recovery [25]; that improving paren-
tal functioning and resources improves substance abuse
outcomes for adolescents [26]; and that participation in
organized religion and the family and social contexts
that promote such participation are among the stron-
gest predictors of not initiating substance use in chil-
dren and adolescents [27]. Clearly, the dynamic
interface between the social group and the individual
has a powerful influence on addiction.
Several general psychological theories describe the
relationships between social context and individual
addictive behavior. Among these, social control theory
emphasizes the motivational effects of the bonds between
group members, social learning theory emphasizes the
importance of role models in the development of
Addiction, 102, 352–361
354 Elizabeth Gifford & Keith Humphreys
substance-related behaviors and attitudes, and stress and
coping theory emphasizes the impact of stressors result-
ing from social disorganization on the coping resources of
the individual [28]. All these approaches describe influ-
ence processes moving bidirectionally between individu-
als and their social setting [21]. Current psychological
research is focused on characterizing these mutual
influence processes; for example, some of the dynamic
adaptational interactions between environments and
individuals described below.
FUNCTIONAL
BEHAVIORISM/BEHAVIORAL
ECONOMICS
Addictive behavior interacts dynamically and
lawfully with its environment.
The basic principles of learning and conditioning
observed by Thorndike [29] and other psychologists (i.e.
operant and respondent paradigms) continue to provide a
framework for understanding the interactions between
environment and addictive behavior. For example, Herrn-
stein’s Matching Law characterizes patterns of interac-
tion between changes in reinforcement opportunities and
individual choice [30]. The Matching Law showed that
the ratio of behavior distributed between two choices will
‘match’ the ratio of reinforcement distributed across
them, expanding the notion of functional relationships to
include a broader environmental context rather than just
a unitary reinforcer. For example, environments with
greater levels of available positive reinforcement in
general may make it less likely that a particular positively
reinforced behavior, such as substance use, will occur
[31]. The Matching Law has provided the basis for many
behavioral economic theories of choice which attempt to
quantify the relationships between benefit/cost ratios of
substance consumption and benefit/cost ratios of other
activities [32].
We would note here that ‘reinforcement’ is a fre-
quently misunderstood term that refers to a fundamen-
tally personal phenomenon. The form or topographic
features of an event do not define it as a reinforcer (e.g.
giving a weeping client candy is unlikely to reinforce
continuing discussion of the costs of using); rather,
reinforcement refers to the functional impact of the
experienced event for that particular person (more
technically, whether the event functions to increase
the probability of the behavior it follows in a specific
context [33,34]). Reinforcement is a function of a
multi-dimensional person interacting with a complex
environment. Attention, perception and motivation, for
example, may be critical in establishing how a reinforcer
functions in any given setting.
© 2007 Society for the Study of Addiction. No claim to original US government works
Learning principles characterize certain dynamic
interactions between individuals and their environments,
and also offer a unique bridge for integrating basic and
applied domains. The most successful psychosocial treat-
ments for addiction have applied basic functional models
to clinical settings [35]. Contingency management, for
example, an empirically supported treatment for stimu-
lant abuse and for promoting retention in methadone
maintenance programs, applies operant processes of
contingent reinforcement such as vouchers for clean
urine tests and take-home doses for attending clinic
counseling sessions [36]. Motivational interviewing, an
empirically supported cognitive behavioral treatment for
substance abuse, positively reinforces treatment relevant
behaviors such as ‘change talk’ using interpersonal pro-
cesses within the therapy session (i.e. support, empathy
and contingent feedback; [37,38]).
Dynamic functional processes of problem resolution
may also occur outside treatment settings [39]. The con-
tingency of reinforcement mediates contingency man-
agement treatment, as specified in its functional model.
Yet treatment is only one structured context where these
principles operate. Other social contexts such as 12-Step
fellowships or religious communities may also reduce the
likelihood of drinking or relapse by naturally reinforcing
adaptive alternatives to substance use, e.g. sponsors in
12-Step programs may provide social support contingent
on abstinence and encourage socially normative activi-
ties such as working, self-care, family life, recreational
activities, etc. [40]. Communities bring these functional
processes into play without the conceptual framework of
behavioral psychology, e.g. ‘reinforcement’, etc. [41].
THE PSYCHOLOGICALLY INFORMED
NEUROSCIENCE OF ADDICTION
Addiction involves learned responses to a drug and
to the environments in which drug taking is
experienced. The brain encodes these learning
histories as neuroplastic adaptations including
alterations in the mesolimbic dopamine
reinforcement systems.
Learning principles link not only basic and applied
domains within psychology but also psychology and
other disciplines, thus offering one natural point of inter-
disciplinary integration. Psychological data derived from
the application of learning principles in animal models
have been essential to progress in the neurobiology of
addiction. As stated recently in this journal, the agenda of
modern addiction brain science is to validate molecular
and neurochemical candidate systems functionally by
demonstrating their causal relationships with addictive
processes [42]. Basic behavioral methods provide a
framework for evaluating the function of candidate
Addiction, 102, 352–361

neurobiological systems (e.g. place preference paradigms,
drug self-administration, reinstatement of drug seeking,
etc.). Relevant systems include those involved in the neu-
ropharmacological processes of behavioral response to
substances as well as the neuroadaptive mechanisms
within specific neurocircuits that may mediate addictive
behavior, such as the circuits recruited in the transition
from occasional use to uncontrolled use, from positively
reinforced to negatively reinforced addictive behavior, or
from compulsive use back to controlled use or abstinence.
Studies of mesolimbic dopamine circuits, for example,
have identified neuroadaptive processes linked to rein-
forcement in general (e.g. [43]) and have also identified
effects specific to drugs of abuse that may lead to the
overvaluation of drug rewards as compared to natural
reinforcers [44,45].
Cue-elicited craving offers one example of psycholo-
gy’s leadership role in transdisciplinary neuroscience col-
laborations [46]. The presence of cues associated with the
availability of learned reinforcers such as alcohol or other
drugs will increase behavioral responding for these
rewards [47]. Cue conditioning is a key element in the
development and maintenance of addiction, and cue-
elicited craving a key aspect of relapse [48]. The neu-
ropeptide cortisol-releasing factor (CRF) offers one
possible pathway for the relationship between stress, cue
conditioning and relapse in habitual users [49]. CRF
released in the nucleus accumbens shell in response to
stress may increase the incentive salience of cues signal-
ing the availability of learned reinforcers, increasing
behavioral responding for rewards when such cues are
present. Because drug withdrawal can be a significant
stressor, potently releasing CRF in limbic brain circuits,
this process may become a negative reinforcement cycle
driving ongoing drug use, described as ‘the downward
spiral of addiction’ [50]. Notably, this explanation
describes neurobiological mechanisms conceptualized in
terms of behavioral principles of negative reinforcement.
Cue-elicited craving has been associated with neu-
ronal processing in the anterior cingulate cortex and
frontal cortex [51–53]. A related promising line of neu-
roscience research examines how the frontal cortex
inhibits automatic responding in immediate decision-
making tasks. Performance on executive function/task-
switching tests (which include inhibition) has been
associated with neural processing in the prefrontal cortex
in both neuroimaging and electrophysiological studies
[54–56]. For example, several studies have demonstrated
that activity in areas of the frontal cortex is associated
with the ability to alter responding in a well-trained
signaled response task [57,58]. These studies are provid-
ing important information on individual decisions about
behavior choice, and about how alternate behaviors can
be produced even when a given response has become
© 2007 Society for the Study of Addiction. No claim to original US government works
Psychology of addiction 355
‘automatic’ and favored. Understanding this process has
obvious importance for modifying impulsive behavior in
addiction. In particular, these studies have shown that
the ability to inhibit automatic responding by the frontal
cortex is easily overwhelmed by loading of working
memory, which occurs when experiencing stressors such
as cravings. In other words, a person may not be able to
stop a well-trained behavior such as drug taking using
frontal cortex inhibition when they are experiencing high
levels of cue-elicited craving.
Psychology has thus expanded, and at times tran-
scended, its own discipline, applying learning principles
and other contributions toward improving our under-
standing of the neuroanatomical substrates of affective
and cognitive processes such as stress and executive func-
tion. The field continues to play a pivotal role in identify-
ing the dynamic neurobiological processes involved in
vulnerability to addiction, consequences of substance use
and important aspects of addiction including relapse, loss
of control, craving and drug choice.
Psychology can also serve as a useful guard against
concluding that because brain systems are involved in
addiction, all solutions to addiction are found in the brain
(or in genes; see [59]). The environmental stressors that
facilitate certain genetic expressions are not equal in their
effects across individuals. Psychological factors influence
how stressors are appraised and coping responses can
minimize or augment their impact; and changes in the
environment can change individual behavior. The behav-
ior economic literature, for example, suggests the impor-
tance of restricting access to substances as a strategy for
reducing addiction, as it raises the behavioral costs of use
and thereby increases the attractiveness of other behav-
iors. This has been well demonstrated in the effect of ciga-
rette cost on smoking [60].
INTERVENTION
Many empirically based substance use disorder
behavioral interventions facilitate recovery from
addiction, although not necessarily for the reasons
specified in their theories.
Research indicates that well-specified psychosocial sub-
stance use disorder treatments have a positive impact on
outcome, and there are many such treatments from
which to choose. The US National Institute of Drug
Abuse, the British Association of Psychopharmacology
[61] and the Swedish Council of Health Care Technology
Assessment [62] are among notable organizations who
have compiled lists of empirically supported treatments
for addiction and its prevalent comorbidities. Most of
these treatments were developed by psychologists based
on psychological theories, including motivational
Addiction, 102, 352–361
356 Elizabeth Gifford & Keith Humphreys
interviewing, social skills training, combined behavioral
and nicotine replacement therapy for nicotine addiction,
structured family and couples therapy and community
reinforcement approach and family training [63].
Psychologists have taken a leading role in proposing
new theories of treatment and in promoting rigorous
treatment evaluation, including the development of
treatment integrity measures and other methodological
innovations (e.g. despite occasionally being portrayed as
a ‘touchy-feely’ irrationalist, the psychologist Carl Rogers
helped begin the tradition of rigorous evaluation of psy-
chotherapies; see [64]). The results of trials comparing
well-specified behavioral therapies (and at times behav-
ioral versus pharmacotherapies) show that different well-
specified substance use disorder treatments usually have
similar levels of efficacy [65–67]. However, exceptions to
this rule exist. For example, a recent meta-analysis of
cue–exposure therapy [68] yielded equivocal evidence for
its efficacy and also failed to support its specified mediat-
ing model, i.e. reductions in cue–reactivity are not pro-
duced by this treatment and/or do not effect the critical
behaviors [69].
Large controlled trials including mediational analyses
have rarely identified a treatment with reasonable evi-
dence for its purported mechanism of change. Among
the few exceptions appear to be contingent reinforcement
of abstinence in cocaine addiction [70] and Alcoholics
Anonymous participation in 12-Step facilitation counsel-
ing [71,72]. Accurately identifying mediators is vitally
important, because clarifying the critical aspects of treat-
ment may allow us to improve its potency and determine
for whom a particular treatment might work [73]. It is
not as useful to know, for example, that men do better in
certain smoking cessation treatments than women
unless we also know why and what to do about it (see [74]
for an excellent discussion).
WEAKNESSES
Psychology has made major contributions to under-
standing addiction, but we would be the first to acknowl-
edge that it has also occasionally ‘filled a much-needed
gap’ in the field’s approach and knowledge. Psychologists
have at times tried to explain individual behavior without
sufficient appreciation of context. US psychology has
been the worst offender, in some ways reflecting the larger
cultural narrative that individuals create their own lives
and triumph over all contexts (or if they do not, they have
only themselves to blame). For example, for every pub-
lished article concerning ‘drug use and poverty’ in the
psychological literature, more than 50 articles focus on
‘drug use and personality’ [75]. Callous behavior by soci-
eties and governments are justified too easily when prob-
lems shaped by powerful environmental forces are
© 2007 Society for the Study of Addiction. No claim to original US government works
attributed entirely to intrapersonal variables. Disregard
for context has led to some psychologists making pro-
nouncements on the ‘universal features of addiction’
(among many other features of human existence) on the
basis of how small samples of white, middle-class under-
graduates have filled out a questionnaire.
Psychologist have also at times over-psychologized
‘addiction’ by not taking drugs sufficiently seriously as
environmental features with unique, genuine and power-
ful properties not determined solely by the individual
user’s expectancies, psychodynamic conflicts or cognitive
biases. Psychologists who market services for alleged
‘addictions’ to work, shopping and television should
weigh carefully the public health implications of implic-
itly equating long days at the office, discounts at Sains-
bury’s and re-runs of Star Trek episodes with nicotine,
heroin and alcohol. The latter three environmental fea-
tures should be handled differently by programs and
policy makers because they are objectively different than
the former three, no matter how many people say that
they feel addicted to them, ‘just like being addicted to
drugs’. The inner life of individuals is, of course, an
important part of psychology, but only in the context of
environmental features interacting with behavioral
responses, and what the individual learns from those
interactions. Acontextual theories risk addressing only a
small portion of an integrated system, and thus misdirect
our attention to less relevant details at the expense of
factors related more directly to the phenomenon of
addiction [13].
SETTING THE COURSE: TREATMENT
RESEARCH AS AN EXEMPLAR
What can psychology do in the future to avoid repeating
missteps and to break into new directions? Clarifying our
theoretical assumptions may help to guide future
research efforts. The field of treatment research offers one
example.
Decades of research on clinical treatment has led to a
substantial knowledge base. We know that treatment
benefits a significant proportion of addicted people, and
we have a variety of reasonably effective treatments to
offer. However, the results of large, well-funded and well-
designed treatment research studies such as Project
MATCH [76], the UK Alcohol Treatment Trial [77] or the
VA Multisite Substance Abuse Treatment Study [78]
show that null findings are arguably the single most
common outcome in large-scale substance use disorder
treatment studies. Although one cannot prove the null
hypothesis that treatments do not differ, the consistency
of these non-results in well-powered studies suggests that
our theories are failing to capture critical factors. It is
time to consider additional strategies.
Addiction, 102, 352–361

Psychologists have long discussed factors common to
different treatment approaches that may be responsible
for treatment effects. The therapeutic relationship is the
most frequently researched of these so-called ‘common
factors’ [79]. Although researchers described originally
the therapeutic relationship as ‘non-specific’ in an
analogy to the pharmacologically inert component of
medication, it has become clear that the therapeutic rela-
tionship is an active interaction [80,81] that may
increase treatment engagement and other recovery-
relevant behaviors [24,82]. Currently, the critical ques-
tion is how the therapeutic relationship functions, i.e.
how does the provider interact with the patient in specific
processes which change the patient’s behavior and are
responsible for treatments’ effects [83]?
Miller [84] recently distinguished ‘name brand’ treat-
ments from the mediating processes by which treatments
exert their effects. Summarizing the current knowledge
base on addiction in the biological, psychological, social
and intervention research domains, Miller and colleagues
drew a number of evidence-based conclusions: addictive
behavior is reinforcing, chosen behavior; emerges gradu-
ally and occurs along a continuum; does not occur in
isolation but as part of behavior clusters; occurs within a
family context; responds to changes in reinforcement; is
affected by a larger social context; has identifiable risk and
protective factors, tends to become self-perpetuating once
established; is motivated behavior; and is influenced by
the therapeutic relationship [84]. Notably, all these con-
clusions reflect a functional perspective.
Psychology has an opportunity to lead the addiction
field by identifying functional concepts that characterize
the multi-dimensional processes responsible for treat-
ments’ effects. Clarity about these processes will permit
systematic treatment improvement [35,83]. Conducting
transdisciplinary research requires a shared conceptual
or theoretical framework that integrates knowledge fully
across disciplines [85–87]. Among the many contribu-
tions discussed previously, psychology has also developed
the most precise scientific methodology for validating
conceptual constructs (e.g. multi-trait–multi-method
matrices); such methods might be used to identify theo-
retically based functional processes that synthesize
research across disciplines [88].
Functional models, by definition, characterize
individual–environment interactions, and therefore
provide a pragmatic means of changing behavior via
environmental factors. For one example, behavior
change is more likely with abstinent supportive social
reinforcement [28]. In applied settings, treatment per-
sonnel who behave in a supportive rather than a confron-
tational manner appear to improve the likelihood of
positive outcomes [82], perhaps by increasing patient
involvement [89] and helping patients learn to accept
© 2007 Society for the Study of Addiction. No claim to original US government works
Psychology of addiction 357
and respond differently to internal states previously asso-
ciated with using [90]. In a recent study, patients from
treatment programs with supportive, involved relation-
ships were more likely to respond adaptively to internal
states associated previously with substance use, develop
constructive social relationships and achieve long-term
treatment benefits. This functional model accounted for
41% of the variance in outcomes 2 years after treatment
[41]. Researchers continue to examine the processes
involved in socially reinforcing interactions via social
neuroscience, basic and clinical process and outcome
research.
Emphasis on function provides a common empirical
ground for examining the behavior change process
across treatment modalities. The pre-existing practices of
a variety of treatments and treatment settings include
factors related to positive outcomes [41]. Identifying
these practices might bring parsimony to the multiplicity
of available treatments and aid in dissemination by build-
ing on aspects of treatment that providers already deliver.
The dissemination gap between empirically supported
treatments and substance use disorder treatment pro-
vider practice is arguably a result of the failure of
researchers and administrators to address the functional
aspects of clinicians’ behavior. Rather than simply
attempting to impose top-down change, viewed from a
functional perspective the dissemination question
becomes: ‘How do we facilitate behavior change in the
treatment provider?’. To answer this question one first
needs to understand what providers are doing and then
use this information to shape changes in behavior, i.e.
build upon constructive evidence-based practices and
weaken competing alternatives. Data regarding the func-
tional dimensions of clinician behavior include studies
showing that meaningful changes in treatment provision
are less likely with a single workshop (e.g. [91]) than with
ongoing supervisory feedback [92]. Functional principles
offer specific environmentally based ways of facilitating
behavior change in both patients and providers, includ-
ing building on current repertoires, shaping new ways of
interacting and providing systematic methods for gener-
alizing behavioral changes [93].
In short, using a functional approach to modeling
behavior change directly targets the patient behaviors
that lead to better long-term outcomes; serves as a point
of integration for interdisciplinary research efforts aimed
at characterizing the process of behavior change; pro-
vides pragmatic methods for influencing these changes in
behavior; and builds upon what programs and providers
are already doing in order to improve treatment delivery.
A final compelling reason for focusing scientific efforts
on processes of change is that these adaptational or func-
tional principles apply beyond the treatment context. The
processes that contribute to improvement in treatment
Addiction, 102, 352–361
358 Elizabeth Gifford & Keith Humphreys
may also be implicated in recovery in mutual help
organizations, processes involved in ‘natural’ recovery
(which, indeed, is how most individuals overcome addic-
tion), prevention and recovery in religious/spiritual cul-
tural communities, etc. From a functional perspective,
treatment essentially provides a structured environment
within which to influence (i.e. boost variability in) rel-
evant processes. Thus treatment is particularly important
for those who do not have access to these types of context
in their natural environment or who are in need of more
intense exposure to curative environments. Broadening
the lens to include context also entails recognizing that
treatment may be simply one chain in a larger causal
model [94]. Clients describe their own change process in
both intrapersonal and interpersonal terms, embedded in
the contexts within and outside the treatment setting
[95]. Indeed, causal mediators of treatment may be diffi-
cult to find because the critical processes occur outside
treatment. For example, Longabaugh and colleagues [96]
found that improvement in social skills did lead to
improved alcohol treatment outcomes, as described by
their theoretical model, but causal chain analyses
revealed that these changes in social functioning did not
occur within treatment.
Most members of the field concede that addiction
research is more informative when it is theoretically
based. Less commonly discussed is the fact that our
assumptions specify what sort of theoretical explanations
are considered adequate and thereby guide the direction
of inquiry. In general, the field of psychology has suffered
from a proliferation of theories with relatively little
pruning [35] (see [13] for an excellent discussion; also
[97]). However, the propagation of labels should not be
mistaken for scientific progress [98]. Psychology’s com-
mitment to rigorous evaluation offers both great progress
and humility. We may need to surrender some of our
cherished ways of speaking in order to further our
ongoing goal of improving interventions that treat and
prevent addiction.
CONCLUSION
We have adumbrated psychology’s contributions to
addiction in the social, behavioral, neurobiological and
intervention domains. This survey fails to describe innu-
merable contributions, including much of cognitive
psychology, developmental psychology, physiological psy-
chology and neuropsychological assessment. Further,
our assumptions and the principles we derive from these
domains are our own, and both other assumptions and
other interpretations are possible. We simply hope to
show the relationship between definitional assumptions,
explanations and progress in what we view as a particu-
larly important and vital knowledge base.
© 2007 Society for the Study of Addiction. No claim to original US government works
The psychologically derived principles or descriptions
of the ‘functioning of natural phenomena’ presented
here share an assumption, namely that addiction
research is concerned fundamentally with interactions
between individuals and their environments, and that
maintaining clarity about our subject matter will help
promote a focused, flexible and progressive addiction
science. Future questions include application of these
principles to broader social contexts. For example, how
might we apply these principles to addiction in the public
health and public policy domains [99]?
Addiction involves dynamic adaptations occurring at
multiple levels that are influenced by a variety of contexts
including but not limited to treatment environments. If
we want to improve our understanding of addiction and
recovery, we should examine these processes directly. Psy-
chological science is well suited for this endeavor.
Acknowledgements
This work was supported by the US Department of Veter-
ans Affairs Office of Mental Health Services and Health
Services Research and Development Service. We thank
Stephen Maisto, Rudolf Moos and Robert West for
extremely helpful comments and discussions.
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