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Fundamentals of Addiction: a new approach

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November 18-22 is National Addictions Awareness Week (NAAW), an annual national campaign by the Canadian Centre for Substance Abuse (CCSA) to highlight issues and solutions to help address alcohol and drug-related harm. This National Addictions Awareness Week, CAMH is celebrating the release of a new book, Fundamentals of Addiction: A Practical Guide for Counsellors. In this guest blog post Wayne Skinner, Deputy Clinical Director in CAMH’s Ambulatory Care & Structured Treatment Program and Head of the Problem Gambling Institute of Ontario, discusses how this new resource captures a distinctly Canadian approach to addiction and recovery. (Image: Julia Greenbaum (L), CAMH Education oversaw development of the Fundamentals of Addiction, edited by  Wayne Skinner).

I am sitting in the Ottawa Airport, on my way home from  the Issues of Substance (IOS) Conference hosted by the Canadian Centre on Substance Abuse . A truly transnational meeting, there were participants from every province and territory. It was also my first chance to see Fundamentals of Addiction: A Practical Guide for Counsellors in print. Co-editing this book with Marilyn Herie has been a major project over the past three years.  Walking in to the exhibit area on Monday morning to see the finished product on display in the bookseller’s booth was an amazing moment – holding this baby in my hands was a total delight, one that represented, as all births do, the end of one journey, and the start of another one.

Let me explain: The book is the fourth edition of a text first published about 20 years ago. Over that time it has grown, both in size and recognition, to become a core major Canadian resource on addiction treatment. It is used to teach students across all disciplines and has been a CAMH best seller for a number of years.

Information focused on action

When Marilyn and I were invited to edit this latest version, in ongoing discussion with the folks involved in technical production, particularly Julia Greenbaum and Diana Ballon, we decided knowledge and need had evolved.  We could offer a new version that took what we could offer the reader to a new level.  We wanted to put the focus on a key word in the title: practical.  That meant offering really useful knowledge to the reader, information that focused on action based on know-how.

In the end, we had 29 chapters authored by key experts who not only could summarize the knowledge in the topic areas, but also illustrate what they were talking about with clinical vignettes, and provide practice tips and resources to the reader.  In addition, the scope of the book went beyond alcohol and other drugs to include behavioural addictions. And that’s when we all agreed to change the name.

The foreword is a key part of a book of this kind.  We wanted a Canadian, and we wanted someone who had a view of addiction that was comprehensive and integrative, as well as compassionate and humane.  We also wanted someone who would constructively challenge the reader to see how addiction work demands wholehearted engagement. We asked Dr. Gabor Maté if he would take up the task, and we are so grateful that he did.  He uses the occasion to highlight themes that have made him such a highly regarded writer and speaker on the topics of addiction and recovery.

Appropriately, he just gave the opening keynote address at IOS. Talking about seven myths of addiction, Mate insists we view addiction with compassionate curiosity, respecting the fact that it constitutes in the moment the person’s best effort to soothe the pain of deep injuries or to find pleasure when it is not available to them in other ways. That spirit of compassion, seeing the complex ways addictive behaviour affects the whole person, is something that guides the book. It is at the heart of what I see emerging as a distinctly Canadian approach to addiction and recovery.

A Canadian approach to addiction and recovery

First of all, that spirit of compassion, concern and care is a guiding feature.  What this manifests itself in is an interest not in the idea that there is a single solution, but that we need a cornucopia of approaches to helping and healing, and that, increasingly,  we have a range of options.

If compassion leads to respect and therapeutic optimism, from a Canadian perspective what people concerned with addiction expect is that it also be grounded in clinical pragmatism.  Helping people with complex problems respects the fact that changing addictive behaviour is a process. It has to start in ways that are practical, useful and meaningful to the client.  That includes ways that lead to direct action to work on alternatives to addictive behaviours but also ways of working incrementally with people to kindle the possibility of more substantial and continuing change, with abstinence and healthy resilience as ultimate targets.

For us, in preparing the book, this meant challenging our authors to distill their knowledge into practice tips that would stand out as guideposts for clinicians.  Another request we made, now possible more than ever with the internet’s constant growth, was to point to resources where key tools and information could be found.

It was also important to frame the broad scope of the book in the context of the reality that it is the ways that children and youth develop and grow that the risk for addiction is found.  As much a problem as addictive behaviour is in itself, it is the result of other problems that compromise and injure a person as they grow into adulthood.  To see things this way is to insist on seeing addiction as a complex phenomenon that is not understood if we reduce it to genetics, disease, socially determined or whatever – it is all of these and more.

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