An individual’s behaviour, neurological functioning and resulting internal personal experience are bound together. Ahabit takes over as we continue with an addictive behaviour, increasing the level of obsession or compulsion. It could be argued that any behaviour that brings intense experiencing, and is continued over time and to excess creates a kind of neurological, psychological and/or chemical dependency. So how can we identify whether we have an addiction, or an obsession or compulsion that is tending towards addiction? Try and deny yourself that something that you do habitually, and see what happens. A word of caution: this can be dangerous if we are talking about substance use, particularly alcohol. In this case, suddenly stopping when there is physical (i.e. chemical) dependence can be life-threatening, and a gradual reduction is much safer. But otherwise, try to deny yourself a particular experience and observe what happens, what internal dialogue starts to take place: ‘you don’t have a problem’, ‘do it anyway’, ‘you’re in control’. Deny yourself an episode of your favourite soap opera. There will be a sense of loss – yes — that is normal, but is it more than this? Is it genuinely depressing? Do we feel anxious, on edge, preoccupied with thinking about what we are missing?

The range of obsessions and compulsions that may become addictions in our society is growing. Eating, particularly foods that are fatty, sugary, and/or highly processed; not eating/dieting; exercising and working-out; using the internet; shopping, watching soap operas or horror movies; drinking alcohol; taking drugs; watching or participating in violent behaviour; following a football team; betting and gambling; playing computer games, listening to music; cleaning; having sex; taking risks and pursuing danger. We generally think of an addiction as a personal behaviour, but what of collective, societal addictions? As a society, do we generate collective addictions that people are conditioned into, simply in order to be part of ‘normal society’? And from this perspective might individual addictions also be considered as symptoms of an unwell society, a society that preoccupies itself with experiences and behaviours that assume an importance incongruent to their true value? And what of the young people being conditioned into these social norms from an early age?

In my view one of the roles of therapy, perhaps the core role, is that of enabling someone to become more authentically themselves, and less driven by external conditioning. Therapy helps people to become clearer about who they are and what urges them to make the choices they make. They may continue to make a particular choice, but they can then do so with greater understanding, knowing why and what part it plays in their life experience. Therapy brings the possibility of a genuine freedom to choose.

The article that follows by Kate Hayes powerfully reminds us that alcohol is a major problem, though Government funding continues to be aimed at ‘drug’ rather than ‘alcohol’ services. Kate’s article takes me back to my years of working as an alcohol counsellor, culminating in my own writing on this topic¹. As she observes, so many treatment services are substancecentred, but people are so much more than their substance use. There are many effective responses for those with alcohol problems, and I have always found that information conveyed with warmth, empathic sensitivity and genuineness can make all the difference.

Jean Latham explores an integrative way of working, and conveys the complexity of the kind of work that can be required from a counsellor in the context of an alcohol agency. What is the correct balance between information giving, medical treatment and therapeutic listening? What models of working are most helpful? She highlights the notion of particular therapies being most helpful at particular stages and levels of change. And yes, clients move back and forward between addressing the outer, drinking behaviour and the inner meanings and experiences that drive them to drink – and this presents its own challenges.

Often the greatest difficulty for counsellors working with clients with substance misuse problems is linked to their trying to make the client change, or having a preconceived notion of what the client should become. Sue Wilders and Sam Robinson reject this way of working, and describe very clearly a non-directive approach, drawing on the ideas of Carl Rogers and others from the person-centred tradition. They make a powerful case for ensuring that the therapeutic relationship is central to effective work, and argue that the client is the expert on their own life. They therefore challenge traditional notions of treatment, stressing the importance of feeling and conveying genuine acceptance of the person. Such warm acceptance powerfully challenges conditioning based on the often judgemental and rejecting reactions that confront many substancemisusing clients, and offers the opportunity for real change and growth.

Chris Ford and her colleagues acknowledge in their article how services have traditionally focused on the problem of drug use rather than the person. The talking therapies (perhaps more correctly called ‘listening therapies’) have so much to offer to help people unravel the underlying causes of their substance use. So often a holistic response is required, and treatment and support responses are needed that are physical, emotional, psychological, and much more besides once we think of social networks and family systems. Like Chris, James and Brian, I agree with the value of partnership between counsellors and GPs. I too have worked in this environment, and know that it works. Not for everyone, true — but then not all medications work for everyone. Their use of case studies to bring their work alive deepens our connection with the person and the process. It seems to me that there is so much ‘practicebased’ evidence; professional people and their clients who know, from personal experience, what has worked, and what has helped them. Such ‘practice-based evidence’, to those who apply it on a daily basis, is truly ‘evidencebased practice’.

Paula Hall’s article on sexual addiction offers insight not only into another world of addiction, but also into another model for understanding the process of addiction. Again she uses case material, revealing a genuinely human edge to her client’s dilemma that highlights the more deepseated origins of their addictive behaviour. It brings me back to the thought that so often what become addictions are rooted in choices we make in order to feel different, or better, or in extreme cases simply not to feel, or to feel something, anything.

I hope you will find the articles that follow as interesting and thoughtprovoking as I have. Addiction is a growing feature of our society. As therapists we all need to have clarified our own attitudes and values in order to work effectively with this client group so that we can, as Sue Wilders and Sam Robinson suggest, ‘empathise with our clients’ experience [of addiction] without imposing our values and judgements’.