1Choice Theory Within Reality Therapy

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Choice Theory Within Reality Therapy
Choice Theory Within Reality Therapy

Write a 7-page research paper (Choice Theory within Reality Therapy) , not including the cover, abstract, and reference pages. Current APA format is required. At least 5 scholarly, empirical, current sources that are directly related to the level headings of the paper are required.(SEE BELOW FOR HEADINGS AND ARTICLES). You can use research articles or books. sources. The use of quotations is not allowed. You will be required to use your own words; however, you still must cite the information.

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Note: the 7-page limit does not include the cover, abstract, and reference pages.

Choice Theory within Reality Therapy
1. Cover page
2. Abstract
3. Body
4. References: At least 5 references required—textbook, books, and journals.( I HAVE PROVIDED)

The body of your paper must be organized according to the following content headings. You must also use current APA format.
• History of Theory
• Types of Problems Theory is Most Useful
• Strengths of the Theory
• Weaknesses of the Theory
• Conclusion


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Choice Theory Within Reality Therapy

published: 06 May 2013 doi: 10.3389/fpsyt.2013.00031

Addiction and choice: theory and new data Gene M. Heyman*

Department of Psychology, Boston College, Boston, MA, USA

Edited by: Hanna Pickard, University of Oxford, UK

Reviewed by: Serge H. Ahmed, CNRS, France Bennett Foddy, University of Oxford, UK

*Correspondence: Gene M. Heyman, Department of Psychology, McGuinn Hall, Boston College, Boston, MA 02467, USA. e-mail: heymang@bc.edu; gheyman@harvard.fas.edu

Addiction’s biological basis has been the focus of much research. The findings have per- suaded experts and the public that drug use in addicts is compulsive. But the word “compulsive” identifies patterns of behavior, and all behavior has a biological basis, includ- ing voluntary actions. Thus, the question is not whether addiction has a biology, which it must, but whether it is sensible to say that addicts use drugs compulsively. The relevant research shows most of those who meet the American Psychiatric Association’s criteria for addiction quit using illegal drugs by about age 30, that they usually quit without professional help, and that the correlates of quitting include legal concerns, economic pressures, and the desire for respect, particularly from family members. That is, the correlates of quitting are the correlates of choice not compulsion. However, addiction is, by definition, a disorder, and thereby not beneficial in the long run. This is precisely the pattern of choices predicted by quantitative choice principles, such as the matching law, melioration, and hyperbolic dis- counting. Although the brain disease model of addiction is perceived by many as received knowledge it is not supported by research or logic. In contrast, well established, quantitative choice principles predict both the possibility and the details of addiction.

Keywords: addiction, choice theory, remission, correlates of recovery, brain disease model

Choice Theory Within Reality Therapy

INTRODUCTION Addictive drugs change the brain, genetic studies show that alco- holism has a substantial heritability, and addiction is a persistent, destructive pattern of drug use (e.g., Cloninger, 1987; American Psychiatric Association, 1994; Robinson et al., 2001). In scien- tific journals and popular media outlets, these observations are cited as proof that “addiction is a chronic, relapsing brain dis- ease, involving compulsive drug use” (e.g., Miller and Chappel, 1991; Leshner, 1999; Lubman et al., 2004; Quenqua, 2011). Yet, research shows that addiction has the highest remission rate of any psychiatric disorder, that most addicts quit drugs without professional help, and that the correlates of quitting are those that attend most decisions, such as financial and familial con- cerns (e.g., Biernacki, 1986; Robins, 1993; Stinson et al., 2005; Klingemann et al., 2010). However, addiction is “disease-like” in the sense that it persists even though on balance its costs outweigh the benefits (e.g., most addicts eventually quit). Thus, in order to explain addiction, we need an account of voluntary behav- ior that predicts the persistence of activities that from a global bookkeeping perspective (e.g., long-term) are irrational. That is, addiction is not compulsive drug use, but it also is not rational drug use. Several empirical choice principles predict the possi- bility of relatively stable yet suboptimal behavior. They include the matching law, melioration, and hyperbolic discounting (e.g., Herrnstein, 1990; Ainslie, 1992). These principles were discov- ered in the course of experiments conducted in laboratories and natural settings, and in experiments these same principles also distinguish addicted from non-addicted drug users (e.g., Kirby et al., 1999). For example, ex and current heavy drug users were more likely to suboptimally “meliorate” than were non-addicts in a choice procedure that invited both long-term maximizing and

melioration (Heyman and Dunn, 2002). Thus, we have on hand a research based, non-disease account of the defining features of addiction, which is to say its destructive and irrational aspects. As this essay is based on how those we call addicts behave, it would be most efficient to begin with a brief summary of key aspects of the natural history of addiction.

LIKELIHOOD OF REMISSION AND TIME COURSE OF ADDICTION Figure 1 shows the cumulative frequency of remission as a func- tion of the onset of dependence in a nation-wide representative sample of addicts (United States, Lopez-Quintero et al., 2011). The researchers first recruited a sample of more than 42,000 indi- viduals whose demographic characteristics approximated those of the US population for individuals between the ages of 18 and 64 (Grant and Dawson, 2006). The participants were interviewed according to a questionnaire designed to produce an APA diagno- sis when warranted. For those who currently or in the past met the criteria for “substance dependence” (the APA’s term for addic- tion), there were additional questions aimed at documenting the time course of clinically significant levels of drug use. Figure 1 summarizes the findings regarding remission and the duration of dependence.

On the x-axis is the amount of time since the onset of depen- dence. On the y -axis is the cumulative frequency of remission, which is the proportion of individuals who met the criteria for lifetime dependence but for the past year or more had been in remission. The fitted curves are negative exponentials, based on the assumption that each year the likelihood of remitting remained constant, independent of the onset of dependence (Heyman, 2013).

Choice Theory Within Reality Therapy

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Heyman Addiction as ambivalence (not compulsion)

FIGURE 1 | The cumulative frequency of remission as a function of time since the onset of dependence, based on Lopez-Quintero et al.’s (2011) report. The proportion of addicts who quit each year was approximately constant. The smooth curves are based on the negative exponential equations listed in the figure.

The cumulative frequency of remission increased each year for each drug. Indeed, the theoretical lines so closely approximated the observations that the simplest account is that each year a constant proportion of those who had not yet remitted did so regardless of how long they had been addicted. By year 4 (since the onset of dependence) half of those who were ever addicted to cocaine had stopped using cocaine at clinically significant levels; for marijuana the half-life of dependence was 6 years; and for alcohol, the half- life of dependence was considerably longer, 16 years. As the typical onset age for dependence on an illicit drug is about 20 (Kessler et al., 2005a), the results say that most people who become addicted to an illicit drug are “ex-addicts” by age 30. Of course, addicts may switch drugs rather than quit drugs, but other considerations indi- cate that this does not explain the trends displayed in Figure 1. For example, dependence on any illicit drug decreases markedly as a function of age, which would not be possible if addicts were switching from one drug to another (Heyman, 2013).

The graph also shows that there is much individual variation. Among cocaine users, about 5% continued to meet the criteria for addiction well into their 40s; among marijuana users, about 8% remained heavy users well into their 50s, and for alcoholics, more than 15% remained heavy drinkers well into their 60s. Thus, for both legal and illegal drugs some addicts conform to the expecta- tions of the “chronic disease” label. However, as noted below, the correlates of quitting drugs are the correlates of decision making, not the correlates of the diseases addiction is said to be similar to.

CAN WE TRUST THE DATA? The results in Figure 1 replicate the findings of previous nation- wide surveys and targeted studies that selected participants so as to obtain representative samples (e.g., Robins and Murphy, 1967; Anthony and Helzer, 1991; Robins, 1993; Warner et al., 1995;

Kessler et al., 2005a,b). For instance, in every national scientific survey of mental health in the United States, most of those who met the criteria for dependence on an illicit drug no longer did so by age 30, and addiction had the highest remission rate of any other psychiatric disorder. However, research on remission faces well-known methodological pitfalls. Those in remission may relapse at some post-interview date, and the subject rosters of the large epidemiological studies may be biased in favor of those addicts who do quit. For instance, addicts who remain heavy drug users may not cooperate with researchers or may be hard to contact because of their life style, illnesses, or have higher mortality rates. These issues have been discussed in some detail elsewhere (Hey- man, 2013). The key results were that remission after age 30 was reasonably stable, and that it was unlikely that there were enough missing or dead addicts to alter significantly the trends displayed in Figure 1.

THE CORRELATES OF QUITTING AND THE ROLE OF TREATMENT The correlates of quitting include the absence of additional psychi- atric and medical problems, marital status (singles stay addicted longer), economic pressures, fear of judicial sanctions, concern about respect from children and other family members, worries about the many problems that attend regular involvement in ille- gal activities, more years spent in school, and higher income (e.g., Waldorf, 1983; Biernacki, 1986; Waldorf et al., 1991; Warner et al., 1995). Put in more personal terms, addicts often say that they quit drugs because they wanted to be a better parent, make their own parents proud of them, and not further embarrass their fam- ilies (e.g., Premack, 1970; Jorquez, 1983). In short, the correlates of quitting are the practical and moral concerns that affect all major decisions. They are not the correlates of recovery from the diseases addiction is said to be like, such as Alzheimer’s, schizo- phrenia, diabetes, heart disease, cancer, and so on (e.g., Leshner, 1999; McLellan et al., 2000; Volkow and Li, 2004).

Much of what we know about quitting drugs has been pro- vided by researchers who study addicts who are not in treatment (e.g., Klingemann et al., 2010). This is because most addicts do not seek treatment. For instance, in the survey that provided the data for Figure 1, only 16% of those who currently met the crite- ria for dependence were in treatment, and treatment was broadly defined so as to include self-help organizations as well as services by trained clinicians (Stinson et al., 2005). Since most addicts quit, the implication is that most addicts quit without professional help. Research supports this logic (e.g., Fiore et al., 1993).

A NON-DISEASE ETIOLOGY FOR PERSISTENT SELF-DESTRUCTIVE DRUG USE Although self-destructive, irrational behavior can be a sign of pathology, it need not be. The self-help industry is booming, which reflects the tendency of so many of us to procrastinate, overeat, skip exercising, and opt for whatever is most convenient. Why buy a book or go to a lecture on how to improve your life if you did not realize that (1) you were behaving imprudently, (2) knew you probably could change, but (3) so far have not taken the requisite steps. Similarly, human irrationality drives the story-line of most novels, memoirs, movies, and plays. Agamemnon sacrifices his

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own daughter to advance his political and personal goals but then publicly embarrasses Achilles his most powerful and skillful war- rior. Both actions are selfish, and the second undermines the goals of the first, which anyone could have foretold. However, Homer is portraying human nature not writing a psychiatric text. Thus, it seems fair to say that who cite selfishness and myopic choices as evidence of pathology (e.g., “she has to be sick because she bought drugs rather than groceries”) naively misread human nature.

In support of the poet’s as opposed to the brain disease account of human nature, behavioral psychologists and economists have discovered principles that predict self-defeating, selfish patterns of behavior. They include “hyperbolic discounting,” “melioration,” and the “matching law” (Herrnstein, 1970, 1990; Rachlin and Green, 1972; Ainslie, 1992; Rachlin, 2007). These are quantitative, empirical laws of choice that predict how different species, includ- ing humans, choose between different commodities and activities, such as food, water, and exercise. Their relevance to addiction and other self-defeating behaviors is that under some conditions they predict relatively stable yet suboptimal patterns of behavior. For example, Heyman and Herrnstein (1986) arranged an experiment in which the matching predicted the lowest possible rate of rein- forcement. As predicted the subjects shifted to matching, lowering their overall reinforcement rate as they did so. This finding has been replicated numerous times (e.g., Herrnstein et al., 1997), and it is analogous as to what happens as drug use turns into addiction.

Or, put another way, general principles that apply to everyday choices, also predict compulsive-like consumption patterns that are consistent with the behavior of addicts.

These choice laws reflect a basic, but often overlooked property, of most choice situations. There is more than one “optimal” strat- egy (Heyman, 2009). One is optimal from the perspective of the most immediate circumstances, such as the current values of the options, taking into account just the most pressing needs and goals. The others are optimal in terms of wider time horizons and the perspectives of others. For example, in settings in which current choices affect the values of future options, it is possible for the cur- rent best choice to be the worst long-term choice (e.g., Herrnstein et al., 1993; Heyman and Dunn, 2002). This is relevant because a common feature of addictive drugs is that they provide immediate benefits but delayed costs. Thus, it is possible that the drug is the best choice when the frame of reference is restricted to the current values of the immediately available options but the worst choice when the frame of reference expands to include future costs and other people’s needs. According to this account, persistent drug use reflects the workings of a local optimum, whereas controlled drug use or abstinence reflects the workings of a global optimum. Put somewhat differently, whether or not drug use persists depends on the factors that influence decision making, particularly values that emphasize global as opposed to a local frame of reference (e.g., values related to family, the future, one’s reputation, and so on). Scores of studies support this analysis (e.g., Waldorf, 1983; Biernacki, 1986; Mariezcurrena, 1994; Klingemann et al., 2010).

OLD CLINICAL FOLLOW-UP STUDIES: EMPIRICAL SUPPORT FOR THE DISEASE ACCOUNT Imagine that what we knew about addiction was restricted to those individuals who make up the right-hand tails of the cumulative

distribution curves in Figure 1. We would have good reason to believe that addiction is a chronic relapsing disease. This is pre- cisely the situation for much of the history of addiction research. Until the mid 1970s virtually all empirical studies of addicts were based on individuals who had been in treatment, which was most often detoxification in American prison/hospitals or similar insti- tutions (e.g., Brecher, 1972; Vaillant, 1973; Maddux and Desmond, 1980; Hser et al., 1993). In some studies virtually all of the partici- pants were males with extensive arrest records, poor work histories, lower than average marriage rates, and lower than average educa- tional achievement (e.g., Vaillant, 1973). That is, the understanding of addiction as a chronic disorder was based on a population of drug users whose demographic characteristics – we now know – match those that predict not quitting (e.g., Klingemann et al., 2010). In the 1960s illicit drug use spread to college campuses and upscale neighborhoods. This new generation of addicts included individuals who were employed, married, and well-educated (e.g., Waldorf et al., 1991). With these demographic changes, the natural history of addiction changed. More often than not, the pressures of family, employment, and the hassles of an illegal life style eventually trumped getting high. Figure 1, which is representa- tive of every major epidemiological study conducted over the past 30 years, reflects this reality; received opinion does not.

BUT DRUGS CHANGE THE BRAIN With the exception of alcohol, addictive drugs produce their bio- logical and psychological changes by binding to specific receptor sites throughout the body. As self-administered drug doses greatly exceed the circulating levels of their natural analogs, persistent heavy drug use leads to structural and functional changes in the nervous system. It is widely – if not universally – assumed that these neural adaptations play a causal role in addiction. In support of this interpretation brain imaging studies often reveal differences between the brains of addicts and comparison groups (e.g., Volkow et al., 1997; Martin-Soelch et al., 2001) However, these studies are cross-sectional and the results are correlations. There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug. For example, in a frequently referred to animal study, Robinson et al. (2001) found dendritic changes in the striatum and the prefrontal cortex of rats who had self-administered cocaine. They concluded that this was a “recipe for addiction.” However, they did not evaluate whether their findings with rodents applied to humans, nor did they even test if the dendritic modifications had anything to do with changes in preference for cocaine in their rats. In principle then it is possible that the drug-induced neural changes play lit- tle or no role in the persistence of drug use. This is a testable hypothesis.

First, most addicts quit. Thus, drug-induced neural plasticity does not prevent quitting. Second, in follow-up studies, which tested Robinson et al.’s claims, there were no increases in prefer- ence for cocaine. For instance in a preference test that provided both cocaine and saccharin, rats preferred saccharin (Lenoir et al., 2007) even after they had consumed about three to four times more cocaine than the rats in the Robinson et al study, and even

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though the cocaine had induced motoric changes which have been interpreted as signs of the neural underpinnings of addiction (e.g., Robinson and Berridge, 2003). Third, Figure 1 shows that the likelihood of remission was constant over time since the onset of dependence. Although this is a surprising result, it is not without precedent. In a longitudinal study of heroin addicts, Vaillant (1973) reports that the likelihood of going off drugs neither increased nor decreased over time (1973), and in a study with rats, Serge Ahmed and his colleagues (Cantin et al., 2010) report that the probability of switching from cocaine to saccharin (which was about 0.85) was independent of past cocaine consumption. Since drugs change the brain, these results suggest that the changes do not prevent quit- ting, and the slope of Figure 1 implies that drug-induced neural changes do not even decrease the likelihood of quitting drugs once dependence is in place.

BUT THERE IS A GENETIC PREDISPOSITION FOR ADDICTION Twin and adoption studies have repeatedly demonstrated a genetic predisposition for alcoholism (e.g., Cloninger, 1987), and the lim- ited amount of research on the genetics of illicit drug use suggests the same for drugs such as heroin, cocaine, and marijuana (Tsuang et al., 2001). However, all behavior has a genetic basis, including voluntary acts. The brain is the organ of voluntary action, and brain structure and development follow the blueprint set by DNA. Thus, there is no necessary connection between heritability and compulsion. In support of this point, monozygotic twins are much more likely to share similar religious and political beliefs than are dizygotic twins, even when they are separated before the age of 1 year old (e.g., Waller et al., 1990; McCourt et al., 1999). That is, learned, voluntary religious and political beliefs have substantial heritabilities just as do many involuntary human characteristics. The relevance to addiction is that a genetic predisposition is not a recipe for compulsion, just as brain adaptations are not a recipe for compulsion.

SUMMING UP Addiction involves an initial “honey moon” period, followed by alternating periods of remission and relapse, and then an eventual return to a more sober life. Most addicts quit using drugs at clinically significant levels, they typically quit without professional help, and in the case of illicit drugs, they typically quit before the age of 30. The correlates of quitting include many of the factors that influence voluntary acts, but not, according to Figure 1, drug exposure once drug use meets the criteria for dependence. Thus, we can say that addiction is ambivalent drug use, which even- tually involves more costs than benefits (otherwise why quit?). Behavioral choice principles predict ambivalent preferences, semi- stable suboptimal behavior patterns, and the capacity to shift from one option to another. In contrast, the brain disease account of addiction fails to predict the high quit rates; it fails to predict the correlates of quitting; it fails to predict the temporal pattern of quitting; and it is tied to unsupportable assumptions, such as the claims that neural adaptations, heritability, and irrationality are prima facie evidence of disease. To be sure “compulsion” and “choice” can be seen as points on a continuum, but Figure 1 and research on quitting make it clear that addiction is not a borderline case.

It is time to think about addiction in terms of what the research shows, particularly the more recent epidemiological studies, and it is time to abandon the medical model of addiction. It does not fit the facts. The matching law, melioration, and hyperbolic discount- ing predict that drugs and similar commodities will become the focus of destructive, suboptimal patterns of behavior. These same choice models also predict that individuals caught in a destruc- tive pattern of behavior retain the capacity to improve their lot and that they will do so as a function of changes in their options and/or how they frame their choices. This viewpoint fits the facts of addiction and provides a practical guide to measures that will actually help addicts change for the better.

REFERENCES Ainslie, G. (1992). Picoeconomics: The

Strategic Interaction of Successive Motivational States Within the Per- son. Cambridge: Cambridge Univer- sity Press.

American Psychiatric Association. (1994). Diagnostic and Statisti- cal Manual of Mental Disorders: DSM-IV, 4th Edn. Washington, DC: American Psychiatric Association.

Anthony, J. C., and Helzer, J. E. (1991). “Syndromes of drug abuse and dependence,” in Psychiatric Disorders in America, eds L. N. Robins and D. A. Regier (New York: The Free Press), 116–154.

Biernacki, P. (1986). Pathways from Heroin Addiction: Recovery Without Treatment. Philadelphia, PA: Temple University Press.

Brecher, E. M. (1972). Licit and Illicit Drugs; The Consumers Union Report on Narcotics, Stim- ulants, Depressants, Inhalants,

Hallucinogens, and Marijuana– Including Caffeine, Nicotine, and Alcohol, 1st Edn. Boston, MA: Little, Brown.

Cantin, L., Lenoir, M., Augier, E., Vanhille, N., Dubreucq, S., Serre, F., et al. (2010). Cocaine is low on the value ladder of rats: possible evidence for resilience to addiction. PLoS ONE 5:e11592. doi:10.1371/journal.pone.0011592

Cloninger, C. R. (1987). Neurogenetic adaptive mechanisms in alcoholism. Science 236, 410–416.

Fiore, M. C., Newcomb, P., and McBride, P. (1993). “Natural his- tory of tobacco use and addic- tion,” in Nicotine Addiction: Prin- ciples and Management, eds. C. T. Orleans and J. Slade (New York: Oxford University Press), 89–104.

Grant, B. F., and Dawson, D. A. (2006). Introduction to the National epidemiologic survey on alcohol

and related conditions. Alcohol Res. Health 29, 74–78.

Herrnstein, R. J. (1970). On the law of effect. J. Exp. Anal. Behav. 13, 243–266.

Herrnstein, R. J. (1990). Behavior, rein- forcement, and utility. Psychol. Sci. 1, 217–224.

Herrnstein, R. J., Rachlin, H., and Laib- son, D. I. (1997). The Matching Law: Papers in Psychology and Economics. New York: Russell Sage Foundation.

Herrnstein, R. J., Loewenstein, G. F., Prelec, D., and Vaughan, W. (1993). Utility maximization and melio- ration: internalities in individual choice. J. Behav. Decis. Mak. 6, 149–185.

Heyman, G. M. (2009). Addiction: A Disorder of Choice. Cambridge, MA: Harvard University Press.

Heyman, G. M. (2013). Quitting drugs: quantitative and qualitative features. Annu. Rev. Clin. Psychol. 9, 29–59.

Heyman, G. M., and Dunn, B. (2002). Decision biases and persistent illicit drug use: an experimental study of distributed choice in drug clinic patients. Drug Alcohol Depend. 67, 192–203.

Heyman, G. M., and Herrnstein, R. J. (1986). More on concurrent interval ratio schedules. J. Exp. Anal. Behav. 46, 331–351.

Hser, Y. I., Anglin, D., and Powers, K. (1993). A 24-year follow-up of Cal- ifornia narcotics addicts. Arch. Gen. Psychiatry 50, 577–584.

Jorquez, J. S. (1983). The retirement phase of heroin using careers. J. Drug Issues 13, 343–365.

Kessler, R. C., Berglund, P., Dem- ler, O., Jin, R., Merikangas, K. R., and Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distrib- utions of DSM-IV disorders in the National comorbidity survey repli- cation. Arch. Gen. Psychiatry 62, 593–602.

Frontiers in Psychiatry | Addictive Disorders and Behavioral Dyscontrol May 2013 | Volume 4 | Article 31 | 4




Heyman Addiction as ambivalence (not compulsion)

Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., and Walters, E. E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National comor- bidity survey replication. Arch. Gen. Psychiatry 62, 617–627.

Kirby, K., Petry, N., and Bickel, W. (1999). Heroin addicts discount delayed rewards at higher rates than non-drug-using controls. J. Exp. Psy- chol. Gen. 128, 78–87.

Klingemann, H. K., Sobell, M. B., and Sobell, L. C. (2010). Continuities and changes in self-change research. Addiction 105, 1510–1518.

Lenoir, M., Serre, F., Cantin, L., and Ahmed, S. H. (2007). Intense sweetness surpasses cocaine reward. PLoS ONE 2:e698. doi:10.1371/journal.pone.0000698

Leshner, A. I. (1999). Science-based views of drug addiction and its treatment. J. Am. Med. Assoc. 282, 1314–1316.

Lopez-Quintero, C., Hasin, D. S., de los Cobos, J. P., Pines, A., Wang, S., Grant, B. F., et al. (2011). Probabil- ity and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National epidemiologic survey on alcohol and related conditions. Addiction 106, 657–669.

Lubman, D. I., Yucel, M., and Pan- telis, C. (2004). Addiction, a condi- tion of compulsive behaviour? Neu- roimaging and neuropsychological evidence of inhibitory dysregula- tion. Addiction 99, 1491–1502.

Maddux, J. F., and Desmond, D. P. (1980). New light on the matur- ing out hypothesis in opioid depen- dence. Bull. Narc. 32, 15–25.

Mariezcurrena, R. (1994). Recovery from addictions without treatment:

literature review. Scand. J. Behav. Ther. 23, 131–154.

Martin-Soelch, C., Chevalley, A.-F., Kunig, G., Missimer, J., Magyar, S., Mino, A., et al. (2001). Changes in reward-induced brain activation in opiate addicts. Eur. J. Neurosci. 14, 1360–1368.

McCourt, K. B., Thomas, J. Jr., Lykken, D. T., Tellegen, A., and Keyes, M. (1999). Authoritarianism revisited: genetic and environmental influ- ences examined in twins reared apart and together. Pers. Individ. Differ. 27, 985–1014.

McLellan, A. T., Lewis, D. C., O’Brien, C. P., and Kleber, H. D. (2000). Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. J. Am. Med. Assoc. 284, 1689–1695.

Miller, N. S., and Chappel, J. N. (1991). History of the disease concept. Psy- chiatr. Ann. 21, 196–205.

Premack, D. (1970). “Mechanisms of self-control,” in Learning Mecha- nisms in Smoking, ed. W. A. Hunt (Chicago: Aldine), 107–123.

Quenqua, D. (2011). July 10. Rethinking Addiction’s Roots, and Its Treatment. New York Times. Available at: http://www.nytimes.com/2011/07/ 11/health/11addictions.html

Rachlin, H. (2007). In what sense are addicts irrational? Drug Alcohol Depend. 90(Suppl.), S92–S99.

Rachlin, H., and Green, L. (1972). Com- mitment, choice, and self-control. J. Exp. Anal. Behav. 17, 15–22.

Robins, L. N. (1993). Vietnam veterans’ rapid recovery from heroin addic- tion: a fluke or normal expectation? Addiction 188, 1041–1054.

Robins, L. N., and Murphy, G. (1967). Drug use in a normal popula- tion of young Negro men. Am. J.

Public Health Nations Health 57, 1580–1596.

Robinson, T. E., and Berridge, K. E. (2003). Addiction. Ann. Rev. Psychol. 54, 25–53.

Robinson, T. E., Gorny, G., Mitton, E., and Kolb, B. (2001). Cocaine self-administration alters the mor- phology of dendrites and den- dritic spines in the nucleus accum- bens and neocortex. Synapse 39, 257–266.

Stinson, F. S., Grant, B. F., Dawson, D., Ruan, W. J., Huang, B., and Saha, T. (2005). Comorbidity between DSM- IV alcohol and specific drug use dis- orders in the United States: results from the National epidemiological survey on alcohol and related con- ditions. Drug Alcohol Depend. 80, 105–116.

Tsuang, M. T., Bar, J. L., Harley, R. M., and Lyons, M. J. (2001). The Har- vard twin study of substance abuse: what we have learned. Harv. Rev. Psychiatry 9, 267–279.

Vaillant, G. E. (1973). A 20-year follow-up of New York narcotic addicts. Arch. Gen. Psychiatry 29, 237–241.

Volkow, N. D., and Li, T. K. (2004). Drug addiction: the neurobiology of behaviour gone awry. Nat. Rev. Neurosci. 5, 963–970.

Volkow, N. D., Wang, G. J., and Fowler, J. S. (1997). Decreased stri- atal dopaminergic responsiveness in detoxified cocaine-dependent sub- jects. Nature 386, 830–833.

Waldorf, D. (1983). Natural recov- ery from opiate addiction: some social-psychological processes of untreated recovery. J. Drug Issues 13, 237–279.

Waldorf, D., Reinarman, C., and Mur- phy, S. (1991). Cocaine Changes: The

Experience of Using and Quitting. Philadelphia, PA: Temple University Press.

Waller, N. G., Kojetin, B. A., and Bouchard, T. (1990). Genetic and environmental influences on reli- gious interests, attitudes, and val- ues: a study of twins reared apart and together. Psychol. Sci. 1, 138–142.

Warner, L. A., Kessler, R. C., Hughes, M., Anthony, J. C., and Nelson, C. B. (1995). Prevalence and cor- relates of drug use and depen- dence in the United States. results from the National comorbidity survey. Arch. Gen. Psychiatry 52, 219–229.

Conflict of Interest Statement: The authors declare that the research was conducted in the absence of any com- mercial or financial relationships that could be construed as a potential con- flict of interest.

Received: 18 March 2013; accepted: 23 April 2013; published online: 06 May 2013. Citation: Heyman GM (2013) Addic- tion and choice: theory and new data. Front. Psychiatry 4:31. doi: 10.3389/fpsyt.2013.00031 This article was submitted to Frontiers in Addictive Disorders and Behavioral Dyscontrol, a specialty of Frontiers in Psychiatry. Copyright © 2013 Heyman. This is an open-access article distributed under the terms of the Creative Commons Attribu- tion License, which permits use, distrib- ution and reproduction in other forums, provided the original authors and source are credited and subject to any copy- right notices concerning any third-party graphics etc.

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International Journal of Choice Theory and Reality Therapy • Fall 2014 • Vol. XXXIV, number 1 • 6


Ezrina L. Bradley, Chicago State University


An old cub scout saying states that “We need to keep things simple and make them fun,

and then before we know it, the job will be done.” Notably, William Glasser seemed to be

aware of this saying as he sought to create Choice Theory and Reality Therapy. Truly, he

consistently sought to help others to better relate to their experiences, and then guided

them regarding how they might more readily take efficient control of their lives. This brief

overview simply seeks to explain how all of this can be simply done.


Often times, we blame other people or things for our own misery. “The kids are driving me

crazy.” “My husband makes me so mad.” “Being sick is making me depressed.” When

saying these things, many do not realize that they are actually choosing how they feel, and

that these people or things are not causing their emotions. According to choice theory

(formerly known as control theory), we choose all of our actions and thoughts, based on the

information we receive in our lives. Other people or things cannot actually make us feel or

act a certain way (Glasser, 1998)

Choice theory, developed by Dr. William Glasser, evolved out of control theory, and is the

basis for Reality Therapy (Howatt, 2001). Control theory,on the other hand, was developed

by William Powers and it helped explain many of Dr. Glasser’s beliefs, but not all of them.

Dr. Glasser spent 10 years expanding and revising control theory into something that more

accurately reflected his beliefs, what we now know as choice theory (Corey, 2013).

Although reality therapy is based on choice theory, it was actually reality therapy that was

coined first in 1962. It wasn’t until some 34 years later, in 1996, that Glasser announced

that the term “control theory” would be replaced with “choice theory”. The rationale for the

name change was that the guiding principle of the theory has always been that people have

choices in life and these choices guide said life (Howatt, 2001).

Glasser believed that people needed to take more responsibility for their behavior and that

reality therapy could help them do this. The essence of choice theory and reality therapy is

that we are all responsible for what we do and that we can control our present lives (Corey,

2013). Glasser also believed that the root problem of most unhappiness is unsatisfying or

non-existent relationships. Because of this void, an individual chooses their own

maladaptive behavior as a way to deal with the frustration of being unfulfilled. In reality

therapy, a person can be taught how to effectively make choices to better deal with these

situations. Reality therapy can help an individual regain control of their lives, instead of

letting their emotions run the show, which is the key to their own personal freedom

(Howatt, 2001). Although traditionally thought of simply as a therapy technique, reality

therapy is actually a philosophy of life that is applicable to more than just psychological

deficits. It can be used in all aspects of human relationships and in various settings,

including schools, hospitals, and correctional institutions (Corey, 2013).

International Journal of Choice Theory and Reality Therapy • Fall 2014 • Vol. XXXIV, number 1 • 7


Choice theory is an internal psychology that postulates that all behavior is a result of

choices, and our life choices are driven by our genetically encoded basic needs. Originally,

Dr. Glasser presented only two basic needs: love and acceptance (Howatt, 2001; Litwack,

2007). By 1981, the basic needs had increased to five and are: survival, love and belonging,

power, freedom, and fun (Litwack, 2007; Brown, 2005; Corey, 2013; Glasser, 1998).

Survival is the only physiological need that all creatures struggle with. Love and belonging is

a psychological need and is considered the primary need in humans. Power is also a

psychological need that includes feelings of accomplishment, success, recognition, and

respect. Freedom is a psychological need that involves expression of ideas, choices, and

creativity. Lastly, fun is also a psychological need that involves laughing and enjoying ones

life. These basic needs are not in a hierarchy as Abraham Maslow’s needs are. Instead, our

basic needs as presented by Dr. Glasser vary in strength depending on the person, and can

also change within an individual over time and circumstance. If any of these needs are not

being met, which can be displayed in our feelings, we respond accordingly to achieve

satisfaction (Corey, 2013).

Choice theory also postulates that everyone has what they would consider their quality

world. This is the place in our minds where we store everything that makes, or that we

believe would make, us happy and satisfied. This is where all of our good memories and fun

times go. This is also where that dream vacation and dream home would go. It is like a

photo album or inspiration board of all our wants and needs (Corey, 2013). People are the

most important part of this quality world, remembering that a key point of choice theory is

that behavior is the result of unsatisfying relationships or the absence of relationships.

Without people in your quality world, there are no relationships. Without relationships, the

quality world cannot be satisfied. Part of the goal of the reality therapist would be to

become a part of their client’s quality world, thereby facilitating the process of learning to

form satisfying relationships (Corey, 2013).

Choice theory explains that all behavior is made of four components: acting, thinking,

feeling, and physiology. These four components combine to make up our total behavior.

Our acting and thinking controls our feelings and physiology. Choice theory also explains

that all behavior is purposeful, and is an attempt to close the gaps between our needs,

wants and what we are actually getting out of life (Corey, 2013). Our behavior can help us

deal with our emotions, give us some control over our circumstances, help get us the help

we need from others, or become a substitute for behavior that should occur. Behavior is like

a language sending out coded messages to the world on our behalf expressing our wants

and needs (Wubbolding & Brickell, 2005). Again, usually these wants and needs stem from

unsatisfied relationships.

The focus of reality therapy is to address the issue of these unsatisfying relationships which

can result in unfavorable behavior. Emphasis is placed on the client focusing on their own

behavior rather than playing the blame game. We cannot blame others for our lives and, in

turn, cannot control the behavior of others. “The only person you can control is yourself.”

(Corey, 2013). Reality therapy also involves being in the present and not focusing on the

International Journal of Choice Theory and Reality Therapy • Fall 2014 • Vol. XXXIV, number 1 • 8

past. The past is just that, the past. We cannot allow the past to dictate our present and

future actions. Again, focus should be on current behavioral issues since that is what needs

to be “fixed” (Corey, 2013).


As stated, the primary focus of reality therapy is to address the issues associated with

unsatisfactory or non-existent relationships. The therapist is responsible for helping the

client learn better ways to satisfy their needs while establishing better relationships. They

will help the client establish attainable short and long-term goals as a focus for therapy.

Also as mentioned, the therapist must try to make a connection with the client in order for

the process of learning how to establish beneficial relationships to begin. It is not the

therapist’s job to judge or evaluate the client. Rather, they strive to challenge the client to

look deeply at their behaviors and help to establish goals to make changes in their lives

(Corey, 2013).

In order to establish a good client-therapist relationship, the therapist needs certain

personal and professional qualities that support a therapeutic learning environment. Some

personal qualities that a reality therapist need are empathy (understanding), congruence

(genuineness), positive regard (acceptance), energy, and the ability to see everything as an

advantage or positive while not being naïve to the nature of humans. Some professional

qualities include having the ability to communicate hope, the ability to redefine the problem

in solvable, more attainable terms, the ability to use metaphors effectively, and cultural

sensitivity (Wubbolding & Brickell, 1998).

The therapeutic process is one of exploration of the client’s wants, needs, and perceptions.

The client’s responsibility in the therapeutic process is to stay on task, focusing on the

present behaviors and not past experiences. They should participate in the exercises as

presented by their therapist and answer questions as truthfully as possible, in an effort to

get a better understanding of their behavior in relation to their quality world and the

relationships they have established. These sessions are seen as a learning process so the

client should be able to take away lessons on how to deal with problems as they arise and

use the information learned in their daily lives. Again, choice theory and reality therapy can

be viewed as a way of life instead of just a form of therapy (Brown, 2005).


Reality therapy uses action-oriented techniques that include teaching, positiveness, humor,

confrontation, questioning, role-playing, and feedback. It is a “cycle of counseling” which

consists of creating an effective counseling environment and implementing specific

procedures that lead to change (Corey, 2013). Creating the counseling environment

involves establishing a therapeutic relationship with the client that is supportive yet

challenging. Therapist should avoid non-productive behaviors such as demeaning and

criticizing, and focus more on mildly confronting the client while being caring and accepting.

After the counseling environment is created, reality therapist can use the WDEP (Wants,

Direction and Doing, Evaluation, and Planning and Action) system to individualize the

International Journal of Choice Theory and Reality Therapy • Fall 2014 • Vol. XXXIV, number 1 • 9

process of exploring wants, needs and perceptions, determining possible actions they can

do to elicit change, self-evaluating their progress, and helping in designing an actual plan of

action for change (Corey, 2013; Radtke, Sapp, Farrell, 1997). When exploring their wants,

needs, and perceptions, a therapist will ask probing questions to help the client realize what

they truly want and need. A question as simplistic as “What do you want?” can be used but

often does not elicit a fully accurate response. Other questions that could be used are “What

would you be doing if you lived as you want to?” and “If you were the person that you wish

you were, what kind of person would you be?” It’s important to know what type of questions

to ask, and when and how to ask them. When exploring the possibilities of actions for

change, the therapist starts by asking the client what they are currently doing to make

change in their lives. Questions such as “What are you doing to get what you want?” and

“When you act that way, what are you thinking or feeling?” can be used. The next phase

would be a self-evaluating phase for the client. During this phase, the therapist will inquire

as to the effectiveness of current problem behaviors. “Is what you are doing working for

you?” or “Is what you are doing getting you what you want?” are just two of the questions a

therapist might use to elicit such information. The last phase would be to assist with putting

a plan of action into place to address the needs explored and confirming commitment to

enact the plan. The therapist can ask “What are you prepared to do?” or “What is your

plan?” These techniques can be used one-to-one and in a group setting.


Reality therapy has been around for decades and for some has been very useful in

addressing problem behaviors and unsatisfactory relationships. But many are asking, does

research support the use of reality therapy? This subject has actually been one of the major

criticisms of reality therapy. There seems to be a lack of in-depth research about the

effectiveness of the therapy. There have been studies conducted and dissertations written

on various topics relating to choice theory and reality therapy, but not much beyond

“anecdotal reports” (Litack, Fall 2007). In 1997, Radtke, Sapp, and Farrell conducted a

meta-analysis of the effectiveness of reality therapy and found that reality therapy has

many applications and it has a medium effect on behavior in relation to the 21 quantitative

studies that were examined. But the meta-analysis was limited due to the limited number of

quantitative studies addressing the theory. Radtke, Sapp, and Farrell also noted that reality

therapy can be categorized as a cognitive-behavior therapy whose concept is easy for

clients to understand, but that more research is needed to truly determine reality therapy’s


According to David Sansone in “Research, Internal Control and Choice Theory: Where’s the

Beef?” (1998), there are standards for evaluating theories and therapies for effectiveness.

He points out that a theory and therapy should be scientific in nature, they should relate

well, they should be flexible to possible growth, the theory should provide a sound basis for

understanding the therapy, and both the theory and therapy should be based on verified

evidence. Although it would seem that choice theory and reality therapy mostly fill these

requirements, it would also seem the main area of discontent is with verified evidence or a

scientific basis. Many challenge that choice theory is not a scientific psychology at all but

actually more of a self-help coaching method (Sansone, 1998). In addition to these general

International Journal of Choice Theory and Reality Therapy • Fall 2014 • Vol. XXXIV, number 1 • 10

standards, there are very specific ethical considerations that should be considered while

evaluating rather or not reality therapy is a valid scientific, psychological therapy.

Standards for counselors and therapists all address the issue that psychologists, therapists,

or counselors should work with valid and reliable methods that are based on scientific


When Sansone looked at the various articles in the Journal of Reality Therapy, the primary

publication for all things choice theory and reality therapy, he noted that only 9% of the

articles were of a research nature; far less were reported in other journals and databases.

In essence, it seems that there is not a lot of scientific research on which to base this theory

and therapy. In 2000, Wubbolding & Brickell noted that this is actually a misconception.

They believe that there is research which provides credibility for the practice of reality

therapy. Wubbolding agrees that more research is needed which is better controlled and

more visible in the professional world. Wubbolding noted that the 21st century would mark a

period in which the reality therapy community would be held more accountable for research

and validity of the method. Future generations will have to continue the momentum that

has been established (Burdenski, 2010). Dr. Glasser himself responded with his own call to

action. He requested that his work be independently researched and documented in order to

validate the effectiveness of choice theory and reality therapy (Glasser, 2010).

In these calls to action, emphasis was placed on research focusing on the multi-dimensional

nature of reality therapy. Research has supported that reality therapy is self-empowering

and can be effective in treating a variety of issues, including schizophrenia (Kim, 2005),

PTSD (Prenzlau, 2006), marriage and family issues (Duba, Graham, Britzman, & Minatrea,

2009), adult developmental issues (Mottern, 2008), and school related issues (Mason &

Duba, 2009; Wubbolding, 2007). One response to these calls for efficacy research was

answered in a study on the effectiveness of a graduate-level, interdisciplinary course on

choice theory and reality therapy at Northeastern University (Watson & Arzamarski, 2011).

The purpose of this study was to evaluate the value placed on choice theory and reality

therapy by the students, both professionally and personally. In this study, a total of 87

students were surveyed over a 5 year period. The results of the survey indicated that

students did indeed believe that reality therapy and choice theory were effective. The study

also noted that some students felt the theory was limited by confusion caused in attempts

to understand the basic concepts, not being applicable to some fields of study or

professions, and that the therapy cannot be a stand-alone therapy. This study should be

repeated with other test groups to test its validity.

In addition to the challenge of limited scientific research, some found it challenging to

incorporate the knowledge gained in therapy to their everyday lives. It is believed that a

client can have all the intentions in the world of implementing the plan of action developed

during therapy but often they do not. According to Robert Renna (1996), sometimes the will

to follow through is just not present. Role playing cannot substitute for the real world.

Renna believes that clients must be continually motivated and encouraged to follow through

with their plan of action and commitment. It is important for the therapist to start this

encouragement as part of the WDEP process.

International Journal of Choice Theory and Reality Therapy • Fall 2014 • Vol. XXXIV, number 1 • 11

Despite these issues, it seems that choice theory and reality therapy have a global following

that is getting stronger everyday (Lennon, 2010). In fact, choice theory and reality therapy

are now taught and practiced on every continent except Antarctica (Wubbolding, Robey, &

Brickell, 2010). This is because choice theory and reality therapy are thought to be credible

and universal, and can be applied to any culture. Choice theory teaches that all humans

have basic needs, a quality world, choices, and purposeful behavior. Some universal

behaviors and wants include cooking, dancing, education, folklore, gestures, language,

mourning, personal naming, and property rights. So no matter where you are in the world,

more than likely, your civilization has some, if not all, of these behaviors and wants. It is

important that reality therapist become multiculturally competent so they can properly

address the needs of their multicultural clients (Wubbolding, Al-Rashidi, Brickell, Kakitani,

Kim, Lennon, Lojk, Ong, Honey, Stijacic, & Tham, 1998).

This same globalization is also involved in the push for future development. It is part of the

choice theory philosophy itself that constant improvement is sought. This means the

organization not only has to strive for validity, but it also has to strive to put more

educated faculty in place to teach choice theory and reality therapy, and increase the

quality of their resources (videos, books, etc.) (Lennon, 2010). In order for choice theory to

survive, in addition to the scientific research and validation, it needs commitment and a

thriving organization backing it (Wubbolding, Robey, & Brickell, 2010). The William Glasser

Institute for Research is going in the right direction when it formed a relationship with

Loyola Marymount University and is continuing to foster that relationship in years to come.

This relationship is still very new but is one based on sustainability. It is hoped that this

relationship serves as a model for other institutions and agencies; to embrace choice theory

and reality therapy since an academic research institution is essential to the future of choice

theory (Smith, 2010).


As demonstrated, choice theory and reality therapy are global initiatives that are hopefully

here to stay. Choice theory began as a way of explaining peoples’ behaviors and has

evolved into much more than that. The basic philosophies of choice theory can be used

every day and can be a way of life or lifestyle if fully embraced all the time, not just in a

therapy session. These philosophies include the ideas that we all have choices in life, we can

only control our own behaviors, all behavior is total and purposeful, focusing on the present

rather than the past, most problems are the result of unsatisfying relationships, and we can

“fix” unsatisfying relationships by satisfying our basic needs pictured in our quality world.

Reality therapy uses techniques such as confrontation, questioning, role-playing, and

feedback to help guide an individual to discover their wants and needs and to help put a

plan of action into place for change to occur. With more research and establishing more

academic relationships, choice theory and reality therapy will surely thrive for many

generations to come.

International Journal of Choice Theory and Reality Therapy • Fall 2014 • Vol. XXXIV, number 1 • 12


Brown, T. & Stuart, S. (2005). Identifying Basic Needs: The Contextual Needs Assessment.

International Journal of Reality Therapy, 24(2), 7-10.

Burdenski, T. (2010). What Does the Future Hold for Choice Theory and Reality Therapy

from a Newcomer’s Perspective? International Journal of Choice Theory and Reality

Therapy, 29(2), 13-16.

Corey, G. (2013). Reality Therapy. Theory and Practice of Counseling and Psychotherapy,

9Th edition, 333-359. Belmont, CA: Brooks/Cole, Cengage Learning.

Duba, J., Graham, M., Britzman, M., and Minatrea, N. (2009). Introducing the “Basic Needs

Genogram” in Reality Therapy-based Marriage and Family Counseling. International Journal

of Reality Therapy, 28(2), 15-19.

Glasser, W. (1998). Choice Theory: A new psychology of personal freedom, 1st edition.

New York, New York: HarperCollins Publishers, Inc.

Glasser, W. (2010). My Vision for the International Journal of Choice Theory and Reality

Therapy. International Journal of Choice Theory and Reality Therapy, 29(2), 12.

Howatt, W. (2001). The Evolution of Reality Therapy to Choice Theory. International

Journal of Reality Therapy, 21(1), 7-12.

Kim, J. (2005). Effectiveness of Reality Therapy Program for Schizophrenic Patients.

Journal of Korean Academy of Nursing, 35(8), 1485-1492.

Lennon, B. (2010). Choice Theory: A Global Perspective. International Journal of Choice

Theory and Reality Therapy, 29(2), 17-24.

Litwack, L. (2007). Basic Needs-A Retrospective. International Journal of Reality Therapy,

Spring, 2007, 26(2), 28-30.

Litwack, L. (2007). Research Review: Dissertations on Reality Therapy and Choice Theory-

1970- 2007. International Journal of Reality Therapy, Fall 2007, 27 (1), 14-16.

Mason, C. & Duba, J. (2009). Using Reality Therapy in Schools: Its Potential Impact on the

Effectiveness of the ASCA National Model. International Journal of Reality Therapy, 29(2),


Mottern, R. (2008). Choice Theory as a Model of Adult Development. International Journal

of Reality Therapy, 27(2), 35-39.

Prenzlau, S. (2006). Using Reality Therapy to Reduce PTSD-Related Symptoms.

International Journal of Reality Therapy, 25(2), 23-29.

Radtke, L., Sapp, M., & Farrell, W.C. (1997). Reality Therapy: A Meta-Analysis. Journal of

Reality Therapy, 17(1), 4-9.

International Journal of Choice Theory and Reality Therapy • Fall 2014 • Vol. XXXIV, number 1 • 13

Renna, R. (1996). Beyond role play: Why reality therapy is so difficult in the real world.

Journal of Reality Therapy, 15(2), 18-29.

Sansone, D. (1998). Research, Internal Control, and Choice Theory: Where’s the Beef?

International Journal of Reality Therapy, 17(2), 39-43.

Smith, B. (2010). The Role of The William Glasser Institute for Research in Public Mental

Health at Loyola Marymount University in the Future of Choice Theory. International

Journal of Choice Theory and Reality Therapy, 29(2), 35-40.

Watson, M.E. & Arzamarski, C.B. (2011). Choice Theory and Reality Therapy: Perceptions

of Efficacy. International Journal of Choice Theory and Reality Therapy, 31(1), 97-108.

Wubbolding, R. (2007). Glasser Quality School. Group Dynamics: Theory, Research, and

Practice, 11(4), 253-261.

Wubbolding, R., Al-Rashidi, B., Brickell, J., Kakitani, M., Kim, R.I., Lennon, B., Lojk, L., Ong,

K.H., Honey, I., Stijacic, D. & Tham, E. (1998). Multicultural Awareness: Implications for

Reality Therapy and Choice Theory. International Journal of Reality Therapy, 17(2), 4-6.

Wubbolding, R. & Brickell, J. (2000). Misconceptions About Reality Therapy. International

Journal of Reality Therapy, 19(2), 64-65.

Wubbolding, R. & Brickell, J. (2005). Purpose of Behavior: Language and Levels of

Commitment. International Journal of Reality Therapy, 25(1), 39-41.

Wubbolding, R. & Brickell, J. (1998). Qualities of the Reality Therapist. International

Journal of Reality Therapy, 17(2), 47-49.

Wubbolding, R., Robey, P., & Brickell, J. (2010). A Partial and Tentative Look at the Future

of Choice Theory, Reality Therapy and Lead Management. International Journal of Choice

Theory and Reality Therapy, 29(2), 25-34.

Brief Bio—

Ezrina Bradley received her Bachelor’s Degree in General and Integrative Studies with

concentrations in psychology and social work from Loyola University Chicago. She is

currently a graduate student in the counseling program at Chicago State University, with

hopes of becoming a licensed clinical professional counselor and going on to earn her

doctorate degree. Ezrina has worked over 15 years in the social services field, with her

most recent work being with troubled youth and adults with intellectual and developmental


Ezrina is currently working toward certification in Reality Therapy and Choice Theory and is

looking forward to completing it soon.

In her free time, Ezrina enjoys traveling, crafting, exercising, gardening, event planning,

and volunteering with the American Red Cross and with Girl Scouts.

Course Paper Instructions

Write a 7-page research paper (Choice Theory within Reality Therapy) , not including the cover, abstract, and reference pages. Current APA format is required. At least 5 scholarly, empirical, current sources that are directly related to the level headings of the paper are required.(SEE BELOW FOR HEADINGS AND ARTICLES). You can use research articles or books. sources. The use of quotations is not allowed. You will be required to use your own words; however, you still must cite the information.

Note: the 7-page limit does not include the cover, abstract, and reference pages.

Choice Theory within Reality Therapy

1. Cover page

2. Abstract

3. Body

4. References: At least 5 references required—textbook, books, and journals.( I HAVE PROVIDED)

The body of your paper must be organized according to the following content headings. You must also use current APA format.

· History of Theory

· Types of Problems Theory is Most Useful

· Strengths of the Theory

· Weaknesses of the Theory

· Conclusion

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

_______________________________________________________________ Report Information from ProQuest November 23 2014 18:39 _______________________________________________________________

23 November 2014 ProQuest

Table of contents

1. “Drugs” Versus “Reality Therapy”………………………………………………………………………………………………….. 1

23 November 2014 ii ProQuest

Document 1 of 1 “Drugs” Versus “Reality Therapy” Author: Barness, Ryan; Parish, Thomas S ProQuest document link Links: Linking Service, Check for full text via Journal Finder Full text: ABSTRACT External Controls on people tend to rob them of their “personal choices.” Notably, this paper presents some ideas concerning how various medications have done this, but then presents important insights regarding how Reality Therapy avoids this whole externally-controlled orientation by facilitating individuals in their efforts to find “positive alternatives.” In North America, medication is commonly used for behavioral control of children. With the frequent diagnosis of disorders such as ADD and ADHD in children, the overuse of stimulant medication and its long-term effects are drawing criticism. Is society taking the easier path by medicating these children instead of dealing with the underlying reality of a child’s problem? The diagnosis of Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD) in children and the common usage of stimulant medication for behavioral control has become a customary practice in North America. ADD is a neurological disorder for which there is yet no cure. Emotional problems, vision, hearing, and intellectual impairment, family stress, and general medical issues are factors that may produce behaviors representing ADD. This condition or disorder occurs primarily in early childhood, almost always evident before seven years of age. ADD affects children, adolescents, and adults of any gender or cultural environment, and across a wide range of intelligence (CHADD, 1992). In 1995, the International Narcotics Control Board (INCB) expressed concern that “10 to 12 percent of all boys between the ages of 6 and 14 in the United States have been diagnosed as having ADD and are being treated with Methylphenidate.” Previously, the US Drug Enforcement Administration (DEA) proclaimed an eight-fold increase in the production quotas for Methylphenidate (MPH) from 1.768 kg in 1990 to 14.442 kg in 1998 (Feussner, 1998). In addition, the brisk marketing of amphetamines, a stimulant medication, has further escalated usage (Breggin, 1998). The US DEA (1995, 1996) and INCB (1995, 1997) have both cautioned regarding the risk of abuse and dependence among youth who have recently been prescribed stimulant medication. Medications such as Dextroamphetamine and Methylphenidate (MPH) are used to treat ADD/ADHD and other associated disorders. Cardiovascular problems have been associated with the psychostimulant, MPH, i.e., it has been shown to raise the blood pressure of children, adding stress to the cardiovascular system. This effect in adults can be a major health risk. Additional problems including arrhythmias, shock, and cardiac muscle pathology have been reported by Ellinwood and Tong (1996). Adults given MPH, in a study by Volkow et al. (1997), decreased in the metabolic rate in the basal ganglia and demonstrated other changes associated with the dopamine receptors. Studies have concluded that children diagnosed with ADHD and treated with stimulants grow to do poorly as young adults. Early drug interventions have been used to offset these effects, with questionable results. Helping professionals are often too quick to prescribe medications for children, and many are unaware of the risks involved with their long-term effects. Reality Therapy, in contrast, proposes a different approach to these issues, e.g., facilitating rather than retarding children’s choices to make adequate and responsible decisions. Reality Therapy helps individuals understand themselves better, communicate more effectively with others, and better motivate themselves to fulfill one or more of their five needs (i.e. love and belonging, power, fun, freedom, and survival).

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Kindness, support, compassion, and protection are the kinds of treatment tools often employed in Reality Therapy, no matter what the diagnosis of the disorder. Reality Therapy simply requires intense personal involvement, rejects irresponsible behavior, and provides the opportunity for individuals to learn better ways to conduct themselves by facing reality. Since Reality Therapy doesn’t assume an external mode of treatment, it actually produces different results from treatment procedures that do. Reality Therapy is deemed to be an internal control approach that seeks to help individuals to make accurate assessments for themselves regarding responsible decision making behaviors. External control, which is often associated with medications used in the treatment of ADD/ADHD, takes the control out of the individual’s hands and restrains him/her by an outside force over which the individual has no control, bestowing the control of the individual on those who would impose an external source of constraint.. Children, adolescents and adults with disorders such as ADD/ADHD often behave irresponsibly, in order to fulfill their needs (i.e. love and belonging, power, fun, freedom, and survival), but their efforts usually fail (Classer, 1990). Generally, these individuals are usually reaching out for help because they are missing an accurate depiction of their needs (i.e. love and belonging, power, fun, freedom, and survival), and often how to fulfill them. When prescribed medications are used to control behavior without examining the real picture, the individuals’ opportunities to act responsibly, of their own accord, is often lost. Reality Therapy requires understanding by individuals, which helps them to figure out which of their needs are not being met, and then, assists individuals in making choices that help them meet their goals. In the home, tactics are usually used to address underlying needs through Reality Therapy, which involve dealing with the basic needs of love and belonging, power, fun freedom, and survival. Reality Therapy doesn’t let the individuals act out in behaviors associated with ADD/ADHD. Reality Therapy requires others to relate to them, as well as gets them involved in appropriate, “sane” behavior that can be shared. In doing so, it helps prevent ADD from developing into behavioral disorders, such as ADHD. A Reality Therapist/parent/teacher must have very responsible attributes such as being committed, tough, interested, humane, and sensitive. The individuals need to be able to communicate openly about their struggles so that they can see and adapt and act responsibly when going through tough times. Reality Therapists must control what they do, say, feel, think and/or value. The therapist must get involved with individuals and be able to withstand intense criticism from them while consistently providing positive techniques in dealing with their behaviors. In addition, the therapist must show that a person can act responsibly, although it may often take great effort to do so (Classer, 1990). Students suffering from the disorder of ADD will often lack self-esteem, complain of boredom, become distracted very easily, act and speak before thinking, have poor listening habits, fail to finish class work and tests, and many other symptoms that range from being unable to focus to engaging in destructive behavior. Strategies that a Reality Therapist may utilize in order to aid these individuals may include: extra time for support and supervision of the children on certain tasks, structure in the home (such as consistent rules and organization to help organize activities), providing attention while establishing eye contact, using auditory and visual cues, and encouraging them when they attempt to take responsible actions in their lives. What this requires is knowledge about ADD, teacher flexibility, commitment, and the willingness to work with ADD/ADHD students on a personal level. Strategies such as using communication between school and home, having good teamwork on behalf of the ADD/ADHD students, respecting students’ privacy and confidentiality, and assisting with organizational and environmental modifications can help build students’ supportive base by valuing them for their differences and by bringing out their strengths (CHADD, 1992). The willingness to work with ADD/ADHD students involves many more of these critical factors that make a difference in their behaviors and learning processes. With the overwhelming time, responsibility, and commitment that it takes to deal with people who suffer from disorders such as ADD, it is understandable why parents, teachers, and helping professionals may opt to choose using medication as a shortterm “easy out.”

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After all, there are often many challenges associated with students with ADD/ADHD, e.g., Oppositional Defiant Disorders (ODD), plus when one is dealing with other things, (e.g., other children, a turbulent marriage), short- cuts are frequently welcome. However, are such medications really better for such students, especially in the long run? Will the use of such medications be able to facilitate more responsible behavior in these students, especially later on when drugs are not used and/or are unavailable? The answer is, “doubtfully.” So it may be that the best choice (i.e., Reality Therapy) may require more effort, more patience, and more time, but if all are properly used, the ADD/ADHD students’ actions should ultimately become more responsible, more positive, and more maturing as they do so, which is what we would hope to find. There is a choice. Give stimulant medication and accept the health consequences, or deal with the real issues the disorder brings by understanding the basic needs and providing a natural way to deal with these challenging behaviors the individuals display. Truly, it may take great dedication and commitment to avoid medication when working with individuals with such disorders, and use Reality Therapy instead, but as we do so coinsistently, it should get a lot easier and more rewarding.. References REFERENCES _____. Drug Enforcement Administration (DEA). (1995, October). Methylphenidate (A background paper). Washington. DC. Drug and Chemical Evaluation Section. Office of Diversion Control. DEA. US Department of Justice. _____. Children and Adults with Attention Deficit Disorder (CHADD), (1992). A Booklet for Parents, 3-13. _____. Drug Enforcement Administration (DEA). (1996). Conference report: Stimulant use in treatment of ADHD. Washington. DC. Drug and Chemical Evaluation Section. Office of Diversion Control. DEA. US Department of Justice. _____. International Narcotics Control Board. (INCB). (1995. Februrary 28). Dramatic increase in methylphenidate consumption in US: Marketing methods questioned. INCB Annual Report 1995: Background Note No. 2 Vienna. Austria. _____. International Narcotics Control Board. (INCB). (1997. March 4). INCB sees continuing risk in stimulants prescribed for children. INCB Annual Report Background Note No. 4. Vienna, Austria. Breggin, RR. (1998). Talking Back to Ritalin. Monroe. ME: Common Courage Press. Ellinwood, E.H. &Tong. H.L. (1996). Central Nervous System stimulants and anorectic agents. In M.N.G. Dukes (Ed.), Meyler’s side effects of drugs: An encyclopedia of adverse reactions and interactions (13th edition), pp. 1- 30. New York: Elsevier. Feussner, G. (1998). Diversion, trafficking, and abuse of Methylphenidate. NIH consensus development conference program and abstracts: Diagnosis and treatment of attention deficit hyperactivity disorder, pp. 201- 204. Rockville, MD: National Institutes of Health. Glasser, W. (1990). Reality Therapy: A New Approach to Psychiatry. New York: Harper &Row. Lambert, N.M. (1998). Stimulant treatment as a risk factor for nicotine use and substance abuse. NIH consensus development conference program and abstracts: Diagnosis and treatment of attention deficit hyperactivity disorder, pp. 191-200. Rockville, MD: National Institutes of Health. Lambert, N.M. &Hartsough, C.S. (in press). Prospective study of tobacco smoking and substance dependence among samples of ADHD and non-ADHD subjects. Journal of Learning Disabilities. Murray, J.B. (1998). Psychophysiological aspects of amphetamine-Methamphetamine abuse. Journal of Psychology, 132, 227-237. Volkow, N.D., Wang, G.J., Fowler, J.S., Logan. J., Angrist, B., Hitzemann, R., Lieberman, J., &Pappas, N. (1997). Effects of methylphenidate on regional brain glucose metabolism in humans: Relationship to dopamine D2 receptors.

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American Journal of Psychiatry, 154. 50-55. AuthorAffiliation Ryan Barness and Thomas S. Parish The first author is a student at Upper Iowa University majoring in biology and minoring in psychology. The second author is associate professor of psychology at Upper Iowa University, Fayette, Iowa AuthorAffiliation The first author may be contacted at 323 E. Elm, West Union, IA 52175 Publication title: International Journal of Reality Therapy Volume: 25 Issue: 2 Pages: 43-45 Number of pages: 3 Publication year: 2006 Publication date: Spring 2006 Year: 2006 Publisher: International Journal of Reality Therapy Place of publication: Highland Park Country of publication: United States Publication subject: Psychology ISSN: 10997717 Source type: Scholarly Journals Language of publication: English Document type: General Information ProQuest document ID: 214440418 Document URL: http://www.liberty.edu:2048/login?url=http://search.proquest.com/docview/214440418?accountid=12085 Copyright: Copyright International Journal of Reality Therapy Spring 2006 Last updated: 2010-06-08 Database: ProQuest Central,ProQuest Social Sciences Premium Collection

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  • “Drugs” Versus “Reality Therapy”

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reality Therapy in Action Daya Singh Sandhu Professional School Counseling; Apr 2000; 3, 4; ProQuest pg. 296

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