Pathways Interventions for Chronic, Relapsing Substance Abuse Disorders

  • Angele McGrady
  • Donald Moss


The authors regard substance abuse and addictive behavior as a chronic recurrent illness, with psychological, behavioral, and medical components. They call for multi-modal intermittent treatment throughout the life span, addressing the emotional, social, and biological dimensions of the disorder. A case study of a lifelong alcohol and drug-dependent male illustrates the often chronic relapsing course of the illness. The patient, Colin, was a gifted trial attorney, who struggled with alcohol, marijuana, and cocaine use for decades. The chapter provides an example of a Pathways Model treatment program, integrating lifestyle changes, complementary therapies, spiritual intervention, and professional treatment for addiction to assist this individual in managing his condition, and recovering his life.


Substance abuse Addiction Recovery Relapse Second phase recovery Intervention 


  1. Alcoholics Anonymous. (2004). Twelve steps and twelve traditions. New York, NY: Alcoholics Anonymous World Services.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.CrossRefGoogle Scholar
  3. Bauer, L. O. (2001). Predicting relapse to alcohol and drug abuse via quantitative electroencephalography. Neuropharmacology, 23, 332–340. CrossRefGoogle Scholar
  4. Begleiter, H., & Porjesz, B. (1999). What is inherited in the predisposition toward alcoholism? A proposed model. Alcoholism: Clinical and Experimental Research, 23, 1125–1135.CrossRefGoogle Scholar
  5. Cross Disorder Group of the Psychiatric Genomics Consortium. (2013). Identification of risk loci with shared effects on five major psychiatric disorders: A genome-wide analysis. Lancet, 381(9875), 1371–1379. CrossRefPubMedCentralGoogle Scholar
  6. DeSalle, M., & Agley, J. (2015, September 24). SBIRT: Identifying and managing risky substance abuse. Counseling Today. a publication of the American Counseling Association. Retrieved from
  7. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York, NY: Delacorte.Google Scholar
  8. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.Google Scholar
  9. Kabat-Zinn, J. (2006). Mindfulness for beginners: Reclaiming the present moment. (Educational CD). Louisville, CO: Sounds True.Google Scholar
  10. Learsen, E. (1985). Stage two recovery: Living beyond addiction. New York, NY: HarperCollins.Google Scholar
  11. Lee, J. D., Kim, S. G., Jung, T. G., Jung, W. Y., & Kim, S. Y. (2015). Effect of Zhubin (KI9) acupuncture in reducing alcohol craving in patients with alcohol dependence: A randomized placebo-controlled trial. Chinese Journal of Integrative Medicine, 21(4), 307–311. CrossRefPubMedGoogle Scholar
  12. Lin, J. -G., Chan, Y. -Y., & Chen, Y. -H. (2012). Acupuncture for the treatment of opiate addiction. Evidence-based Complementary and Alternative Medicine, 739045.doi: CrossRefGoogle Scholar
  13. Margolin, A. (2003). Acupuncture for substance abuse. Current Psychiatry Reports, 5(5), 333–339.CrossRefGoogle Scholar
  14. McCraty, R. (2016). From depletion to renewal: Positive emotions and heart rhythm coherence feedback. In D. Moss & F. Shaffer (Eds.), Foundations of heart rate variability (pp. 82–84). Wheat Ridge, CO: Association for Applied Psychophysiology and Biofeedback.Google Scholar
  15. McGrady, A., & Moss, D. (2013). Pathways to illness, pathways to health. New York, NY: Springer. CrossRefGoogle Scholar
  16. McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kieber, H. D. (2000). Drug dependency: A chronic medical illness. Journal of the American Medical Association, 284(13), 1689–1695.CrossRefGoogle Scholar
  17. Meade, C. S., Lukas, S. E., McDonald, L. J., Fitzmaurice, G. M., Eldrige, J. A., Merrill, N., et al. (2010). A randomized trial of transcutaneous electrical stimulation as adjunctive treatment for opioid detoxification. Journal of Substance Abuse Treatment, 28(1), 12–21. CrossRefGoogle Scholar
  18. Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford.Google Scholar
  19. Mooney, A. J., Eisenberg, A., & Eisenberg, H. (1992). The recovery book. New York, NY: Workman Publishing.Google Scholar
  20. Moss, D. (2005). Psychophysiological psychotherapy: The use of biofeedback, biological monitoring, and stress management principles in psychotherapy. Psychophysiology Today: The Magazine for Mind-Body Medicine, 2(1), 14–18.Google Scholar
  21. Moss, D. (2008). Zur psychosomatischen Psychotherapie (Toward a psychosomatic psychotherapy). Biofeedback in der Praxis, Band II. Erwachsene. (Biofeedback in practice: vol. 2. Adults). Vienna/New York: Springer Medizin.Google Scholar
  22. Peniston, E. G., & Kulkosky, P. J. (1989). Alpha-theta brainwave training and beta endorphin levels in alcoholics. Alcoholism: Clinical and Experimental Results, 13(2), 271–279.CrossRefGoogle Scholar
  23. Penzlin, A. I., Siepmann, T., Illigens, B. M.-W., Weidner, K., & Siepmann, M. (2015). Heart rate variability biofeedback in patients with alcohol dependence: A randomized controlled study. Neuropsychiatric Disease and Treatment, 11, 2619–2627.CrossRefGoogle Scholar
  24. Pollock, V. E., Volavka, J., Goodwin, D. W., Mednick, S. A., Gabrielli, W. F., Knop, J., et al. (1983). The EEG after alcohol in men at risk for alcoholism. Archives of General Psychiatry, 40, 857–864.CrossRefGoogle Scholar
  25. Porjesz, B., & Begleiter, H. (2003). Alcoholism and human electrophysiology. Alcohol Research and Health, 27(2),153–60.Google Scholar
  26. Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care. New York: Guilford Press.Google Scholar
  27. Sokhadze, E. M., & Trudeau, D. (2016). Alcohol substance use disorders. In G. Tan, F. Shaffer, R. Lyle, & I. Teo (Eds.), Evidence-based treatment in biofeedback and neurofeedback (3rd ed., pp. 22–26). Wheat Ridge, CO: Association for Applied Psychophysiology and Biofeedback.Google Scholar
  28. Scott, W. C., & Kaiser, S. (1998). Augmenting chemical dependency treatment with neurofeedback training. Journal of Neurotherapy, 3(1), 66.Google Scholar
  29. Scott, W. C., Kaiser, D., Othmer, S., & Sideroff, S. S. (2005). Effects of an EEG biofeedback protocol on a mixed substance abusing population. The American Journal of Drug and Alcohol Abuse, 31(3), 455–469.CrossRefGoogle Scholar
  30. Zhang, X. (2003). Acupuncture: Review and analysis of reports on controlled clinical trials. Geneva, Switzerland: World Health Organization.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Angele McGrady
    • 1
  • Donald Moss
    • 2
  1. 1.Department of PsychiatryUniversity of ToledoToledoUSA
  2. 2.College of Integrative Medicine and Health SciencesSaybrook UniversityOaklandUSA

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