Introduction

The outcome of any therapy depends not only on the use of appropriate treatment strategies but also on how persistently and conscientiously the patient carries them through. It is the tenacity of the individual in pursuit of his or her chosen goal that is a crucial factor in long-term success. Heather (1992) put it succinctly when he commented that ‘addictive disorders are essentially motivational problems’. The therapist is more than just a dispenser of appropriate treatments or a donator of advice. The therapist must act as a catalyst to help unravel the motivational forces that contribute to the persistence of old self-defeating behaviours or, alternatively, the intiation and maintenance of new more adaptive ones.

The word motivation comes from the Latin root meaning ‘to move’ and is an attempt to understand what moves us or why we do what we do (Wade and Tarvis, 1992). It is an inferred set of processes, which cause a person to move towards a particular goal. Miller (1985) gives us a practical definition of motivation as the ‘probability that a person will enter into, continue and adhere to a specific change process’.

There has been considerable debate among psychologists over the years on how best to account for the complexity of human motives. The early focus on instincts gave way to drive theory (Hull, 1943), which dominated our thinking in the mid-twentieth century. However, this approach did not full take account of the interaction between socially learned motives and biological needs. Festinger's (1957) work began to bridge this gap with his ideas on cognitive balance and dissonance leading to an understanding of the human motives to organise and deal with experiences in terms of a more general belief system. Later McClelland (1961) noted that forces like the need for competence, predictability, achievement, or power, can fuel our goal-directed journey. The historical development of general motivational theories within psychology is, however, beyond the scope of this chapter.

The following section examines the background of some cognitive interventions which have become popular in the addictions literature. It is argued that these are best understood in motivational terms.