--and you, Albert Ellis, what were you doing down by the watermelons?

I was particularly intrigued by Ellis’ point #3 on page 156:

Family, social, and cultural influences learned at a young age may strongly encourage people to engage in behaviors that, under different conditions would not lead to addiction. For example, in order to win the approval of peers, youths may ‘willingly’ addict themselves to smoking, drinking, and criminal acts.

While I believe that family, social, and cultural influences may in fact encourage people (esp. adolescents) to engage in destructive behaviors like substance use (and my current research is pointing in this direction), I am not sure I am willing to accept Ellis’ explanation that this is due to a difficulty in distinguishing between strong desires and rigid demands.

I believe that if adolescent substance use was not so culturally normative, we would see less of it overall. But I do not think that this would greatly reduce the number of those that go on to develop substance use disorders (SUDs). To say that there would not be some other circumstances that would likely elicit destructive, addictive behavior would be naïve. We already have a plethora of evidence implicating the importance of biological predispositions and emotional dysregulation in the onset of substance use disorder (note here, I mean addiction, not substance use itself). Thus, I agree with Ellis that there are biological and environmental factors that are associated with the onset and maintenance of self-destructive behaviors like SUD. However, I am not convinced that thinking about it in terms of desires and demands is theoretically correct or even helpful.

That being said, I was disappointed that the meta-analysis did not provide evidence regarding SUD treatment. Ellis would probably be inclined to say that cognitive-behavioral treatments like RET would in fact be effective in treating SUDs, so long as the client was willing to “choose to do the hard work and practice that is usually required for change” (p. 156). I, myself, am inclined to think that some sort of CBT would in fact work for those with SUDs whose use was motivated by emotion regulation. However, there are indeed cases where emotion regulation plays little to no role in the maintenance. In these cases, I am not sure whether or not CBT would be effective.

This leads me to the question of whether or not understanding etiology would make an important impact on the efficacy of CBT.