I read and re-read Guy du Plessis’ challenging and fascinating book “An Integral Foundation for Addiction Treatment” and had the experience of concepts coming in and out of focus as objects may appear and disappear in the headlights of a car making its way along a road into an unknown landscape. I am no academic in the field of addiction, nor in integral theory nor a recovering addict. I have however been touched very directly by the devastation that addiction causes having lost dear friends over the years and I too can sense the addict part of myself. I also facilitate weekly art sessions in a recovery centre and the images that the clients have made came in and out of focus too as I read [1].

The South African statesman Jan Smuts is acknowledged and referred to throughout Guy’s book; locating Guy in the South African landscape and also crediting Jan Smuts as an early proponent of the philosophy that underlies “integral theory”. Guy sites Smut’s notion of “fields” in his (1926) book “Holism and Evolution” on pg 64; “We have to return to the fluidity and plasticity of nature and experience in order to find the concepts of reality [2]. When we do this we find that round every luminous point in experience there is a gradual shading off into haziness and obscurity…a thing is not merely that which presents itself as such in a clearest definite outline, but this central area is surrounded by a zone of intuitions and influences which shades off into the region of the indefinite…”

Guy writes on pg 95 “…as therapists, we are dealing with the immense complexity of another human being that will ultimately remain only partly intelligible to us. The aim of IRMt is simply to make it more intelligible than it would be without a metatheoretical framework, to provide stronger headlights for navigating the recovery journey of the client” [3].

These two passages support my experience of going on this ride with Guy into the depths of what it means to be human with his headlights to guide us and with Smuts standing in the darkness in the background reminding us of how complex it is to have an explanation of an ultimate truth or reality but in the end it is this quest for a shared unity that is our salvation. Guy concludes with this passage from Smuts [4].

In the last resort a civilization depends on its general ideas; it is nothing but a spiritual structure of the dominant ideas expressing themselves in institutions and the subtle atmosphere of culture. If the soul of our civilization is to be saved we shall have to find new and fuller expression for the great saving unities-the unity of reality in all its range, the unity of life in all its forms, the unity of ideas throughout human civilization, and the unity of man’s spirit with the mystery of the Cosmos in religious faith and aspiration [5,6].

-General Jan Smuts (1926, pp. v-vi)

The book is ambitious and hopeful and strives to find a fuller expression of what addiction is and embrace all forms of recovery in what feels like a last resort; this because relapse rates for alcoholism are said to be between 70% and 90% for alcoholism and 90% for illicit drug use. It is fair to say that there is at this time no cure for addiction and it is frustrating given that considerable investments have been made in this field but with little to show for it [7].

Guy takes us through all the available recovery models and his explanations of each give a good summary; the extensive bibliography is also a good resource for further investigations. He includes the Twelve Steps model and gives us an interesting history of how it came about. He defends this model as being quite effective in treatment and urges its critics to experience it before shooting it down [8-10].

There have been attempts at integrating all the various models in treatment plans especially the “bio psychosocial model of addiction” which is the most widely recognized compound approach to addiction. This model combines biomedical, psychological and sociological factors in its explanation and subsequent treatment of addiction. Guy criticizes the model for not being truly integrative in its approach as each component is isolated from the other and the overall context or how these factors relate to one another are not fully taken into account. Philosophical threads weave this book together and it is at the bio psychosocial model that the ontological foundation of addiction treatment is identified as abstractionist and positivist and thus problematic.

Critics of the biopychosocial model have proposed a relational ontological approach to addiction but the author states that his book presents another option and he notes “...that what creates the so-called conceptual confusion in addiction sciences is real from an epistemological perspective, and is a result of ontological reductionism” pg 42.

This book proposes that the use of integral theory can help to address the conceptual chaos prevalent in the field and by doing this ineffectual treatments can also be tackled. So what is integral theory?

Guy gives a background of the American philosopher Ken Wilber’s (2000, 2004) integral theory and his AQAL model: all quadrants, all levels, all lines, all states and all types. We are told that integral theory has been applied in over 35 disciplines and addiction science is just one of them. Integral theory is not a theory in and of itself but its subject matter is other theory. It seems that integral theory has been used in addiction science at the level of treatment but it has not been used in trying to integrate a conceptual framework for what addiction is in the first place. The pioneering spirit of this book proposes “an integral foundation” for addiction treatment which examines the underlying philosophical constructs of what addiction is.

The work of integral scholar-practitioner; Sean Esbjorn-Hargens who identified three pluralisms of integral theory namely: Epistemological, methodological and ontological is core to the concept of enactment. This is a key concept of the book; the idea that addiction is not one thing or one object but rather “…a multiple object with no existing reality to be discovered” Pg 50.

Is the neurobiologist seeing the same addiction as the existential therapist? Is the psychoanalyst talking about the same addiction as the Twelve Step counsellor? Is the biochemist measuring the same addiction as the social scientist? Yes and no. Yes, in the sense that that they all attempt to view the socially defined and agreed-upon phenomena called addiction; and no, in the sense that they are “bringing-forth-into-the-world” and enacting different realities, ranging in ontological complexity (first, second, and An Integral Foundation F 52 or Addiction Treatment third orders of ontology)- which can overlap ontologically, but are not the same ontic phenomenon [11].

In short, there are essential structures of addiction that share the various enactments of it, but how it “exists-in-the-world” varies, depending on the unique permutation of its integral enactment triad of “Who–How–What” pg 51-52.

The book is packed with theories which the author at times reminds us cannot be dealt with in-depth and the idea of this unknown landscape not yet fully illuminated by the headlights but on the fuzzy edges of our field of vision accompanies me throughout this read.

Integral methodological pluralism (IMP) as set out by Wilber is explored and applied and the author includes visual aids of the eight zones to help simplify these concepts for the reader. Adding to the layers; IMP is then placed within the larger context of integral epistemological pluralism (IEP) which is the multiplicity of perspectives or worldviews.

There are some criticisms mentioned regarding integral theory and that it may be an overreaction to postmodern theories. There is a slight unease at this point as the complexity of the approach seems somewhat overwhelming. The applied theory is however very clearly articulated.

There are four irreducible quadrants in integral theory: The subjective, intersubjective, objective, and interobjective. A succinct and fascinating account of the various addiction theories and models is integrated into these four quadrants. The road at this point seems more clearly illuminated.

An integral meta-therapy for addicted populations will have two main features, paradigmatic and met paradigmatic. The paradigmatic aspect refers to the recognition, compilation, and implementation of various methodologies in a comprehensive and inclusive manner. The met paradigmatic aspect refers to the capacity to weave together, relate, and integrate the various paradigmatic practices, pg 92 [12].

The book also discusses existential philosophy and existential phenomenology as a critical part of understanding and treating addiction and examines the Twelve Steps from this perspective. The author suggests that treatment failure is also a result of models such as the bio psychosocial model neglecting existential matters as their foundation are of a natural scientific worldview and positivistic methodology which has limits for treating the complexity of addiction.

The final chapter puts the reader in the driver’s seat and explains how the author has used integrated recovery meta-therapy (IRMt) in a recovery program. An overview is given on how to assist a client in compiling an integrated recovery program and to develop a recovery lifestyle. The reader is referred to the author’s book, An Integral Guide to Recovery: Twelve Steps and Beyond 2015 for a more detailed version.

IRMt has two philosophical foundations: An existential foundation and one that defines being-in-the-world and recovery-in-the-world, and then an overarching metatheoretical foundation informed by integral theory. The author proposes that once the primary phase of active addiction has been dealt with the IRMt approach can lead to a sustainable recovery. He notes that there is no end-point in recovery; no final “serenity” to be found. A sustained recovery is the process of being-in-the-world and living in the world and about nurturing a healthy self and a healthy relationship with the world or other.

Guy refers to the renowned therapist Yalom (1980), who noted that there are four givens in our existence that we must all face: freedom to choose the way we live our lives, the unavoidability of death, our social isolation, and the meaninglessness of life. Guy notes that these existential givens are magnified in addiction. He picks out the words freedom and powerlessness as core concepts in the recovery process. The serenity prayer comes to mind here. I feel we have travelled far into the inner being and that this multiple object thing of addiction has shed light on those dark inner spaces. We are all facing something here; we are all travelling this road of being and a sustained recovery is not some isolated path that addicts take; it is the road that we all travel as beings and some of us have better headlights and can read road signs better than others [13].

The re-thinking and embracing of the unknown and the all in the philosophical underpinnings of what addiction is will hopefully lead the way to a recovery that is sustainable. It is with this in mind that I will continue to facilitate art sessions at the recovery centre; for images by their nature hold the same kind of complexity as an integral metatheory.

There is ambition and hope in Guy’s book. Most importantly this book has the intention of being a guiding light in the field of addiction science with the ultimate goal of saving lives where too many have been lost.