Therapy of an addiction

therapy

The most important thing in addiction therapy is the patient's motivation and willingness to change. Without a motivation, the disease can never be treated sustainably. The reason most addicts have such great difficulty motivating themselves is because of the difference between positive effects “in the here and now” and the negative consequences “in the future”.

Example: cigarette addiction

It has been known for over 100 years that Smoke is a very unhealthy habit. At the latest with the spread of the media and comprehensive education of the population in the 80s and 90s, almost every smoker knew that he was actively shortening his life and damaging his environment. Even so, a great many people still smoke today, as the threat lurks somewhere in the fog of the future. The pleasant feeling that nicotine creates in the body and the “coolness factor” in the psyche is directly present.

Most of the time, this attitude changes when the negative consequence suddenly and unexpectedly “hits” the present. A sudden attack of suffocation while smoking, a stroke or even causing a fatal accident while inebriated can significantly increase willingness to treat. Other factors that increase the likelihood of change motivation are:

• high social competence (e.g. the opportunity to express your own opinion, assert yourself against others, etc.)

• stable self-expectation ("If I try hard enough, I'll be fine!")

• Accumulation of negative consequences from addiction (e.g. partner leaves me, my driver's license is gone, the creditors threaten, etc.)
  
• Knowing about offers of help (addiction counseling, inpatient detoxification, self-help groups, etc.)

Read more about the here Consequences of drugs, like cannabis, amphetamines or ecstasy

Relapses in addiction

Relapses into addiction:

Even if the motivation can be assessed as good or bad due to such factors, the so-called “ambivalence” is a constant companion for the motivated patient. Even after years of not using the drug, a patient can relapse into addiction. In many patients there is also a frequent change from abstaining from substance use and frequent relapses.

Overall, the chances of relapse are quite high, but vary from substance to substance. The probability of at least one relapse within 2 years after treatment is around 40-50% for alcohol, around 60-70% for illegal drugs, and over 70% for tobacco.

One of the reasons for the frequency of such relapses is that certain situations and stimuli (sounds, smells, etc.) are assigned certain positive emotions during active addiction.

Read more on the topic: Drug addiction

Example: alcohol addiction

"Whenever I sit with the boys in the pub and have a drink, I feel really good."

Is the real one Addiction also practically no longer active, these "trained stimuli" (bar noise, bowling alley) are still associated with the pleasant feeling as well as with alcohol consumption. The desire to relive the pleasant situation may also be directly associated with the desire for alcohol.

Other factors that increase the likelihood of a relapse are suddenly changing life situations (separation or death of a loved one) or also mental disorders (Depression etc.).

Part of the therapy must therefore be the prevention of relapses. In this context, the edits to the following points have proven useful:

• Recognizing situations that could potentially become "dangerous"
• Discuss ways to avoid such situations.
• Processing of "dangerous" stimuli in such a way that they become normal, original stimuli again in the course of the therapy. (Pub noise is just noise etc.)
• Processing of behaviors when the first slip has occurred. (An emergency case is packed, so to speak, that is used before one completely slips back into the old behavior pattern.)
• Strengthening self-expectation

Controlled use

Controlled use of substances:

There are various opinions on the question of whether only the permanent renunciation of a substance, or also a controlled use, is a good therapeutic means in the fight against addiction. In fact, there is evidence that some patients are more likely to be able to drink a defined amount of alcohol and not consume anything else.

A similar approach is followed in the treatment of opiate addicts. By substitution with artificial opiates such as Methadone, you can counteract both the high risk of infection and frequent criminal behavior. At the same time, psychotherapeutic measures are being carried out.

Psychotherapeutic procedures

Psychotherapeutic procedures (simplified representation):

In recent years, as knowledge about both the disorder and possible measures has improved, a special disease-related approach has developed. The focus here is on:

• the therapy motivation
• Preventing relapse

Therapy motivation:

The therapeutic work to promote therapy motivation is divided into several stages.

1. Stage: Analysis of the problem and its background
   In this first important step, the therapist and the patient clarify which reason was ultimately responsible for the start of therapy. Furthermore, it is clarified which positive consequences such a treatment can bring. In addition, the patient's expectations of himself and of possible abstinence are analyzed.
   
2. Level: Working out factors which help change and which could inhibit change.
   At this stage the patient and therapist clarify e.g. what risk the patient has to suffer a relapse if he remains in his familiar environment. In this phase it is also important for the patient to think about the time after the end of the therapy (future perspectives)
   
3. Level: goals
   At this stage of therapy, realistic goals must be worked out together with the patient. Here you can e.g. clarify whether there is a real desire for abstinence or for controlled drinking or to continue the previous habits Therapy will only be successful in the long term if a patient can set himself credible, realistic goals.
   
4. Level ranking:
   At this stage, seals are formulated which are particularly important for the patient. For this purpose, the patient creates a ranking list on which goals are formulated that lead to a sense of success as quickly as possible.
   
5. Stage implementation of therapy:
   This step is about implementing the goals worked out in the previous stages. Furthermore, the patient learns e.g. Opportunities to improve your own skills, which are necessary for a permanent change in behavior. In addition, he learns to observe himself in different situations in order to maintain his own self-control over the long term. Last but not least, stimuli that can lead to relapse are deleted.

Prevention of relapse

Preventing a relapse:
In this therapeutic approach, too, one pursues different stages.

1. Level which situations can be dangerous:
   In this stage, situations are identified in which the patient has experienced certain moods in the past that led to consumption.
   
2. Step How can dangerous situations be avoided:
   Often, patients with a dependency find themselves in very problematic life situations. For this reason, it must be clarified with them whether and how a change in this life situation can be brought about. Often it is e.g. need to part with old "friends" in order not to be in danger again.
   
3. Stage change in behavior:
   This stage is specifically about changing or deleting old behavior. For this purpose the patient learns e.g. Relaxation procedures or procedures with which critical thoughts can be changed or stopped
   
4. Stage change in self-concept:
   At this stage it is important to work with the patient so that he or she learns to believe in himself.Only those who can assess themselves and the learned behavior as positive will be able to avert relapse in dangerous situations.
   
5. Stage What happens after a relapse:
   Relapses are common. For this reason they have to be part of the therapy. In this important stage, it is important that the patient grapples with the possibility of a relapse and, as it were, packs an emergency case, which is used if a relapse could not be prevented. (e.g. how do I avoid taking further substances, where can I get help from, etc.).
   Studies have shown that the above therapeutic approaches achieve significantly better results than others. About half of all alcohol addicts in were permanently abstinent even after several years.