The most important thing in the therapy of addiction is the motivation or willingness to change of the patient. Without motivation, the disease will never be treated sustainably. The reason why most addicts have so much trouble motivating themselves is due to the difference between positive effects “in the here and now” and the negative consequences “in the future”.
Most of the time this attitude changes when the negative consequences suddenly and unexpectedly “hit” the present. A sudden choking attack while smoking, a stroke or even causing a fatal accident while under the influence of alcohol can significantly increase the willingness to seek treatment. Other factors that increase the probability of change motivation are
- High social competence (e.g. the ability to express one’s own opinion, to assert oneself against others, etc.
)
- A stable self-expectation (“If I only try hard enough, I’ll manage! “)
- Accumulation of negative consequences due to the addiction (e.g. partner leaves me, my driver’s license is gone, creditors threaten etc. )
- The knowledge about offers of help (addiction counseling, inpatient detoxification, self-help groups, etc.
)
relapses into addiction: Even if the motivation by such factors can be judged as good or bad, the so-called “ambivalence”, i.e. the “being torn to and fro” is a constant companion for the motivated patient. Even after years of abstinence from the drug, a patient can suffer a relapse into addiction. In many patients there is also a frequent alternation between substance renunciation and frequent relapse.
The overall probability of relapse is quite high, but varies from substance to substance. The probability of suffering at least one relapse within 2 years after treatment is about 40-50% for alcohol, about 60-70% for illegal drugs and over 70% for tobacco. The reason for the frequency of such relapses is, among other things, that certain situations and stimuli (sounds, smells, etc.)
are associated with certain positive emotions during active addiction. Even if the actual addiction is virtually no longer active, these “trained stimuli” (pub noise, bowling alley) are still associated with both the pleasant feeling and the consumption of alcohol. The desire to re-experience the pleasant situation is therefore also directly associated with the desire for alcohol.
Other factors that increase the likelihood of a relapse are sudden changes in life situations (separation or death of a close person) or psychological disorders (depression etc.). Part of the therapy must therefore be the prevention of relapses. In this context, the treatment of the following points has proven to be useful:
- Identifying situations that could potentially become “dangerous
- Discuss possibilities to avoid such situations.
- Processing of “dangerous” stimuli in such a way that they become normal, original stimuli again in the course of therapy.
(Pub noise is simply noise etc. )
- Processing of behaviour when the first slip has occurred. (A kind of emergency case is packed, which is used before you slip back into the old behavior patterns completely).
- Strengthening of self-expectation
