Addictions General Intervention Model And Treatment Techniques

There are many substances and behaviours to which people can become dependent. In any therapeutic intervention with a person with addiction, several objectives must be achieved in the treatment process. These are graduated according to the dependency itself; little can be done with a psychological intervention if the person is intoxicated when they go to the consultation, Or little can be done to try to improve your healthy lifestyle if you do not know adequate measures to do so.

Addictions Treatment

The first goal of treatment is for the person with an addiction to accept that they need treatment. In both legal and illegal drugs, there is a process of denial by many of the addicts to them (Becona, 1998a). Drugs produce pleasure, well-being, and satisfaction (positive reinforcement). At the same time, the drug allows them to avoid withdrawal symptoms (negative reinforcement) when they do not consume or do not have enough of it.

Once the person assumes that they have to change, they will request different help. Moreover, it is important to make him see that he needs help. That he has to change his behaviour due to the serious and obvious consequences that are taking place, but that the person does not see at that moment.
Once the denial phase has been overcome, the reason for seeking help, related factors and other difficulties caused by the dependency must be clearly defined. This is the evaluation phase.

Withdrawal in Addictions

The treatment for Addictions will be oriented initially so that the person achieves abstinence. Here the approach will vary depending on whether it is a person dependent on alcohol, nicotine, heroin, cocaine or gambling or the Internet Internet. However, within more common than different aspects regarding the treatment techniques we will use with one or the other. Today there are harm reduction programs, mainly methadone maintenance.

Once the detoxification has been achieved, or what is the same, that the person stops consuming the substance, the process of psychological detoxification begins. This is the longest and most complex process of the addictive process. It is excepted when the person is in a methadone maintenance program, in which case both processes go in parallel.

Cessation Addictions

The psychological detoxification in Adiciones aims to ensure that the dependent person can face withdrawal.

In the case of heroin dependence, they are trained using techniques to face life without drugs. This is to avoid them, reject them and reorganize their environment so they can be without them (Becoña & Vázquez, 2001). This is one of the most complex parts because sometimes they have been consumed for many years. Also, many have discovered that they can get better quickly when they feel sick by taking drugs. Hence the relevance of training in coping strategies in situations of risk for consumption.
Drugs produce immediate effects. A few seconds pass between consumption and its effect. There is also great availability, and the person can access them. Training to generate skills to live without drugs, feel good and obtain social support are some of the keys to successful treatment. It should not be forgotten that drugs achieve not only an immediate effect but that, due to previous consumption, they have become reinforcing. You have to look for reinforcing alternatives to counteract the negative consequences of consumption (since when you are addicted, you only see the positive ones). Also, find the advantages of not consuming on a personal, family, social level, etc.

Relapse in Addictions

Since we know that relapse in Additions is closely linked to substance dependency or behavioural addictions, training in preventing relapse is a highly relevant element once the previous phases have been overcome.

The Marlatt and Gordon (1985) model offers effective techniques so that the person does not relapse. Relapse prevention has become one more component of treatment. We can get the person to remain abstinent; if he relapses, he can return to abstinence.

If the person changes their previous lifestyle to a healthy one, they are more likely to stay abstinent long-term. Reality shows us that a lifestyle change is not always easy, especially for opioid addicts. It will depend on multiple circumstances, both the subject and the family and social environment, opportunities, maturity, etc.

When we achieve an abstinence-related lifestyle change, it is more likely and easier to achieve abstinence. The analysis of comorbidity related to the change in lifestyle is of great relevance. Keeping track of it and intervening in the problems associated with addiction is one factor that facilitates the maintenance of abstinence.

Treatment of Addictions. overall model

Next, we present a general model for treating addiction and then continue with a specific technique for specific addictions.

The phases of treatment for a person with an addiction consist of the phases of demand for treatment, evaluation, treatment and follow-up. In turn, within the treatment, six phases are distinguished: detoxification or maintenance; psychological withdrawal or achievement of withdrawal from the substance or cessation of the behaviour; normalization, change of previous lifestyle and search for new alternative goals to addiction; relapse prevention; maintenance program or support program in the short, medium and long term; and, where necessary, controlled gambling or harm reduction programs (e.g., in heroin dependence). In addition, as in other disorders, the psychologist has to implement all available therapeutic resources that our science provides us.

Techniques for Addictions

The different techniques for the above objectives are explained below:

Increased motivation for change

Today we know the importance of motivation for change. In addictive behaviours, it is frequent that many patients do not go to treatment. Of those who attend, a part abandons it after the first sessions, and those who attend only sometimes follow the instructions. Hence, this aspect has become another therapeutic element called motivational interviewing (Miller & Rollnick, 1999).

The Motivational Interview

This type of interview for Addictions is the most suitable way to increase motivation for change. It should not be forgotten that not all people with an addiction voluntarily go to treatment for the first time; this is the exception. Sometimes they come for external reasons, whether family or legal. In other cases, to seek specific help. Retaining the subject in treatment, or retaining him at the beginning so that he can start treatment, is a fundamental question.

The motivational interview (MI) in Addictions allows for addressing the lack of motivation in those subjects in the pre-contemplation or contemplation phases. It uses eight motivational strategies, which effectively motivate the patient to change her behaviour. These are:

  • Give information and advice.
  • remove obstacles
  • Give several options to the patient so that he can choose.
  • Decrease the factors that make consumption behaviour desirable
  • and promote empathy
  • Give feedback.
  • Clarify objectives
  • Provide you with active help.

With EM, we can not only motivate the subject to carry out the treatment but also break down the barriers and effectively start the change process.…

Exposure With Prevention of Response

The exposure technique with prevention of response is essential in the treatment of pathological gamblers (Becona, 1996b; Fernandez-Montalvo & Echeburua, 1997; González, Jiménez & Aymami, 1999; Labrador & Fernandez-Alba, 1998). However, it is also an essential technique in other addictions (e.g., heroin dependence, sex addiction, etc.). For example, we indicate below how it applies to addiction to slot machines.

The purpose of the exposure is to expose the player to a slot machine. Through the presence of the clues that have been associated, notice the annoying sensations that, without preventing the response or with money, would lead you to gamble. The prevention of the response has as its objective the impossibility of consummating his behaviour, in this case, his behaviour of playing.

The most frequently associated clues to gambling behaviour in slot machines are being at the bar and looking at the machine. The person notices how the coloured lights of the machine are changing in an upward direction. He also watches as another person puts money into the machine and gets a prize. Other people look at the person who has received an award and comment on it, etc.\

Stimulus control

A technique that is frequently used in Addictions is stimulus control. In the case of pathological gambling, it is essential to treat the individual (Becona, 1996b). With this technique, we restrict access to those places where the probability of gambling increases or hours of greatest risk or of consuming a substance. The person is trained in the search for alternatives to their previous customs. Also, to have someone accompany him in situations of greater risk to gambling or buying heroin, for example.

It is important to control money since it is one of the most important stimuli for a person to gamble or buy a drug. Your probability of gambling or buying drugs is greatly reduced if you don’t have money. In this case, the player must transfer all his money to a relative or a close person to be controlled or dosed.

Problem-solving training

Problem-solving training (ESP) is a procedure to train people with Addictions to recognize their problems. Also, to find appropriate solutions to them and implement the best solution in the situation where the problem occurs.

Problem-solving training consists of five phases:

  • General orientation towards the problem.
  • Definition and formulation of the problem.
  • Generation of alternative solutions.
  • Decision making.
  • Implementation and verification of the solution.

In problem-solving training, you must pass the previous one to move from one phase to another. When there is not enough information in a specific phase, a previous phase has been underestimated or skipped, you are in a training phase, or the chosen solution is not adequate, you have to go back to the previous phase or phases so that once it has been carried out correctly, we can continue with the following ones.

In recent years, ESP has become an element in many treatment programs due to its rationality, ease of explaining the subject, and effectiveness. It is also a strategy included in almost all relapse prevention programs.…

Cognitive Therapy in Addictions

Cognitive therapy starts from the premise that disorders are produced and maintained due to distorted underlying cognitions. Also, to different errors in the processing of information. Treatment aims to correct these distorted premises and cognitive errors (Beck et al., 1993). Beliefs and urgencies are very relevant in cognitive therapy for Addictions. For Beck, the behaviour (e.g., consumption) and the biological (e.g., withdrawal syndrome) occur from the maladaptive cognitive pattern. What cognitive therapy is going to do is modify the individual’s thoughts and mistaken beliefs and teach self-control techniques.

Although the cognitive therapy approach may seem reductionist, in practice, it is not. Along with the weight given to the person’s cognitive part as a cause of the explanation of substance use, their current vital problems, evolution from childhood, assumptions, compensatory strategies, elements of vulnerability, behaviour, etc., are also considered essential aspects. Similarly, treatment will focus on several aspects related to the problem (Beck et al., 1993).

Great importance is given to the therapeutic relationship within the treatment, and cognitive techniques such as Socratic dialogue, reattribution, homework, identification and modification of drug-related beliefs, relaxation, problem-solving, etc., are used. As treatment progresses, along with controlling urges and associated beliefs and activating control beliefs, other problems associated with drug use problems and relapse prevention become more relevant.

Anxiety and stress reduction training

One of the problems associated with withdrawal from substance use, as in pathological gambling and other addictions, is the anxiety and stress associated with said state. Therefore, evaluating this problem and applying techniques for its control is necessary. Specific programs aim to alter the perception of the degree of threat attributed to the stressor and their lifestyle to reduce both the frequency and severity of external stressors and enable them to use active coping strategies that inhibit or replace disabling stress responses.

Any of the existing ones for this problem can be used as a general intervention technique, such as training in stress management and relaxation techniques, cognitive techniques, bibliotherapy, lifestyle change, etc. IRelaxationtraining is a widely used technique, along with cognitive ones, to change erroneous beliefs about the causes of anxiety or stressful elements. When suffering from a specific anxiety disorder (for example, panic attacks), it is necessary to apply effective techniques for its treatment (Gutiérrez, 2003).

Social skills training

Many people with drug dependency and other behavioural addictions are given training in social skills to improve their social competence. When they lack adequate interpersonal and intrapersonal skills, skills to control their emotional state without going to play or consume the substance, and skills to manage their relationship with their partner, their children, at work, etc., this training is essential. Social skills training thus becomes an important part of treatment when there is a social skills deficit (Monti et al., 1995). In addition, it will be possible to have a relapse prevention strategy in the future. Relapse situations occur when there is frustration and inability to express anger, inability to resist social pressure, intrapersonal negative emotional state, and inability to resist intrapersonal temptation, among others.

The potential relationship between poor social skills and gambling activities or drug use is discussed with the patients. It is important to recognize that people with Addictions may need more than the usual social skills to deal with their relational conflicts. For example, some players need assertiveness training to improve their ability to decline invitations to play with friends. Role-playing can be used to improve communication skills.…

Control of Anger and Aggressiveness in Addictions.

Sometimes, the person with substance dependence has associated problems of anger and aggressiveness. These, in turn, cause him different problems in his family, social or police environment. If this happens, they can further increase their initial dependency problem or maintain their dependency over time because they do not have a way to solve the other problem. Also, anger and aggressiveness are associated with falling and relapse as negative emotional states (Marlatt et al., 1999).

When this is the case, it is necessary to use anger and aggression control strategies such as the stress inoculation technique, role-playing, assertiveness training, relaxation training, Contingency management, problem-solving or cognitive restructuring.

Drug use is maintained by the positive reinforcement that the substance produces in the person (e.g., euphoria, pleasure) and by negative reinforcement (use to avoid the negative consequences of the withdrawal syndrome). Drug use, therefore, is influenced by learning and conditioning. Also, through the principles of learning and conditioning, we can change this maladaptive behaviour for an adapted one without drug use.

From the operant perspective, it is known that the development of a substance abuse or dependence disorder (Addiction) is due to the reinforcing power of the drug and other factors, such as biological, environmental, and behavioural variables (Becoña, 1999). But, without denying this, about treatment, an intervention mechanism is proposed, the alteration of behavioural contingencies, which is independent of specific etiological factors.

Techniques such as applying aversive stimuli, reinforcing alternative behaviours incompatible with consuming drugs, extinction or several of the above simultaneously facilitate the change in consumption behaviour. Another extension of these is contingency contracts or relapse prevention strategies. The use of contingency management techniques and other techniques often allows us to have a useful and effective approach for many patients who come for treatment. Especially for a person to carry out alternative behaviours to drug use, contingency management is sometimes the main technique for the person to maintain their abstinence. Contingency control techniques, such as the already seen stimulus control.

Self-control techniques

One of the strategies for treating different addictions, both in an abstinence-oriented program and controlled gambling or harm reduction, is to train patients in self-control techniques (Hester, 1995). This can be done after the person has agreed to participate in abstinence-oriented treatment, when they are having difficulty getting it, or when their goal is controlled gambling or harm reduction. Sometimes self-control starts in the middle part of the treatment when the minimum objectives have already been achieved to maintain treatment adherence.

Self-control techniques are aimed at making the person aware of their problem behaviour and being able to deal with it using techniques they have learned without putting it into practice. With self-control, the person is taught strategies to control or modify their own behaviour through different situations to achieve long-term goals. To do this, the person is trained in different techniques so that they do not carry out the behaviour or, if the behaviour occurs, do so unproblematic and with the idea of ​​achieving total abstinence.

Self-control techniques also emphasize maintaining changes, especially through self-reinforcement when the behaviour is carried out in the expected direction and self-punishment when the undesired behaviour is carried out. Finally, the cognitive procedures within self-control are becoming increasingly important, especially due to the ideas, beliefs, thoughts or erroneous attributions that the person has about their game and the game environment, as well as about the result of it.…

Group Therapy

Group therapy is a therapeutic modality frequently used to treat people with different addictions (Galanter et al., 1998). Together with individual treatment and the other interventions you may be carrying out, group therapy is of great relevance in several specific treatments for addictions, especially perhaps in people who go to drug addiction centres and self-help associations, where it is an essential part of the treatment.

The objective sought with group therapy is the same as that of individual therapy, but in a group format and with dynamics that develop within each group. It allows the patient to compare himself with others, have support, learn control strategies and techniques, acquire skills, and assume group functioning norms. The central objectives of it are to solve problems and perform tasks that lead to abstinence or allow you to maintain it to finally be able to change your lifestyle.

Prevention of relapse in Addictions

The first use of the substance or having a gambling episode after quitting does not have to represent a relapse; it may just be a fall or a temporary slip. For Marlatt and Gordon (1985), relapse is any return to addictive or problematic behaviour or previous lifestyle after an initial period of abstinence and lifestyle change.

A fall is a brief return to the addictive behaviour at a specific moment, that is, a loss of specific control over the behaviour. This can lead the person to carry out some sporadic consumption. Relapse in addictions can manifest in different ways: return to the previous lifestyle, use substitute drugs, perform random and risky activities or compulsive sexuality, etc. In the case of gambling, the most common way to manifest is to return to play regularly. The same happens in the case of psychoactive substances.

The so-called withdrawal violation effect is a fundamental concept for understanding the relapse process. This effect comprises two key cognitive elements:

  • cognitive dissonance (conflict and guilt)
  • a personal attribution effect (blaming oneself as the cause of relapse)
  • sometimes the anticipation of positive drug or gambling effects

The combination of these three components predisposes the patient to a total relapse.

Model

The relapse prevention model views addictions as an acquired habit that can be changed by applying the principles of classical, operant, and vicarious conditioning. In addition, it gives great importance to the cognitive factors involved in relapse. Relapse prevention strategies are aimed at anticipating and preventing the occurrence of relapses after treatment and how to help patients deal with relapse if it occurs. It is a self-control program where patients are taught to anticipate and deal effectively with problems after treatment or during follow-up. Therefore, relapse prevention can be applied as a maintenance strategy to prevent relapse, or with a more general approach, to change lifestyle.

The main causes of addiction relapse are negative emotional states, interpersonal conflict, and social pressure (e.g., Marlatt & Gordon, 1985). Negative emotional states are situations in which subjects experience a negative emotional state, mood, or feelings, such as frustration, anger, anxiety, depression, or boredom, before or at the same time as the occurrence of the first fall. Interpersonal conflicts include a current or relatively recent conflict associated with any interpersonal relationship, such as marriage, family members, work relationships, etc. Social pressure refers to situations in which the patient responds to the influence of another or other people who exert pressure to involve him again in the consumption of substances.

Relapse prevention strategies

There are three main strategies for relapse prevention: the social support approach, the lifestyle change approach, and the cognitive behavioural approach (Becona, 1999). Cognitive-behavioural techniques for relapse prevention are the most effective. They aim to increase self-efficacy, improve impulse control, promote cognitive restructuring and improve decision-making strategies.

Strategies aimed at lifestyle change are aimed at strengthening the patient’s overall coping capacity and at reducing the frequency and intensity of the irresistible urges and urges to gamble that are often the product of an unbalanced lifestyle.

Among the relapse prevention techniques that are applied are cognitive restructuring programs, training in identifying and controlling stimuli, exposure to stimuli in vivo (real) or at an imagined level, thought arrest, covert conditioning, external reinforcement programs, etc. If, in a high-risk situation, the patient anticipates what could happen to him (for example, when he passes the bar where he usually gambled or the neighbourhood where he bought the substance) and has a strange sensation similar to when he entered and played or used the drug, he can implement different coping strategies, especially when he has emergencies, in order to cope and not fall or relapse into his addictive problem again.