One of the main adversities faced by patients with addiction problems is the lack of motivation to quit alcohol or drugs and the ambivalent feelings that make them question whether they should continue with treatment. In these types of cases, therapists must develop a series of skills that allow them to be effective in helping their patients by directing them toward change to confront passivity, disagreement, and denial.
Of course it is not an easy process to navigate. It is common for therapists to also feel frustrated, overwhelmed, not knowing how to guide their patients who are not making progress.
The professional section of the renowned psychology website in English, recently published a series of strategies to help patients improve adherence to treatment and improve the most common difficulties of addictions:
1 -Encourages patients’ courage
Many people with addiction problems do not see themselves as brave people, but the simple fact that they are trying treatment is a sign in itself of their courage and bravery. Many of them fear the process of detoxification or abandoning the main coping mechanism they use to deal with problems. These people cannot remember what their life was like before drugs and cannot imagine a future without them.
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It is important that the therapist can strengthen the patient’s courage by helping him identify and focus on the achievements he had made before the addiction. For example: in a session the therapist can ask his patient to tell him something he is good at or some achievement he achieved in his professional career. This should be the first step to explore before delving into the problems you had with your addiction. The therapist should not let the addiction be the only narrative that defines the person. This intervention will help the patient remember that if they were able to achieve a personal/professional goal before the addiction, they can also achieve it now.
2 – Use motivational interviewing
It is a widely researched intervention that has a good level of effectiveness that allows respectful exploration of the resistance and ambivalence of patients with addictions. Without making the patient feel lectured or threatened, and at the same time guiding them to change. Motivational interviewing invites the patient to develop their own reasons for quitting alcohol/drugs. Many patients tend to report more reasons to continue using (because it prevents physical or emotional pain, improves their coping strategies, etc.) than to stop, because they have lived like this for many years. Therefore, it is essential that the therapist can take the time necessary to explore these reasons with the patient and expand on the reasons for stopping using.
3 – Encourage patients to find sober friends
Once they enter the recovery process, many patients report fear of losing all their friends, since most of their “friends” belong to their using group. Here the therapist must help the patient develop and strengthen healthy relationships with true friends who support their sobriety and must also encourage them to open up to new friendships and a healthier lifestyle.
4 – Train functional coping skills
Substance use is one of the main coping resources for patients with addictions. For the treatment to be effective, the therapist must train the patient with skills and functional resources that allow replacing alcohol/drugs with other methods to cope with stress and difficult situations, for example: mindfulness, meditation, physical exercise, breathing exercises, etc. that allow the patient to develop a functional coping repertoire.
5 – Train honesty
Patients with addictions feel a deep shame in accepting that they have a problem, which makes the process of recognizing the difficulties they face difficult. It is necessary for the therapist to be able to remind the patient that he is there to help, not to judge him and that he will do everything he can to develop a relationship of trust between them.
A resource that is usually very useful to strengthen honesty is to ask the patient to write a letter, which they will not send, in which they express the most unpleasant thoughts and emotions about the addiction. This exercise promotes the honest expression of emotions without the fear of being judged by others, and in fact, is a more “manageable” type of exposure for the patient. The main goal of honesty in addiction treatment is to help patients cope with the anxiety of telling the truth and find an authentic voice in the process.
6 – Encourages service to others
Being of service to others is part of the 12-step program of Alcoholics Anonymous. This service involves volunteering in the community and helping other people who are also going through the recovery process. Being of service to others also helps the patient gain perspective on the difficulties and struggles each person faces with addiction and at the same time promotes their own recovery from it.
7 – Identify possible relapse triggers
The first element of relapse prevention is learning to detect and avoid triggers and situations that encourage or tempt use. For example, you can work through role-play activities on different ways to say “no” when someone invites you out for a few beers after work. The therapist will also practice stress and anxiety regulation strategies with the patient that trigger the need for consumption (a fight with a partner, a stressful day at work, etc.).
A good way to teach these skills to the patient is to explain that physical relapse — the act of using alcohol or drugs — is the result of a previous mental or emotional relapse. What does this mean? Mental relapse usually occurs when the patient becomes involved in situations where they are more likely to give in to temptation, such as visiting a friend who has a problem with alcohol, and they believe that they can resist the temptation or that they can even have a beer and control yourself. Which inevitably leads them to a relapse.
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