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Practice for Psychotherapy & Counseling
Dr. Phil Stöckli , ph.D.
Gemeindestr. 26 | 8032 Zürich
Tel. 076 282 8885
Practice for Psychotherapy
Dr. Phil Stöckli, PhD
What is Addiction therapy?
Addiction therapy is the collective term for
treatment of persons who suffer from substance
abuse or behavioral addiction (internet, sex, porn,
handheld, etc.).
Definition of substance addiction
Following
the
classification
manual
ICD-10,
at
least
three
of
the
criteria
mentioned
below
must
apply:
•
A
strong
desire
or
sense
of
compulsion
to
take
the
substance
(”Craving”,
“psychological
addiction”)
•
Difficulties
in
controlling
substance-taking
behaviour
in
terms
of
its
onset,
termination,
or levels of use
•
A
physiological
withdrawal
state
when
substance
use
has
ceased
or
been
reduced
(withdrawal symptoms)
•
Evidence
of
tolerance,
such
that
increased
doses
of
the
psychoactive
substances
are
required
in
order
to
achieve
effects
originally
produced by lower doses
•
Progressive
neglect
of
alternative
pleasures
or
interests
because
of
substance
use,
increased
amount
of
time
necessary
to
obtain
the
substance
or
to
recover
from
its
effects
•
Persisting
with
substance
use
despite
clear
evidence
of
overtly
harmful
consequences
(such
as
harm
to
the
liver,
job
loss,
health
problems,
relationship
problems,
loss
of
drivers license, etc.)
Ingredients for a successful addiction therapy
•
Self-motivation:
In
order
to
attain
real
and
sustainable
change,self-motivation
is
absolutely
essential.
If
the
affected
person
is
coming
to
therapy
to
please
others
or
to
make
up
for
something,
the
therapy
might
not
work.
In
my
experience,
no
one
starts
an
addiction
therapy
unless
they
experience
some
level
of
suffering
or
negative
consequence from their addiction.
•
Interest
in
getting
to
know
yourself
better,
including the vulnerable aspects
•
Wllingness to self-reflect
•
A
good,
trusting
relationship
with
the
therapist
•
Social
support
in
the
environment
or
a
supportive partnership
•
A regular daily routine / work
What is the standard procedure in a addiction
treatment?
It
is
obvious
that
the
treatment
will
not
solely
focus
on
addiction
but
on
the
person
with
all
of
its
facets,
traits,
skills
and
experiences.
The
addictive
behaviour
usually
is
just
the
symptom
of
an
underlying
issue,
such
as
a
self-esteem
problem
or
a
trauma.
Oftentimes,
the
drug
is
used
as
a
strategy
for
dealing
with
stress
and
emotional
issues.
So,
in
therapy,
I
am
interested
in
the
entire
person
and
which
function
the
drug
is
playing
in
their
life.
It
is
crucial
to
explore
what
a
person
gets
out
of
a
drug
for
themselves,
what
got
somebody
started.
If
you
will
just
quit
the
drug
without
understanding
its
function
in
your
life’s
equilibrium,
this
will
most
likely
render
you
out
of
balance
and
be
unsustainable.
In
order
for
the
change
to
be
stable,
it
is
necessary
to
substitute
the
function
of
the
substance
by
finding
a
healthier
way
to
satisfy
this
need.
If
the
drug
is
used,
for
example,
to
be
able
to
act
more
assertively
in
social
situations,
then
the
substitution
could
be
to
improve
social
skills,
to
build
up
self-acceptance
and
self-confidence.
This
will
help
improve
the
internal
balance
and
therefore
render
the
drug
useless.
Usually
these
processes
happen
simultaneously,
(a)
reducing
the
consumption
of
the
drug,
and
(b)
practicing
new
skills.
Moving
ahead
too
quickly
stopping
the
drug
by
doing
a
quick
detox
-
without
sufficient
functional
replacement
–
often
leads
to
a
quick
relapse.
The
affected
person
has
not
really
understood
the
deeper
layers
of
their
addiction.
That
is
the
reason,
why
therapeutic
support
is
essential
after
detox,
and
why
in-patient
detox
is
usually followed by a ‘Entwöhnungstherapie’.
The psychodynamic of addiction
People
with
addiction
oftentimes
feel
ashamed
of
their
addictive
behavior.
They
perceive
themselves
to
be
inadequate
or
inferior
in
some
way.
These
feelings
are
so
uncomfortable
and
agonizing
that
those
affected
try
to
get
rid
of
them
in
various
ways.
The
most
common
strategies
include
denial,
numbing
your
emotions
and
your
body
with
drugs,
projection
(“Others
have
much
bigger
problems”),
trivializing
(“It's
not
that
bad,
I
can
stop
at
any
time”),
etc.
The
person
is
splitting
itself
into
a
“strong
acceptable
part”
and
a
“weak
unacceptable
part
”
,
which
contains
vulnerable
feelings.
This
weaker
part
is
responsible
for
the
addiction
and
therefore
also
called
the
“addictive
part”.
The
fact
that
is
largely
being
hidden
and
neglected
by
the
strong
person,
makes
it
“hungry”
and
unsatisfied.
This
is
where
the
addictive
behavior
comes
in.
It
beautifuly
solves
the
problems
of
the
strong
and
weak
parts,
unfortunately
only
temporarily:
It
numbs
the
bad
feelings,
therefore
calms
down
the
weak
part.
Once
the
effects
of
the
drug
fade,
they
give
space
to
feelings
of
shame
and
guilt.
These
in
turn
are
so
uncomfortable
that
they
need
to
be
suppressed
and
there
we
have
the
vicious
cycle
of addiction
(see graphic below).
The
cycle
symbolizes
this
constant
struggle
for
control
between
the
stronger
and
the
weaker
part.
The
stronger
part
tries
to
suppress
the
bad
weak
feelings
and
vows
for
more
discipline
each
time
(“This
time
it
will
be
different,
I
am
really
determined
now
to
stay
sober…”),
while
the
vulnerable
part
fights
back
to
have
their
needs
to
be
satisfied.
Once
a
person
starts
acknowledging
the
needs
of
their
weaker
part,
healing
can
start
happening,
meaning
the
equilibrium
can
start
being
strengthened.
Most
of
my
former
addiction
patients
wanted
to
make
those
negative
emotions
to
disappear
(their
strong
parts
wanted
that).
That
is
not
possible.
We
feel
what
we
feel
and
suppressing
it
will
in
a
way
only
strengthen
its
influence.
What
will
help
instead
is
to
learn
to
feel
these
emotions
so
you
will
not
have
to
be
afraid
of
them
anymore
and
can
start
integration
them
instead
of
suppressing
them.
That
might
sound
absurd
at
first,
but
it
makes
perfect
sense
when
you
consider
that
hungry
children
scream
more
than
those
who
are
fed.
In
order
to
get
the
vulnerable
feelings
under
control,
one
has
to
learn
to
understand
and
satisfy
the
needs
behind
them.
This
needs
to
be
practiced,
in
a
safe
environment
and,
if
possible,
with
professional
support.
When
the
weak
part
of
a
person
receives
acceptance
and
support
-
almost
like
a
child
in
need
-
it
will
calm
down
and
have
less
motivation
for
‘bad
behavior’
like
drug
abuse.
Addiction
therapy
has
an
enormous
potential
for
the
development a person.
Treating comorbid disorders
As
mentioned
above,
addictions
are
usually
just
the
symptoms
of
a
different
underlying
issue.
Therefore
it
is
not
surprising
that
most
people
with
addictions
qualify
for
other
diagnoses,
so
called
comorbid
disorders.
These
illnesses,
such
as
depression,
anxiety,
trauma
or
neglect
should
also
be
treated,
if
needed
with
medication.
The
order
of
treatment
depends
on
the
extent
of
the
drug
consumption
and
the
level
of
suffering
from
the comorbid illness.
Mindfulness
Becoming
more
mindful
/
aware
of
your
momentary
state
can
help
stop
the
‘autopilot’
that
often
underlays
addictive
behavior.
The
goal
is
to
achieve
more
awareness
in
your
daily
life
and
learn
how
to
deal
with
unpleasant
emotions
differently
than
to
use
drugs.
Meditation
and
mindfuless
exercises
will
help
you
bring
the
focus
of
your
attention
back
to
yourself.
This
method
can
help
not
only
with
addiction
but
with
many
other difficult situations or disorders.
Links & literature for addiction therapy
•
Treatment Approaches for Drug Addiction
•
Mindfulness-based relapse prevention
•
Guided mindfulness exercises with Jon
Kabat-Zinn