Integrative Addiction Psychotherapy – Overview

Humanistic Addiction Psychotherapy – Overview

Foundational Concepts

People take drugs for reasons, reasons that need to be respected and, in many cases, directly addressed – sometimes before the patient will be willing to make changes in their drug and alcohol use. (Tatarsky)

Multiplicity of Self: In this model, the internal world of patients is conceived of as containing different parts, selves, modes, or identities – many of which are playing or may play a role in the patient’s suffering, drug use, and healing and recovery. Patients change, heal, and recover in fundamental ways as they re-balance, re-organize, and re-structure their inner worlds. (Kellogg)

Components of Treatment

Therapeutic Alliance

  1. A central factor in successful recovery
  2. Therapists demonstrate
    1. Love
    2. Empathic Listening
    3. Authenticity and Optimism
    4. Courage and Determination
      1. Within the context of their own personal style

Complexity and Multiplicity

  1. The Reasons for Problematic Drug and Alcohol Use Can Generally be Organized into Six Domains
    1. Self-Stimulation/Avoidant Coping
    2. Self-Soothing/Avoidant Coping
    3. Drug-Based Biological Changes/Medical Issues
    4. Physical and Medically-based Pain-Driven Use
    5. Social Identity – Groups, Subcultures, Friendship Networks
    6. Social Oppression
  2. Identifying and Respecting the Motivations for Change
    1. Threats to Family/Parental/Relational Roles
    2. Job Loss/Economic Damage/Prestige Threat
    3. Existential/Spiritual Issues
    4. Health Concerns
    5. Legal Problems
    6. Other Reasons

Decisional Balance

  1. Positives and Negatives of Drug Use
  2. Positives and Negatives of Change

Creating a Mode Map

  1. Identifying the Different Parts, Modes, Energies, and Archetypes

Dialogue Work/Chairwork

  1. Giving Voice to all of the Different Parts, Modes, Energies and Archetypes – on Both Sides
    1. Clearly and Strongly
    2. Everyone Speaks Several Times
    3. Both a Diagnostic and a Motivational Practice
  2. Identify, Connect with, and Begin to Empower the Inner Leader, Healthy Adult Mode, Ego, etc.
    1. Usually a Part that is Concerned About the Drug Use

Identify and Label Specific Mode-Use Patterns

  1. Use the Five Domains as a Guide
  2. Some Modes may be Substance-Specific

Goal-Setting/Problem List Development (Persons)

  1. Mode-Use Patterns
    1. Work with the Drug Use First?
    2. Work with the Underlying Problem/Psychopathology First and Monitor the Drug Use?
    3. Do Both Simultaneously?
    4. Harm Reduction, Moderation, “Nonaddictive” Use, or Cessation?
  2. Institutional Goals (If Applicable)
    1. Embrace Them
    2. Ally with Patient Against Them and Use Harm Reduction Strategies (Wallace)
  3. Work with Other Therapeutic Problems

Techniques: Vertical Interventions

  1. Treating the Underlying Pain and Psychopathology
  2. Psychotherapeutic Domains
    1. Problems Connected to the Past
      1. Trauma, Grief, and Moral Failure
    2. Problems Connected to the Present
      1. Depression, Anxiety Disorders, Assertiveness, Personality Disorders
    3. Problems Connected to the Future
      1. Existential Life Decisions, Identity Creation, Anxiety, Recovery, Hero’s Journey
  3. Six Categories of Intervention
    1. Relational
    2. Cognitive
    3. Behavioral
    4. Existential
    5. Experiential
    6. Meditative/Self-Soothing

Techniques: Horizontal Interventions

  1. Substance Use Management/Harm Reduction (Bigg)
    1. Reducing the Amount Consumed
    2. Changing the Methods of Use
    3. Reducing the Time of Involvement
    4. Altering the Context of Use
    5. Drug Substitution
    6. Learning Overdose Prevention Measures/Naloxone
  2. Relapse Prevention (Marlatt)
    1. Understanding and Identifying Triggers, Cues, and High-Risk Situations
    2. Skills Training
      1. Cognitive Restructuring, Relaxation Therapy, Distraction, Social Support, Mindfulness/Urge Surfing
    3. Assertiveness
      1. Drink and Drug Refusal
  3. Ideal Use Plan (Tatarsky)
  4. Contingency Management/Positive Reinforcement Systems
    1. Mutually Choosing a Target Behavior
      1. Safer Use, Reduction, or Cessation
      2. Attendance
      3. Other Treatment Goals

Identity Transformation

  1. The Foundation of Long-Term Recovery
  2. Developing Identities that are Reinforcing and Meaningful
    1. Which Challenge and Replace Those Based on Drug Use
  3. Creating and Restructuring Identities
    1. Self-Definitions – Values and Choices
    2. “Who Are You and Who Do You Want To Be?”
    3. Reference and Membership Groups
    4. Identity-based Actions
  4. Identity Dialogues

Monitoring and Working with Countertransference

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