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Psychology Today: Treatments that Work.

Posted by Faradism.net on January 2, 2005, at 12:21:17

In reply to Punishment is medicine.Aristotle.Nicomachean Ethic, posted by Faradism.net on January 1, 2005, at 19:51:15

Because addiction has no solitary cause, the new view toward it demands that
single-minded approaches to drug treatment be abandoned. At least four studies, according to William Miller, have found no differences between groups of
alcoholics assigned to Alcoholics Anonymous and to no treatment at all. AA
simply doesn't work for a lot of people.

The investigators, William Miller and Catherine Baca, M.D., of the University
of New Mexico's Center on Alcoholism, Substance Abuse and Addictions:
he says, the chug treatment community has been curiously resistant to using
what works. His colleague, Reed Hester, after a review of treatment outcomes
from 1980 to 1990, concluded that "despite much more knowledge of what works, treatment for substance abuse hasn't changed much in 40 years."
"Then we went looking for what was really happening. We gave one group the
manual and another group no manual. The manual turned out to be the variable
that was the potent treatment. But why?
"The key was that we had inadvertently motivated the control group and in spite
of our expectations, the addicts changed and moderated their drinking. Simply
giving them the manual, saying to them that we believed they could help
themselves, could handle it, you can do this, was enough."

Feedback--specific and tailored to the individual, not general;
Responsibility--it's up to you, your choice, you are not a helpless victim of a
disease;

Advice--firm and clear recommendations; Menu--there are different ways
to work this out; Empathy--the best therapists have this and are neither pushy
nor confrontational, but supportive and warm; and Self-efficacy--you can do it;
empowerment.

"Warm turkey." Tapering down and "sobriety sampling" give addicts a chance to kick their habits and help them not give up if they fail.

In the hands of trained therapists, this and other forms of "relapse prevention"
teaches addicts skills for coping with mistakes and setbacks. These methods also allow for moderate continuation of some addictions for some people, rather than insisting on total abstinence.
Some patients claim it not only stops cravings for long periods without
withdrawal, but also suppresses all desire for any drugs and generates an
emotional confrontation with their own thoughts and feelings, during which they
are inspired to reorganize their lives.

Until now, says Miller, behavioral scientists have stuck to the conviction that
real change, if it happens at all, is gradual and painstaking. Now, says Miller,
we know that "relatively sudden and profound changes can and do occur, at least occasionally." If that capability could be harnessed, the impact on addiction
could be profound.

Aversion therapy.

Toni Farrenkopf uses aversion conditioning to treat addictions, particularly those involving gambling and sexual behavior. He's worked with patients for whom a single incident of voyeurism, or indecent exposure, sometimes at a very early age, was so arousing that the addiction held
for decades.

"What we've learned is that people who are voyeurs and exposers are addicted to
the rush they get from contemplating, planning, and doing the behavior, not
necessarily from sexual release itself. With pedophiles, other factors drive the
addiction. But in all cases, you want to try and countercondition the behavior."

Aversive therapy works by introducing negative consequences immediately after
the pleasurable experience occurs. One reason that many people don't become
addicted is that they rarely experience the worst consequences of their behavior
soon enough to override the pleasure.

Farrenkopf uses covert sensitization with imagery. He'll show a sexual addict
arrest scenarios--being handcuffed, jailed, searched--10 seconds after an erotic
exposure and do this repeatedly. Or he'll expose them to a noxious odor or
painfully snap a rubber band on a wrist. "I help the patients experience all of
the painful things that happen when they are caught, or have to confront their
families after getting caught," he says. "It works for many."

http://cms.psychologytoday.com/articles/pto-19940901-000021.html


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poster:Faradism.net thread:436519
URL: http://www.dr-bob.org/babble/subs/20041128/msgs/436792.html