Excessive consumption of substance may cause dependence and result in numerous serious problem. For example harmful drinking pattern can damage the liver and result in memory loss. Harmful drinking is also estimated to cause road traf?c accidents and violence. Additionally, repeated alcohol use can negatively impact on family and social life of a person. Several evidence-based questionnaires can detect the problematic pattern of substance use. One easy to use screening tool to detect the alcohol problem is known as an acronym of CAGE. It require two or more positive replies.
C stands for cut down (Have you ever tried to cut down your alcohol drinking?).
A means annoyed (Have you ever been annoyed by your friend’s and family’s criticism of your drinking? ).
G stands for the guilty (Have you ever felt bad or guilty about your drinking).
E stands for eye opener (Have you ever felt shaky or hang over in the morning that you had to take a drink or two to get rid of that feeling?).
Once alcohol interferes with the normal routine life, it is apparent that individual may want to quit the habit of drinking. Unfortunately, the period of abstinence often results in relapse, and individual can again goes back to the old pattern of drinking. Thus, family and friends need a supportive mindset to deal with the problem. It is important to know that giving up alcohol is not easy for a long term user and it need support from the community. The same approach can be applied to the use of a range of substances.
One of a popular theory is Stage of change cycle where behaviour is modified according to the stage of the person. The following is a brief outline of the 'Stages of Change'.
1. Pre-Contemplative stage: Individuals at this stage do not usually consider changing. Individual often express as ‘I enjoy drinking and doesn’t want to change
2. Contemplative stage: Individual at this juncture is aware of the harm of drinking, however ambivalent to change.
3. Preparation stage: Individual at this stage are prepared to act. The individual will often express I am ready to cut down on alcohol. Goal setting strategies are useful at this stage.
4. Action stage: Individual at this stage, are currently engaged in attempts to reduce or stop drinking.
5. Maintenance or relapse stage: Individual at this stage successfully change drinking behaviour, however, need strategies for relapse prevention.
CBT means cognitive behaviour therapy. It entails our thought, feeling and behaviour are all interrelated. For example, if we think negatively as it happens in depression, our behaviour becomes quite withdrawn, we lose interest in various things and our life becomes quite dull. Therefore, we feel quite bad in our mood. Bad mood often attracts us to addiction as a way of coping.
Similarly, sometimes people may think quite black and white about the consequences of not using substance. For example, they may think that 'if I don't drink alcohol, my friend will leave me'.
Moreover, some people may assume that what happened in one situation in the past may happen in all such situations in future. For example, an individual may believe that because he started drinking again last year after a period off abstinence, he will never be able to stop.
Furthermore, an individual may respond to an event by blowing things out of proportion. For example, an individual may believe that because of their past experiences, if he gets craving to drink or take drugs it will be unbearable, and he will give in to it. Additionally, an anxious person may feel that alcohol or drugs can help them to survive.
CBT helps people to challenge their negative thoughts and consider the situation from more realistic perspective. Hence CBT helps to breakdown the cycle of negative mood and addiction.
Exposure therapy desensitizes an addict for high risk situations. It is almost inevitable to avoid high risk situations in our day to day life. Exposure to high risk situation often precipitates relapse after a period of sobriety. Exposure therapy helps people to identify high risk situations through self-monitoring. Then it helps people to gradually desensitize through controlled exposure to confronting situations. Later on, people feel more confident to deal with the situation in their daily life without reverting to substance use.
This group of people generally find it very difficult to say NO when substance is being offered to them or they face a trigger situation. Assertiveness training involves learning some strategies to say NO to substance when exposed to a confronting situation. It also involves enhancing someone's skills of setting boundaries around people and activities which may have negative influence in terms of substance use. Assertiveness training comprises of a wide range of behavioural and communication strategies to empower people to be assertive they are on the verge of relapse.
Self-monitoring means allowing one to take charge of their addiction. It involves encouraging people to maintain a dairy of their daily substance use. The aim to make a person aware of how much, when, where and why he drinks and ascertaining the situation where they are likely to drink more than their usual limits. It also involves developing strategies to deal with high risk situations. This strategy usually empowers an addict and helps them to take control of their addiction problem.
Structured problem solving
Problem solving skill of an addicted person is generally impaired. They often resort to substance use rather than constructively resolving their problems. This pattern becomes a type of reflex in their life. However, problems are inevitable in our life; such as interpersonal conflict, social crisis and life turmoils that may threaten our commitment to change our substance use habit. Structured problem solving is a scientifically proven approach to effectively dealing with stressors rather than turning to substance to cope with their problems. Structured problem-solving approach involves brain storming exercise to generate a range of solutions and pros and cons of different solutions.
There is a large body of evidence to suggest that most important step in addiction rehabilitation is profound change in individual's environment and life style that it promotes sobriety and eliminates all potential risk factors usually associated with relapse. Psycho-social enrichment entails establishing new relationship and reviving previous healthy relationship. It also involves developing new interest and hobbies. It emphasizes an individual consciously making choices and accepting self-responsibility for addiction free life style. It also involves cultivating a sense of acceptance and forgiveness within the sufferer.