The addiction treatment institution is not obliged to keep the patient, only the patient is obliged to undergo treatment.
Patients obliged by the court to undertake treatment constitute a smaller, though still significant, percentage of people reporting to drug treatment centers. There is a fairly widespread belief that working with these patients in most cases does not bring positive results because they lack motivation. However, much can be done to increase the effectiveness of therapy, also with this group of people addicted to alcohol. It is worth starting by looking at the specificity of the psychological situation in which there are people obliged to undergo treatment. The underlying disease, i.e. the same addiction to alcohol is the same, in the same way they function in the psychological mechanisms of addiction, i.e. their experiencing and thinking is subordinated to compulsive principles. The content and intensity of experiences and defensive thinking are different, however, because the negative consequences of drinking, which is borne by every alcoholic, are the result of a court hearing during which our patient was accused of negative, sometimes even criminal, alcohol-related activities. This raises the belief that treatment is not a form of help, but a penalty for misconduct. From the point of view of the concept of psychological mechanisms of addiction, this strengthens the mechanism of illusions and denials: “I am not sick, but I am wrongly accused of alcoholism.” It seems that the logical way out of this situation will be to prove innocence.
The addicted person’s mind is trained to use various types of defense patterns: rationalization, justification, denial and – in this case – mainly blaming others are activated. This serves not only to protect the possibility of drinking, although the stress associated with a lawsuit, sentence, tense family situation must cause strong craving for alcohol. The patient is overwhelmed with unpleasant feelings: anger, shame, anxiety, guilt and harm, the tension that the patient partly tries to relieve increases, showing rebellion and aggression to all whom he perceives as people who can stand on the hostile side. It would only be a relief if he had a drink of alcohol. And that was what he was forbidden under various sanctions.
His sense of security, the possibility of influencing his own fate as well as his sense of pride and self-esteem are also shaken. The JA dispersal mechanism makes it impossible to look at the situation from any distance, because the addicted person finds it difficult to set the limits of his JA and find permanent support points in himself.
It is also extremely difficult to look for constructive solutions, because the mechanism of illusion and denial changes the perception of an addict from “my drinking has caused harm and now I’m in trouble” to “I feel bad because I have been hurt” – which hinders the mechanism of habitual regulation of feelings. This causes worse and worse mood and thirst for relief related to drinking alcohol, and the JA distraction mechanism prevents you from seeing your own share of current problems, understanding your needs other than drinking and taking
and analyzing decisions on actions to improve the situation.
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So there is a crisis that more or less meets almost every person who applies for drug treatment, but the strength of this crisis is much greater. In addition, a sharp confrontation in an atmosphere of danger and in conditions in which there is no support, must trigger a much stronger defense.
Understanding what happens to the patient who is required to treat determines the therapy strategy. The general assumption is that obligated patients must be subject to the same standards as other patients in the healthcare facility. This means that a patient who breaks the rules and, for example, drinks alcohol in the ward, or does not participate in classes, should be discharged from the ward in accordance with the rules of the institution, because the drug treatment center is not obliged to hold the patient, only the patient is obliged to treatment a. Treatment means participation in therapy and management in accordance with the plant’s regulations. Being in a ward is not, of course, medical treatment and a patient who limits himself to this does not fulfill the legal obligation. There is no reason for healthcare facilities to support this situation.
Patients obliged to undergo treatment should undergo the same basic addiction therapy program as is carried out in the given institution as other patients. However, this program should be enriched with impacts adapted to the specificity of the problems of “forced” patients. These interactions include, first of all, the management in the first stage of treatment, i.e. in the stage of initiating therapy, which may be continued and deepened in the next stages. The strategy of working with these patients includes:
a) work on motivation during the first contacts,
b) work on emotional problems related to court obligations,
c) work on changing beliefs regarding the assessment of the patient’s current situation,
d) work on changing destructive behaviors and attitudes that hinder therapy.
As always when working on motivation, the most important thing is to enable the patient to discover the benefits that he would have received from treatment. The vast majority of people addicted to alcohol do not have a deep internal motivation for therapy. In this respect, those required to undergo treatment are typical. You can even look at their motivation in such a way that they have an additional motive to start treatment: the threat of very real problems with the court and police in the event of failure to meet the conditions of the commitment.
Therefore, it is up to the therapist to talk about this aspect of the case, sometimes even referring to legal consultation. During the first stage of starting therapy, the patient should be able to see the fact: undertaking treatment is a condition to avoid further legal problems.
This is obviously external motivation, but it gives a chance for any agreement with the patient, not so different in essence from the motivation resulting from family pressure, trouble at work or health problems.