A field that is hard for psychotherapy to reach

Addictive disorders have become one of the most serious problems in the field of mental health for governments. Consumption statistics are generally established through surveys and reflect a partial reality, given the tendency of substance users to conceal the truth.

Rehabilitation work, and psychotherapy in particular, in the field of addictions presents itself as a reality that is hard to reach for most psychiatrists and psychologists, given the particular characteristics of the problem. Practising insight-oriented psychotherapy in private or individual consultation is particularly difficult, especially in the early stages of treatment, when recent use alters the processes of cognitive analysis and blocks the addicted patient’s capacity for emotional response. We prefer the first stages of rehabilitation to take place in group processes, and that only after a certain period of evolution should group or individual psychotherapy be undertaken, once the patient is stabilised and free of cognitive or emotional alterations due to the drug.

An integrative model, a constructivist epistemology

In recent years, we have developed a model for treating addictions that incorporates concepts from integrative psychotherapy. This orientation, promoted by SEPI (Society for the Exploration of Psychotherapy Integration), seeks to gather the most important contributions of the main paradigms of psychotherapy, in order to obtain more numerous and better-quality inputs into the process of diagnosing and treating the individual’s problems.

From an epistemological point of view, the model adheres to a moderate constructivist approach to the construction of reality and, in our experience, the genesis of an addiction takes place on the basis of the early experiences that influence the development of the self of the patient with an addictive disorder. In applying the model, we use certain therapeutic techniques drawn from the constructivist model, such as: the examination of a personal philosophy on the basis of G. A. Kelly’s personal construct theory; the opportunity for self-knowledge as development of oneself; the construction of the autobiography as narrative reconstruction; the identification, on the basis of the early construction of psychophysiological rhythms, of the basic ingredients of self-awareness, so that emotional schemas or maps thus become the basic ingredients of self-awareness; and therapy as a space for dialogue for the encounter with the experiential realities sustained since an early experience, which encompasses the first ten years of life. The use of these techniques makes it possible to conduct processes that bring understanding of how, on the basis of experience, the autobiographical self carries out different processes aimed at leading the person to seek adaptive resources and coherences with the functions of the self.

We understand the self as the central core of the personality, which has several functions, among which we highlight identity, the organisation of experience, meaning, impulse control and spirituality.

The self of the addicted patient is built from childhood with strong contradictions and incoherences, and the drug makes them experience a sensation of coherence when they use it for the first time.

How is the autobiographical self constructed?

Various authors argue that, from the very moment of birth, our nervous system begins to feel in a very particular way, according to each individual’s experiences. There is no doubt that we live through intense experiences of attachment, distancing, warmth, coldness, etc., which our lack of language will at first be unable to identify, but which remain engraved, according to our singular way of feeling. Thus, with the emergence of language, a particular way of interpreting experiences becomes more complex and structured, giving continuous sense and meaning to reality.

Various biological factors will influence the development of the self; in the case of addicted patients in particular, we know that there are temperamental predispositions such as neuroticism, extraversion or psychoticism, whose manifestations will determine particular forms of structuring of the self of the future addict.

Moreover, the manifestation of certain pathologies, such as attention deficit disorder, can act as a predisposing factor, by structuring a reality on the basis of poor impulse control, a high sensory threshold to affective and emotional stimuli, and with an impact on the constructions of self-esteem and identity, the child perceiving himself as a person who constantly fails and who is heavily criticised for his poor results in school activities.