Interview with Pablo Carbajosa: this is how drug addiction works

Drug addiction is often seen as an overly simple problem.; addicts are criminalized, assuming that they have "chosen" to lead their lives on that path, and that if they do not change for the better it is because they lack willpower.

However, the reality is much more complex than that. Substance dependence has several dimensions, and one of the most important has to do with the way in which the context influences the person. That means it's not all down to the addict's willpower or making the wrong decisions, and Fortunately, it also means that by modifying the context, recovery can be achieved, overcoming the disorder addictive.

In the next lines you will find an interview with Pablo Carbajosa, a psychologist specializing in Clinical Psychology, who works at the Cepsim Psychological Center (located in the Chamberí area, Madrid) helping patients with drug addiction of all kinds, among other things. Let's see how placing patients in other contexts and training them to modify their environment in their favor can help them leave drugs behind.

• Related article: "15 consequences of drug use (in your mind and in your body)"

Interview with Pablo Carbajosa: the psychology of drug addiction

Pablo Carbajosa is a psychologist specializing in behavioral and mental health disorders that have to to do with adverse contexts: consequences of family violence, sexual abuse and drug addiction From the Cepsim Psychological Center, a psychotherapy clinic in Madrid, helps patients whose interactions with their immediate environment have led them to develop psychological disorders such as substance dependence, trauma, or extremely high self-esteem low.

What are the most consumed drugs among patients with addiction problems who go to the psychologist for help?

In our center the most common in adults are alcohol, cocaine and hashish. Among the youngest users, the main problem is the consumption of hashish and designer drugs, and others such as ecstasy and cocaine on weekends.

Can we talk about a profile of the regular drug user with addiction problems? Or are there multiple profiles?

There is no single profile of drug user. Research shows different types of consumers based on sociodemographic variables, the drug used, severity of dependence, and personality traits.

Today we know that there are certain personality traits such as impulsiveness, the search for sensations or self-control that are related to the age of initiation of consumption and the severity of the addiction. Also of importance is the high prevalence of borderline and antisocial personality traits and disorders, especially in cocaine users. The presence of these factors is related to a greater probability of abandoning the treatments.

It is essential to carry out a comprehensive evaluation of the case, paying special attention to how these factors are configured in each person in order to design an effective intervention.

What are usually the main reasons why people with drug addiction problems start using these substances?

Consumption usually begins in adolescence or youth, associated with leisure on weekend outings. It usually begins with the consumption of alcohol, and in the peer group they seek to try new experiences by trying hashish, cocaine or designer drugs.

And the reasons why they start going to psychotherapy?

Although each case is unique and the motivations are multiple, in general the reasons are related to some type of negative consequence derived from the continued use of substances.

Consumption begins to generate family, economic, work and mood problems. In adolescents or young people, it is common for parents to discover it due to changes in mood, isolation, school problems, aggressive behavior or excessive spending of money will not justified.

Initially, these young people come basically due to family pressure, they have little motivation for treatment and very little awareness of the problem. Generating this motivation for change and increasing awareness of the problem will be one of the cornerstones at the beginning and during treatment.

In adults it is common that after years of weekly or monthly consumption and several failed attempts to try control consumption and not being able to maintain abstinence, the awareness of problem. It is usually the case that the couple or the family find out and treatment is made as a condition to continue the relationship.

In other cases, consumption begins to generate work and economic problems, or it affects the general state of mind (depression, anxiety, irritability). In these cases, it is common for the frequency of consumption in the last year to have increased, as has the feeling of lack of control.

It is difficult to summarize the work of psychologists, but... What are the techniques and tools that psychotherapy professionals usually use to treat people with addiction problems?

The techniques will depend on the treatment approach we use and on whether we work in a group or individual format, in a public outpatient center or in a therapeutic community.

However, along with general techniques, motivational interviewing to address motivation and problem awareness are fundamental.

The techniques of the cognitive behavioral model such as relaxation, cognitive restructuring or current techniques such as the Detur protocol based on EMDR or Mindfulness will be essential to intervene on specific characteristics of this population, such as the management of craving or the urge to consume.

It is also necessary to use techniques directed at the addict's lifestyle and consumption environments. It is important to agree with the person and gradually establish commitments to stimulate control (economic control, avoiding environments and people associated with consumption, etc.) and management of contingencies to reduce as much as possible the triggering stimuli for the desire to consume.

In parallel, it is necessary to work on all personal aspects related to consumption. At the end of the treatment, the techniques will focus on the relapse prevention approach.

In what aspects do you think it is important for psychologists to be humane and close to substance-dependent patients?

Fundamental in cases of patients with addictions. One of the specific characteristics of this type of people is that they have a low motivation for change and awareness of the problem is usually low initially and highly fluctuating throughout treatment. This makes establishing a good therapeutic alliance is key to the success of the treatment.

Is it necessary to reinforce the self-esteem of these people so that they trust in their ability to leave drugs behind?

In many cases there may be trauma or serious attachment problems prior to consumption. In addition, continued consumption itself puts the person in situations of personal risk and erodes self-esteem. This means that consumption itself generates negative consequences at a personal, work and family level.

All this is going to affect self-esteem and the feeling of self-efficacy or ability to stop using. Reinforcing self-esteem, motivating change and increasing the sense of self-efficacy will be a continuous objective during treatment.

It is probably not easy for a substance-addicted patient to seriously commit to therapy. What can psychologists and relatives of patients do to encourage them not to abandon treatment?

Motivation and awareness of the problem are one of the keys to this problem. Motivation is fueled by positive and negative consequences. To promote awareness of the problem and motivate change, the family has to support the process at all times, while maintaining pressure on the negative consequences of abandoning it. The balance between these two aspects will favor that the motivation continues to be maintained.

In the case of professionals, continuously reinforce the therapeutic alliance and be attentive to fluctuations in motivation. For example, it is common for patients who achieve a period of abstinence, after a period of treatment, to feel that the problem is over and think about abandoning treatment. Detecting these situations and reinforcing the need to continue advancing in the process of change, to maintain abstinence in the long term, will be essential.