MEMO: Treatment of Addiction-Dual Diagnosis

  1. There is a conflict or competition in the addicted individual between two modes or states: the addictive modes and the adaptive modes.
  2. The competition revolves around the relative strength of the effectively toned beliefs in each state.
  3. The affectively toned beliefs depend on the individuals’ specific belief system. However, some of the general beliefs in the addicted state are: cravings, urges, etc. which when paired with an affective state, leads to motivation. The affective state that exists in the expectancy or the actual drinking or using consists of feeling beliefs or feeling ideas such as, “I feel high and that’s good”, “The high feeling gives me a sense of mastery and tranquility”, “I no longer feel sad or regretful”.
  4. The adaptive state also has ideas with feeling attached to them: “When I am doing something other than using which involves utilizing my own heart or skills, working towards my aspirations, or helping other people, it gives me a good feeling”: being worthwhile, being in control of my life, being satisfied with what I am doing, and self-satisfaction of helping other people.
  5. To build up the adaptive mode, it is important to provide a trajectory of some type towards a specific aspiration. The individual is then asked regarding the feelings associated with fulfilling the aspiration. The next step is to have the individual image achieving the aspiration. This involves questioning about feeling ideas: I feel worthwhile, I feel as though I am doing something meaningful. The individual is next asked how good these feelings are and how he feels when he thinks about reaching the aspiration. The individual may say: I feel like a good person, I feel effective, or I feel strong. The clinician then asks what the individual can do right now to recreate that same feeling. The next step is to facilitate the individual actually participating in an activity that would recreate the feeling of mastery, being valuable, being strong, etc.
  6. The individuals then can draw on these feelings beliefs of strength, mastery, and control to resist the urge to drink or use.
  7. **It is important to note that it is not so much the activity itself that is therapeutic, but the meaning attached to the activity. If the aspiration is too remote to be credible, the clinician can outline the kinds of steps that could be taken to recreate the feeling that goes with reaching the aspiration.
  8. The use of images is important particularly in those individuals who are good imagers. So, the images can be used to create the good feeling/ attitude associated with the adaptive mode and can be also utilized in rehearsals directed towards avoiding drinking or using as well as behavioral rehearsals directed towards the aspirations. Then finally, the methodology is similar to that employed in individuals with negative symptoms: build up the investment in the adaptive mode which reduces the investment in the maladaptive psychotic or addictive modes.