As Malaysia is not free from the problem of substance abuse and dependence, I feel it is only proper that we devote some space in our PERSIKOL homepage to this topic. For a start I will discuss very briefly the model of addiction that is important in understanding the causative and maintaining factors of addiction so that we can begin to understand why they do what they do and how we can all help them. Perhaps other readers can contribute articles on this topic in future issues so that we can all exchange information and together help these unfortunate persons better.

Many addicted individuals have characteristics that predispose them to drug abuse. These predispositional factors include
(1) general exaggerated sensitivity to unpleasant feelings
(2) deficient motivation to control behaviour
(3) impulsivity
(4) excitement seeking and low tolerance to boredom
(5) low tolerance for frustration, and in most cases
(6) insufficient prosocial alternatives for gaining pleasurable feelings, and a sense of hopelessness in ever achieving the goal.

Low frustration tolerance (LFT) is characterized by exaggeration of the degree of loss resulting from thwarting, blaming other people for any frustration, a strong desire to punish the offender, and overlooking other ways of problem solving. Each of these predispositional factors is addressed in the couse of therapy or counselling.

The sequence of addiction often follows a vicious cycle proceeding from anxiety or low mood to self medication by using drug. This behaviour in turn, produces and/or exacerbates financial, social and/or medical problems, which leads to further anxiety and low mood. Patients often ascribe their drug use to “uncontrollable cravings and urges”. However, certain dysfunctional beliefs tend to fuel these cravings.Abusers tend to ignore, minimize, or deny the problems resulting from their drug use or attribute these problems to something other than the the drugs. An important factor in maintaining psychological dependency is the belief that withdrawal from the drug will produce intolerable side effects. In actuality, through careful clinical management these side effects generally turn out to be tolerable. Another important set of core beliefs centres around the addicted individual’s sense of helplessness in controlling the craving.

Cravings are associated with wanting gratification or relief, whereas urges are concerned with doing something to provide a gratification or relief. The delay between the experience of craving and the implementation of the urge provides an interval for therapeutic intervention. Cravings and urges tend to be automatic and may become autonomous; the thrust of therapy is to provide voluntary methods for managing them. Patients tend to equate the strong craving with the imperative “need” and an uncontrollable urge. Although the craving leading to drinking and using is involuntary, controlling the urge is voluntary and can be adopted even though the patient may feel helpless. Increasing the ratio of the subjective power of control to the subjective power of the urge may be used as a guide for intevention.

One of the ways to treat addiction is through cognitive therapy. It is a system of psychotherapy that attempts to reduce self-defeating behaviour by modifying erroneous thinking and maladaptive beliefs and teaching techniques of control. In the cognitive therapy of drug abuse, the specific case formulation forms the basis for the therapeutic regimen. This formulation, in turn, is based on the cognitive model of addictions.

The therapeutic approach consists of undermining the urge by weakening the beliefs that feed into the urge and, at the same time, demonstrating to the patient the various ways of controlling and modifying their behaviour. Cognitive therapy of substance abuse is characterized by the following
(1) it is collaborative (builds trust)
(2) it is active
(3) it is based, to a large degree on guided discovery and empirical testing of beliefs
(4) it is highly structured and focussed, and
(5) it attempts to view the drug problem as a technical problem for which there is a technical solution.

AZHAR M. ZAIN
Psychotherapy Clinic
USM Hospital
Kubang Kerian
16150 Kota Bharu