Addiction Center
Addiction is a challenging process that affects the whole family as well as the individual. Therefore, the needs of relatives are also included in the treatment process. Assessing the needs of relatives and providing support during the treatment process is important for both the patient’s process and the health of relatives. Not only when substance use is a problem, but also individuals at risk (e.g. adolescents) should be approached appropriately.
It also provides information and counseling services for the family and relatives of the person during the entire process that can lead to addiction.
What is Addiction?
Substance addiction or substance use disorder is the inability to stop using substances even when one wants to. The desire and urge to use substances is so intense that the person is unable to control these urges even though they want to. The concept of addiction is nowadays also associated with addictive pursuits such as gambling, shopping or internet. Behavioral addictions are defined by the inability to control the excessive time spent on these activities.
The pleasure center of the brain sustains behaviors that we need to repeat in order to survive and reproduce, such as eating, drinking, pain relief and sexuality. Addictive substances stimulate the same center in the brain and are learned as a source of pleasure. This time, the repeated behaviors are not routine behaviors such as eating, sleeping or seeking relief from pain, but behaviors that trigger the desire to use the substance. All this leads to permanent changes in the brain. As a result, the substance replaces the pleasures and invades the person’s life. It affects interpersonal relationships, interferes with work, and damages physical and mental health.
Addiction is a Treatable Brain Disease
Addictive substances affect the brain functions that determine how we feel, think and behave. With repeated use, these effects of the substance cause permanent changes in the brain. We can use other chronic conditions to understand these changes and the resulting addiction.
For example, once we develop sugar or blood pressure, there are some permanent changes in our body. However, if the person pays attention to his/her diet, exercises and takes his/her medication regularly, his/her sugar or blood pressure will remain within normal limits. The person is now a healthy blood pressure or diabetes patient. If he/she does not follow his/her diet and does not take his/her medication, his/her sugar will rise, his/her blood pressure will rise and the disease will worsen again.
Relapses after withdrawal can lead to relapse, as in the example mentioned above.
This means a worsening of the disease, just like an increase in sugar or blood pressure. If the aim is to keep sugar and blood pressure low in the aforementioned diseases, the aim is to stay away from the substance in addiction. In conclusion, the disease of addiction improves, but it is not completely cured. Long-term efforts are needed to prevent relapse.
Addiction Process
Substance use becomes addictive through a process. Substance use disorders are a chronic process that starts with substance experimentation and progresses through a cycle of withdrawal and relapse. In order to understand the person with a substance use problem, it is first necessary to understand the cycle of addiction.
Encounter:
The first use of a substance, the first introduction to it, creates a memory that can be important for continued use. This immediate gratification comes at a price, as opposed to the delayed gratification we feel as a result of long and tiring working hours. Instead of facing the challenging realities of life, choosing substances that make us forget them for a short time is an attempt to deny reality. This kind of coping will bring temporary or false momentary relief instead of real fulfillment or solutions.
Precontemplation:
The person first denies, minimizes, blames it on others and denies the consequences of substance use. The person is not really drinking that much, the substance is good for them, there are many other unhealthy things in life and the substance is not as harmful as they say.
Some realities take time to be accepted and at first we “can’t believe our ears” and “this can’t be real”. The feeling of “it’s all a dream” after the loss of a loved one is a healthy denial response. However, after a certain period of time, it is expected to gradually give way to other feelings of grief. It is not easy for people to accept the reality that substance use has become problematic. Before accepting these problems, the person tries to deny them with some distortions:
I wouldn’t drink if I didn’t want to / If I wanted to now, I would quit now.
This is not a wrong sentence. But the problem is that the person does not want to “not drink”.
I drink because of this job/this marriage.
Making excuses is one of the methods of denying reality. Here the person avoids problems by using alcohol or drugs instead of solving them. However, problems are inevitable in life.
I only drink with friends on weekends
Quantity is as important as frequency. Drinking too much alcohol in a short period of time is a type of alcohol use disorder with very serious consequences. Accidents, beatings and risky behavior are common with this type of alcohol use.
However, all these justifications are only effective up to a point. As the negativities in the person’s life increase, they begin to realize the not-so-good aspects of the substance they are using. During this period, communication with the person must be maintained and at the same time the boundary must be protected. It is important to learn about the illness and to understand the person.
Period of Mindfulness (contemplation):
After a while, the person realizes the consequences of substance use. However, this awareness is not enough to change their behavior. Because the person finds himself/herself experiencing tides on a scale with two scales. On one side of the scale are the damages he/she has suffered, the reactions he/she has received from his/her environment, and his/her dreams that are getting further and further away, and on the other side are his/her intense cravings and needs for the substance.
As the person thinks about what the substance has cost him/her, he/she thinks about getting away from substance use, which has become a coping mechanism or the only means of entertainment. Changing the circle of friends and habits will not be that easy. On the other hand, the changes in the brain caused by substance use and physical problems such as withdrawal symptoms make it difficult to get away from the substance. This ebb and flow of awareness is characteristic of this illness. It is important to know this fact in order to understand the person’s needs. During this period, it is best to support the person to maintain their motivation instead of trying to direct them by forcing them.
Decision-Change-Sustaining
Awareness is not enough for a person to stop using substances. First, the person decides to stop using the substance, researches what they can do to do this and then takes action. Stopping substance use is a change and the person has reached this stage. The next step is to sustain the change.
Sustaining change involves a series of changes. Quitting substances means changing one’s daily life, one’s environment, one’s friends, one’s sense of fun. This is a challenging and fragile process. If the person maintains the change, they will leave the cycle of change, but there is a risk of relapse at every stage.
Relapse:
Relapse is part of the addiction cycle. A person who has stopped using is not someone who has never used a substance. Reminders and inadvertence can lead to relapse. This is not surprising in treatment and should not be a discouraging development. As can be seen, addiction is a cycle and relapse, which we call slipping, will be followed by a decision to quit again. The important thing is to support the person to live in such a way that they can stay away from the substance and suffer the least harm.
Behavioral Addictions
Although addiction is often understood as chemical dependence, psychiatric authorities accepted the concept of behavioral addiction for the first time in 2013 and defined “gambling disorder” as the first example. However, many behaviors were already being described as addictions in society and in the media. In the same way, many scientists continue to work on explaining some behavioral patterns with the “addiction” theory. It is expected that new behavioral addictions will be added to behavioral addictions that have only recently found their place in official diagnoses. A few examples of addictive behaviors are listed below.
- Gambling disorder
- Internet-related addictions
- Shopping
- Don’t eat
- Work
- The Game
- Sex
- Exercise
- Love
- Excitement and danger
- Aesthetic surgery
As we have seen, it is not easy to define the “excess” of behaviors that are part of our lives and even seem beneficial. Things like overworking or exercising excessively can be confused with being “overzealous” and it can be extremely difficult to distinguish between the two. The person may often claim that their environment does not understand them and that they are unfairly stigmatized by addiction.
So, when does a behavior become addictive?
Addiction is defined according to how extreme and damaging the behavior is. If a behavior affects your life in the following ways, you should consider that it may have reached the level of addiction:
The addictive behavior becomes the most important activity in a person’s life. It affects and directs all feelings, thoughts and behaviors. The person makes plans and interpretations according to this behavior.
The person repeats the behavior, sometimes as a source of pleasure, sometimes to avoid anxiety, and eventually the addictive behavior becomes a way of coping with challenging situations.
After a while, tolerance to the effects of this behavior on emotions develops, and the time and repetition required to achieve the expected effect increases.
When the person is unable to perform this behavior, they begin to experience uncomfortable feelings such as tension and irritability. They may experience physical difficulties, such as tremors, a feeling of heaviness or lightheadedness.
There is a constant state of conflict when addictive behaviors are carried out. The behavior is contrary to the wishes and expectations of both the person and their environment. These behaviors are incompatible with the person’s hobbies or other activities.
Periods of getting the behavior under control may soon be followed by repeated and intense episodes of relapse.
It is important to consider the above 6 key points about the behavior in order to “NOTICE” the addiction. In case of such a suspicion, it is important to consult a specialist.
Treatment Methods
Outpatient Treatment Service
Outpatient treatment means being able to continue the treatment of substance use disorder in appropriate cases without hospitalization, with frequent outpatient visits.
With this method, instead of isolating the person, they can continue their work and school without restricting their life and do not need to interrupt the flow of their life.
While the person is in outpatient treatment, we turn the fact that they are confronted with the factors that lead them to substance abuse into a benefit. We aim to be an easily accessible department to identify these factors and develop coping methods. We aim to provide continuous treatment cooperation with the person after hospitalization when they experience relapse or slippage. Our main goal is to provide easy accessibility and the capacity to be shaped according to the needs of the individual.
Treatment Plan Based on Individual Needs
We aim to customize our treatment plan according to the needs and goals of the individual. We create the most appropriate treatment plan together with the person after a comprehensive assessment that covers not only their physical health but also their psychiatric needs, relationships, professional and social needs.
Treatment is not only focused on substance use. Since the person’s family dynamics, individual characteristics and habits, lifestyle and past experiences can also be predisposing and sustaining factors, it is handled as a whole. Appropriate drug treatment, psychoeducational activities, individual psychotherapy and interventions to improve coping mechanisms constitute the content of the treatment program.
We Care About Your Privacy
Substance use and related disorders can cause serious discrimination and stigmatization in society. As with many mental disorders, there are serious prejudices against substance use. The consequences of these prejudices can go as far as preventing people from getting help for their problems. Most people who are afraid of facing prejudices from both their environment and the treatment team postpone applying for treatment. General treatment facilities provide anonymity and remove the “fear of exposure” that prevents people from seeking treatment.
In our department, general privacy rules are applied with full attention. Arrangements have been made to ensure that the reason for the person’s application is not shared with anyone other than the physician.
Another problem with treatments that require periodic check-ups is that the person has to take time off during working hours and therefore has to provide information about their illness.
Our department, where you will be welcomed by a team that respects your privacy without discrimination, is also available outside working hours.
Our Treatment Services
Initial Examination and Assessment
Individualized treatment is essential in our department. In the first examination, psychiatric evaluation and planning for appropriate medication are made. If necessary, emergency medical interventions and necessary referrals are provided. In order to customize the treatment for the individual, a detailed assessment interview is conducted and a needs analysis is provided. The services provided vary according to the needs of the individual. A treatment plan is created by focusing on the needs, expectations and individual characteristics of the person. Individual services are mainly provided in our department. Our outpatient department includes variable services according to the needs of the person:
Substance Detoxification and Replacement Therapies
Long-term substance use can sometimes lead to life-threatening withdrawal. After a psychiatric and medical evaluation, the most appropriate treatment method is selected and we provide substance detoxification treatment. In patients who do not need intensive medical follow-up and isolation, we provide detox and maintenance treatment while continuing their lives without hospitalization within the framework of the determined program.
Other Psychiatric Treatments
Psychiatric disorders that may accompany substance use disorders are evaluated and treatment is planned. Comorbid psychiatric disorders can negatively affect the treatment process, sometimes by causing substance use and sometimes by reducing motivation to quit. With appropriate diagnosis and treatment, these risks are reduced and longer well-being can be achieved.
Psychoeducation
Understanding and learning about the disease is one of the important steps that facilitate the treatment process. For this purpose, psychoeducation programs are organized for patients and their relatives. Topics such as the chronic nature of addiction, its perpetuators and what awaits us are some of these topics.
Individual Psychotherapies
Substance use is sometimes seen as a poor coping method. Sometimes it is seen as an avoidance effort to cover up psychological needs and sometimes as a sustainer. In order to meet these needs, coping skills, psychological difficulties, traumas and relationships are addressed through individual psychotherapies when necessary.
Preventing Relapse
Treatment for substance use disorders is not only about abstinence. The aim is also to prevent relapse. In outpatient treatment, the person has contact with the outside world and factors that facilitate relapse. It allows the treatment team to accompany and support behavioral changes. All real-life experiences are addressed in an easily accessible treatment system.
The patient is at the center of the treatment plan. The importance of the patient’s participation in decisions during the treatment process ensures the sustainability of the treatment.
Consulting services
People who are trying to understand whether their own use is harmful or not, people who are worried about someone close to them and people who want to quit but have doubts need accurate information first and foremost. We offer counseling to understand and explain the situation, to develop the most appropriate approach and to talk about everything related to substance use.
Family Needs Support
Substance use disorders are a group of diseases that also concern the family and relatives. It is extremely important in terms of both the function of referral and support to treatment and the fact that they are the group most affected by the difficulties experienced.
It provides counseling services to families on issues such as communication methods, boundary setting skills, and recognizing the disease. I aim to provide information in accordance with the needs of each individual, from families who suspect substance abuse to relatives who are trying to support during and after the treatment process. In addition, the difficulties experienced by family members or relatives of patients are discussed, support is provided and treatment is provided when necessary.