Alkol ve Madde Kullanım Bozukluklarında Grup ve Bireysel Psikoterapiler
Özet
Alkol ve madde kullanım bozukluğu (AMKB) tedavisinde farmakolojik yaklaşımların yanı sıra psikososyal tedaviler de kritik bir öneme sahiptir. Bu kapsamda uygulanan bireysel psikoterapiler arasında, bireyin geçmiş yaşam dinamiklerini ve bilinçdışı süreçlerini inceleyen psikodinamik yönelimli terapiler; hastanın bilişsel çarpıtmalarını hedef alarak daha işlevsel alternatifler geliştirmeyi amaçlayan bilişsel davranışçı terapiler (BDT) ve bireyin şimdiki ana yargısız bir şekilde odaklanmasını sağlayan farkındalık temelli üçüncü kuşak terapiler yer almaktadır. Grup psikoterapileri ise benzer süreçlerden geçen hastaların etkileşiminden yararlanarak akran desteği, yüzleşme ve düşük maliyet gibi avantajlar sunmakta ve en az bireysel yöntemler kadar etkinlik göstermektedir. Grup uygulamaları kapsamında; farkındalık yaratmayı hedefleyen psikoeğitim grupları (SAMBA gibi programlar dahil), hastaların reddetme ve öfke yönetimi gibi günlük becerilerini artıran beceri geliştirme grupları ile bilişsel davranışçı grup terapileri (BDGT) aktif olarak kullanılmaktadır. Ayrıca, eyleme dayalı sosyometrik psikodramatik grup terapileri sayesinde hastalar, dürtüsel döngülerden çıkarak davranışlarını dışarıdan gözlemleme, yeni roller deneyimleme ve sorun çözme yetilerini geliştirme fırsatı bulurlar. Sonuç olarak, hastanın motivasyon düzeyi ve bireysel özellikleri doğrultusinde seçilen bu psikoterapiler, kuru kalma sürecine ve doz azaltımına doğrudan katkı sağlamaktadır.
Pharmacological treatments for alcohol and substance use disorders (ASUD) are significantly complemented by psychosocial interventions. Individual psychotherapies utilized in this field include psychodynamic therapies that analyze past dynamics and unconscious processes; cognitive behavioral therapies (CBT) aiming to replace cognitive distortions with functional alternatives; and mindfulness-based third-wave therapies focusing on non-judgmental present-moment awareness. Group psychotherapies leverage client interaction to offer mutual support, confrontation, and cost-effectiveness, proving to be at least as effective as individual formats. Within group applications, psychoeducation groups (including structured programs like SAMBA) build awareness, while skill development groups enhance everyday behaviors such as refusal and anger management, alongside cognitive behavioral group therapies (CBGT). Furthermore, action-oriented sociometric psychodramatic group therapies allow individuals to break impulsive cycles, observe their behaviors from an external perspective, experiment with new roles, and enhance problem-solving capacities. Consequently, these psychosocial approaches, selected tailored to the patient's motivation and personal characteristics, substantially contribute to maintaining sobriety or reducing substance doses.
Referanslar
Teeters JB, Lancaster CL, Brown DG, Back SE. Substance use disorders in military veterans: prevalence and treatment challenges. Substance abuse and rehabilitation. 2017;8:69.
Manuel JK, Hagedorn HJ, Finney JW. Implementing evidence-based psychosocial treatment in specialty substance use disorder care. Psychology of Addictive Behaviors. 2011;25(2):225.
McGuire AP, Mota NP, Sippel LM, Connolly KM, Lyons JA. Increased resilience is associated with positive treatment outcomes for veterans with comorbid PTSD and substance use disorders. Journal of Dual Diagnosis. 2018;14(3):181-6.
Sobell LC, Sobell MB, Agrawal S. Randomized controlled trial of a cognitive–behavioral motivational intervention in a group versus individual format for substance use disorders. Psychology of Addictive Behaviors. 2009;23(4):672.
Potik D. An historical overview of psychoanalytic perspectives on drug abuse and addiction–Part I. Psychodynamic Approaches for Treatment of Drug Abuse and Addiction. 2020:5-14.
Alvarez-Monjaras M, Mayes LC, Potenza MN, Rutherford HJ. A developmental model of addictions: integrating neurobiological and psychodynamic theories through the lens of attachment. Attachment & human development. 2019;21(6):616-37.
Giugliano JR. A psychoanalytic overview of excessive sexual behavior and addiction. Sexual Addiction & Compulsivity. 2003;10(4):275-90.
Akvarda Y, Arkar H, Akdede BB, Gül S, Sarı Ö, Tunca Z. Alkol kullanım bozukluklarında kişilik özellikleri. Bağımlılık Dergisi. 2005;6(2):53-9.
Taşkent A. Alkol ve/veya madde bağımlıları ile bağımlılığı olmayan bireylerin savunma mekanizmaları açısından karşılaştırılması, çocukluk çağı travmaları, disosiyatif yaşantılar ve bağımlılık şiddetinin savunma mekanizmaları üzerindeki etkisinin incelenmesi: Maltepe Üniversitesi, Sosyal Bilimler Enstitüsü; 2010.
Khantzian EJ. Psychodynamic psychotherapy for the treatment of substance use disorders. Textbook of Addiction Treatment: Springer; 2021. p. 383-9.
Verma M, Vijayakrishnan A. Psychoanalytic psychotherapy in addictive disorders. Indian Journal of Psychiatry. 2018;60(Suppl 4):S485.
Leichsenring F. Applications of psychodynamic psychotherapy to specific disorders: Efficacy and indications. In G. O. Gabbard (Ed.), Textbook of psychotherapeutic treatments . American Psychiatric Publishing, Inc; 2009. pp.97-132.
Ray LA, Meredith LR, Kiluk BD, Walthers J, Carroll KM, Magill M. Combined pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders: a systematic review and meta-analysis. JAMA network open. 2020;3(6):e208279-e.
Haller M, Norman SB, Cummins K, Trim RS, Xu X, Cui R, et al. Integrated cognitive behavioral therapy versus cognitive processing therapy for adults with depression, substance use disorder, and trauma. Journal of Substance Abuse Treatment. 2016;62:38-48.
Sugarman DE, Nich C, Carroll KM. Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders. Psychology of Addictive Behaviors. 2010;24(4):689.
Kabat-Zinn J. Foreword: Seeds of a necessary global renaissance in the making: the refining of psychology’s understanding of the nature of mind, self, and embodiment through the lens of mindfulness and its origins at a key inflection point for the species. Curr Opin Psychol. 2019;28:xi-xvii.
Bautista T, James D, Amaro H. Acceptability of mindfulness-based interventions for substance use disorder: A systematic review. Complementary therapies in clinical practice. 2019;35:201-7.
Grant S, Colaiaco B, Motala A, Shanman R, Booth M, Sorbero M, et al. Mindfulness-based relapse prevention for substance use disorders: A systematic review and meta-analysis. Journal of addiction medicine. 2017;11(5):386.
Brewer JA, Elwafi HM, Davis JH. Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychology of Addictive Behaviors. 2013;27(2):366.
Li W, Howard MO, Garland EL, McGovern P, Lazar M. Mindfulness treatment for substance misuse: A systematic review and meta-analysis. Journal of substance abuse treatment. 2017;75:62-96.
Razeghi N, Takallo ME, Rafei Z. The effectiveness of mindfulness-based cognitive therapy on reducing drug tendency and death anxiety among male adolescents with substance abuse. Payesh (Health Monitor). 2019;18(1):77-85.
Coco GL, Melchiori F, Oieni V, Infurna MR, Strauss B, Schwartze D, et al. Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials. Journal of substance abuse treatment. 2019;99:104-16.
Lo Coco G, Melchiori F, Oieni V, Infurna MR, Strauss B, Schwartze D, et al. Group treatment for substance use disorder in adults: a systematic review and meta-analysis of randomized-controlled trials. Journal of Substance Abuse Treatment. 2019;99(February):104-16.
Weiss RD, Jaffee WB, Menil de VP, Cogley CB. Group therapy for substance use disorders: what do we know? Harvard review of psychiatry. 2004;12(6):339-50.
Kargin M, Hicdurmaz D. Psychoeducation program for substance use disorder: effect on relapse rate, social functioning, perceived wellness, and coping. Journal of Psychosocial Nursing and Mental Health Services. 2020;58(8):39-47.
Sarkhel S, Singh O, Arora M. Clinical practice guidelines for psychoeducation in psychiatric disorders general principles of psychoeducation. Indian journal of psychiatry. 2020;62(Suppl 2):S319.
Thylstrup B, Schrøder S, Hesse M. Psycho-education for substance use and antisocial personality disorder: a randomized trial. BMC psychiatry. 2015;15(1):1-12.
Moore KE, Hacker RL, Oberleitner L, McKee SA. Reentry interventions that address substance use: A systematic review. Psychological services. 2020;17(1):93.
Şimşek M, Dinç M, Ögel K. Determinants of the addiction treatment drop-out rates in an addiction counseling centre: a cross-sectional study. Psychiatry and Clinical Psychopharmacology. 2019;29(4):446-54.
Morgan‐Lopez AA, Saavedra LM, Hien DA, Campbell AN, Wu E, Ruglass L, et al. Indirect effects of 12‐session seeking safety on substance use outcomes: Overall and attendance class‐specific effects. The American Journal on Addictions. 2014;23(3):218-25.
TÜRKCAN A, COŞKUN B, İLEM E, ÇAKMAK D. Alkol bağımlılarında bir tedavi programının 3 aylık izlem sonuçları. Bağımlılık Dergisi. 2001;2(1):30-3.
Yıldırım Z, Sütcü S. Effectiveness of cognitive behavioral group therapy for the treatment of substance-related disorders: A systematic review. Psikiyatride Güncel Yaklaşımlar. 2016;8(Ek 1):108-28.
Giacomucci S. Addiction, traumatic loss, and guilt: A case study resolving grief through psychodrama and sociometric connections. The Arts in Psychotherapy. 2020;67:101627.
Treatment CfSA. Quick guide for clinicians based on TIP 41 substance abuse treatment: Group therapy. Treatment Improvement Protocol (TIP). 2005;41.
McVea CS, Gow K, Lowe R. Corrective interpersonal experience in psychodrama group therapy: A comprehensive process analysis of significant therapeutic events. Psychotherapy Research. 2011;21(4):416-29.
Testoni I, Cecchini C, Zulian M, Guglielmin MS, Ronconi L, Kirk K, et al. Psychodrama in therapeutic communities for drug addiction: A study of four cases investigated using idiographic change process analysis. The Arts in Psychotherapy. 2018;61:10-20.
