Damián Ruiz
Treating cocaine addiction in a private practice is complex because this substance not only affects the normal functioning of the brain on a biochemical and neuronal level but also, on a symbolic level, compensates for deficiencies, personal aspects that have not been integrated or elaborated or truly unsatisfactory lifestyles.
Cocaine creates the idea that without it it is difficult to carry out certain actions: enjoying a party, sex, concentrating, relaxing, disconnecting, overcoming fear or shyness, withstanding work pressure, daring to make decisions, etc. It is a drug that the brain adapts in order to adapt to the needs of the individual. It is a drug that the brain adapts to generate different functions.
Giving it up can be easy or very complex. Around this substance we have created a paradigm at a social level: getting off it has become a way, metaphorically speaking, of climbing Everest. It is an impossible task that requires a lot of infrastructure, a lot of will and a lot of effort and perseverance. And so it is in most cases.
If we talk about smoking, a minor issue in comparison, we know people who have quit from one day to the next, after years of considerable smoking, without relapsing, and others who need long clinical processes with the intervention of different types of medical and psychological professionals, and even so, even if they want to, they cannot quit.
With cocaine, there is a strong insistence on the will of the user or addict. And although it is essential before treatment, a first question is asked: Do you want to stop taking this substance completely? If the patient answers “I really like using it, I come here because I think I have to stop”, “I would like to control it, so that I can do a line once in a while, even if it is only once a month or at certain times”, then he or she is not ready to start treatment, and it is better to postpone it.
The person with this problem must meet two preconditions for therapy to be successful: firstly, they have personally made the decision to stop using the substance, regardless of the influence of their environment, and secondly, they want to eradicate it completely from their life.
From this point on, serious work can begin.
My approach, in this case, is not based on the patient’s will.
I understand that he will do his best in the beginning, even if the therapeutic alliance between the two is good, it is very likely that for a first period of time this will serve as a motivation to sustain himself without using.
But… sooner rather than later, frustration, the need to consume, the mourning for the absence of the substance, the famous “craving”, so well known to those who have undergone different treatments, may begin.
And how can we work against this in a psychological consultation if the patient can have immediate access to the substance?
In my case, I base my work on two aspects: a sustained progress focused on the reduction of intakes and quantities, where will and control are involved but in a more moderate way, and two, the search, in real and unconscious life, for those factors that precipitated or precipitate this consumption, beyond the biochemical aspects already encrypted by the time of addiction. The latter is a more complex task, but if they begin to be detected and to try to remedy them by making them emerge into consciousness and transforming the actions to be taken in reality and even transforming the lifestyle.
My Jungian psychoanalytic training (although this therapy is eclectic) and a resolute character that understands that the knowledge of something does not transform it by itself and that an action is required, leads me to seek, together with the patient, that necessary change.
I am well aware that someone who gives up cocaine cannot become a normative, monotonous person, trapped in standard habits, however apparently happy and successful their life and environment may seem. This is someone who is going to need a level of stimulation, even passion in life that is well above average. She may even have developed a certain intolerance to frustration. All of this will be taken into account.
In short, the cocaine cessation therapy I follow will not be based, as I said, on the activation of the patient’s will but, as I explain in the book I wrote on the subject, on his or her capacity to transcend it, to not need it because unrecognised aspects have been integrated and elaborated and a new, more motivating lifestyle has been generated.