Dealing With Addictions In The Practice Of A Psychologist

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Clients' appeals on the problem of addiction are almost the most common: it can be a manifestation of dependent behavior of a partner or a loved one - and then we are talking about codependent behavior, or a manifestation of dependent behavior in the client himself. So, we classify the types of treatment according to the dependency problem:

1) Drug addiction;

2) Alcohol addiction;

3) Nicotine addiction;

4) Food addiction;

5) Codependency.

The most "insidious" and difficult to work with are the last two types - food addiction and codependent behavior. Food addiction is a socially acceptable type of addiction that does not harm anyone around you. Therefore, the addict himself often does not "suspect" about the presence of his deviation. Codependent behavior is particularly challenging to work with. Since the first step of working through is incredibly difficult - awareness. It is extremely difficult for a codependent to admit that they have this disease. Despite the symptoms, difficulties and even suffering. Next, we will take a closer look at the disease picture of each type of addictive behavior. And everywhere the "red thread" will slip through negation. In codependent behavior, it manifests itself especially clearly. It's hard to deny addiction by using drugs. It is difficult to deny food addiction, being 30 kg or more overweight. Codependency is a kind of screen, the main task of which is to create and maintain the illusion of well-being.

The “12 steps” program proved to be the most effective [1]. And it is quite easy to adapt it to any kind of addictive behavior, including codependency. We have seen this by using the program in practice. The 12 Steps program was originally created by people with alcohol addiction and their followers in the United States. Then the program was tested for drug addiction rehabilitation. By the mid-1950s, the 12 Steps program had become popular around the world and applicable to all types of addiction. She successfully adapts to work with codependent people who seek counseling about the illness of their loved ones. As we worked through each of the 12 steps with codependent mothers, wives, and husbands of chemical addicts, we were convinced that the program was effective.

Increasingly, psychologists are faced with a request for excess weight. The main cause of obesity today is food addiction. And in this case, the "12 steps" program gives positive results. The object of addiction here is not a chemical, but food. Given this difference, we can successfully work through all 12 steps of the program. The experience of a psychologist shows that in the fight against excess weight, emphasis on psychological characteristics is most effective. Diet, weight control and calorie control can only be a temporary measure that does not address the cause of the problem.

The 12 Steps program is mainly used in the format of group consultations. In practice, there are often requests for individual work with a dependency problem. In this case, it is important for the psychologist to know the basic characteristics of the addict's personality, the characteristics of his behavior. This is important for determining the possibility of one's own competence and the specifics of working with a client. So, let's consider the main types of addiction, their common features and differences.

In the literature, addiction is defined as "addiction" (addiction). This is a form of destructive behavior, which manifests itself as a desire to escape from reality through a change in the state of consciousness. This state is achieved through the ingestion of a chemical, uncontrolled food intake, or constant fixation of attention on certain objects or actions (activities), which is accompanied by the development of intense emotions. This process captures a person so much that it begins to control his life. A person becomes helpless in the face of his addiction. Willpower weakens and makes it impossible to resist addiction. Codependency is manifested through fixation of attention on the relationship with a certain person.

Over time, the hierarchy of values changes: the object of addiction comes first, and this determines the entire way of life of the addict. All his daily life is subject to the object of addiction and "revolves" in a circle of illusory compensatory activity, there is a significant personal deformation.

B. S. Bratus believes that each addict has his own internal picture of the disease. Its formation is influenced by current needs and expectations. This is reflected in

psychophysiological background of intoxication, making it psychologically attractive [9].

B. S. Bratus describes the types of the mechanism of the predominance of the need for a chemical substance and the formation of addiction with a complex of clinical symptoms:

1. Evolutionary mechanism. The more intense the euphorizing effect, the stronger the need for the substance is. Thus, the need first manifests itself as secondary, competing with the basic, basic needs. Then it becomes dominant, dependence is formed.

If a person turns at this stage of the formation of addiction, then it is necessary to work with the needs. It is necessary to identify those of them that are in "deficit". Psychological help will be to find alternative, healthy ways to meet this need.

2. Destructive mechanism. There is a destruction of the personality: its mental, intellectual structures, the sphere of feelings and emotions, the system of values. Those needs that were previously basic lose their meaning for the addict. The search for and use of a chemical (a large amount of food) becomes the semantic motive of the addict's activity.

At this stage, you can also work with a “scarce” need. It is important to work with the history of life, childhood, family situation. Psychological help consists in finding healthy ways to satisfy needs, the addict needs to learn to analyze his thoughts, actions, and control impulses.

3. The mechanism of the formation of personality anomalies. At this stage, the changes become stable, the personality changes as a whole [9].

At this stage, the picture of the disease is often comorbid, accompanied by various symptoms and syndromes: from psychosomatic diseases to manifestations of a borderline level of mental activity. Here, the help of a clinical psychologist, sometimes a psychiatrist, is more adequate. The help of a psychologist - consultant is limited.

At all stages of addiction formation, the "12 steps" program can be effective. In practice, the groups are always heterogeneous: there are addicts with different "experience" of use. This is not a limitation on the application of the program, on the contrary, the different experience of the participants is a resource for successful work in a group.

The development of addiction is accompanied by an increase in defense mechanisms (mainly denial and regression) designed to minimize the feeling of guilt from addictive realization. The addict is more and more afraid to reflect, to be alone with himself, seeks to constantly be distracted, to occupy himself with something. Other defense mechanisms begin to be involved, in particular rationalization, which helps explain one's behavior to others. Subsequently, with the appearance of symptoms of loss of control, even the addictive logic of rationalization and “thinking at will” collapses [7]. The patient does not perceive psycho-traumatic situations, personality problems that served as triggers of drug breakdowns as deserving of attention, does not understand their connection with addictive behavior, which causes difficulties in establishing a trusting dialogue with addicts.

The addictive patient in the counseling process, as a rule, takes a passive-consumer position or resists change. Many, not seeing the need for long-term psychological consultations, ask to do something “radical”, for example, hypnotize, encode, “remove” the desire to use drugs. At the same time, the lack of self-efficacy and fear of reflection (“fear of meeting oneself, fear of oneself”) constitute the core of addictive identity [8].

According to V. Frankl, if a person does not have a meaning in life, the implementation of which would make him happy, he tries to achieve a feeling of happiness with the help of chemicals [14].

For all types of addiction, there is something in common that influenced the formation of addictive behavior. Alexander Uskov, in the foreword to the book "Psychology and Treatment of Addictive Behavior", writes that in counseling, addicted patients did not evoke sympathy in him: "How can you put some chemical substance at the center of your life and consider it the focus of all your problems?" - the author writes. Uskov explains this by the phenomenon of countertransference, which often arises in the process of counseling: there is a reflection of rejection and lack of sympathetic understanding, from which these people suffered in childhood [12, p.5]. Therefore, the addict from childhood gets used to identify himself with something inanimate, partial, a kind of object. Later, the patient will choose the chemical as their primary target.

However, chemical dependence, unlike other types, is not only a psychological problem, but also a social one. Other types of addiction are not treated forcibly, except as a "challenge" to society.

Codependency is different in that the object of addiction is not a dead chemical or food, but a living person, a relationship. Nevertheless, these relationships are largely "mortified", since a healthy relationship is a series of rapprochement and distance. A codependent relationship is a stable fusion. In such a relationship, distance is experienced as the end of the relationship.

All forms of addiction are characterized by compulsive and irresistible attraction. All of them are nourished by the powerful power of the subconscious, and this becomes the cause of demanding and insatiable. It is with these manifestations that the psychologist should work especially carefully and for a long time. The ability of an addict to control his condition is minimized. Deviant behavior can vary in severity, ranging from near-normal behavior to severe physical and psychological dependence.

The 12 Steps program allows you to effectively work with addictive behavior through a correct understanding of the essence of this phenomenon.

Alcoholism is a disease. The alcoholic is not responsible for his condition, but is responsible for his actions and deeds. This approach is also confirmed by genetic studies [12]. Sobriety is maintained through caring and caring relationships within the group or with a counselor. The addict first of all needs the experience of such a relationship, where he learns to take care of himself, to take responsibility for his life in order to control affects.

One of the characteristics of alcohol addiction is the inability to maintain self-esteem and take care of oneself. With this aspect, you can successfully work in counseling, restoring the addict stability in the perception of himself by realizing his characteristics, needs and desires, his rights and abilities.

The main reasons for the formation of alcoholism and other types of addiction:

1) long-term neurotic conflicts;

2) structural deficit;

3) genetic predisposition;

4) family and cultural conditions.

There is often an association between addictive behavior and propensity for depression and personality disorders.

The main reason for addictive behavior is the lack of adequate internalization of parental figures and, as a consequence, a violation of the ability to self-defense. It is for these reasons that other functions of addicts are disrupted:

• Reflection, • Affective sphere, • Pulse control, • Self-esteem.

Many addicts are unable to build and maintain close interpersonal relationships because of these manifestations of insufficiency. In an intimate relationship, the addict is mainly hampered by narcissistic vulnerability and affects, impulses that he himself is not able to control. Affects cause tension and pain, which the addict tries to alleviate through substance use or fusion in a relationship. This becomes a desperate attempt to somehow control oneself and control one's behavior, state. Another target in psychological work with addiction is the ability to release tension without resorting to the object of addiction. The addict needs to learn to withstand life's difficulties, physical discomfort, without changing the state of consciousness. It is important to learn to cope with stress through meditation, introspection, learning to ask for help from loved ones.

Blatt, Berman, Bloom-Feshbeck, Sugarman, Wilber and Kleber examined the nature of drug addiction in detail and identified the main factors:

1) The need to get rid of aggression, contain it;

2) The desire to satisfy the need for a symbiotic relationship with the mother figure;

3) The need to relieve depression and apathy;

4) An endless struggle with feelings of shame and guilt, a sense of one's own insignificance, combined with increased self-criticism [12, p.18].

The world of drugs (another substance or another person) becomes a saving refuge from the harsh reality, where his Super-Ego becomes his own tormentor and tyrant. This is the case in severe neurotic patients.

In order to change the life of an addict, long-term deep psychological work is required. The addict must first stop using the subject of addiction. Although abstinence in itself is not a guarantee of serious changes. To work out the dependence, work is necessary based on the following points:

• Control of affects

• Sustainability of self-esteem

• Building close relationships

Psychologists are often confronted with alexithymia. Most of the addicted people do not know how to recognize, be aware and define the feelings and emotions experienced. The work of a psychologist begins with the recognition of the sphere of feelings.

Much research on addictive behavior has focused on the libidinal elements, sadism, and masochism. In 1908, Abraham (1908) in his work identified the relationship between alcohol dependence and sexuality. Addiction destroys the defense mechanism of sublimation. Therefore, previously repressed manifestations of child sexuality arise: exhibitionism, sadism, masochism, incest and homosexuality. Drinking alcohol is a manifestation of the alcoholic's sexuality, but as a result leads him to impotence. As a result, the illusion of jealousy arises. Abraham identified the relationship between alcoholism, sexuality and neurosis. Freud and Abraham believed that the main cause of addiction was impaired libido. Rado described the picture of addiction as the need to relieve pain, receiving pleasure at the cost of suffering and self-destruction. The pleasure of sexual intercourse is replaced by the pleasure of the chemical.

In 1927, Ernst Simmel (1927) in his work "Psychoanalytic treatment in a sanatorium" describes a special regime for keeping patients with chemical dependence. The patients were in the sanatorium around the clock. They were allowed any destructive activity: breaking off tree branches, killing and devouring personnel images. The patients were fed 2-3 times a day and were allowed to stay in bed as long as they wanted. In addition, a nurse was assigned to each patient, who always encouraged and supported him. Thus, the patient, giving up the chemical, received what he needed most in his life: the opportunity to be a child with a kind, always supportive, affectionate mother who is always there and never leaves him [12]. Then there is a gradual exit from this phase - like weaning. The patient is taught to introspection, to take responsibility for his life. Thus, the addict has the opportunity to gain a new healthy experience of early relationship with the mother. After all, they were the ones who were injured by the addict.

Glover (1931) also points to the psychological nature of addictive behavior. He believes that without psychological work, treatment of addiction is impossible, abstinence will only have a temporary effect. Glover came to the conclusion that the most attention should be paid to the first two years of a person's life, to study more deeply the oral eroticism of addicts.

Robert Savitt, in his article "The Psychoanalytic Study of Addiction: Ego Structure and Drug Addiction" (Robert Savitt, 1963), examines several types of addiction, highlighting their differences. Common to all is the violation of relationships in the mother-child dyad. Depending on the degree of impairment at the early stage of ego development, people manifest different addictions to food, tobacco and other objects. The more severe the violation, the stronger the addiction.

Addiction is a child's hunger for warmth, closeness, and care. This is what the alcoholic looks for in the company, creating the illusion of friendship, support and acceptance. The addict seeks to separate from his mother, to independently control his life, creating the illusion of controlling his use. Smoking is an illusion of fullness, an attempt to make up for the bodily contact that the child so much needed during the breastfeeding period. Food addiction helps maintain the illusion of pleasure, well-being in relationships, and fill emptiness and loneliness. Codependency is an illusion of close relationship. In essence, many traits of the "alcoholic personality" are being formed in "alcohol companies". Only here, and nowhere else, the patient begins to feel in his element, to feel the community, welded together by one goal - drinking. It is here that the formation of many concepts, a special worldview, even a whole "code of honor" of an alcoholic patient takes place. When asked to name the traits that they like most in other people, patients with chronic alcoholism, for example, often named such traits as honesty, fairness, and camaraderie. At first glance, the answers given seem to be quite common, but it was necessary for patients to carefully question what they mean by partnership or, conversely, by betrayal, as it turned out that they often associate the circumstances accompanying alcohol consumption with these concepts [11].

About the peculiarities of social identity and communication in a group of co-users, Bratus writes that truly group-centric relations are not formed within the "alcohol company". Since the existence of the "company" is conditioned, sealed in the end by drinking, its ritual, and not in itself by communication and the support of friendly relations. External liveliness and warmth, hugs and kisses (so easily turning into quarrels and violent fights) are essentially just attributes of the same illusory compensatory activity - an imitation rather than a true reality of emotional communication. Over time, these forms of imitation become more and more stereotyped, hackneyed, alcoholic action - more and more curtailed, less and less mediated, its participants - more and more random and easily replaceable. Thus, the author points to the degradation of the personality of a patient with alcoholism as a "decrease" and "flattening" of his personality [11].

So, in the course of the disease, profound changes occur in the personality, in all its main parameters and components. This, in turn, inevitably leads to the emergence and consolidation in the personality structure of certain attitudes, ways of perceiving reality, semantic shifts, cliches that begin to determine everything, including "non-alcoholic" aspects of behavior, generate their specific features for alcoholism, attitudes towards yourself and the world around you. Among such attitudes, the following are encountered: an attitude toward quick satisfaction of needs with little expenditure of effort; setting on passive methods of protection when encountering difficulties; the attitude to avoid responsibility for the acts committed; setting on a small mediation of activity; an attitude to be content with a temporary, not entirely adequate result of the activity [11].

Drug addiction is an irreversible process, and all negative changes that have occurred as a result of use, namely: changes in the inner world, ways of existence and relationships with other people, remain with these people forever [4].

The psychological literature describes the "pre-narcotic" personality of the addict. The determining factor is considered to be an impulsive nature, which is more conducive to the development of addiction. The picture of the disease is similar to impulsive neurosis. However, in order to determine the prerequisites for the formation of addiction, it is important to pay attention to the symbolic meaning of the object of addiction. What a patient gets by using a chemical: the illusion of friendship and intimacy, the illusion of control and calmness, and the like [2].

Drug addiction gives the illusion of confidence and sustained self-esteem, an apparent satisfaction of the need for respect. Studies show that substance dependence develops due to these illusions, and not the pharmacological action of the substance itself. The dependency object is found only by those for whom it is of great importance. Observations show that it is extremely difficult for an addict to withstand stress, pain, any physical and emotional discomfort. Any expectation, uncertainty is experienced as unbearable. Narcissistic traits and passivity are most pronounced. In psychological counseling, one can see significant differences in the personality traits of drug addicts and alcoholics.

The alcoholic is predominantly neurotic. He tolerates loneliness hard, so in the group he tries to join the leader or find like-minded people. The psychologist is a strong parental figure for him. The alcoholic has a high level of guilt, from which he tries to free himself by communicating in a group. He follows the rules, completes assignments, tries to be “good”. In this regard, it becomes difficult to work with feelings of discontent, anger and irritation, since the alcoholic is used to suppressing them. Aggression is a big risk for him.

Due to the non-acceptance of himself, his “I”, his identity, the alcoholic constantly strives to merge with the group, which can be traced in his phrases: he says “we” instead of “I”, often resorts to generalizations or the position “I am like everyone else. . Someone else's experiences evoke strong feelings in him precisely because he “joins” other participants: “I feel how offended you are” or “I feel how you miss”. It is difficult for an alcoholic to separate his own experiences, he is very afraid to present himself in a group.

Violation of personal identity in drug addicts manifests itself in a different way, more often it is more serious violations than in the case of alcohol addiction. The addict is dominated by narcissistic traits. He, unlike an alcoholic, does not tolerate merging, seeks to isolate himself in a group. This shows his fear of losing control, being "consumed". Unlike an alcoholic, a drug addict often enters into confrontation, devalues the psychologist, the participants, and the process itself. One of the difficulties in working for drug addicts is the manifestation of devaluation. This process must be noticed, made conscious and analyzed in a group. The addict does not know how to ask and receive support, since for him this is an admission of his own weakness. In the process of counseling, the addict learns to feel this need - to be supported, heard, to accept compassion. Then there is no need to devalue everything that happens. He lives with a constant fear of humiliation, in a narcissistic fluctuation from a feeling of omnipotence to a feeling of insignificance [10].

Alcohol addiction is a desire for community and fusion, and drug addiction is a desire for independence. The alcoholic ensures his safety through the illusion of closeness, and the drug addict through rejection and denial of his need for intimacy [10].

Zmanovskaya E. V. in the book "Deviantology" describes food addiction: “Another, not so dangerous, but much more common type of addictive behavior is food addiction. Food is the most readily available object of abuse. Systematic overeating or, on the contrary, an obsessive desire to lose weight, pretentious food selectivity, exhausting struggle with "excess weight", fascination with more and more new diets - these and other forms of eating behavior are very common in our time. All this is more the norm than a deviation from it. Nevertheless, the eating style reflects the affective needs and state of mind of a person.

The connection between love and food is widely reflected in the Russian language: “Beloved means sweet”; “To desire someone is to feel a hunger for love”; "To win someone's heart is to win someone's stomach." This connection originates in infantile experiences, when satiety and comfort merged together, and the warm body of the mother during feeding gave a feeling of love”[5, p. 46].

Zmanovskaya E. V. writes that frustration of basic needs at an early age is the main cause of developmental disorders in the child. The cause of food addiction, as well as chemical addiction, lies in the disturbed early relationship between the infant and the mother [12, 13]. For example, when a mother cares primarily about her needs, not noticing the needs of the child. In a state of frustration, the child cannot form a healthy sense of self. “Instead, the child experiences itself simply as an extension of the mother, and not as a full-fledged autonomous being.

Equally important is the emotional state of the mother while feeding the baby. The results of research by R. Spitz convincingly confirmed the fact that regular, but unemotional feeding does not meet the needs of the baby”[13, p. 62]. If the children of the orphanage lived in such conditions for more than six months, then a quarter of them died from digestive disorders, the rest developed with severe mental and physical disabilities. If each child was provided with a nanny, nursing in her arms, with a smile, then the deviations did not arise or disappeared. Thus, feeding a baby is a communicative process.

The reason for food addiction lies in the history of early childhood, when the child lacked love, warmth and a sense of security. These early childhood needs are as important as nutritional needs. That is why being “hungry” without warmth and safety, the child grows up as if with the lost ability to feel fullness in food. He is used to being "hungry." The seizing mechanism is chosen unconsciously in order to cope with affects, to prevent emotional "hunger" (depression, fears, anxiety). Controlling consumption also becomes problematic: a person is either unable to control consumption, as well as his own affects, or spends all his energy and attention on controlling appetite.

Eating disorders are promoted by culture: fashion for physical parameters, and at the same time there is a "cult of consumption" and abundance. As living standards rise, so does the incidence of eating disorders.

The difference between food and chemical addiction is that this type of addiction is not dangerous to society. However, E. V. Zmanovskaya points out: "at the same time, such extreme variants of food addiction as neurotic anorexia (from the Greek" lack of desire to eat ") and neurotic bulimia (from the Greek" wolf hunger ") present extremely serious and insurmountable problems" [5, p..46].

The name "anorexia nervosa" appears at first glance to mean a lack of appetite. But the main mechanism of violation in this case is the desire for thinness and the fear of being overweight. A person sharply restricts himself in food, sometimes completely refuses to eat food. "For example, a girl's daily diet may consist of half an apple, half a yogurt and two pieces of cookies" [5, p. 46]. It can also be accompanied by induction of vomiting, excessive physical activity, the use of appetite suppressants or laxatives. Active weight loss is observed. The addict is focused on the overvalued idea of losing as much weight as possible. The most common cases occur during adolescence. Food addiction leads to disruption in the hormonal sphere, sexual development, which are not always reversible. At the stage of exhaustion, serious neurophysiological disorders occur: inability to concentrate, rapid mental exhaustion.

The most common symptoms that accompany eating disorders are: inability to control one's activity, disturbance of body schema, loss of feeling of hunger and satiety, low self-esteem, narrowing of the range of interests, decrease in social activity, appearance of depression, eating rituals, obsessive thoughts and actions appear, interest in the opposite sex decreases, the desire for achievements and success increases. All these manifestations of impairment are associated with weight loss: when normal weight is restored, these symptoms disappear.

Food addiction is especially closely related to adolescence. This becomes a way to avoid growing up and psychosexual development, while remaining externally and internally as a child. Instead of going through separation from their parents, the teenager directs all of his energy to solving nutritional problems. This enables him to remain in a symbiotic relationship with his family.

Girls with anorexia have very low self-esteem, although objectively they are always “good girls”. They do well in school and try to meet the expectations of their parents. Anorexia nervosa develops as an attempt to separate from parents, not to depend on the opinions and expectations of others. The family where the anorexic personality grows up looks quite prosperous. But there are characteristic features: an excessive orientation towards social success, tension, tenacity, excessive solicitude and overprotection, avoiding conflict resolution [13]. Disturbed behavior can represent a protest against overcontrol in the family.

In bulimia nervosa, weight remains relatively normal. Bulimia manifests itself more often as paroxysmal or persistent overconsumption of food. With bulimia, the feeling of fullness is dulled, a person eats even at night. At the same time, there is weight control, achieved with the help of frequent vomiting or the use of laxatives.

Bulimic individuals usually use interpersonal relationships as a way of self-punishment. The source of the need for punishment may be unconscious aggression directed against parental figures. This rage is shifted to food, which is absorbed and destroyed. People with food addiction generally cannot regulate their relationships in a satisfactory way, so they shift the conflicts in relationships to food [13].

The considered food addictions are difficult to correct. This can be explained by the fact that food is too familiar and accessible object, that the family is actively involved in the origin of this disorder, that the ideal of harmony dominates in society, and finally, that disturbed eating behavior in some cases has the character of a systemic functional disorder.

The association of the studied problems with early experiences and trauma (presumably in the first year of life - for eating disorders, and the first two to three years - for chemical dependence) partly explains the special persistence of addictive behavior. This does not mean that dealing with addiction is not having a positive result. There is a myth that "there are no former drug addicts." In fact, addiction can and should be dealt with, despite the complexity and length of the recovery process. The person himself may well cope with addictive behavior, provided that the addiction is recognized, that he is aware of his personal responsibility for positive change and that he receives the necessary help. Life demonstrates many positive examples of this [1].

The phenomenon of co-dependence. The family plays a key role in shaping and maintaining the addictive behavior of a family member. Codependency is understood as negative changes in the personality and behavior of relatives due to the dependent behavior of one of the family members [6, 11]. The codependent suffers from living with the addict, but unconsciously always provokes the addict to relapse. Living with an addict is hard, but habitual. In these relations, the codependent unconsciously realizes all his needs: the need to control and care for someone, the feeling of being needed by someone, against the background of a “bad” addict, the codependent feels himself to be a “good”, “savior”. That is why codependent people often choose professions where these needs can be met: medicine, sociology, psychology, and others. The problem of codependency is growing according to the principle of a "snowball", we will give a "classic" example. A woman who grew up in an alcoholic family has certain behavioral features. In raising her children, she imparts unhealthy, addictive ways of communication and behavior patterns to them. The son of such a woman becomes a drug addict. The development of the disease begins. As they live together, the disorders increase in both: the son develops dependence more and more, the mother develops codependency more and more. Relatively speaking, the more a mother wants to “save” her son, the more she will unconsciously provoke a breakdown in him. Because, in fact, she is more used to living in a family with an addict. This significantly complicates the work on the first step of the program - awareness and recognition of one's own illness. It is difficult for a mother to admit that she, "wishing well for her son," only makes him worse. But practice shows that the more a codependent relative works, the easier it is for an addict to live in sobriety.

The 12 Steps program allows co-dependent loved ones to build healthy boundaries in the family, learn to take care of themselves, thereby helping the dependent loved one. The program helps to understand what kind of help a chemically addicted person needs, what he really expects from his parents. Thus, a codependent mother has a chance to give her dependent son the very love and warmth that he expects. And then he will not need to look for it in the illusory world of intoxication.

Thus, the problem of addictive behavior expands to a marital disorder. The best way out of a series of problems is psychological assistance to the addict and his codependent relatives.

So, the 12-step program is considered the most effective in dealing with addictive behavior. Let's consider the main steps of the program described in the literature of the world community "Narcotics Anonymous" [1]:

one. We admitted that we are powerless in front of our addiction, admitted that our lives have become uncontrollable [1, p.20].

2. We have come to believe that a Power greater than our own can restore sanity to us.

3. We made a decision to turn our will and our lives over to the care of God as we understood him.

4. We examined ourselves deeply and fearlessly from a moral point of view.

5. We have recognized before God, ourselves and any other person the true nature of our delusions.

6. We are fully prepared for God to deliver us from all these defects of character.

7. We humbly asked Him to deliver us from our shortcomings.

8. We have compiled a list of all those people whom we have harmed, and were filled with the desire to make amends for all of them.

9. We have personally compensated for the damage caused to these people, where possible, except for those cases when it could harm them or someone else.

10. We continued to introspect and, when we made mistakes, immediately admitted it.

11. Through prayer and reflection, we tried to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to do so.

12. Having achieved spiritual awakening as a result of these steps, we tried to carry the message about this to other addicts and apply these principles in all our affairs [1, p.21].

These 12 steps take a long time to complete. The longer the addiction formed, the longer the recovery path. A lifelong journey, since addiction is a disease that does not lead to recovery, but only to remission. Addiction cannot be completely cured; you can learn to live with it. There are three more principles in the program: honesty, open-mindedness and willingness to take action - are necessary for the addict. A very important component of the program is its group format. Narcotics Anonymous members believe that this approach to addiction is advisable, since the help of one addict to another is of incomparable value. The addicts themselves can understand each other better than others, share their valuable experience in coping with the disease, preventing breakdowns, and building close relationships. “The only way not to return to active drug use (substances, relationships) is to avoid the first try. One dose is too much, and a thousand is always not enough”[1, p. 21]. Transferring this rule to codependency, the emphasis is on relationships. A breakdown for a codependent is a withdrawal into control, psychosomatics, suppression of one's feelings and desires, switching one's attention to the life of a partner, leaving into a painful fusion. Psychological work is aimed at relationships with a partner, most often an addict.

Psychological work with addictions is carried out in the format of group and individual consultations for chemically dependent, separately for codependent relatives. There are certain rules and principles of the group. Each meeting is dedicated to a topic set in the literature. The psychologist relies not only on the basic twelve steps, but also on "tradition." And also, conducts analysis and discussion of life situations, discussion and reading of the literature of the community of Narcotics Anonymous [1].

The "12 steps" program was developed for the treatment and psychological work with alcohol addiction. Using the program at work, we came to the conclusion that it is effective at any stage and does not require special changes and adaptation to various types of addictive behavior. By working through each step, analyzing the features of the manifestation of addictive behavior, we come one step closer to recovery.

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