Addiction

I. Definition
• The use of alcoholic drinks or other substances.
• Inability to stop or reduce the amount used despite the desire to quit or
reduce usage.
• The presence of physical symptoms of excessive use in medical tests
(e.g., liver function).
• Denial of addiction despite physical and psychological harm from use.
• Continued use of drugs or alcohol despite knowing the social,
physical, psychological, or legal problems they cause.
• The need to increase the amount of substance to achieve the desired
effect.
• Withdrawal symptoms when abstaining.
• Inability to engage in social and occupational activities without using.
• Continued use despite developing a physical illness caused by it.
II. Treatment:
1. Long term goals:
• Acknowledgment of addiction and willingness to participate in a special
program for addicts.
• Commitment to continuous abstinence from substance use, leading to an
improved quality of life

2. .Short-term goals
• Willingness to engage with the therapist and comply with treatment rules.
• Identifying the negative effects of addiction on various aspects of life
(family, work…).
• Using the “I” statement: e.g., “I’m an addict,” accepting that.
• Encouraging discussion about his addiction and the reasons behind it and
desire for recovery.
• Recognizing the positive effects of quitting addiction.
• Identifying relapse triggers and working on them through therapeutic tools.
• Recognizing basic changes that he needs to make in his life to maintain
awareness and abstinence.
• Identifying sources of support to help him abstain in the present moment.
• Recognizing the need for stability, safety, and recovery.
• Raising self-awareness of reasons and factors that led to addiction (via
functional analysis and self-assessment scales).
• Help the addict gain insight into life changes needed to sustain long-term
recovery.
• Assign the addict to write a personal plan for post-treatment life, including
actions and goals.
• Explore available sources of positive support for abstaining and reinforce a
positive self-image.
• Encourage them to make constructive life adjustments.
• Ask them to prepare a list of positive recovery effects on life and promote
social engagement, especially helping other youth at risk. (e.g., joining
groups, writing plays, role-playing, etc.)
 Alcohol Use Disorder
Rami, a 32-year-old man, was referred to psychotherapy by his general practitioner
following recurring complaints of insomnia, digestive issues, and increased alcohol
consumption. He arrived at his first session neatly dressed, speaking with confidence
and using humor to deflect.
At the beginning of the sessions, Rami believed that the therapist did not care about
what he said and was indifferent to him)
In One session he said, “I guess my doctor thinks I need to talk about my feelings or
something,” he said with a smirk. “But I’m not the type to cry over stuff. I work, I’m
functional.”
When asked about his family, Rami gave brief, rehearsed answers. “We were a
normal family. My dad was strict, but that was just how things were back then. My
mom? Always tired. Typical house stuff.
He described himself as the “quiet one” growing up, always trying to keep peace
between his two brothers, one of whom he hasn’t spoken to in years. He brushed off
the estrangement: “Families fight—it’s not a big deal.”
As sessions progressed, Rami occasionally mentioned vague memories of his father
drinking in the evenings, often yelling or slamming doors. “He wasn’t violent or
anything, just intense.” Later, when recalling being yelled at for wetting the bed as
a child, Rami laughed (reaction formation by laughing, he hides feelings of shame
or hurt nervously: “I must’ve been annoying crying over nothing.”
He then quickly changed the topic, saying, “Anyway, it’s not like that stuff matters
now.”
Rami’s emotional responses appeared flat, often masked by sarcasm or jokes. When
asked about his drinking, he minimized it: “I only drink to relax. Who doesn’t?”
Yet over time, he admitted to blacking out “once or twice a month” and missing work
occasionally due to hangovers. Still, he insisted, “I’m not like those guys who ruin
their lives—I’m in control.”
He described his father as “disciplined and tough, the kind of man people respected,”
and his mother as “quiet, too sensitive—always hiding in the kitchen when things
got loud.”
Despite his dismissive tone, Rami seemed to mimic his father’s stoicism and
struggled to speak about his own emotional needs. “You either handle life or you
don’t,” he said. “Crying doesn’t fix anything.”
When faced with any stressful situation, he tends to withdraw and isolate himself.
He sits in his room and drinks excessively.
When discussing romantic relationships: He described himself as “independent” and
said he wasn’t interested in drama or “needy people.”
He missed a scheduled session immediately after talking about romantic
relationship.
When asked about intimacy, he appeared uncomfortable: “It’s complicated. I don’t
hate it—it’s just messy. People get clingy.” He added, “It’s easier to keep things
casual.”
When exploring stressors, Rami often spoke in detached language. However, in
moments of emotional intensity, he would curl his fists tightly or shift in his chair.
After describing a recent panic episode following an argument with his boss, he
chuckled, “Probably just low blood sugar or something,” and dismissed the topic.
He spoke proudly of his volunteer work with an animal shelter, calling it “the only
thing that makes me feel like a decent human being.” He described animals as
“easy—they don’t ask questions, they don’t leave.”
in one session, after expressing frustration and sadness about his brother’s rejection,
Rami grew quiet, then said in a low voice, “I guess I wasn’t enough.”
When he noticed the therapist’s expression, he straightened his back, laughed
abruptly, and added, “Forget I said that. I’m just tired. It’s been a long week.”