[Addictions: Motivated or forced care]

Abstract

Patients presenting with addictions are often obliged to consult. This constraint can be explicit (partner, children, parents, doctor, police, justice) or can be implicit (for their children, for their families, or for their health). Thus, beyond the fact that the caregiver faces the paradox of caring for subjects who do not ask treatment, he faces as well a double bind considered to be supporter of the social order or helper of patients. The transtheoretical model of change is complex showing us that it was neither fixed in time, nor perpetual for a given individual. This model includes ambivalence, resistance and even relapse, but it still considers constraint as a brake than an effective tool. Therapist must have adequate communication tools to enable everyone (forced or not) understand that involvement in care will enable him/her to regain his free will, even though it took to go through coercion. We propose in this article to detail the first steps with the patient presenting with addiction looking for constraint (implicit or explicit), how to work with constraint, avoid making resistances ourselves and make of constraint a powerful motivator for change.