Learning the Language of Abstinence in Addiction Treatment: Some Similarities between Relapse–Prevention with Disulfiram, Naltrexone, and Other Pharmacological Antagonists and Intensive “Immersion” Methods of Foreign Language Teaching

Abstract

Relapse-prevention (RP) is an educational process. Learning to abstain from alcohol or opiates after years of dependence involves selectively suppressing old, maladaptive habits of thought and behavior and establishing new, adaptive ones. This process resembles foreign language (FL) learning. Effective FL teaching techniques are relevant to RP. "Immersion," the most effective FL teaching method, discourages students from using their first language ab initio, requiring them to use the FL instead, however inexpertly. It resembles exposure and response-prevention for phobic or compulsive disorders. Supervised disulfiram aids RP by discouraging alcoholics from responding to real-life drinking cues in the "language" of excessive drinking, requiring them, ab initio, to practice new, alcohol-free responses. Supervised or depot naltrexone acts similarly in opiate dependence. We discuss the concept of antagonist-assisted abstinence.

Implantes de naltrexona: un avance terapéutico, tanto comportamental como farmacológico

“…As we have pointed out before, learning to abstain successfully is very similar in principle to learning to speak a foreign language fluently (Brewer 1988, Brewer & Streel, 2003. It is not enough simply to know the foreign words, or the social and psychological techniques for resisting temptation.…”

“…Muchos pacientes que tienen implantes de ciclo relativamente corto de primera generación eligen continuar con ellos hasta verse libres de opiáceos durante el tiempo suficiente para haber consolidado los hábitos de un rehabilitado (Foster et al 2003;Brewer & Streel, 2003). Sin embargo, muchos adictos conocen perfectamente las trampas mentales que se ponen a sí mismos y las formas por las que se convencen de que, al haber estado libres de opiáceos durante dos o tres meses, quizá ya no necesiten el apoyo de la naltrexona.…”

“…Como hemos señalado antes, aprender a abstenerse de consumir es, en principio, muy similar a aprender a hablar una lengua extranjera con fluidez (Brewer 1988, Brewer & Streel, 2003. No es suficiente conocer las palabras extranjeras o las técnicas sociales y psicológi-cas para resistir la tentación.…”

“…Many patients who have the relatively short-acting first generation implants choose to have further implants until they have remained opiate-free for long enough for new opiate-free habits to become consolidated (Foster et al 2003;Brewer & Streel, 2003). However, many addicts also have good insight into the "mind games" that they play with themselves and the ways in which they manage to persuade themselves that having been opiate-free for two or three months, perhaps they do not really need the support of naltrexone.…”

El disulfiram supervisado es más eficaz en alcoholismo que la naltrexona o el acamprosato e incluso la psicoterapia: cómo funciona y por qué es importante

“…This process has been compared to the rapid learning of a foreign language when circumstances deprive you of people who speak your usual one -a situation which any good language school will happily create for you in an 'immersion' course. (Brewer and Streel 2003) Clearly, like all effective alcoholism interventions, SDT needs to be continued for long enough for old, unhelpful habits to have a chance of giving way to new and better ones. This can take anything from a few months to a few years in the case of recurrent treatment failures but some programmes incorporate SDT for long periods as part of a comprehensive outpatient rehabilitation programme on the 'Community Reinforcement' model.…”