Abstract
Studies have repeatedly supported the assumption of general practitioners that alcohol and tobacco occur together in psychosocial practice.
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The terms sociotherapy and social therapy are used synonymous in relevant literature. In America, the term “multi-systemic therapy” is also used in certain contexts.
Steingass is the director of a sociotherapeutic home for alcohol dependents in Remscheid.
A finding that has also been documented by Doerner and Plog in their textbook (Doerner and Plog 2002).
In sociology, social processes are examined on three levels: macro-, meso-and micro level. The macro level includes phenomena of the entire society (e.g. social stratification), the micro level includes phenomena of smaller groups (e.g. families) and individuals, where sociology often overlaps with sociopsychology.
“Even if medical care improves disease progression and life expectancy in some acute diseases, the social and economic conditions, which make people ill and in need of care, are by far more important for the health of the total population”. WHO
Emmy E. Werner’s long-term study counts to the fundamental works of resilience research. On the Hawaiian island Kaunai, she observed 698 children, born in 1955, for 40 years. Around 30% (210 children) grew up in poor conditions: birth complications, stress in the family, parental psychopathologies, divorce. Two thirds of these 210 children developed learning and behaviour problems, turned delinquent or/and mentally ill. Yet, despite these adverse conditions, one third of the children turned into competent, confident and caring adults who successfully completed school and coped well with societal norms. By age 40, none of these persons was unemployed or had problems with the law. Divorce rate, mortality and the number of chronic health problems were average when compared with the normal population. Certain personality traits that were already present in childhood turned out to be resilience factors. These were e.g. certain active behavioural patterns already apparent during babyhood, later, a relationship to at least one stable attachment figure, mostly from within the family, the children’s ability to recruit a substitution for parents, integration in groups (e.g. church). A crucial result was also that adult subjects experienced a fundamental improvement in their ability to succeed in life between age 32 and 40. This often manifested in “turning points”, especially where chances came up that they could better take advantage of at this age. Of eminent importance for the effective use of turning points was the successful coping with crises (e.g. recovery from a life-threatening disease or accident). Werner 2006
The questionnaire developed by Petzold and Mueller (PMFR) to assess resilience and protective factors, can be recommended for social work.
In the case of the Kaunai-study cited, only 5% of the group, which showed the strongest resilience, were in psychotherapeutic treatment. They were better educated and rather introverted (Werner 2006)
For information about the application of the salutogenesis approach in addiction research, see Franke et al. 1998.
“The role of the group in therapy with the elderly — concepts for an “integrative intervention”
“The consistency of the social atoms changes when we get older, especially the possibility of replacing lost family members or friends. The social atom changes intermittently when we are young and full of resources. When a single member is gone, another individual can take his place by playing a similar role. A friend is lost and quickly replaced by someone else. This social repair seems to take place almost automatically ... When we get older it is more difficult to replace people we have lost, just like it becomes more difficult for our body to repair itself with increasing age. This describes precisely the phenomena of the “social” death: not in terms of the mind and how we are dying internally, but how we are dying externally ... When we live longer than those we love or hate, a small part of us dies with them, by seeing how the shadow of death strides from one person to the next in our social atom.” (Moreno 1960 [1947], S. 63 f.)
Miller ER, S.Rollnik Miller WR and Rollnick S (2002). A sound description of this method for practical use has been offered by Koerkel, Kruse 1997, chapter 15
There is almost no available therapeutic provision for tobacco withdrawal therapy in regard to inpatient withdrawal or cessation.
The Vinzenz House of the Caritas in Vienna, ALOA and GOA in Upper Austria, Aloisianum in Graz, the alcoholics housing community in Feldkirch, SOALP in Salzburg, the residential home in Schillerstrasse, Berlin, Hans-Scherer House in Munich, Type IV housing community in Vienna.
In most cases, the care institutions for alcohol dependents have developed from housing projects for the homeless, in which the specialisation on the group of alcohol dependents has resulted in higher-threshold therapy offers.
Jean Vanier has founded the international project “Arche”, where handicapped individuals live with non-handicapped individuals in a community.
In a survey, carried out in 2006, asking 1,000 Austrian citizens about the causes and target groups to which they donate money, it was shown that most sums went to children (40%), catastrophies (27%) and the handicapped (17%). Only 1% of donations went to drug and alcohol dependents who therefore represented the end of the “popularity scale”. Source: APA-market research.
The sociological arguments for this thesis can be found in the anomy theories ranging from Durkheim to Merton, see Reinhardt 2005. Here, civilisation’s request for the individual to demonstrate self-control is explored as a theme (Norbert Elias). The failure to demonstrate the required self-control leads to sanctions or compensations, like stigmatising the ill, which relives both the individual and society.
The number of type IV patients receiving continuing treatment is below average. “It seems that therapists are still trying to make work easier by motivating patients, who already show certain amounts of self-motivation, in both motivational and withdrawal therapy”. Oberlaender, Platz, Mengering 1998
Also Rauchfleisch, who argues from a psychoanalytical perspective, has stated that a unilateral motivation concept could be debilitative. He thinks it possible that the patient experiences the therapist’s rejection as a narcissistic insult: “If we want to offer efficient and professional help, then we have to critically analyze the traditional concept of motivation and examine whether the so-called “lack of motivation” really is a characteristic of the client or whether it might represent a problem belonging to the therapist.” (Rauchfleisch 2002)
In the literature, these phenomena are described as “protracting withdrawal syndrome” (Feuerlein, Schuckit) or as phases of degradation (Scholz). (Schuckit et al.1994)
In line with this, the renowned expert for personality disorders, Peter Fiedler, has summed up: “It is quite terrifying how we have adapted to specific schools of therapy and methodological therapy and profession stereotypes. In reality, the attempt to generate solutions and perspectives with individuals who have reached the limit of their possibilities is often hopeless. Dialogue-based psychotherapy, which only takes place in the therapy room, is mere nonsense in many of these extreme cases. The antiquated and possibly completely absurd 45-minute rhythm of a private practice with a “come attitude”, binds the psychotherapist to his armchair in his role as a helper. Especially this approach needs change gradually, when dealing with people, who have come to grief in life!” (Fiedler 1998, S. 399).
As we have seen, the admission to, and payment of, sociotherapy is linked to assessment, thus to the diagnosis of a medical specialist
The embedment of the individual in a social network is described by Jakob Moreno as the „social atom“.
For example the „Ambulant group programme for controlled drinking“, which has been taking place in Nuremberg since 1999. (Koerkel et al. 2001).
A dependent is chronically affected if his chronic consumption of alcohol or other substances has led to acute or gradual physiological and psychological damage (incl. co-morbidity) and above normal or gradual social disintegration, so that he can’t activate any vital resources by himself and doesn’t have enough support from family or other people, which makes him dependent on institutional support ... CMA (almost always, H.H.) have an impaired or no ability at all to structure their day.” (Boettger, quoted by Hesse 2004.)
Nitrosamines, which are released during smoking, are synthesised into formaldehyde and thus have toxic effects additionally to aldehydes, which are synthesised from alcohol.
LIMO means in German: LOBEN, INTERESSE ZEIGEN, MÄNGEL ZUGEBEN, OFFENHEIT, it is translated here as PRAISING; INTEREST; ADMITTING FAULTS AND OPENNESS and could be taken as „PIFO“-Technique
Chronisch mehrfach beeinträchtigte Abhängigkeitskranke (CMA): ‚chronically multiply impaired alcohol dependents’
Experiments with primates have shown that social dominance stops the development of an addiciton. “This suggests that environmental conditions, like social isolation or living in a community, modify the cerebral metabolism and consequently the behaviour.” (Schmidt 2005; Bauer 2006, 2007).
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Wetschka, C. (2011). Sociotherapy of alcohol-and tobacco dependents with regards to Lesch’s typology. In: Alcohol and Tobacco. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0146-9_10
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