The commonly accepted definition of addiction is being a complex, multifactorial disorder characterized by the loss of voluntary control of the behavior and the recurrence of the seeking and consumption behavior despite the negative consequences. By reiterating these concepts, new approaches are always sought to a really difficult challenge for treatment and prevention.
Recently a crowded webinar organized by Medicine of Addiction (MdD) of the Aoui of Verona (director Fabio Lugoboni) and from CLad, center to fight addiction (which has completed 10 years of activity) has reported research and new approaches on this front. If the expert Gilberto Gerra (Director of Mental Health and Addictions Ausl Parma) traced the fundamental genetic and above all epigenetic-environmental aspects, with reference to the relational ones, starting with the mother-child relationship and the effects of post-partum depression, which lead to addictions, was Stefano Canali of the Sissa of Trieste (neuroscience area) to lead us, on the basis of research, towards new advanced perspectives.
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Narrative therapy – Research conducted by the Sissa laboratory together with the computational linguists ofUniversity of Rome 3 it concerned the quantitative and qualitative analysis of texts, material and interviews, linked to various addictions, from substance abuse to gambling. Interviews and stories of 80 patients from public care centers were linguistically evaluated through software and by analyzing the narrative variables to arrive at real markers of addictions and of the various phases of them and also of recovery.
“Experimental Evidence Towards a Narrative Therapy of Substance Use Disorder and Gambling Disorder” was the explanatory subtitle of the research exhibited. Original approach that draws on narrative theories of the ego and the most recent discoveries in neuroscience. According to this approach, the ego (as it states Daniel Dennet) has a narrative center of gravity: this is what holds it all together. Knowing how to narrate oneself has a lot to do with our integration and with the different and opposing internal forces. The language, therefore, assumes a decisive importance and becomes almost a litmus test of our (or rather of the multiple) Self. Not only that: knowing how to narrate emotions is important; giving words to emotions promotes emotional control.
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Research – This line of addiction research – he stressed Channels – “he has already seen two important publications and we are processing data for others”. On the 80 patients (of two hundred) on which we have worked so far we have analyzed the answers to a semi-structured questionnaire on seven topics for which we were asked to narrate and give answers: definition of addiction, phases of addiction – onset, chronicity, relapse-, desire, loss of control, control strategies, treatment-recovery, possible future relationship with the object of addiction.
Results that emerged: elusiveness of the “condition of dependence”, the subjects are unable to give it a coherent vision, to “narratize” it; importance of automatisms and at the same time believing to be responsible, to make choices (considered right) and therefore not to be “acted out”, thus contradicting the very idea of automatisms. In the case of the players a clear prevalence of negative reinforcements: urgency, frenzy, tension, anxiety. Then there is late awareness of the problem; elusive and confused character of desire, they are unable to articulate the experience of desire; uncertain and weak reference to the role of the environment and of others, total absence of projection into the future. “Projecting oneself into the future is one of those” wise “elements – he says Channels – that is, do not give in to immediate reward (use of substance) “.
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A linguistic analysis – The other analysis carried out, the quantitative one through language, is very significant. It is based on a methodology (LIWC) created in 20 years of research that has shown how much the choice of words, the syntactic constructions, the conjugation of verbs, the adjectives used, are a precise mirror of internal dynamics, a cross-section of emotional and personality traits. So it could be seen in the 7 thematic areas with respect to specific psychological categories and emotional states (I, Self, You, Us, Positive-Negative Emotions, Anxiety, Sadness, Anger, Sociality, Positive-Negative Sensations, Feelings, Inhibitions, Time – past, present and future – Introspection, Causality , Optimism) the differences and differences between types of addicts, between gamblers and addicted to substance use. Gamblers, for example, are the epitome of contradictions: they have more positive feelings and more negative emotions than substance abuse disorder. They have more positive feelings but a much higher recurrence of the term “sadness”.
The missing future – “We explored the categories of time – explains the researcher – observing frequent recurrences of the present, much of the past especially for the players, while the projections into the future are almost nil for both groups “. The aspect of the space / time narrative is very significant.” Canali again underlines – we have already seen a strong deficit of fiction in time and space; they never make precise references to places or times, confusing them, almost an abstract narrative. Similarly in the stories of addiction, the chronological organization makes leaps in the stories, first forward then backward then back again. It lacks consistency. Same problem in the development of the theme, difficulty of the sense of the story, of the general meaning and of the causal links or even between the characters of the story “.
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It has now been seen that the greater the narrative coherence, the greater the self-control, the less impulsiveness. The Sissa team sought a “matrix” (this is the original aspect) linked to the coherence of the narrative, general and partial. The plot concerns agency (the fact of being actors of choices, through action verbs or indications of choices), passivity, causes of action, motivations, the projection of oneself over time. After creating this “matrix” on the basis of categorizations and systematization of texts by volunteers, we moved on to the analysis of the stories of subjects with addictions. Well, in the stories analyzed, it has been seen that narrative coherence is very low when subjects try to define or talk about addiction, confirming the qualitative analysis set out above. The story becomes coherent instead when we talk about the onset and chronic phase, it comes back confused when we talk about relapses, desire, loss of control, while it goes back up addressing the control strategies.
Treatment strategy – The conclusions are an invitation to more research and to try the narrative approach as a complement. “It can be decisive because it is possible to circumvent the problematic nucleus which, in the face of the therapies and tools used up to now, leads to a retraction of the subjects”, he said. underlined Channels. Various researches have shown that the use of narrative tools, reading and writing stories, directly intervenes on the beliefs and the scaffolding that preside over the processes of control, thus impulsivity can be increased or decreased, for example. Therefore improving the linguistic / narrative tools can be a way. And the researcher dictates the possible recipe: “Train the ability to build coherent, timely stories, organized in time and space, where the roles of the various actors and factors involved are distinguished and integrated, centered on the theme, linked to an outcome / solution ; Train the ability to imagine, build and tell stories and in particular stories with projections into the future (aspect as seen very lacking in people with addiction) to increase self-control; Work on the emotional vocabulary, on the ability to name and describe emotional, visceral, motivational states “.
In services, for preventive purposes, it is necessary – research suggests – work to provide a more coherent narrative of the condition of addiction and not only mechanically biomedical: only in this way will the subjects have in mind a much more precise and articulated enemy to fight. Today, as we have seen, they do not even know how to describe it. Finally, the mass media: enhance scientific communication on these conditions and find time, even among operators, to communicate well. In the words of Wittgenstein: “The boundaries of my language are the boundaries of my universe”, or with Lacan and psychotherapies “the word that heals”. On the other hand too Nanni Moretti it reminds us with irony that “words matter”. IS Channels: “The repertoire of symptoms and also the vulnerabilities are also due to the way in which we talk about the psychopathological condition, talking about it better helps!”
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