[Addiction and brief-systemic therapy: working with compulsion].

Area of Science:

• Psychiatry and Behavioral Sciences
• Public Health
• Systemic Therapy

Context:

• Public hospitals frequently encounter patients with addictive disorders who are unwilling or unable to consent to treatment.
• French law permits psychiatric treatment without consent for mental illness but not always for addiction, creating legal and ethical challenges.
• Patients are often referred by third parties (family, GPs) or seek help "for others," complicating the therapeutic alliance.

Purpose:

• To explore how therapists can navigate the paradox of treating unmotivated patients with addictive disorders.
• To demonstrate how external compulsion can be transformed into a motivating factor for behavioral change using brief systemic therapy.
• To outline a five-point assessment framework for clarifying patient requests and objectives in addiction treatment.

Summary:

• Brief systemic therapy addresses the challenge of treating patients with addictive disorders who are not self-motivated by focusing on interactions and defined objectives.
• A five-point assessment helps clarify the patient's role in seeking treatment, redefine objectives, concretely define the problem, identify failed solutions, and consider patient values.
• The approach aims to help patients become active agents of change, even when the initial request for treatment is externally imposed.

Impact:

• Offers a pragmatic approach to addiction therapy, facilitating earlier intervention and potentially improving treatment outcomes.
• Empowers therapists to manage the dual role of helper and agent of coercion, fostering a more effective therapeutic relationship.
• Highlights the importance of identifying and utilizing the patient's underlying motivations, even when stemming from external pressure, to drive behavioral change.