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The Risks of Nocebo Effect in Addiction Treatment

The power of suggestion is important when treating addiction.In the medical community the use of the placebo is a standard procedure used to measure the effects of drugs during group experimentation. The determination of the actual effect of the drug is measured against the effects upon those patients who are, in fact, not taking the drug. But, often those taking the placebo experience specific effects related to the drug. This argues that the power of suggestion – the belief that they are being exposed to the medication – induces the mind into a behavioural pattern that convinces the body that the medication has, in fact, been introduced. A related phenomenon is the “nocebo” effect. When one group of patients is told of potential side effects of a drug and another is not, the first group will experience those side effects at a much higher level than the latter group. Again, this suggests that the power of suggestion – the power of words – is formidable. In the medical community these studies have led to the consideration of new approaches to doctor/ patient communication. Doctors are being asked to be more attune to the language they employ when communicating with their patients. They are being asked to recognise that the specific language they use, and even the tone and manner in which they present their findings can have unsought effects upon their patients and their recovery.

These findings have a direct bearing on the treatment of recovering alcoholics and drug addicts. The use of proper cognitive behavioural therapy must take into account the way in which the therapy is communicated. The vulnerability of those in addiction recovery leaves him or her susceptible to the power of suggestion.  In all likelihood they are getting “advice” from a number of sources (family and friends) that, while given in good faith, could have detrimental consequences. Well-intentioned parents and spouses can inadvertently curtail the emotional recovery of their loved one’s addictive behaviour with such seemingly benign comments like: “It’s going to be hard, really really hard, but you can do it”. While the encouragement contained in the latter half of such a comment (“you can do it”) is a positive reinforcement affirming the “strength “ of the individual, the first part – the part that he or she is primarily exposed to – can negate much of the “positive” intentions. This is not to say that the recovery is going to be “easy”, and there are great risks in “lying” to those in recovery since the establishment of “trust” is imperative. But the means by which “honest” proclamations regarding the recovery procedure are presented is of paramount importance. This is where rehabilitation centres and the therapies that they employ become so essential to the recovering addict.

As in the medical community, rehabilitation therapists are well schooled in the particulars of “communication”. Behavioural therapy that speaks to the specific difficulties faced by the addict utilizes a dialogue-based program that understands the complexity of language and the importance of the well-chosen “word”. At Sobriety Home Foundation, the particular emphasis is placed on this procedural communication. Those employed at Sobriety Home are trained to use the power of their words appropriately. Honesty breeds strong relationships and, for those in recovery from drug or alcohol addiction, these first relationships with those participating in their recovery are essential. The difficulties that the addict will be encountering are talked about and analysed in ways that maintain that honesty without the use of language that could potentially lead to the above described “nocebo” effect that has now been recognised throughout the medical community. Recovering addicts are often battling pessimistic outlooks and negative language can often heighten that pessimism and produce dangerous behavioural traits in the addict. This common vulnerability, especially in the early stages of addiction recovery treatment, needs to be constantly addressed in ways that reduce the potential for negative emotional responses. The means of communication plays a huge part in the progress the addict will make in recovery and addiction counsellors need to always be cognisant of the “power” of the word.

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