At the end of the 19th century the rule of abstinence was introduced i
nto the treatment of alcoholism. Eversince the issue of motivation has
been at the centre of modern treatment of addiction. At any time of t
he process of change the conflict arises wether to maintain or give up
addictive behaviour. This basic problem has been reformulated again a
nd again during the last 50 years. Attention was focused on the centra
l idea that this process of change arises out of the development of ad
diction. At the same time the complexity and intrapsychic dynamic of t
he coping process have been described with ever more sophistication. I
nitially the concept of phases in the development of addiction was for
mulated. According to the underlying model of illness, the addiction g
ets worse and worse until a low is reached. This led to the therapeuti
c metaphor of rock bottom according to which the various negative cons
equences of the critical confrontational process lead to a gradual ove
rcoming of the addiction. The model of coping formulated later stresse
s the powers of self-change within a maturation process. These powers
turn against an addictive process which at midlife comes up against li
mits. This led to the therapeutically useful metaphor of a revolving d
oor which emphasizes the importance of specific coping processes in di
fferent stages of change. In modern psychotherapy a motivational model
of the intrapsychic dynamics of the process of change was developed.
The opposing motivations towards maintaining the addiction or overcomi
ng it through self-imposed abstinence reflect the ambiguity towards ch
ange as the core issue of the problem of motivation. The metaphor of a
balance was created showing the pros and cons of either side of the c
onflict.