THE DEVELOPMENT OF ADDICTION AND THE DYNA MICS OF MOTIVATION

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.