HYPNOSIS WITH SUBSTANCE ABUSERS

By Judith B. Strauss and Clorinda G. Margolis 

Hypnosis has been used to help patients reduce or eliminate drug abuse, including abuse of tobacco, alcohol, barbiturates, opiates, amphetamines, and cannabis. Successful hypnotic treatment of smoking cases has been documented most carefully, and by and large, tobacco smoking represents the least difficult substance disorder problem to treat. The case we are presenting is a smoking case. 
Hypnotic intervention with alcohol and drug abusers will be discussed in the last section of this article, where treatment of nicotine addiction as a paradigm case of substance abuse must be questioned. Although more attention has been paid to hypnotherapy for smoking, the overall results are equivocal. 

HYPNOSIS AND TOBACCO DEPENDENCE 

Much more attention has been paid to hypnotherapy for smoking than for other addictive substances. Holroyd (1980) reviewed 17 studies conducted from 1970-1979 and evaluated them in terms of long-term abstinence, a measure of the effectiveness of the treatment. It seems apparent from that review that hypnosis for smoking is most effective when there are several hours of treatment, interpersonal interaction, personalized suggestions that trade on patients' motivations, and where there is additional counseling or contact. She concludes that when these conditions are met, 55% to more than 66% of smokers remain abstinent for at least 6 months. Long-term abstinence results are impressive in a study that used a group treatment modality but emphasized individual patient involvement (Kline, 1970). Sixty patients were asked not to smoke for 24 hours prior to treatment and then participated in a 12-hour marathon session in groups of 10 each. Every participant was individually hypnotized until eventually the entire group was in trance. They were made aware of feelings associated with smoking deprivation and alternately had periods of deep relaxation induced. At a l-year follow-up, 88% of the patients had not resumed smoking. Herbert and David Spiegel (1978) are well known for their short-term treatment strategies in using hypnosis for cigarette smoking. Initially, a brief clinical history is taken, which includes the number of years smoking, the average number of cigarettes smoked, who else in the household smokes, any successful cessation in the past, physical symptoms if any, and the events leading to the decision to look for help at this time. The patient is taught an exercise that must be repeated a minimum of 10 times a day. The exercise is composed of a self-hypnosis procedure and what the authors call the critical points. 

1. For your body, not for you, for your body, smoking is a poison.
2. You need your body to live. 
3. You owe your body this respect and protection. 

TREATMENT PLAN FOR SMOKING DEPENDENCE 

This case is typical of the successful cases that we see for hypnosis. It is interesting to note that our treatment plan consists of measures that Holroyd (1980), in her analysis and evaluation, stated were most effective in producing abstinence. Several hours of treatment, interpersonal interaction, individualized suggestions, and additional counseling suggest positive therapeutic outcomes. 
Our first session is a detailed initial interview rather than simply a brief smoking history. This is important in terms of maximizing the individual life experiences of the patient and determining whether this is the right time to stop smoking. For example, when someone is about to take comprehensive or professional examinations or is initiating divorce proceedings would probably not be the best time to begin treatment. We encourage the patient to prove to us that he or she is ready to stop. In fact, the patient must convince us that this is the right time. At this first session, behavioral techniques are suggested that will be used the 1st week. As many smoking rituals as possible should be changed - smoking with coffee, after meals, with alcohol, in the car, at the desk, and so on. The patient should immediately switch to a less favored brand of cigarette. 

The second session is the key session - a double session in which the patient will be hypnotized several times and not smoke again. The third session is basically a follow-up and reinforcement session. There is an additional session in 1 month and also 6 months later. 

CASE STUDY 

First Session: Initial Interview
The patient, Mr. B, a 50 year old white male, was referred by his family physician, who had been encouraging him to stop smoking because of a chronic sinus condition. Mr. B had two grown children who lived away from home, and with whom he maintained a close relationship. Mr. B had been adopted 1 month after birth, and for the first 5 years of his life he had been frequently hospitalized because of allergy and sinus problems. Because of this condition, his family moved to Arizona. As a young man, Mr. B began his career with a major corporation that required him to move about the country. His father, who lived in Florida, had been a heavy smoker, but because of health reasons, had not smoked for the past 10 years. His mother had never smoked. Mr. B began smoking as a teenager behind his parents' back and was smoking two packs a day at the time of the initial interview. 
He considered his job very demanding and stressful but identified no major or unusual problems. He stated that he drank a lot of coffee at work, about an average of 15 cups, always accompanied by cigarettes. As many of his colleagues had stopped smoking, Mr. B was embarrassed by his smoking behavior and uneasy about smoking in meetings. When he traveled, he no longer sat in the smoking section. He normally had a martini for lunch and drank a few beers at home in the evening. He had not had much exercise in the past 3 years, and though he used to jog, he stopped because he became short of breath so quickly. 
He stopped smoking about 15 years ago for about 2 years, but started again at a cocktail party. His wife of 27 years was a moderate smoker who had no plans to stop. 
There were marital problems several years ago based primarily around their frequent moves. The couple had brief marital counseling, which improved their relationship. 
Mr. B was concerned about going to the best hypnosis practitioner -the best providing the most effective treatment. He was worried that he might not be hypnotizable. Additional historical material was gathered around his childhood, and some happy experiences were elicited. Careful questioning revealed no overt psychopathology; he appeared to be a well functioning man in control of and generally pleased with his life. At the end of the session, he agreed to change many smoking habits. For example, he was to switch to a mentholated brand, not smoke when he drank coffee or with his lunchtime martini or evening beers, not smoke when he spoke on the telephone, and give up the after-meal cigarette. The patient was not instructed to cut down on his smoking behavior, but to change it.