During the 1990s, Switzerland was hit by a drug epidemic. Zurich, for example, was one of the biggest drug capitals in Europe.
Since then, the Swiss government has worked hard to alleviate this problem. It now emphasises therapy and treatment, instead of criminalisation.
For example, almost 70% of those that suffer from heroin addiction are undergoing therapy.
Switzerland’s drug policies now include available medical prescriptions for heroin.
Those with a heroin dependency are offered Diacetylmorphine – synthesised heroin that has less unpleasant side effects than methadone.
However, rehab facilities are available, and studies have shown that Swiss rehab facilities are longer and offer more therapy sessions.
Switzerland also has a four-part drugs strategy: prevention, therapy, damage limitation and repression. (1)
This includes proper education for the public about issues relating to substances and information about substance addiction prevention programmes.
Those that are suffering from substance dependency are provided with free therapy.
Medical and private facilities are provided to those with substance dependencies.
The prohibition of illegal substances.
Currently, as statistics by the Swiss Federal Office of Public Health show, in Switzerland, 3% of people use cocaine, 27.7% cannabis, and 0.8% heroin. (2)
The article will discuss drug and alcohol rehab in Switzerland.
The admission process for drugs and alcohol rehab in Switzerland are like most international rehabilitation facilities.
It is recommended that individuals research for a facility that is to their suiting and contact that facility.
Individuals will then undergo a pre-medical and psychological assessment. This will help determine the duration of the stay and which treatment is best suited.
A start date will then be organised, and individuals will be advised on what to pack for their stay. (3)
There are two different types of addiction: physical and psychological. Both interact and can influence each other.
Physical addiction refers to a psychological dependency upon a substance. After a prolonged intake of a substance, bodies will become dependant upon that substance to function correctly.
Without the substance, people will begin to experience psychological withdrawal. This can range from shakes and headaches to vomiting.
Psychological addiction is a mental preoccupation with a substance and often influences a person’s behaviour. This can be to achieve a desired emotional or mental state or to deal with a mental health issue, such as anxiety. (4)
The first step to overcoming an addiction is detox. This refers to the process of the body expelling toxins and substances that are harmful.
This process can vary depending upon the substance but will often lead to withdrawal symptoms.
Alcohol Withdrawal Syndrome (AWS), for example, is often experienced by those with an alcohol dependency; this can be either mild or severe.
Detoxing from Alcohol can lead to symptoms such as depression, anxiety, vomiting and nausea. More severe symptoms include seizures and abnormal breathing.
When detoxing from alcohol, withdrawal symptoms tend to be experienced within 6-16 hours from the last consumption. Withdrawal symptoms should begin to abate after 24 hours but sometimes symptoms will persist for up to five days.
It is possible to treat mild symptoms at home – if there is medical supervision – or through an outpatient programme. Medical care, however, is necessary when a person experiences more severe withdrawal symptoms. (5)
Detoxing from heroin is a slightly different process. This is due to heroin being highly addictive and there being, potentially, more serious physiological and psychological consequences from detox.
Withdrawal will usually begin within 4-6 hours after the final dose. Again, these symptoms can be mild or severe, ranging from nausea to hyperthermia. These symptoms can last between 5-7 days.
There are, however, serval elements that can influence which withdrawal symptoms a person will experience: how much of the substance is consumed, the method of consumption and the period that a person has been using the substance. (6)
Like both heroin and alcohol, cocaine varies in its withdrawal symptoms. Again, this can range from mild to severe. Symptoms include nausea, vomiting, sweats, restlessness, and fever.
Detox will occur between 8-12 hours from the last dose but should subside after 5-7 days.
When entering rehab, it is most common for those suffering from alcohol or cocaine dependency to first undergo a detox. Individuals will be provided with assistance by medical professionals.
Patients are then moved to an inpatient setting – this means staying in the facility for a period – where they will receive daily therapy and counselling. This can include psychoanalysis, Cognitive Behavioural Therapy, and group therapy.
Once completing the inpatient portion of their rehab, patients will be moved to an outpatient care programme. This means leaving the facility but continuing to receive medical and psychological support.
There are two common outpatient programmes in Switzerland: Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP).
PHP involves the patient attending a facility up to five days a week but returning home in the evenings. IOP involves attending a facility several times a week for several hours per visit.
Once completing the outpatient care programme, patients will receive aftercare. This includes continued therapy and counselling and helps to obtain and maintain important social and life skills. (7)
Switzerland, unlike other European countries, offers a wide range of support for heroin dependency.
Heroin Assisted Treatment (HAT) is available. This involves the administration of diacetylmorphine – this is a regulated and controlled amount given by a medical professional.
People that undergo HAT treatment will also receive psychological care, such as therapy and counselling. (8)
However, individuals suffering from heroin dependency can still opt for traditional rehab.
Like alcohol and cocaine treatment, heroin rehabilitation follows a similar process: detox, inpatient care, outpatient care and aftercare.
Some facilities offer methadone treatment and medication to help with the detox and withdrawal process.
However, some offer a natural withdrawal process that focuses on nutrition. (9)
When a person suffers from a mental health issue and suffers from a substance dependency, it is known as dual diagnosis.
It is common for both to influence each other, or for one to lead to another.
In many cases, substances are used to help cope and overcome mental health issues.
Studies have shown that people suffering from depression or anxiety will sometimes use substances such as cannabis, cocaine, and alcohol as a coping mechanism.
This can, potentially, if used consistently, lead to a substance dependency.
However, studies have also shown that when a person consumes a substance, they are at risk of experiencing mental health issues. Substances such as cocaine have been linked to anxiety and paranoia, which can lead to personality disorders.
Similarly, both alcohol and heroin have been found to lead to depression and anxiety.
Mental disorders and substance abuse can lead to a vicious cycle. Therefore, it is common that both will be treated simultaneously. (10)
In Switzerland, the duration that a person will spend in rehab is dependent upon the substance and the necessary treatment. It can also vary depending upon the facility.
However, most commonly, inpatient rehabilitation lasts between several months up to one year.
Rehabilitation can take a lot longer, though, and based on the needs of the individual.
Outpatient programmes can last for several years, and therapy can sometimes be a life-long process.
Whether a person is an inpatient or outpatient, an important part of the rehabilitation process is therapy. This is offered in Switzerland by rehab facilities and through medical professionals.
Most commonly, this is centred around psychoanalysis, talk therapy and group therapy. However, therapy is often based on a person’s need and medical professionals will advise on the best option.
Generally, though, therapy is used to confront the reasons why a person has become substance dependent. It might explore previous trauma, coping mechanisms and relationships.
CBT, as the name suggests, is based on cognition and behaviour.
The premise of CBT is that a person can positively reframe their thought processes. This, in turn, can lead to positive behaviour changes. In a cycle, the positive behaviour changes lead to positive thinking.
Studies have shown that CBT is an effective tool in maintaining sobriety, as it helps a person overcome temptations associated with negative thoughts and behaviours. (11)
DBT is like CBT but focuses on moods, traumatic past experiences and is often a more long-term therapy. People that undergo DBT will be introduced to various coping strategies, such as cognitive reappraisal and emotional regulation. (12)
Contingency Management is a behaviour-based therapy that centres around a reward system. People will be rewarded for positive behaviour changes. This can include praise, small gifts or even money.
When a person engages in negative behaviour, these rewards are withheld. (13)
A common therapy to help with addiction is group therapy. Rehabs and organisations, such as Alcoholics Anonymous and Narcotics Anonymous, will often create environments where people suffering from addiction can meet and discuss their issues amongst like-minded individuals.
Studies have shown that group therapy is particularly effective in overcoming addiction and maintaining sobriety. The reason for this is that it encourages accountability, alleviates feelings of isolation and provides important support networks.
Many facilities in Switzerland will offer a 12-step approach to rehabilitation. Originally created by Alcoholics Anonymous, the 12-step programme encourages overcoming addiction and maintaining sobriety by submitting addiction to a higher power. It focuses on accountability and facing the consequences of addiction. (14)
The higher power can vary from person to person. It can be religious, spiritual, a connection with life or self-discipline. When starting a 12-step programme, people are encouraged to choose a higher power.
The 12-steps are as follows:
1. Stating that you have no control over your addiction
2. Higher power can help overcome addiction
3. Allowing the higher power to take control over your addiction
4. Creating a moral ethos
5. Taking accountability – to yourself and the higher power
6. Correcting characteristic flaws through the higher power
7. Seeking help from the higher power to overcome these flaws
8. Listing and then making amends for previous wrongdoings
9. Making amends with those you have hurt
10. Continued reflection and willingness to end wrongdoings
11. Continuing connection with a higher power
12. Sharing the 12-steps with people that need them
Rehab facilities in Switzerland will offer a relapse prevention programme.
What this means, it that when a person completes their rehabilitation, they will work alongside medical professionals to develop tools that will prevent a relapse.
This can include discussing what might lead to a relapse, such as negative thoughts and behaviours, what triggers are there in social environments, how to deal with stress or relationship problems, and the avoidance of old social circles and locations.
Further to this, people will be offered continued therapy and counselling that specialises in life skills and behaviour management.
In Switzerland, after leaving rehab, people will be offered an aftercare programme.
For example, Narconon, a facility based in Steinen, offers a life skills course that helps integrate ex-substance dependents back into society.
It also offers an Ups and Downs life course which teaches people to identify social and antisocial personality characteristics. In doing so, it helps the person to develop healthy relationships. (17)
Other facilities in Switzerland offer continued one-on-one and group therapy and counselling that focuses on life skills.
Both Alcoholics Anonymous and Narcotics Anonymous are available in Switzerland.
AA and NA offer fellowship programmes that provide a group setting. Both offer support and a chance to discuss issues of mental health, addiction, life after rehab and coping in society. (18)
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(4) Johnson, B., 2003. Psychological Addiction, Physical Addiction, Addictive Character, and Addictive Personality Disorder: A Nosology of Addictive Di. Canadian Journal of psychoanalysis, 11(1), pp.135-160.
(6) Wallace, B.C., 1987. Cocaine dependence treatment on an inpatient detoxification unit. Journal of Substance Abuse Treatment, 4(2), pp.85-92.