30 years ago, alcoholics and other addicts could only be treated in hospital. Then the late Eduard Löhnert founded the Client-Centered Problem Advice Center (KPB) in Dachau. Dr. Felicitas Dahlmann and Birgit Hey show how important the facility is.
30 years ago, alcohol and drug addicts only had the option of receiving inpatient treatment, which meant being out of their familiar surroundings for months. Then the late Eduard Löhnert founded the Client-Centered Problem Advice (KPB). In the interview, the medical director Dr. Felicitas Dahlmann and head of administration Birgit Hey, how important the outpatient offer of the KPB is, why alcoholics can often no longer decide for themselves whether they drink and what mistakes relatives often make.
Let's go back 30 years. What options for rehabilitation did addicts have before the KPB was founded?
Birgit Hey: The only option that existed was to be treated in hospital. Back then, that meant being out of your environment for at least six months. Away from work, away from the family, from everything.
If you are away for six months, you have to talk about where you are. Was that why, compared to today, was the inhibition threshold of many affected people too high to take this step?
Dr. Felicitas Dahlmann: Definitely. And many patients lost their jobs. Or even her apartment.
Was it because outsiders condemned the patients or because they had to do without an employee for so long?
Dahlmann: Certainly both. In the past, there was also a completely different understanding of disease. People thought that this was a character weakness. It was not seen as a disease that can largely affect you completely through no fault of your own.
What does the truth look like?
Hey: Everyone can be affected, just like everyone can break a leg. No matter whether you are a man or a woman, very young or already relatively old. This runs through all social classes. Often there is no one specific trigger for addiction.
Dahlmann: People with alcohol are people like you and me.
Do negative prejudices still exist today?
Dahlmann: The education is now better. But these old pictures are still in the mind. Even in the minds of the patients. They then say things like: "I'm not an alki!" Because the picture they associate with an alcoholic is still often the homeless under the bridge.
Has the situation in working life improved?
Hey: The companies take their duty of care very seriously. They installed things to accompany patients or make treatments possible.
Dahlmann: The big companies often have their own addiction advice and a so-called five-point system, so that it does not go straight to the warning, but rather to advise the employee.
Many people drink alcohol regularly. What is normal and when do you realize that you are alcoholic?
Dahlmann: It is a very gradual process. At the very beginning you generally decide to drink something alcoholic. Then it becomes a habit and at some point the alcohol takes over. You don't really notice: When does the dependency begin and when can I actually no longer do without it? There are special criteria that show when normal alcohol consumption turns into an illness.
What do these criteria look like?
The person concerned has to drink regularly, but that is not enough. The amount has to increase over time because the body gets used to the alcohol and tolerates larger and larger amounts. Another criterion is when people can no longer stop - the loss of control. The feeling is missing: "Now I have enough." Add to that the addictive pressure. This means if you have a strong, compulsive craving for alcohol in certain situations or times of day. Another indicator is the withdrawal symptoms such as tremors, sweating or the like. Alcohol often takes on certain functions, e.g. you drink to be able to switch off better or to endure marital problems. Another factor is when everyday life, work or other interests are neglected in favor of alcohol consumption. Or there is already health damage and people continue to drink.
And if these criteria apply, are you alcoholic?
Dahlmann: If three or more of the six criteria apply at the same time, one speaks of alcohol addiction.
Can a person who is addicted to alcohol consciously decide whether he drinks or not?
Hey: I often hear that people still think: Then he just shouldn't drink anything. Or: He only needs to leave the third beer. However, people often do not understand that those affected simply cannot do it, that this is an illness. It is interpreted as a lack of willpower, as a weakness of character.
Dahlmann: If a dependency has been reached, the person concerned no longer really has it in hand. Because there are changes in the brain, the so-called addiction memory develops.
So is it true that a sip of beer can make you relapse?
Dahlmann: Yes, even if that doesn't happen suddenly. That's why abstinence is so important. Also avoiding alcohol in food. Even the smallest stimuli can trigger the addiction memory, so that one slowly falls back into old behavior patterns.
What helps those affected?
Dahlmann: If you are looking for professional help. And if you contact your family doctor that they do not trivialize the problem, but refer the patient to the appropriate places.
What can relatives and friends do for alcoholics?
Dahlmann: Address the person concerned. Don't hide the topic. Motivate for therapy, do not apologize for the behavior, do not trivialize. And if possible, remove the alcohol from the household.
Hey: But first, the patient has to recognize that he has a problem and that he is sick. Making an appointment as a relative - that doesn't work.
Many relatives are overwhelmed and slide into a co-dependency. What does it look like and what is the danger in it?
Dahlmann: That you lose yourself in your partner's illness and slip into depression yourself. However, there is also a risk that the partner's addiction can be maintained through his own behavior. For example, if I excuse my husband with excuses or trivialize the illness like "He only drinks a beer". But controlling is also poison for the relationship because it leads to a power struggle. You are no longer a partner, but a controller.
Why don't those affected manage to stop alone, but must seek help?
Dahlmann: Because you can no longer control the situation yourself. If you could do it yourself, it would be a matter of will again - not a disease. Then you could simply say: "Now pull yourself together and give yourself a kick in the butt!" You need professional help that can help you with the treatment of addiction. When you're drowning, you can't pull yourself out, you need someone on the shore.
Have people increasingly asked for your help in the Corona crisis?
Dahlmann: Yes. You can clearly feel that people have great concerns. The daily structure breaks down, overwhelmed by homeschooling and much more. There is a quick risk of relapse, but many new patients have also come forward.
Hey: We were never closed and were always there for our patients. That was very important right now. There was a time when, for example, withdrawal was only possible on an outpatient basis because nobody was admitted to the inpatient because of the pandemic to keep capacity free.
The history of the KPB - Finally there was an outpatient offer
It was an absolute novelty nationwide: Eduard Löhnert founded the KPB in 1990 in Dachau, the specialist clinic "Client-centered problem counseling" for addictions. It was the first institution in Germany to offer outpatient treatment and counseling for alcohol and drug addicts as well as men and women addicted to gambling. Löhnert did not want "that these people should be treated like second class people," recalls Birgit Hey, head of administration at KPB. Previously, withdrawal and rehab with therapy was only possible for inpatients, which meant being out of the familiar environment for months. Withdrawal and treatment on an outpatient basis were possible thanks to the KPB. In the meantime, both outpatient and inpatient treatment - in combination - is possible, depending on how the patient needs it. The offers for outpatient rehabilitation at KPB are arranged in such a way that they are all possible while working. Appointments are possible early in the morning, during lunch break or in the evening. Once docked to a qualified specialist clinic, patients can be accompanied for many years, for example in crisis situations, explains Birgit Hey. Today there are KPB outpatient clinics in Dachau and Munich. Around 70 patients a week receive ongoing treatment at the KPB. A total of around 400 patients are treated each year, including initial interviews. Since 1998, over 3,000 qualified outpatient detoxifications have been carried out in both specialist outpatient clinics, including 1,750 withdrawals in Dachau. Hey: “Outpatient rehabilitation is particularly well received by those affected.
