Chapter #3: Basic Concepts in Addiction Recovery. We will consider a standard situation where an addicted person has entered a drug rehabilitation organization. It is important to immediately note that a private consultation with a client with addiction outside the walls of a drug treatment clinic is possible, but that is a different story. This usually happens if a client turns to a psychologist with a problem of a different nature and is not aware of his addiction, but during the consultation process he begins to realize it. In this case, the psychologist’s task is to inform the client about the essence of addiction and the features of recovery, and then recommend that he contact specialists at a drug treatment center. This is due to the fact that help with such a problem is possible only in a comprehensive form, namely: the client will be isolated from the traumatic pathological habitual environment and placed in the therapeutic environment of a rehabilitation center with its healthy daily routine, recovery-supportive environment and the inability to use psychoactive substances; with the client A whole team of specialists will work - a psychologist, a narcologist, addiction consultants, specialists - rehabilitation specialists. And so, when the client himself turns to a drug treatment organization, he is met by a psychologist from this organization, and at this stage the main task of the psychologist is to inform the client about what the therapeutic process looks like and introduce him to the rehabilitation program. So, let's now look at all this in a little more detail, and let's start from the beginning, that is, with the initial reception of an addicted person. Primary reception. Usually, addicted people end up in a rehabilitation center under pressure from their loved ones and relatives. Therefore, they do not feel a strong desire to be treated. This means that we have to motivate them to do this. There will be a separate topic on how an organized motivational interview takes place with the help of relatives and specialists to apply to a rehabilitation organization. There was such a case. The girl was brought to the clinic by her mother. At first the girl did not want to stay for treatment. But suddenly, I met a friend of mine among the clinic’s rehabilitators and immediately agreed, and with great pleasure. In this clinic I work with the so-called “middle management” - these are successfully recovering clients with long periods of sobriety. They help motivate newcomers to stay in the clinic and, by talking about their experience of recovery, are quite successful in persuading them to agree to this very difficult step. In the meantime, when the addict has already arrived at the RC and still, one way or another, wants to do something about his problem, at the first meeting the psychologist needs to try to make the addict believe him. This is a difficult task after all that the client has been through, and even in his current poor condition. But this is absolutely necessary in order for him to accept what is communicated to him. The method used by the consultant is dialogue. The chapter “Psychological consultation with a dependent client: key tasks and methods of work” will discuss this in more detail. Sometimes a client leaves (to the displeasure of relatives) from a rehabilitation center not with a strong desire to “stay here,” but with food for thought in the form of a very brief story about AA (Alcoholics Anonymous) and NA (Narcotics Anonymous) meetings, centers, communities, and meaning their work and, most importantly, that they are all involved in recovery. But he will return. It is important to let him think about what he heard and form his own opinion. It’s good if the client leaves the consulting psychologist with the idea of ​​the psychologist as a normal person who treats him with respect, and an invitation to ask any questions and call after some time to tell him how he’s doing. An honest position of respect for a person and a willingness to help him,at a minimum, it sows seeds of trust that can “sprout” even after a long time. But it happens, and often, that a person immediately responds to the call to get better, and it is immediately, very specifically important for the consultant, together with him, to decide where to start. And we need to start with detoxification. Detoxification. Detoxification is medical treatment to help a person cope with alcohol or drug withdrawal. The client will have to endure withdrawal from all other psychoactive medications. Therefore, a gradual interruption of use is usually necessary. Narcologists give a special course of drug therapy: tranquilizers, antidepressants, Tramal - to heroin addicts, and special medications for alcoholics that reduce intoxication. This is necessary so that the person survives the withdrawal and does not simply die. This happens very rarely, but it does happen. By the way, there is one particularly nasty drug - luminal or phenobarbital, a sleeping pill of the barbiturate group. For people who use these sleeping pills as drugs, abruptly stopping these drugs can be fatal. So, medical intervention is often necessary to ensure that the patient experiences drug withdrawal safely, so that the person has the strength to survive withdrawal and depression. Detoxification is a stage of an exclusively medical nature; a psychologist does not participate in it. Basic rehabilitation. Basic rehabilitation sets the goal of helping a person build himself and his life in such a way that he no longer returns to drug use and at the same time lives and feels normal. Now there are a lot of rehabilitation centers that offer various options for helping people addicted to psychoactive substances. We will not dwell on the features and disadvantages of their programs. I will give an acceptable set of organizational standards of the Center and its programs, sufficient for effective rehabilitation. The Center must employ professionals. These are certified, qualified specialists: psychologists, psychiatrists, narcologists, psychotherapists. Addictions cannot be cured by time, work, sports or religion. These are just auxiliary tools. The basis of addiction therapy is the use of a complex of medical, psychological, social and other measures, collected in a single program approved by the relevant competent authorities. Centers that offer free treatment should be wary. Most likely, the guys there will work on their own rehabilitation, but this is no longer treatment! Also, you should not “buy in” on the high price for treatment of drug addiction and alcoholism. The center must have a mandatory connection with the community of recovering alcoholics and drug addicts (AA and NA). The center must be within the city. This is necessary to be able to provide quick medical assistance to the center’s clients. The center must have recommendations from government agencies. Neither long nor short programs are effective. Minimum rehabilitation period: 4 – 6 months. After completing the rehabilitation program, a resocialization program must be completed: about 4 - 6 months. The rehabilitation center program consists of sequential activities that solve specific problems of recovery. In general, the program represents the following stages in which the psychologist is directly involved: Restoration of the emotional sphere. Getting rid of the victim position (victim). Accepting responsibility for one’s destiny. The main tasks of passing these stages are as follows: Recognition of the presence of a problem of addiction and the inability to cope her on her own. This is the first and main step in the beginning of recovery. Without it, nothing will work, because without admitting that you have a problem, you will not be able to take treatment seriously. Seeking help from specialists. Here it is assumed that the addict himself personally begins to actively engage in recovery, without motivation from relatives and others.stakeholders. Formation of trust in the world and people. This is not a very easy task. Since the entire past experience of a drug addict suggests that you can’t trust anyone! However, without trust in people and specialists, you will not be able to hear them and accept help from them. Therefore, a lot depends on the Center’s specialists, their ability to win over the rehabilitator, who only when he feels trust in himself and the sincere desire of the consultants to help him, will he be able to trust the people helping him. An honest look at himself (formation and development of humility). This is the basic, working task of a rehabilitator during recovery - to study one’s character defects, examine deviations in behavior, admit one’s mistakes, unlearn one’s habits of manipulating people and shifting responsibility for one’s life onto them. Changing one’s behavior. This problem is solved with the help of the regime and daily routine in the rehabilitation center. When an addicted person eats three times a day, rests for the required amount of time, engages in targeted and conscious work, attends group psychotherapy, the necessary doctors, that is, is in the so-called therapeutic environment, his habitual addictive behavior gradually changes to normal, acceptable in society and good for health. Compensation for damage caused to yourself and others during the use of surfactants. This task requires special attention. In Gestalt therapy there is a concept - completed Gestalt. In other words, it’s a finished job. It has long been noted by various psychologists that a person always strives to finish the work he has begun. When he fails, he experiences anxiety and discomfort. Remember how nervous you were when you couldn’t pay off your debts for a long time. This desire to pay back those people from whom we took something, especially if we caused damage, is deeply embedded in our essence. For an addicted person, in his recovery, it is very important to get rid of all possible “unfinished gestalts”. In order not to be tormented by anxiety, which unconsciously, one way or another, will move a person to “relieve tension,” that is, to use surfactants. The rehabilitator consults with a psychologist and his mentor about how to do this. Compensation for damages begins at the rehabilitation center and continues afterward. Most often this is associated with a request for forgiveness from loved ones and relatives about past negative actions towards them. Here the well-known Gestalt technique of the “empty chair” can come to the rescue, when when communicating with a “virtual” person on a chair, the client “let go” of negative emotions and removes self-restraints in order to talk with that person in reality. Finding a new way of life. This is the result of passing the above stages. Supportive rehabilitation. So, our rehabilitator has gone through the first stage of recovery: achieving sustainable sobriety, accepting his powerlessness over addiction, asking for help and accepting it into his life - but all this is not enough for stable recovery. It is necessary to constantly contact people who are in remission and, like them, work according to the 12-step program, meet in AA and NA groups. We'll tell you more about the 12-step program a little later. The tasks of a psychologist at the stages of basic and supportive rehabilitation are the most extensive and include counseling on all possible areas of clients’ psychological problems. Group and individual therapy. The psychologist conducts group and individual psychocorrection. The group as a community becomes the engine of therapy. A new unit is formed - a group, which becomes healing for its participants. One of the very important functions of the group is the emerging opportunity for its participants to make a choice between the former life - familiar, but already almost impossible - of an active drug addict or alcoholic, and a different life that corresponds to their truevalues. To make this choice, to make it a reality, and not just an intention, is possible in its entirety only in a group. Individual therapy, like group therapy, is an indispensable form of assistance in the recovery of an addict. It is here, at this moment, that a psychologist can offer the addict a full range of individual work services! The 12-step program of AA, NA. This is a mandatory rehabilitation program for every person recovering from addiction. A mentor helps to implement it. Psychologist - supports the rehabilitator in going through the “steps”, advises him on overcoming the psychological difficulties that arise along the way, such as anxiety, resistance to recovery in the form of self-doubt and despondency, often despair and disbelief in success. AA, NA is a fellowship that unites people who share their experiences, strengths and hopes with each other in order to solve their common problem and help others get rid of addiction. The only condition for membership in AA and NA is the desire to quit substance abuse. Members of AA(NA) do not pay any entrance or membership fees. They support themselves with their voluntary donations. Since an addicted person completely loses control over the use of psychoactive substances, the main goal of this community is to maintain a sober lifestyle and completely abandon the use of psychoactive substances. An AA (NA) group is a small association of people who meet regularly for the sole purpose of sharing the experience of recovery with others who need help. At some meetings that are just getting started, you can hear participants complaining about life and talking about painful experiences. You shouldn’t be afraid of this, since in just developing groups such communication is quite common. In more developed groups with a high percentage of recovery, such behavior is either no longer approved or is completely prohibited by the group rules. In such groups, participants strive to share successes, not pain. This practice promotes healing. In AA (NA) people recover using the 12-step program, which is described in the books “Alcoholics Anonymous” (Narcotics Anonymous). A beginner can already find a mentor at his first meeting. This is a recovered alcoholic (drug addict) who is ready to help a newcomer walk the twelve steps. Mentor assistance is free. All work on completing the steps lasts several months. During this time, the beginner receives the necessary tools that he will use throughout his life. Immediately after completing the entire program, he himself can become a mentor for other beginners. The 12 Steps of AA(NA) are a spiritual reorientation program for addicts. The goal is to acknowledge one's addiction, appeal to a "higher power" for recovery, repair the damage done to others as a result of addiction, and bring healing knowledge to other addicts. It is very important to learn to turn to God, pray, and entrust your worries to Him. Entrusting your worries to God means following HIM, but still walking with your own feet. This means working with him, but working, not messing around. As a rule, to effectively work through the stages of the program, it is necessary to have an experienced participant (sponsor, mentor) who can explain the principles of each step. The 12 steps of Alcoholics Anonymous (Narcotics Anonymous) go like this: We admitted that we were powerless over alcohol, that our lives had become unmanageable. We came to the conviction that only a Power greater than ourselves could restore us to sanity. We decided to surrender our will to and our lives to the care of God as we understand Him. Have deeply and fearlessly assessed ourselves and our lives from a moral point of view. Admitted to God, ourselves and any other person the true nature of our errors. Fully preparedourselves so that God would deliver us from all our defects. We humbly asked Him to correct our shortcomings. We made a list of all those people whom we had harmed, and were filled with a readiness to make amends to them. Personally compensated for the damage caused to these people wherever possible , except when it might harm them or someone else. Continued self-examination and, when they made mistakes, immediately admitted it. Sought through prayer and reflection to improve contact with God as we understand Him, praying only for knowledge of His will, which we must carry out, and the granting of the power to do so. Having achieved the spiritual awakening that these steps led to, we tried to convey the meaning of our ideas to other alcoholics and to apply these principles in all our affairs. In our opinion, the 12-step program is currently the best way to combat addiction to psychoactive substances. There is a large amount of evidence of the effectiveness of this program from those who have completed it and continue to spread the word about its ideas and principles. Disruptive process. The relapse process is, unfortunately, part of recovery. This is a situation in the life of a recovering addicted person, in which he has a desire to use psychoactive substances, caused by some events of an external or internal nature. Let us note some patterns: ♦ A “fork in the road” or a mechanism that triggers a relapse process, on the path to recovery, usually occurs in good times are when a person is calm and prosperous. This is where a dangerous slowdown in recovery occurs. For example, one of my wards, a recovering drug addict, let’s call him Sergei, after undergoing long-term rehabilitation and then resocialization, successfully found a job, or rather, went into business. I made good money pretty quickly. And, one day, I decided to go on vacation to a warm country. And so, after a week of rest and idleness, he became bored and lonely. Heavy thoughts came over me. And at some point he unknowingly walked into a bar... He came to his senses only three days later, when doctors pumped him out of the intensive care unit. Thank God, everything is fine with Sergei now. He analyzed the situation that happened to him, talked about it with a psychologist and his mentor. Drew the necessary conclusions.♦ As they move along the path of relapse, a drug addict or alcoholic consistently loses what they have achieved on the path of recovery. There is a regression: reverse development.♦ On the path of relapse, a person is not at all going to relapse. He has completely “noble” goals, which he does not evaluate as false. He himself does not see his breakdown!♦ Use occurs quite unexpectedly for the drug addict or alcoholic himself, and is not necessarily immediately severe. The process of returning to the old horror can take the second half of the relapse “ring” (see picture).♦ A relapse is always disappointed expectations, no matter what they are. It’s as if the devil lured, deceived and left with nothing or with an insignificant result. A person never gets what he expected when he relapses. The details of the process may also be different. For example, instead of work, “great love” may appear, which has finally visited our addict, supposedly as a reward for his efforts in recovery. It could be, in fact, any matter that is different from, and therefore opposed to, recovery. Therefore, it is very important for an addicted person to see the signs of his breakdown. Such signs may be the following: Changes in behavior. When: More and more frequent disputes and quarrels “with or without reason” appear; Motives for participation in AA or NA meetings change, the frequency of their attendance decreases or stops altogether; People go to “talk” or “sit for coffee” in places where they usually drank;Increased signs of stress such as smoking more cigarettes or eating more food than usual...Changes in relationships. When: Indifference to sobriety appears, to what is happening around; Excessively negative views on life and situation are updated.