Relapse is a return to the use of drugs, alcohol or other psychoactive substances after a period of abstinence, accompanied by the restoration of dependence symptoms.
Distinguish between relapse and breakdown, which refers to a separate case of drug or psychoactive substance use.
The main task of the treatment and rehabilitation of alcohol and drug addicts is not only to help the patient stop using these substances, but also to ensure the stability of lifestyle changes for a long time. This point of view is due to a number of theoretical and practical studies devoted to the search for the determinants of relapse and the development of therapeutic programs that should help patients resist relapses and relapses.
The psychological principles of overcoming addiction to drugs are determined, in violation of which a breakdown occurs and a relapse of the disease develops.
1st principle. Self-regulation. The risk of relapse decreases in proportion to the increased ability of the patient to self-regulate thoughts, feelings, memories, life decisions, and the development of his personality and behavior.
2nd principle. Integration. The risk of relapse decreases in line with the increase in the level of awareness, understanding and appreciation life situations and events, as well as the use of strategies to avoid the risk of relapse into drug use.
3rd principle. Understanding. The risk of a relapse decreases in accordance with the process of understanding the underlying factors that cause it.
4th principle. Development. The risk of relapse decreases with the constant development of personality resources and stress coping behavior.
5th principle. Social support. The risk of relapse is reduced by constant activity aimed at building a social support network and developing skills to perceive and use social support.
6th principle. Social competence. The risk of relapse decreases with a constant increase in knowledge about the surrounding social environment, the development of empathy and affiliation skills.
7th principle. Self-efficacy. The risk of relapse decreases with the constant development of strategies for effective behavior and understanding of oneself as an effective person.
Based on the summary model of relapse prevention, T. Gorsky developed a model of relapse prevention therapy - SMRT. This model is a multi-pronged method for preventing relapse to drug and alcohol use in drug addicts who have completed primary treatment and have entered a recovery program.
The model has five goals.
Restoration and / or formation of a common (global) lifestyle that prevents relapse. Developing a comprehensive self-perception of one's own life, addiction, and history of relapse(s).
Development personal list signs of a threatening relapse, in which the logic of the formation of a breakdown and the reasons for the transition from a stable recovery to a breakdown should be traced.
Formation and development of strategies for managing (overcoming) relapse symptoms.
Development and structuring of a recovery program aimed at the formation of the patient's self-identification and critical management of signs of relapse.
Development of an early relapse prevention plan that will be implemented step by step by the patient and their significant others to prevent relapse into alcohol or other drug use.
This method is based on the principles of cognitive, affective, behavioral and social therapy and consists of five primary components.
Determination of signs of violation of the identification process.
Determination of relapse management strategies.
Recovery planning.
Relapse prevention training.
The main psychological areas in which the work is carried out: thinking (cognitive); feeling (affective); actions (behavioral).
Main social spheres:
intimate relationships.
The most important thing is to help the patient to establish functioning in each of these areas.
According to the author of this model, changes are a normal and necessary part of life, but main reason stress. A change can easily trigger a reaction that "throws" a person out of the recovery process and into a relapse dynamic if the person is not aware of what is happening or is not ready to deal with it.
Typically, the changes that often "set off" the relapse dynamic begin with a change in attitudes, in particular, the attitude of the need to follow a program of recovery.
Relapse prevention includes the following steps:
Stabilization;
Patient education;
Determination of harbingers of a breakdown;
Revision of the recovery program;
inventory training;
Interruption of stall dynamics;
Involvement important people;
Consistent execution and reinforcement.
Successful relapse prevention efforts need to be completed and reinforced. For this you need:
Develop a further relapse prevention and recovery plan using work in a healing environment;
Integrate relapse prevention planning with ongoing patient and family care;
Combine relapse prevention planning with a sobriety maintenance plan.
Literature
Valentik Yu. V., Sirota N.A. Guidelines for the rehabilitation of patients with dependence on psychoactive substances. - M., 2002.
Lichko A.E., Bitensky V.S. Adolescent narcology. - L., 1991.
Pyatnitskaya I.N. Addictions: A Guide for Physicians. - M., 1994.
Pyatnitskaya I. P., Naydenova N. G. Adolescent narcology. - M., 2002.
Guide to narcology: In 2 volumes / Ed. N. N. Ivanets. - M., 2002.
Relapse Prevention Training
Relapse prevention training is based on the change process model of J. Prochaska and C. DiClemente.
It is based on cognitive-behavioral strategies that promote withdrawal while helping those who are in a state of relapse. Individual studies have shown that the skills clients learn in relapse therapy remain for up to a year after treatment is completed. Based on the model of the process of change by J. Prochaska and K. DiClemente, recovery involves the introduction of changes in stages and testing their effectiveness in practice. The stress that a person experiences when changing, increases tension for a while, and the person needs rest or relaxation. In this regard, there are so-called “stuck points” on the path of recovery. The result of being stuck is a feeling of discomfort that gradually increases and often leads to the idea that the efforts are in vain, the program does not solve either old or new problems that appear after stopping use. The tension grows and the person feels that he cannot stand it. Instead of analyzing the events that led to the stuck and increased tension and taking certain steps to overcome the tension in a constructive way, many Program participants object to this and slow down the process.
Denial is used unconsciously, therefore it automatically blocks the awareness that something is going wrong, something is not right. Being stuck creates stress. Denial blocks awareness of the presence of stress and thus only reinforces it. A person feels uncomfortable, but does not understand the reasons for this condition and does not know what to do to lose it. As a result, the signs of the post-abstinence syndrome become aggravated, the person feels worse and worse, self-esteem decreases, non-constructive defenses begin to work.
For example, a person can say to himself: “It’s not about me and those around me, I feel so bad that it can’t get any worse - a single use of the drug will not change anything and won’t hurt me ...” The person returns to stereotypical (compulsive) non-constructive ways to solve problems. Thus, a breakdown process is launched, which begins long before the fact of using a drug. Using is the end result of the relapse process. A relapse begins with changes in thoughts and emotions, because these are the ones that influence our behavior.
Spiritual and moral education (bibliotherapy)
An important role in the formation of moral qualities is played by the inner world of a person, his "moral core", which is interconnected with the spiritual life of the individual. Spiritual life, in turn, is closely related to the concept of "spirituality".
In the secular understanding, the concept of "spirituality" is based on the introduction of a person to cultural property different levels(ethnic, national, universal). In the "Big Psychological Dictionary" spirituality is understood as a search, practical activity, experience, through which the subject carries out the transformations in himself that are necessary to achieve the truth.
In religious understanding, the category “spirituality” is based on the idea of a person as a triad: body-spirit-soul, and the spirit comes to the fore, and everything else that makes up a person is considered depending on the spirit. An integral criterion of the spiritual method of helping people with addictive behavior is a moral criterion.
Spirituality is understood as a property of the soul, consisting in the predominance of spiritual, moral and intellectual interests over material ones. spiritual man- the result of a long, persistent and purposeful process of self-organization, family and public education and enlightenment.
The key concept underlying the spiritually-oriented methods of conducting group psychotherapeutic work with chemically addicted persons is metanoia, which in Greek means a change in thinking, that is, repentance, which inevitably leads to a change in behavior. A person's aversion to the former way of life is not directed to the void, but to something opposite from what the person is turning away from. He who hates sin, which is drug use, turns to goodness, truth, and this is a new, creative, happy life.
The category "sin and responsibility for sin" does not belong to scientific categories. Science talks about mistakes, finds ways to prevent or correct them.
In spiritual life, a mistake (Greek αμάρτημα - delusion, sin) implies moral responsibility, the formation of which is included in the methodology of spiritual assistance, therefore spiritual conversations are a very important spiritual component of the Program, they can be both general, with the participation of the whole group, and individual .
In order to conduct them, the group gathers together at a specially allotted time for this, and the coming priest or a specially trained Orthodox catechist offers one of the passages of the Holy Scripture (Bible) for analysis. Each participant in the program has a copy of the Bible. A fragment of the proposed passage is read in turn. Next, one of the participants in the lesson is invited to give their interpretation of the read place in the Bible, perhaps with their own examples from life. Then a similar request is addressed to several more participants in the lesson. After that, the leader of the meeting summarizes what was said earlier and offers his version of the interpretation of the read passage of the Bible.
Individual psychotherapy (autotherapy)
Apart from various options group psychotherapeutic interventions, great importance in the rehabilitation program is given to individual psychological work with patients.
For this, 2 manuals specially developed in Europe are used, adapted for use in the department - "Diary of Feelings" and "Guide to Self-Knowledge and Self-Help".
"Diary of Feelings"
It is a basic tool for introspection and self-control of behavior. With the help of a diary, patients explore their own thoughts, feelings and actions in situations of drug use or high-risk situations when there is a craving for drug use. The effect of the use (or abstinence from use) of drugs on the behavioral, cognitive and emotional levels is analyzed.
The "Diary of Feelings" is filled in daily by the participants of the Program at its first stages. In it, they describe the most important events of the past day for them, what feelings they experienced at that moment.
Diaries are written throughout the day: the entry is carried out as soon as a more or less significant event occurs, to which the rehabilitator pays attention.
The main task"Diary of Feelings" - to teach the participant to track the relationship of their emotional state and their actions from events in the external and inner world. Tracking and establishing such relationships in the present, the Program participant learns to manage himself in risky and stressful situations in the future.
Keeping such a diary allows you to teach patients to correctly recognize their experiences, clearly identify them with the help of professional psychologists, and then operate with acquired skills, establishing contact with almost any person. Thus, it can speed up the rehabilitation process by teaching patients how to manage their feelings intelligently. Which, in turn, in the future can prevent a drug breakdown.
Depending on the number of participants, the leader in the lesson can choose those who will read their diary in full (most often beginners of the program and those who have problems with analyzing and formulating feelings), and who will limit themselves to only the most important events.
The Diary of Feelings enhances the ability to recognize and differentiate one's own feelings, expands knowledge about feelings and emotions, develops the ability to accept them without judgment, and to form the ability to show emotions.
These types of activities are characterized by structuredness, emphasis on activity, support and empathy. The module is based on cognitive strategies of psychotherapy.
At the beginning of the module, it is possible to use psychological training to prepare clients to use written language as a tool for verbalizing their own experiences.
Many chemically dependent individuals find it very difficult to recognize and identify their own feelings. They have an undeveloped ability for reflective self-awareness and its component - self-observation. People who use drugs have extremely difficult contact with outside world due to difficulties in expressing their feelings, due to the destruction of the personality structure. To achieve changes in the sphere of self-regulation, it is necessary to train the skills of systematic self-observation and analysis of problem situations, one's own thoughts, feelings and actions. Since patients on initial stage there are problems with the formulation of emotions and feelings, then experts give them a kind of "cheat sheet" with a list of feelings.
In this case, patients should, if possible, correctly name their feelings, using the definitions given at the beginning of the diary. Then the written texts are regularly worked out in specially organized small groups. This process enables the patient, under experienced guidance, to look at his state of mind as if from the outside, to see his shortcomings and advantages, which allows him to work on improving the inner world.
The participant of the rehabilitation program conducts the result of the analysis of his feelings at the end of each week, answering the questions indicated in the “Diary of Feelings”: “What did you manage to do?”, “What else is left to do?”, “What do you want to change in your emotional life?”, What do you want to leave unchanged in your life?
"Guide to Self-Knowledge and Self-Help"
Rules for the lesson:
Confidentiality - not discussed with anyone after the group;
Honesty - to talk about everything that is felt;
Openness – everyone speaks out;
Do not interrupt while one member of the group is speaking;
They do not advise, share only their experience, talk about themselves;
Do not criticize others;
Do not debate on information given to others;
Be active during class
Do not call surfactants, avoid drug addict slang;
If unpleasant experiences appear, they speak immediately so that the consultant decides whether to continue the lesson or postpone it to the next day;
Do not be late for the group;
Agree on a specific date for the group in advance to be ready.
Drug addicts.
relapse
- a return to the use of drugs, alcohol or other psychoactive substances after a period of abstinence, accompanied by the restoration of dependence symptoms.
A distinction is made between relapse and relapse , which is understood as an individual case of the use of a drug or psychoactive substance.
The main task of the treatment and rehabilitation of drug addiction is not only to help the patient stop using the drug, but also to ensure the stability of lifestyle changes for a long time. This point of view led to a number of theoretical and practical studies devoted to the search for the determinants of relapse and the creation of therapeutic programs that should help patients resist relapses and relapses.
Prevention of relapse.
The psychological principles of overcoming addiction to drugs are determined, in violation of which a breakdown occurs and a relapse of the disease develops.
Principle 1. Self-regulation.
The risk of relapse will decrease in proportion to the increased ability of the patient to self-regulate thoughts, feelings, memories, life decisions, and the development of his personality and behavior.
Principle 2. Integration.
The risk of relapse will decrease in line with an increase in awareness, understanding and appreciation of life situations and events, as well as the use of strategies to avoid the risk of returning to drug use.
Principle 3. Understanding.
The risk of relapse will decrease in accordance with the process of understanding the underlying factors causing relapse.
Principle 4. Development.
The risk of relapse will decrease with the constant development of personality resources and stress coping behavior.
Principle 5. Social support.
The risk of relapse will decrease with continued activity aimed at building a social support network and developing skills to perceive and use social support.
Principle 6. Social competence .
The risk of relapse will decrease with a constant increase in knowledge about the surrounding social environment, the development of empathy and affiliation skills.
Principle 7. Self-efficacy.
The risk of relapse will decrease with the constant development of strategies for effective behavior and understanding of oneself as an effective person.
Compliance with these brief principles is preceded by a long and complex joint work with the patient, built on a number of methodological foundations.
Theoretical and methodological basis for relapse prevention: conceptual models of relapse.
Several models of relapse are defined, on the basis of which basic approaches to their prevention are developed.
Psychological models of relapse.
Four main psychological models of relapse are identified: the cognitive-behavioral model (Marlat & Gordon, 1985); personality-situational interactional model (Litman, 1986); a cognitive appraisal model (Sanchez-Craig, 1976); and a self-efficacy and expectancy outcome model (Wilson, 1976; Rollnick & Heather, 1982; Annis, 1986).
For practical work in the field of relapse prevention, it is necessary to understand the content of the basic principles of each of these models.
In the cognitive-behavioral model of Marlat & Gordon, the conceptual concept of relapse is given from the point of view of its understanding by the therapist and the patient. From the traditional dichotomous ("black and white") point of view, the resumption of drug or alcohol use is a "failure" of treatment. However, this view has a lot of negative consequences. One of them is that after a breakdown, the patient stops trying to resume the recovery process and get out of addiction. More constructive opposite point view of the essence of relapse as a mistake that the patient needs to correctly perceive, realize, use as an experience in further recovery from addiction. However, the most important basis of this model is the prevention of relapse and relapse until it occurs. A special place in this model is given to self-efficacy, which develops throughout the period of withdrawal and situations of high risk of relapse, as well as the formation and effective use of coping skills to overcome risk situations. If the patient is unable to use effective coping behavior when faced with risk situations, the result will be a reduced sense of self-efficacy in coping with the illness and the use of the drug or alcohol as a destructive coping mechanism to avoid the problem. If the results of the addiction work are judged to be effective by the patient, the drug and alcohol are less likely to be used. This model received further development from the point of view of the theory of stress and coping Lazarus (1966) in the works of Annis & Davis (1988, 1989), Shiffman (1989), Tucker, Vuchinich & Harris (1985), Vuchinich & Tucker (1991). In these models, which have more similarities than differences, special meaning acquires consideration of risk factors for relapse as a response to emotionally stressful situations. The outcome depends on the effectiveness of a person's coping behavior in these situations. Coping-behavior itself depends on how the patient perceives the situation of risk, how it is assessed, what is the level of development of coping resources (self-confidence, competence, understanding of the problem, the ability to recognize and control one's emotions, be responsible for choosing one's behavior.)
The cognitive-behavioral model has much in common with the personality-situational model, which determines the importance of the individual repertoire of coping skills in a person at risk and his individual perception of his skills as effective or ineffective. The cognitive assessment model focuses on individual perception and evaluation of a risk situation. In the context of this model, the most important is the ability to cognitively assess stressful, problematic and risky situations. All of these models are based on Bundura's social learning and self-efficacy theory (1977, 1982).
Psychobiological models of relapse further expand the understanding of the factors contributing to it. For example, psychobiological directions define important role in the occurrence of relapse, processes that prevent recovery, and an insufficient level of acquired motivation (Solomon, 1980), loss or decrease in subjective control over one's behavior (Ludvig & Wikler, 1974), drug craving (Wise, 1988; Tiffany, 1990), post-abstinence syndrome in the subacute phase and limbic system changes occurring during withdrawal (Mossberg, Liljeberg & Borg, 1985; Gorski & Miller, 1979).
Thus, the cognitive-behavioral model of the relapse process looks like in the following way. An individual can give an effective coping response to a situation of high risk of relapse, aimed at overcoming his attraction in this situation. As a result, he has an increased sense of self-efficacy and a reduced risk of relapse. Otherwise, the individual may not give an effective coping response, as a result of which he has a reduced sense of self-efficacy in overcoming the disease and increases positive expectations from taking the drug. He uses the drug and the result is a withdrawal effect and an intrapsychic conflict caused by a cognitive dissonance between the desired self-rejection and the perception of himself as having lost control. As a result, relapse problems are on the rise.
The following specific strategies are used in relapse prevention:
Increasing the level of knowledge about high-risk situations;
Training skills to overcome high-risk situations;
Increasing self-competence and the ability to understand and control the processes associated with changes in the sphere of one's Self in high-risk situations;
Work with self-identification as a person who effectively overcomes addiction;
Cognitive assessment training for problematic stressful situations and high-risk situations;
Work on increasing internal control over one's behavior;
High risk avoidance training.
In the absence of an effective coping response to a high-risk situation, relaxation training is used;
Learning to manage stress and teaching skills of coping behavior in stressful situations in parallel with the development of coping behavior resources;
Relapse prevention
We will help you not to wait for your loved one to get into trouble again and return to use. After all, it also happens that an addict, having undergone rehabilitation and being in society, cannot get used to a new life, this may be because his emotional state is not stable and he still had to spend some time in rehabilitation. Read carefully what a breakdown is, its development and symptoms. If your loved one has begun any of the stages of a breakdown, do not wait for everything to work out by itself, call our certified psychological support center, our specialists will help you!
Relapse development process
A breakdown is a process of increasing psychological imbalance, which manifests itself in a return to old habits, feelings,attitudes and behaviors, resulting in relapse (return to use). A common misconception is that relapse (return to use) is a sudden and spontaneous event that happens without any warning signs. The truth is that there are many warning signs that precede disruption. ManifestationThese signals can be described as a process of gradual changes in behavior, feeling, desires and thinking from stable, constructive and directed towards recovery, to destructive, destructive and leading to relapse.
The process of development of a breakdown can be conditionally divided into three stages.
Stage 1 - Internal Dysfunction, violation of internal peace and stability.
This process usually starts with appearance of external or internal stress factors causing destabilization(abrupt changes in life or a large number of minor changes), internal stress. Internal voltage in turn leads to the 1st phase of the disruption process - violation of psychological stability , followed by the denial of problems, and, as a result, development internal changes in thought and emotion(2nd phase). This stage is characterized by the ability to control feelings, behavior, and thinking. At this stage, it is enough to remove or minimize stress factors (leave the situation, resolve the conflict, take a break, etc.) to interrupt the development of a breakdown. The main strategies for coping with the relapse process are planning for recovery, one's behavior and psychological reactions in similar situations in the future, etc.
Stage 2 - External Dysfunction, disruption in behavior and relationships.
Domestic growth voltage and changes in thoughts and emotions, as well as unwillingness to somehow respond to them (denial of tension), leads to the fact that consciousness control over the psyche is partially lost. These psychological problems begin to seriously interfere with normal life activities, in the performance of everyday activities, etc. ( changes behavior – 3rd phase). Behavior changes noticeably for others (therefore, this stage is called external dysfunction). At this stage, a person is still aware of what is bad and what is good, he is aware of his mistakes, does not allow negative feelings and destructive thoughts to completely take control of life, but he cannot fully resist them either. The main efforts of a person, at this stage, are usually aimed at controlling behavior (keeping oneself in control, completing tasks and goals, not succumbing to emotions, etc.) and doing nothing with emotions and thoughts, and this is major mistake. Internal problems at this stage it is no longer possible to solve by eliminating external factors, as at the previous one, just to get away from stress, since the destructive process is already going on inside. Internal dysfunction makes a person make more and more mistakes that grow exponentially ( growing personality crisis – phase 4). At this stage, all efforts should be directed to the analysis, minimization and elimination of internal changes (pronunciation, introspection, stress management work, etc.). When the convalescent does not give special attention analysis with the subsequent stabilization of internal processes and external conditions, internal dysfunction increases, and at a certain voltage, a person goes to the next stage of breakdown.
Stage 3 - Loss of control.
At this stage, dysfunctional psychological processes, negative emotions and destructive thoughts, take over the control of a person's life. At first, he is still aware of what is bad for him now and what is good, but already can't control their behavior(who is now completely controlled by negative emotions) and cannot help but commit "evil" deeds ( loss of personal control – phase 5). Moving further in the breakdown, the last phase of this stage comes - loss of control over values. A person no longer realizes what is bad for him and what is good ( degradation – phase 6). The next step is drinking alcohol. The most common mistake of recovering people at this stage is trying to solve their problems on their own. But at this stage, a person can no longer help himself, (he has lost internal control over thoughts and emotions, and external control, does not control his life, behavior). Now to stabilize his condition outside help needed.
The development of a breakdown can be interrupted at any stage of its development by monitoring the signs of its manifestation in time and taking appropriate measures to prevent it.
A relapse prevention class focuses specifically on learning to track the symptoms of a relapse and develop ways to overcome it.
- Family Therapy
- CPP "Blago"
- Campaign to prevent the spread of drug addiction among adolescents and youth
Why choose us
We have combined best programs DayTop and 12 steps!
Treatment of drug addiction and alcoholism (treatment refers to social adaptation) is a task that requires a comprehensive solution. What we do - gives a high result. You can use different methods, but we suggest you play it safe and get a real solution to this problem. This is a complete abstinence from drugs and alcohol.
We leave for the patient anywhere in Russia!
Our employees will not be afraid of the distance to your location and the stage of dependence of your loved one. Transportation is fast and without incident. Moreover, we are able to convince the patient that he needs to get rid of addiction, after that he really wants to recover. Nobody will offer you this. This service is called INTERVENTION (motivation of the addict for rehabilitation).
We provide full legal support!
Few addicts are clean before the law. Do not worry, we are doing everything so that this does not interfere with the passage of rehabilitation and the return to a normal sober life.
We help with employment and training!
We help to bring to life those aspirations that seemed to have been ruined by many years of use.
We use an individual approach!
Each addict is assigned a psychologist who leads his recovery dynamics. An individual program is drawn up for everyone, because of the types of drugs this is an important factor.
EVERYONE with whom we started working ended up in contact and were included in the rehabilitation process.
We care about the physical and psychological condition of the patient!
Since addicts are also people, they need to get used to a sober life after adaptation, so for those who are approaching discharge and, of course, accompanied by our employees, we organize football games, field trips (picnic), excursions, trips to the cinema , theatre.
We comply with the laws of the Russian Federation!
The work is based only on the observance of all the rights of the patient. We do not have handcuffs, a punishment cell and other prohibited methods that break the psyche and life of a person.
We comply with fire and sanitary and hygienic standards! Round-the-clock security of UVO in Ufa!
For comfortable rehabilitation, addicts and their relatives must feel protected and completely safe, so our center has a fire alarm and video surveillance. Complied with sanitary and hygienic standards for the accommodation of residents. The center is under round-the-clock protection of the UVO for the city of Ufa in the Leninsky district. This is not the case in any center.
Round-the-clock medical support of a general practitioner!
Physical health of a person also plays an important role for the complete restoration of the personality, therefore the center cooperates with the State Budgetary Institution of Health of the Republic of Belarus, City Clinical Hospital No. 5 in Ufa, where all the necessary tests are taken. A general practitioner visits the center to monitor residents.
We provide support to the patient after rehabilitation!
This support is necessary so that a person does not feel lonely and abandoned.
We provide Parents' Day!
Every Saturday, Relatives indicated at the conclusion of the contract can come to visit from 14.00 to 16.00 and personally see what changes have taken place with his loved one.
We conduct Family sessions with a psychologist!
Such events are important so that the addict and his relatives learn to communicate with each other again.
Tour of the center!
If you still have doubts about sending your loved one to rehabilitation, you can visit the center with our employee, where you will see everything with your own eyes. Before that, you need to call 8-800-2222-909 to sign up for a consultation with a tour.
CPP Blago meets the national standard of the Russian Federation!
- Self-help groups for drug addiction
- Against legalization
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- Cold wraps are a guarantee of enviable beauty and a slim figure
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Prevention of relapses and relapses
Target groups: — Patients with an established diagnosis of narcological disease, but who have not lost the ability for social and psychological adaptation and resilience.
Socio-psychological adaptation is the process and result of a person's active adaptation to a changing environment with the help of various social means. The level of socio-psychological adaptation is the result of the formation of professional skills, social skills, culture of interpersonal and social relations, skills healthy lifestyle life and self-acceptance.
An indicator of successful social adaptation is the high social status of an individual in a given environment, as well as his satisfaction with this environment as a whole. An indicator of unsuccessful social adaptation is the movement of an individual into a different social environment or deviant, antisocial behavior. This stage is aimed at preventing relapses and relapses of the dependence syndrome and is aimed at patients who no longer have severe physiological or emotional consequences of recent substance abuse. The goals of this phase are to prevent a relapse into active substance abuse, to help the patient learn to control the urge to substance abuse, or gambling and help him restore or improve his health and social status.
Measures to prevent relapses and relapses include psychotherapy, psychocorrectional psychological assistance and social work with the patient after achieving abstinence from the use of psychoactive substances. An important aspect of the assessment and treatment of addictions is the psychological diagnosis of persons dependent on PAS. For this purpose, it is recommended, first of all, to use those tools that are widely used in the world, translated into Russian and adapted for use in the Russian Federation.
An example is the Addiction Severity Index (EuropASI). In particular, the version translated and adapted in the Republic of Belarus is the Belarusian Addiction Severity Index (BASI) and The Maudsley Addiction Profile (MAD). These tools can be used for both research and dynamic monitoring. In many cases, Time Line Followback (TLFB) is a good tool. The PAS intake chart is a form of retrospective assessment by the patient of his daily PAS consumption for last month. For the simplest psychometric assessment of additive craving, it is advisable to use a fairly simple but informative “Visual Analogue Scale”, which is a straight line 10 cm long, the ends of which correspond to extreme degrees of craving intensity (“no craving” at one end, “irresistible craving” - on another).
The patient is offered to make a mark on this line corresponding to the intensity of the this moment sensations. The distance between the end of the “no desire” line and the mark made by the patient is measured in centimeters and rounded up. For a multidimensional assessment of addictive craving, it is recommended to use the Obsessive Compulsive Drinking Scale. The scale was developed on the basis of the Yale-Brown obsessive-compulsive scale and is intended for the patient's self-assessment of ideational manifestations of attitudes towards alcohol over the past week. The scale allows you to identify the intensity of addictive craving, fix the frequency and duration of the appearance of thoughts, urges associated with the use of alcohol. Assess how these urges interfered, caused stress or anxiety and how much effort the patient had to make to resist them. Analysis of the characteristics of attitudes towards alcohol, carried out by the patient himself, is both a diagnostic test and a procedure that teaches self-observation and reflection.
The Obsessive Compulsive Drug Use Scale is a modified questionnaire for drug addicts. The scale helps to determine the severity of obsessive thoughts about the drug and allows you to assess the patient's ability to control their behavior. The Symptom Checklist-90-Revised (SCL-90-R) can be used to clinically assess symptoms of comorbid psychiatric disorders.
The WHO QOL-100 Questionnaire can be used to assess the quality of life. The questionnaire allows you to assess the structure of the individual's perception of his physical and psychological state level of independence, interpersonal relationships and personal beliefs. 6 major areas were subject to assessment: the physical sphere, the psychological sphere, the level of independence, social relations, Environment and the spiritual realm. You can also use the Health Status Survey SF-36 to assess the quality of life. The social functioning of patients can be assessed using the E.O. Boyko.
This scale quantifies the level of social functioning in areas such as labor activity, family relationships, contacts with friends and acquaintances, self-service, structuring free time. Additionally, you can use:
2. The Spielberger-Khanin Anxiety Scale is used to clarify the structure of anxiety and assess its dynamics.
3. Hospital Anxiety and Depression Scale (HADS), an easy-to-use screening tool containing 14 items, each of which corresponds to 4 response options, reflecting the degree of increase in symptoms of anxiety and depression.
4. Family Environment Scale (FES). The methodology is designed to assess the intra-family climate and consists of 90 statements that allow measuring three groups of indicators grouped into ten scales.
When implementing strategies aimed at preventing the occurrence of a relapse or relapse, an approach is recommended that motivates the patient to change the style of substance use, reduce negative consequences or complete abstinence. The prevention of breakdowns and relapses is facilitated by an increase in the quality of life, normative levels of claims, the restoration of emotional adequacy and the development of resilience - the ability to overcome life's difficulties with dignity, to build a normal full life in real conditions, in the presence of a wide variety of life problems. It is mandatory to conduct cognitive-behavioral and motivational psychotherapy, training in the development of social skills and coping with stress.
Cognitive behavioral interventions are a set of techniques that are used to change behavior associated with substance abuse. Methods include functional analysis of problem behavior, cognitive restructuring, self-control, risk management, lifestyle and relapse prevention. An important step in motivational and cognitive-behavioral psychotherapy is the formation of a stable psychotherapeutic alliance and cooperation between a specialist and a patient.
Help in understanding problematic behavior, increasing motivation for treatment, overcoming stigma, pessimism and feelings of hopelessness. Learning skills to identify situations of increased risk of relapse, developing the ability to constructively cope with them, or avoid them.
Risk factors include situations of interpersonal interaction (conflict, anger towards another, etc.) and personal conditions (substance craving, negative thinking, etc.) that caused the patient to use psychoactive substances before treatment. It is necessary to involve patients in preparatory sessions for participation in self-help groups. Such sessions are a form of structured intervention that promotes patient involvement with Alcoholics Anonymous, Narcotics Anonymous, and others.
Work in self-help groups involves a long-term participation of a person in a relapse prevention program and as a result, the participants undergo changes not only in behavior, but also in their worldview, value system, attitudes and beliefs. In order to objectify the results and control during the treatment period, it is recommended to regularly conduct studies on the presence of surfactants in biological media.
The effectiveness of this stage of treatment can be judged by end results in three areas that matter both to the patient and to the public health and safety system:
Cessation or reduction of alcohol and drug use;
Strengthening health and social status;
Reducing the threat to public health and public safety.
The threat to public health and societal safety posed by substance abusers is the result of a variety of behaviors that lead to the spread of infectious diseases (including through blood-based sexual intercourse without a condom and the sharing of needles and other injecting equipment) and the commission of illegal actions and crimes with the aim of financing or continuing the abuse of psychoactive substances.
Efficiency criteria:
The number of patients under the supervision of the narcological service.
Proportion of patients maintaining remission from the contingent of patients.
Reduction in symptoms of dependence (in points), measured by the method "Index of Severity of Dependence".
Time to return to alcohol or drug use after treatment.
Improving quality of life indicators.
International non-profit organization "European Cities Against Drugs" - " European cities against drugs"
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