Treatment-resistance of patients using psychoactive substances and ways to overcome it.

The effectiveness of the addiction treatment is contradictory, controversial and debatable. Different departments of a similar profile, outpatient offices and rehabilitation centers do not give specific figures of recovery or remission. Nobody dares to build more long-term forecasts. The duration of rejection of substance for a year or more is a positive result in drug dispensaries. But in most cases it lasts from 3-4 weeks to 6-8 months. The opinion about the incurability of this disease and patterns of its outcome is found in many media, especially foreign, and in some sources of specialized literature. This position creates pessimism in the search for new therapeutic options for specialists and develops the senselessness of treatment in the eyes of patients. Disbelief in the classical approach of the therapy of one-stage drug substance withdrawal led to the possibility of substitutive methadone therapy, which is now widely spread in Ukraine. In fact, the patients are just legally transferred to other psychoactive substances, even more terrifying and unpredictable.

 

In general, indeed, therapy of drug addicted people is a complex, time consuming and difficult to predict process. The purpose of this study is to attempt to analyze the complex treatment of patients with dependencies (patent number 55863 dated 23. 11. 2011) in terms of allocation of therapy-resistant elements, and search for their origins and ways to overcome them.

One of the basic principles of psychotherapeutic drug addiction treatment center of Dr. Vasylenko in Zaporozhye is a conscious, self-adopted decision of a patient to overcome the disease. However, it is obvious that such a desire can be transient. It is expressed during the most intoxicated periods, but decreases or disappears at the height of the withdrawal syndrome. In this situation, abstinence creates an obstacle to active psychotherapeutic work and to the establishment of productive contact with patient. It is difficult to make a positive prognosis in cases when the choice of treatment is not caused by an internal need, but by parental restrictions or promised incentives (of finance or employment) after the treatment. As a rule, these motifs are originally veiled by a patient and rise up during the group or individual psychotherapy.

Some patients manifest panic fear of physical dependence, especially of sleeping disorders and muscle aches. All the decisions and conclusions are quickly minimized due to the formed stereotype to obtain instant relief by using psychoactive substances. During this period the patient is prone to search for a "drug" by all means. Especially dangerous are the patients who use methadone, because the peak of withdrawal syndrome falls on the 7th-10th day of the treatment.

The main cause for resistance in such situations is the ambivalence of motivations: the need for continued treatment and the desire to get rid of unpleasant physical symptoms. A compromise, according to the patients, is a desire to be "put to sleep for a few days", or they prefer to shift the blame entirely on physicians with statements like "I'm in the hospital, I need help". The result of this position is expressed in constant demands of "anesthetic" or "sleeping pills". The patient almost completely switches from the recovery process to the process of pain relief. Often patients adhere to this stereotype throughout the course of treatment, continuing to complain of physical ailment.

The way to overcome the lack of efficacy of treatment in these cases is addition of unconventional (laser therapy, acupuncture) and physiotherapy (infrared and kryosauna, TRANSAIR) methods. At the same time psychotherapy is added with a suggestive emphasis that all physical manifestations of withdrawal syndrome is the price paid for the "high" in the past and now it shifts responsibility for the suffering only on the patient. Justified is the position of a doctor that is fixing the patient’s attention on a daily physical improvement as a result of his own efforts and the possibility of rapid completion of withdrawal.

In some cases, doctors openly express their opinion about the patient's reluctance to get rid of dependence and the necessity to eliminate ineffective treatment. Often such patients return for further treatment after 1 - 2 months and throughout this period they did not use psychoactive substances. Taking responsibility on themselves for an incomplete course of treatment with the support of micro social environment shaped their need for continued therapy. Such conclusions can be very instructive for the rest of the group of patients undergoing complex treatment. They  give them a chance to rethink the validity of the decision to get rid of symptoms of the disease.

Another factor affecting the efficiency of the treatment is related to sessions of super stress group hypnosis. Sometimes this therapy is perceived as a "mockery", "violence against the personality", and unconsciously it generates another option of psychological protection.

Rarely do patients speak about “false patients or performers” in the course of treatment. This distrust is not always immediately expressed and discussed only among groups or parents. However, this opinion can be quickly detected in the behavior during the session. Such patients repeatedly tried to leave the session. When this was not possible, the patients nonverbally demonstrated alertness and rejection to the code words of the hypnosis. They constantly opened their eyes and looked around; tried to smile, laugh, and talk with neighbors; there was no emotional response to experiences in their mimic manifestations. Such an attitude could be formed by a personal position that a man with strong willpower cannot be influenced by suggestion (hypnosis). Patients with little experience of addiction claimed that the events described during the psychotherapeutic session were absent in their lives and could not happen at all. Patients with long period of substance use said they have seen so much in a lifetime that nothing new could teach them.

These statements require further disproof in the process of individual psychotherapeutic work. Emphasis was made on the allocation of the addicted "sub-personality" and the opportunity to see its manifestation with their "eyes open" and feel it emotionally. The demonstrated "life experience" and "willpower" was recommended to direct to the overcoming of the addiction, and not to the "struggle for independence" during the session. Compelling is the clarification of the fact that such complex diseases require radical psychotherapeutic approach. Ineffectiveness of previous treatment by other methods and programs confirms this conclusion.

An effective resistance management was a combination of hypnosis and simultaneous exposure to visual, auditory, olfactory and gustatory analyzers. Most unpleasant physical consequences of substance use (cachexia, rotted hands and feet, cellulitis at injection site) were translated on a big screen during the sessions. The sessions were potentiated with odor of putrefaction, vinegar, derivatives of cannabis and alcohol. Periodically the oral cavity was introduced with the indifferent substance to create the physical sensations of nausea and vomiting, which were fixed by super stress hypnosis. A selection of asynchronous audio tones and the use of multiple records of speech in different languages were carried out at the same time to make the patients quickly enter the state of altered consciousness. Such complex suggestive influence during the session is held successively by four therapists without pauses and breaks. Psychotherapy session is performed with increasing emotional stress and is accompanied by kinesthetic sensations. The formed effect is fixed by ERT therapy when the sensation of pain and suffering is reflected on the last period of use of substances and former life style.

The conduction of holotropic breathing was a kind of preparation for psychotherapy sessions of super stress suggestion. However, the effectiveness of this method was different among different patients. It was not efficient enough if the patient had the position of "treat me". This motivation observed minimum activity and with only a formal presence in the procedure. This was shown even in the patient's behavior: poses with hands behind the head and constant monitoring of the doctor and other patients actions; attending the session with a pillow and immediate turning to the sleeping pose; demonstrative pose with face down. In case of distrust to an ongoing session any external stimuli could distract the patient: a change of pose by a neighbor or a change in his respiratory rhythm; doctor’s attempt to help rhythmic breathing; the change of music’s sonority and activity.

The next obstacle for experiencing of all the "matrixes" was associated with physical discomfort and psychological memories. On a physical level it was manifested by contraction of facial muscles and reduction of hands. During the process of breathing the last presentation of former addicted life occurred with actualization of negative episodes of life. Often during this period the patient stopped breathing and tried to get up and leave.

Overcoming of these difficulties was implemented in individual psychotherapeutic work. Active independent work during this psychotherapeutic method was necessary to be explained. It is important to inform the patient about the possible negative feelings and psychological phenomena with the obligatory continuation of breathing to overcome them.

In some cases, holotropic breathing became some kind of panacea for all problems and addictions. This opinion was formed in result of a feeling of lightness, euphoria, psychological comfort during the first sessions. The danger of such reasoning is that during the next sessions of psychotherapy patients have attempted to duplicate this effect, ignoring all other components of the treatment process. Especially alarming were statements like - "it's better than the dope". Doctors usually warn that such feelings are only the first stage (matrix) of the treatment and require control of a specialist and do not replace other components of the complex therapy. It allows estimating the occurring phenomena intrinsically.

Another problem for the treatment was the manifestation of codependency among the persons accompanying the patient - phenomena of overprotection, excessive concern formed in a conflict with the ongoing course of treatment, and the difficulties in contact with medical staff and in understanding of the stages of therapy. It is usually the parents (or wives and husbands) that require excessive medical treatment during the first ten days and support such requirements of the patient.

These individuals required the prolonged staged group and individual psychological therapy on awareness and overcoming codependency. The most difficult attitude was: "This is my sick son (daughter), I cannot but take care of him (her)." During the subsequent treatment it was hard to overcome the excessive forms of control of quality and advancing in all procedures. In fact, it was a concealed form of the remaining discredit to the patient and to the effectiveness of the entire program.

In some cases, family seemed to have a complete lack of faith in the possibility of treatment effect; they were telling it to the patient and to all the staff, creating a permanent ground for conflicts and potential relapse. The situation was even more difficult when the accompanying person had no influence on the patient, or was entirely subordinated to him. In such cases, doctors insisted on arrival of not just a friend or relative, but of a person capable to assist positively in the treatment process. In rare cases the therapy was allowed to be continued alone.

Since the end of the second week of treatment there can be possible difficulties associated with a lack of understanding of the full scope of necessary therapeutic measures. Being in a stable physical condition, patients insisted on providing an early "encoding" or even a discharge. Further psychological work is initially aimed at learning of the right conduct in a further life after the discharge. Misunderstanding of its necessity leads to a possible imminent relapse in the former environment. In this case psychotherapeutic work is invaluable in terms of training. It forms the most effective social skills of behavior.

In general if the resistance occurs on any stage of the treatment, the center offers not only “encoding” with a special serum that is incompatible with life, but also its testing, a special “provocation” when a patient can feel physically his respiratory standstill, fear of death and “new birth”. In particularly difficult cases we recommend second fixing course (5-7 days after 3-6 months) for stabilization of emotions and will. If it is impossible, there are daily consultations available on the phone or on our website.

The investigated and description of all difficulties in the process of complex treatment, as well as methods of overcoming them will allow more successful, effective and lasting results among this category of patients.