Psychological assistance in drug addiction treatment

In the treatment of any type of addiction, and even more so - drug addiction, you cannot do without the help of a psychologist.

Of all types of pathological addictions, drug addiction is the most terrible in terms of transience and destructiveness. The use of drugs ruins not only the human body, but also the soul. If the more widespread alcoholism develops on average 10 - 15 years and does not necessarily end in the terminal stage with complete destruction of the personality, organs and tissues, then drug addiction leads to fatal consequences in a period from a year to 4 - 5 years.

It all depends on the type of drug, the intensity of its use and the sanitary and hygienic conditions in which the drug was taken. Of course, a wealthy addict who injects a drug with a sterile syringe from a trusted dealer in a nightclub toilet or in a private apartment is much less likely to catch AIDS or hepatitis C, as well as die from an overdose, gangrene or thrombophlebitis, than the guys and girls who remove the withdrawal symptoms in filthy basement with freshly brewed desomorphine, called "crocodile" for its murderous qualities.

But the essence of the matter does not change depending on social status: the concept of “experienced drug addict”, when it comes to hard drugs, is as absurd as “merry tragedy” - drug addicts do not live long. The only way to save your life is to get rid of it once and for all. addiction.

Getting rid of drug addiction on your own - is it real

The mechanism of dependence on most modern drugs - both opiates and amphetamine-type substances - is formed very quickly. The reason for this is simple - our body has its own opiates, which are responsible for the reactions of excitation and inhibition in the centers of the sense organs and psychoemotional sphere. If the body receives much stronger substitutes from the outside, a psychological dependence will arise, such euphoria that a person will no longer be able to resist the temptation to repeat the minutes of bliss over and over again.

As a result, addicted people in search of funds for the next dose go to crime. At first, relatives and friends become their victims - money gradually disappears from the house, Appliances, jewelry and other valuables. When home sources run dry, the addict switches to friends and acquaintances, and then to strangers. Depending on his physical capabilities and intellect (until the intellect has dried up), he trades in theft, fraud or banal robbery. The strong rob everyone in a row, the weak - children, women, defenseless pensioners.

At the same time, he tries to convince himself and others that this is last time... Alas, it is almost impossible to get rid of the disease on your own, without psychological help for drug addiction. In some cases, people who smoked marijuana or took light stimulant pills managed to do this. In the case of using stronger drugs, especially those that are injected intravenously, the chemical hook is too strong to jump off of it on its own, with one effort of will.

So is there a way out? How to break out of the vicious circle when all efforts are directed towards achieving a single goal - finding money for the next dose? The staff and former wards of the Exodus rehabilitation centers answer this question in the affirmative.

Getting rid of psychological and physical addiction in the network of Exodus centers

In the network of Exodus centers, already opened in dozens of cities of our country, experienced specialists provide spiritual, medical and psychological assistance to people suffering from drug addiction. An important condition for the work of the centers is absolute voluntariness, drug addicts come here of their own free will, sincerely wanting to get rid of their addiction. The only condition for admission to the therapeutic community of the Exodus is a kind of quarantine - a beginner must spend three days under the supervision of a mentor, completely refraining from taking any psychoactive substances (drugs, alcohol, nicotine). This measure becomes a confirmation of a person's firm intention to overcome his illness and the mental weakness that led to him.

We put psychological treatment of drug addiction and work with the inner world of patients on the same level with purely medical measures - detoxification of the body, treatment of dystrophy, which almost all drug addicts suffer, elimination of inflammatory processes on the skin, trophic ulcers, infectious diseases, to which drug addicts are especially vulnerable.

The principle of our center is physical and spiritual rehabilitation through acceptance of faith in God, since it is He who is the force that is capable of curing the most hopeless ailment.

Psychological treatment and getting rid of drugs is not a quick process, we immediately warn you: you cannot get rid of drug addiction in one or two months, as some fraudulent healers promise. The process of inpatient treatment in the therapeutic community alone takes at least six months. Depending on the type of drugs taken, the duration of addiction, the presence of acquired diseases, the period of therapy can last 9 months or a year. All this time, experienced psychologists of the center have been teaching a person to live in new conditions, focusing on spiritual rebirth, striving for creation and self-development.

Inpatient treatment is carried out in strict isolation within the therapeutic community. This is a compulsory measure, since a few weeks after the start of treatment, the withdrawal syndrome in drug addicts ends and the only factor that can lead them astray is communication with asocial elements from the previous environment. Our main task is to prevent such contacts and to ensure stable treatment and rehabilitation of patients.

Modern methods of treating psychological addiction

Doctors, psychologists, junior medical staff, mentors of our wards, who themselves were once patients of the Exodus centers, do their best to help drug addicts as quickly and efficiently as possible. We have at our disposal modern diagnostic and physiotherapy equipment, the latest drugs, the possibility of organizing occupational therapy and full-fledged leisure. If a drug addict has a family, we try to get in touch with it in order to ensure social rehabilitation of the person after completion of inpatient treatment. Sometimes family members of our patients also need the help of a psychologist - we are always ready to provide it.

Anyone who needs psychological help in the treatment of drug addiction and other types of addiction to psychoactive substances can contact the network of rehabilitation centers Exodus by a single toll-free phone 8-800-33-09-81 or call a consultant in their city (the list of phones is available in the section " Contacts"). Our accounts and communities are on all popular social networks.

Drug addiction is a terrible diagnosis. But faith in God and a person's own strengths can work miracles. And the staff and mentors of the Exodus network will always help those in need of healing and revival.

There are situations that seem hopeless. But even in them, relying on divine Providence, one can find a successful Exodus.

Drug addiction is one of the most difficult addictions that have befallen humanity. An uncontrolled craving for a harmful potion makes a person commit the most terrible and unprincipled acts, and the consequences of drug use ruin the lives of thousands of people. The use of drugs already from the first dose begins to have a negative effect on the nervous system of the body, which leads to inevitable degradation, both mental and physical.

Addiction Treatment Methods imply a special range of procedures and different kinds therapy, both physical and mental, for awakening in a dependent awareness of the need to stop taking drugs, as well as for the emergence in his mind of a desire to live a normal life. Modern medicine uses a comprehensive treatment for drug addicts, which includes both time-tested standard techniques and alternative and innovative approaches that affect mentality, spirituality and harmony with oneself.

Nazarliev's method

The method of treatment of Dr. Nazarliev is surrounded by an aura of mystery and enigma. To a proposal to extend their methodology, subject to the publication of a scientific manual with detailed description Doctor Nazarliev refused the course of treatment. It is only known that a receipt is taken from patients stating that the clinic does not bear any responsibility for the state of health of the addict during or after the course of therapy. It was also found that the methods of atropine lumps, holotropic breathing, shamanic rituals and pilgrimage are used to combat drug addiction. The use of which has not been scientifically proven to have a positive effect on the body.

Marshak method

The Marshak method includes 2 stages of therapy. At the first stage, a complete detoxification of the body is carried out using drugs that help remove drug residues and toxic products of their decay from the body. At the second stage, a psychotherapeutic approach is used with a focus on spirituality and mentality. In psychotherapy, kundalini yoga and elements of the "12 steps" program are used, which are aimed at achieving harmony with oneself, at the awareness of the need to quit taking drugs and for training willpower to fight the addiction.

Detox program (detoxification)

The Detox program (detoxification) promises patients a quick, easy and painless recovery from addiction. In the most difficult period of the first withdrawal after the complete abolition of drugs, the addict is put into a state of artificial sleep with the help of medical anesthesia used in surgical operations. After all the residues of narcotic substances and their decay products are removed from the body with the help of opioid antagonists, the patient can be injected with a large dose of a "mysterious" drug, which should relieve the craving for drugs and the high from taking them for at least six months.

Stereotactic brain surgery

Basically, stereotactic brain surgery is one of the methods of harsh psychotherapy, during which the patient is sure that his brain has really been subjected to surgical intervention... In this case, preoperative preparation is carried out - a course of drugs is taken, including medicines that weaken withdrawal symptoms and reduce cravings for drugs. After that, the patient is placed in a special and complex-looking apparatus for the procedure, and this is where it all ends. In the "postoperative period", a course of drug administration is also carried out. But it is also known that in Western countries experiments were actually carried out to identify and remove from the cerebral cortex of the so-called "pleasure center". Reliable positive results of such operations are not yet known.

Methadone substitution therapy

Methadone substitution therapy promises getting rid of drug addiction through the gradual transfer of the addict to another drug, however, as a result, they get addicted to two drugs, which makes the situation even more aggravated. Withdrawal symptoms with methadone withdrawal are much more severe than with heroin withdrawal. Along with this, the action of the drug depresses the respiratory centers, which can be fatal. In Russia, the use of methadone is prohibited by law, and all practitioners using this drug are also considered illegal and, of course, are not subject to licensing. Metadic addiction is considered incurable, so many drug treatment clinics do not even take such patients for rehabilitation.

Narcotics Anonymous Program

The program "Narcotics Anonymous", also known as "12 Steps", is a life-long course of psychotherapy, which is aimed at awareness of addicts of the need to quit drug use, to awaken in their minds the desire to live a normal life without a harmful potion. This therapy does not help to overcome withdrawal syndrome, but it helps the patient to adapt in the circle of new people - for this, both single and group consultations are carried out. There are no specialists in this program, but its uniqueness lies in the fact that while passing it, the addict can objectively assess everything that happens in his life and identify cause-and-effect relationships.

Hypnosis for the treatment of drug addicts

Hypnosis or coding, as it is now fashionable to call this procedure, is not a panacea in the fight against drug addiction. In the course of the session, although the influence on the subconscious is carried out, the effect of hypnosis lasts no more than a day, which already suggests that this method of therapy cannot give the desired result. Refusal to take drugs is impossible with hypnosis alone, but its use in combination with other methods of therapy helps the patient to better cope with his addiction. Also, with the help of hypnosis, it is easier for an addict to open his mind to a psychotherapist to identify the main reasons for using drugs, as well as to find solutions to the problem.

Antidepressants

Antidepressants are drugs, the main task of which is the gradual and imperceptible normalization of the psyche of the addict after refusing to take drugs. Antidepressants have a cumulative effect and begin to take effect only after a week of regular use. As a result, the patient's memory improves, concentration of attention increases, the tone of the body returns to normal, and the mood improves. Antidepressants are not the main drugs in the fight against addiction and, moreover, they cannot replace narcotic substances. Only the attending physician has the right to prescribe antidepressants to a patient.

Acupuncture (acupuncture)

Acupuncture (acupuncture) is a secondary or auxiliary method in the fight against drug addiction. Drug addiction, first of all, implies mental cravings, and only then, and not always, physical ones. Proceeding from this, only long-term and deep psychotherapy can help a drug addict get rid of the addiction, and acupuncture helps the body to better cope with drug withdrawal - blood pressure normalizes, appetite and mood improve, energy tone improves, metabolism "accelerates".

Medical and psychosocial rehabilitation

Medical and psychosocial rehabilitation is one of the most common and basic ways to get rid of drug addiction. The first stage is medical intervention, that is, treatment with drugs, detoxification of the body. The second stage is psychological rehabilitation. During which the patient communicates with psychologists, writes written assignments, participates in lectures, trainings and other activities aimed at realizing his problem and the optimal solution to get out of it. After completing this course of treatment and quitting drugs, the patient should return to normal life - family, friends, work, new acquaintances and communication with people. It can be very difficult for people with an unstable psyche, which addicts are, to adapt in society without the help of specialists. The final stage is aimed at this - social rehabilitation. It consists in helping to get a job, activities are carried out for constructive communication with people, psychological support to prevent relapse, counseling for relatives and friends.

Opioid agonist treatment

Opioid receptor agonists are drugs that act on the central nervous system and reduce its excitability, that is, they have a sedative effect. The use of these drugs, which include morphine, codeine, fentanyl and others, in the treatment of drug addiction, as a rule, leads to an aggravation of the problem, since these substances also cause addiction and withdrawal symptoms. Already after the second dose, dependence develops, which is accompanied by nausea, vomiting, bronchial spasms, constipation, and headaches.

Opioid antagonist treatment

The main drug on the basis of which other opioid antagonists have been developed is naltrexone. The danger of using only the method of taking these drugs, excluding psychotherapy, is that opioid antagonists reduce the degree of sensitivity nervous system to drugs, that is, having taken the usual dose, the addict will not feel the buzz, which leads to an increase in dosage and the likelihood of death due to depression of the respiratory centers of the nervous system. The drugs can be used in complex therapy along with psychoanalysis and other rehabilitation methods.

You need to know that there is no panacea, "magic pill" or method that would cure drug addiction one hundred percent at the moment. The above are only the main and frequently used methods, as a result of which addicts stopped using drugs. Since statistics in this area are not yet kept, it is difficult to say which one is better and which one is worse. As the saying goes, "in war, all means are good." The National Narcological Assistance Project was created to help those who are faced with drug addiction problems. On our website you can familiarize yourself with the causes, symptoms and consequences of this dangerous disease... And by calling our free hotline, our experts in the field of drug addiction will select an individually suitable treatment program for you. And even if drug addiction is a diagnosis, it is not a sentence.

Medical care for those suffering from drug addiction and substance abuse is provided, as a rule, by outpatient and inpatient units of the narcological service. Narcological service is a method drug and substance abuse treatment, as well as a set of specialized organizations that provide treatment-and-prophylactic, medico-social and medico-legal assistance to patients with alcoholism, drug addiction and substance abuse. There is also a hospital, a semi-hospital and an outpatient department.

The main institution-center of the service can be called a dispensary, which determines the early diagnosis of patients, treatment-diagnostic, counseling and psycho-preventive work; carries out dynamic dispensary observation of patients; analysis of the incidence of alcoholism, drug addiction and substance abuse, research on the effectiveness of medical and preventive care; provision of social assistance to the sick; psychological and preventive work, etc. A similar dispensary functions according to the district principle. People who suffer from alcoholism, drug addiction and substance abuse are assigned to the dispensary. A successful outcome of self-medication is observed in very rare cases.

It should be noted that drug and substance abuse treatment outpatient type of drug treatment is becoming the main type of care for those suffering from alcoholism, drug addiction and substance abuse, it consists of primary and secondary prevention of such a pathology. This type of medical care is carried out in the narcological dispensary, or in the narcological rooms of the Central regional hospitals.

The narcological dispensary includes a full-time psychiatrist-narcologist, who is called upon to provide assistance to children and adolescents who are addicted to excessive use of alcohol, drugs and toxic substances. Teenagers, as a rule, are on dispensary and prophylactic records until they reach the age of 18, and then they are transferred under the supervision of narcologists who treat the adult population. The main task of the adolescent drug treatment room is to carry out preventive work in schools, secondary specialized educational institutions and the Vocational Technical School.

The adolescent narcologist is in close cooperation with the juvenile affairs inspectorate and the appropriate commissions, parents of adolescents who are under observation in the office, and school teachers. Such a specialist is well trained not only in narcology, but also in child and adolescent psychiatry. There is a psychologist on the staff of the adolescent office who, in addition to a special psychological examination of adolescents, conducts psychocorrectional work with children and adolescents to confirm the diagnosis.

Addicts and drug addicts doctors-narcologists are placed in specialized departments. All initially established drug and substance abuse patients, as well as patients undergoing repeated drug addiction treatment, are subject to hospitalization. Hospitalization helps to isolate patients, which prevents the acquisition of drugs. Addiction and substance abuse treatment is carried out according to the following principles:

1) the initial stage (carried out only in a hospital) is a detoxification, restorative, stimulating therapy in combination with the termination of the use of a narcotic substance;

2) basic active anti-drug treatment;

3) supportive therapy (carried out on an outpatient basis, certainly includes a conversation and treatment with a psychiatrist).

Treatment of drug addiction and substance abuse begins with a sharp withdrawal of the drug (the only exceptions are cases of abuse of sedative-hypnotics and the combination of other drugs with high doses of these drugs).

Withdrawal of the drug is carried out in stages.

The first stage includes relief of withdrawal symptoms and detoxification measures aimed at normalizing somatoneurological disorders and correcting mental disorders. At the second stage, treatment is aimed at the complete restoration of metabolic disorders, behavioral disorders and the normalization of the mental state (including sleep). The third stage of treatment consists in identifying the main syndrome of mental dependence and conducting targeted therapy. This refers to the definition of the psychopathological design of the pathological craving for drugs and the characteristics of its dynamics (periodic, constant), etc. The last, fourth, stage consists in determining the conditions for the occurrence of relapses of the disease in order to prescribe anti-relapse maintenance therapy. Particular attention is paid to the reasons for the exacerbation of the craving for drugs. Situations and factors that cause the actualization of attraction are determined, including endogenous factors that lead to spontaneous actualization. The first two stages are usually carried out in a hospital setting, the third and fourth - on an outpatient basis.

Since chronic intoxication with narcotic drugs causes an imbalance in certain neurochemical systems of the brain, therapy should be aimed at restoring this imbalance, i.e. on the use of pathogenetically grounded therapeutic agents in combination with traditional methods of detoxification and psychotropic drugs.

Pathogenetically based therapy is naturally determined by the chemical structure and mechanism of action of the drug, as well as the structure of the clinical syndrome.

The most effective means of stopping opium withdrawal sivdroma are clonidine (clonidine), an a2-adrenergic receptor agonist in the central nervous system, tiapride (tiapridal), an atypical neuroleptic from the group of substituted benzamines, and tramal (tramadol hydrochloride), a centrally acting anesthetic. Complex application These drugs allow you to most effectively stop the main manifestations of withdrawal symptoms.

Clonidine therapy begins on the 1st day of withdrawal and continues for 5-9 days, gradually decreasing the dose. The initial daily dose of the drug taken orally should not exceed 0.6-0.9 mg for 3-4 doses. Clonidine most quickly and completely relieves somatovegetative disorders, to a much lesser extent affecting psychopathological and algic symptoms. Side effects of the drug include dry mouth, pronounced sedation, lowering blood pressure. In the case when blood pressure falls below 90/60 mm Hg, the dose of clonidine is reduced and cardiotonic drugs are prescribed (cordiamine, caffeine, etc.).

Tiaprid is highly effective against algic syndrome, psychopathic and affective disorders. Treatment is carried out according to the following scheme: tiapride is administered intramuscularly at a dose of 200 mg 3-4 times a day for the first 3-4 days, then during the next day the dose is reduced to 100 mg.

Tramal is prescribed in the first days of drug deprivation with a pronounced pain syndrome: 2-4 ml (100-200 mg) of tramal intramuscularly

3 times a day, then switch to oral administration of 50-100 mg 3-4 times a day, gradually reducing the dose as the intensity of the pain syndrome decreases. In the presence of joint pain, pheninbutazone (rheopyrin), ibuprofen (brufen) are also used, as well as warm baths, massage, etc.

For the relief of opium withdrawal syndrome, hemineurin (chlormethiazole, dextraneurin) can be used, which normalizes the function of the catecholamine system. Hemeineurin has an effect on disorders such as persistent insomnia, psychopathic disorders, and anxiety. Treatment with hemineurin begins with the development of the initial signs of opium withdrawal syndrome. The drug is prescribed in capsules of 300 mg orally. On average, a single dose is 600-900 mg, daily - from 1800 to 3900 mg, in most cases - 2700 mg (in 3-4 doses). The duration of the drug intake is 3-6 days. Of the side effects, one can note a rarely-felt feeling of weakness, weakness, and headache. This symptomatology stops after dose reduction. The most expedient use of this drug in patients with opium addiction, complicated by the use of barbiturates or other sedatives, because due to its anticonvulsant component, hemeneurin, in addition to relieving the above symptoms, reduces the likelihood of convulsive seizures during the period of withdrawal. In these cases, it is important that under the influence of hemeneurin, sleep disturbances are eliminated, which with opium withdrawal are extremely painful for patients and do not respond well to therapy.

To relieve opium withdrawal symptoms, they resort to a combination of opiate antagonists (naloxone, naltrexone) with clonidine. Naloxone accelerates the release of opium metabolites from receptors, which reduces the time for relief of withdrawal symptoms to 5-6 days. In the first days of therapy, the maximum doses of clonidine (0.9-1.2 mg) and the minimum doses of naloxone hydrochloride (0.2 mg) are prescribed, then the doses of the first are gradually reduced and the doses of the second are increased (up to 1.8 mg / day). so that by the end of the course of therapy, the patient receives only naloxone.

One of the promising directions in the treatment of opium addiction is the use of neuropeptides [Voronin KE, 1993]. Among them are cholecystokinin (pancreozymin), which is close to it in its pharmacological action, tacus (ceruletide), as well as a peptide that induces delta sleep (PVDS).

Takus is a decapeptide isolated from the Australian amphibian and subsequently synthesized. To relieve opium withdrawal syndrome, it is administered intravenously slowly (the dose is determined per 1 kg of the patient's body weight). Apply a solution of the drug in ampoules (in 1 ml

5 mcg). The average single dose is 3.5-4 mcg, the daily dose is 9-10.5 mcg. The contents of one ampoule are dissolved in 10 ml of isotonic sodium chloride solution. This dose is based on 100 kg of body weight. Then, depending on the patient's body weight, 1 ml is poured out for every 10 kg of the patient's body weight and isotonic sodium chloride solution up to 20 ml is added.

Tacus therapy is usually started on the 1-2 day of the development of withdrawal symptoms, when the patient develops pain in the muscles, joints, headache, weakness, lethargy, weakness, lack of appetite, diarrhea, lacrimation, sleep disturbances and other specific signs of this condition. During this period, dysfunctions of the nervous system are also observed - changes in tendon reflexes, nystagmus, mydriasis, dynamic and static ataxia, etc.

15-20 minutes after the administration of tacus, the majority of patients show a marked improvement in their general condition. The effect of a single injection of the drug lasts about 4-5 hours, so 2-4 injections are usually required per day. The total duration of the course of treatment with tacus is from 1 to 6 days (depending on the patient's condition, an average of 3 days), but the main manifestations of withdrawal symptoms usually stop by the 2nd day. Only asthenic phenomena and neurological disorders remain, which are eliminated in the following days.

Among the side effects of tacus treatment in rare cases (mainly with the first injections), there are nausea, vomiting, sweating, a feeling of heat, stomach cramps that develop during the administration of the drug. They can be avoided by slower administration of the drug and a decrease in its concentration in the injected solution.

For the relief of opium withdrawal syndrome, slow intravenous administration of cholecystokinin is also used. The drug is prescribed per 1 kg of the patient's body weight. Before administration, the contents of one bottle are dissolved in 15-20 ml of isotonic sodium chloride solution. A single injection of the drug has an effect within 5-10 hours. Usually 2-3 injections of cholecystokinin are required per day. The duration of treatment is from 2 to 6 days - an average of 4 days. The main manifestations of opium withdrawal syndrome (chills, joint pain, sweating, etc.) usually stop by the end of the 2nd day of treatment, and only asthenic disorders remain (weakness, lethargy, weakness, increased fatigue, etc.). Among the side effects should be noted rarely occurring nausea, vomiting, sweating, dizziness, fever, stomach cramps that develop during drug administration. However, in most cases, they are observed only with the first injections of cholecystokinin, and they can be avoided by increasing the time of administration or by decreasing the concentration of the drug in the injected solution.

For the relief of opium withdrawal use pyrroxane, which has adrenergic blocking properties [Pyatnitskaya IN. et al., 1974]. To relieve acute withdrawal symptoms and suppress the pathological craving for drugs, pill forms of pyrroxan (0.015 g in 1 tablet) are prescribed in large dosages: 0.03 g (2 tablets) 4-5 times a day or 0.45 g (3 tablets) 3 once a day. But it helps to reduce blood pressure, therefore it is contraindicated in severe atherosclerosis, coronary insufficiency, chronic cardiopulmonary syndrome, cerebrovascular accident, blood diseases, pregnancy.

A.G. Hoffman et al. (1979) for the relief of opium withdrawal recommend the use of increased doses of atropine sulfate, believing that the introduction of atropine blocks the cholinergic system. In this case, the excess acetylcholine formed during the withdrawal of opiates is destroyed by cholinesterase. Subsequent administration of eserine removes the blockade of cholinergic systems, establishing a dynamic equilibrium of acetylcholine and cholinesterase, disturbed during withdrawal of opiates, and restores synaptic transmission in cholinergic synapses. Sympathicotonia in this case is replaced by vagotonia, contributing to the elimination of withdrawal symptoms. For this purpose, 2-3 ml of a 1% solution of atropine sulfate is injected intramuscularly. At the same time, 0.25% eserine ointment is placed in the conjunctival sac, and the mucous membrane of the mouth is smeared with vaseline oil. After 1.5-2.5 hours after the introduction of atropine, 2 ml of a 0.1% solution of physostigmine (eserine) is injected subcutaneously. After the development of atropine delirium, withdrawal disorders, primarily autonomic disorders, quickly reverse development and sleep occurs. The next day, patients complain mainly of general physical weakness, a slight decrease in appetite.

For the treatment of opium addiction abroad, buprenorphine is widely used, which is a partial antagonist and partial agonist of opioid receptors. In small doses, this drug has a more pronounced antagonistic effect, and in large doses, it is agonistic. Buprenorphine has similar effects to other opiates and cross-tolerance to them [Biske1 ^ .H.,

1988]. Providing a mild antagonistic effect on opioid receptors, the drug is able to arrest the clinical manifestations characteristic of morphine intoxication, and due to its partially agonistic effect, it relieves acute manifestations of opium withdrawal syndrome. The latter served as the basis for the assumption about the possibility of using this drug for the treatment of patients with opium addiction. For relief of acute manifestations of opium withdrawal syndrome, buprenorphine is administered intramuscularly, an average single dose of 1-2 ml (0.3-0.6 mg). The daily dose depends on the individual dosages of the drug used, the duration of anesthesia, and the patient's somatic state. The average daily dose is 3-6 ml (0.9-1.8 mg) for 2-3 injections. Due to its agonistic action, buprenorphine relieves the algic syndrome rather quickly. At the same time, somatovegetative symptoms are reduced, and emotional tension is relieved. However, the use of the drug can cause the development of addiction to it. In Russia, buprenorphine is not used.

In the United States and a number of Western European countries, methadone, a synthetic opiate agonist, is also used to treat heroin addiction. It relieves acute manifestations of opium withdrawal syndrome, is a means of substitution therapy with supportive anti-relapse treatment.

Methadone was synthesized in Germany during World War II. It was first clinically studied in 1946 in the United States at a Kentucky hospital, where it was used to treat withdrawal symptoms in patients with opium addiction. Almost 20 years later, American scientists W. Bole, M. Muz ^ apdeg (1965) developed a method of methadone substitution therapy for patients with heroin addiction, which was based on the following features of the drug: its prolonged action (it can have an effect within 24-36 hours , therefore, it is administered 1 time per day) and the possibility of ingestion, since it is produced in the form of a powder (there is also a liquid form, which is used mainly to relieve withdrawal symptoms). The initial dose of methadone is 30-40 mg / day. Doses can be increased by 10 mg every 2 days or every week until stable dosages are achieved without withdrawal symptoms. These stable doses range from 50 to 80 mg / day. At the beginning of the outpatient course

supportive care, patients visit the clinic every day, receiving a daily dose of the drug. Then the frequency of visits is reduced to 2-3 times a week. There are short-term methadone programs, when patients receive stable doses of the drug for 6 months, and long-term, when stable doses are prescribed from 6 months to 2 years.

In the late 60s and early 70s, studies were conducted on a more long-acting and methadone-related drug - levo-alpha-acetylmethadyl (LAAM), which can be administered not daily, but once every 2-3 days.

There are many supporters of methadone maintenance therapy who justify the need for the active development of methadone programs by the following circumstances: 1) since few patients themselves can stop using opiates, maintenance methadone treatment carried out by medical personnel contributes to the gradual return of patients to a full life; 2) substitution therapy with methadone significantly reduces the criminality of patients, since it eliminates the need to purchase drugs on the "black market", their theft from pharmacies, and reduces the number of clients of drug dealers; 3) since methadone is used orally, and not intravenously, methadone substitution therapy is an important preventive measure for infectious diseases, primarily AIDS and hepatitis [Ba11 I.

E! A1. 1987; Spinger E. 1991; Bgaskeg E., 1995]. But at the same time, during methadone treatment, there is a risk that patients, along with this drug, will continue to use heroin, and this can lead to drug overdose [Ba11. GB., Kozh A., 1991; Kozh A., 1991]. The possibility of the formation of dependence on methadone is also possible. Substitution therapy with the latter, according to A.G. Hoffman (1994), is the replacement of one drug with another. In addition, methadone can cause complications. Patients on this treatment can trade in the drug and thus involve other persons in drug addiction. In Russia, methadone treatment is prohibited.

When treating patients who abuse drugs of the sedative-hypnotic group (mainly barbiturates), the dose of the drug is gradually reduced to exclude the possibility of the development of convulsive seizures and psychosis in the structure of the withdrawal syndrome. At the same time, on the 1st day, * / s DOSE of barbiturates taken by the patient is prescribed, followed by its decrease every day by * / s- It should be noted that patients often overestimate the doses of drugs taken, therefore, it is necessary to focus primarily on the clinical picture and behavior of patients. If the dose of barbiturates is relatively small, you can cancel them at once, and for the prevention of seizures and psychosis, prescribe replacement therapy: pagluferal (Sereisky's mixture) 1 tablet 2-3 times a day for 3-4 days, phenobarbital - 30 mg for each 100 mg of sleeping pills used by the addict, i.e. about * / W D ° zy. Only after a 2-day stabilization of the patient's condition at the selected dose of phenobarbital, its gradual decrease is carried out until the drug is completely discontinued.

In cases where the patient concealed the intake of sleeping pills or the dose of the drug was sharply reduced, seizures, deceptions of perception and psychomotor agitation may develop. In this case, it is necessary to enter the patient with an additional dose of the drug, which he abused. In order to avoid the development of seizures and psychotic disorders, detoxification measures should be carried out with caution.

When stopping withdrawal symptoms that develop in patients with barbituric drug addiction, substance abuse with sedatives (benzodiazepine tranquilizers, antihistamines, etc.), as well as polydrug addiction, including the systematic use of barbiturates or other sedatives, nice results were obtained using mildranate [Petrakova LB, 1992; Voronin KE, 1993]. Mildranate is a structural analogue of carmitine, its maximum concentration in blood plasma is reached within 2-3 hours. It is produced in capsules of 0.25 g or as a 10% solution in ampoules of 5 ml. It has an anticonvulsant and stimulating effect. Parenteral use of this drug from the first days of withdrawal syndrome (3-4 injections of 5 ml of 10% solution per day) prevents the development of convulsive phenomena inherent in barbituric withdrawal syndrome and relieves severe asthenic disorders characteristic of these forms of drug addiction (feeling of weakness, weakness, lethargy, etc.). The duration of treatment is on average 5-7 days. Side effects and complications were not observed [Voronin KE, 1993].

The optimal treatment regimen for withdrawal in drug addictions caused by the use of psychostimulants is a combination of drugs that affect the dopaminergic mechanisms (bromocriptine), which primarily relieve the asthenic symptom complex and, in part, neurological disorders, and antidepressants that affect the serotoninergic system (fluvoxamine) (fluvoxamine). Bromocriptine (parlodel) is prescribed to patients in the first days of the development of withdrawal syndrome in a daily dose of 2.5-3.75 mg. After the relief of acute withdrawal symptoms, treatment with bromocriptine is continued, prescribing it for oral administration at 1-1.25 mg per day for several months to prevent possible actualization of pathological craving for the drug and prevent relapses. Fluvoxamine is indicated when the main signs of withdrawal syndrome appear - decreased mood, apathy, weakness, lethargy, irritability. The average daily dose is 150 mg (for 3 doses). The duration of therapy is from 1 week to 2 months.

Simultaneously with the described pathogenetic therapy of drug addiction, detoxification and restorative treatment is carried out. For this purpose, a complex of various vitamins, especially of group B, is used: 6% solution of vitamin B [(thiamine) - 4-6 ml intramuscularly per day; 5% solution of vitamin B5 - 2-4 ml per day; 1% solution of vitamin PP - 1-2 ml per day. A 25% solution of magnesium sulfate is also used from 2 to 8 ml with 15-20 ml of a 40% glucose solution. Less commonly, intravenous administration of rheopolyglucin, hemodez, isotonic sodium chloride solution is used (in patients who inject drugs intravenously; in this case, there may be an exacerbation of pathological attraction to them).

For the relief of mental disorders present in the structure of withdrawal symptoms, it is recommended to use antipsychotics and antidepressants. Depending on the condition of the patients and the compatibility of these drugs with other drugs used to relieve acute withdrawal symptoms, antipsychotics and antidepressants are prescribed either from the first days or a few days after the start of therapy. The prescription of these drugs is most relevant when psychopathological disorders come to the fore. Doses of psychotropic drugs are selected individually.

When choosing antidepressants, preference should be given to drugs that, along with thymoleptic, have a sedative or balanced effect. Among antidepressants, amitriptyline is recommended - the average daily dose is 75-100 mg, herfonal (trimepramine) - 100-150 mg, anafranil (clomipramine) - 75-100 mg, pyrazidol - 150-200 mg, ludiomil - 75-100 mg, fluvoxamine - 150-200 mg, azafen - 100-125 mg, miansan (lerivon) - 60-120 mg. With more pronounced depression, amitriptyline is administered parenterally in 2 ml of 1% solution 2-3 times a day. Because depression in drug addiction is usually associated with dysphoria, anxiety, and motor restlessness, antidepressants are best combined with mild antipsychotics. Depending on the severity of anxiety, agitation, hypochondriacal disorders, and behavioral disorders in patients, you can prescribe melleril (sonapax) - 75-100 mg / day, teralen (alimenazine) - 15-20 mg / day, haloperidol - 4, 5-9 mg / day, neuleptil (periciazine) - 20-30 mg / day, eglonil (sulpiride) - 300-600 mg / day. The latter has antidepressant and anxiolytic effects. To correct affective lability and dysphoric disorders, lithium salts (0.6-0.9 g / day) are used, as well as carbamazepine (tegretol, finlepsin) - 600 mg / day.

After relief of acute withdrawal disorders at stages 2-3 of treatment, a high therapeutic effect is obtained by intravenous drip of melipramine (200-300 mg / day), amitriptyline (200-300 mg / day), ludiomil (75-100 mg / day). N.N. Ivanets, I.P. Anokhina, N.V. Strelets (1997) recommend prescribing the procedure in the evening. The entire daily dose is administered slowly over 1.5-2 hours. Subjective improvement in patients' well-being is noted after 1-2 procedures. A total of 7-10 procedures are performed. But in this case, it should be remembered that in patients who inject drugs intravenously, any additional intravenous injections can exacerbate the pathological craving for the drug. To suppress the latter, long-acting and short-acting antipsychotics are used. Among the drugs with prolonged action, the most effective are piportil L-4 (25-50 mg once every 2-3 weeks) and haloperidol decanoate; among short-acting neuroleptics - haloperidol (4.5-6 mg / day by mouth or 1-2 ml of 0.5% solution 2-3 times a day), tisercin (50-75 mg / day), stelazine (15-20 mg / day). You can also use carbamazepine (tegretol, finlepsin) and eglonil. Neuleptil (30-40 mg / day), Sonapax (100-125 mg) are also recommended to correct the behavior of patients, to relieve irritability and dysphoria.

With a pronounced asthenic symptom complex, in addition to other therapeutic agents, mild stimulants and nootropic drugs can be prescribed. However, it should be noted that in some cases, nootropics, in particular piracetam, contribute to the exacerbation of the pathological craving for the drug.

It should be noted the importance of the treatment of agripnic disorders characteristic of most drug addicts at the initial stages of treatment. Therefore, tranquilizers are added to the main complex of funds at night (phenazepam, rohypnol, reladorm, radedorm, seduxen, relanium, etc.). Sometimes it is advisable to use a combination of short-acting benzodiazepines (for example, diazepam or intramuscular rohypnol) with composite preparations, which include benzodiazepines and a small amount of barbiturates. However, such drugs, of course, should be prescribed with caution, and it is more preferable to prescribe antipsychotics with a pronounced hypnotic effect (leponex, 12.5-25 mg), haloperidol, tizercin, chlorpromazine (in conventional doses intramuscularly). In severe sleep disorders, a combination of these antipsychotics with benzodiazepines can be effective.

The relief of mental disorders is most important in the second and third stages of treatment.

In cases of abstinence caused by abrupt withdrawal of cannabis drugs (marijuana, hashish), symptomatic remedies for relieving headaches, sleep disorders, decreased appetite, palpitations, irritability or apathy, etc. bromides with valerian and motherwort, meprotan, trioxazine, oxylidine, elenium, seduxen, chlorpromazine, tizercin at night, as well as iron preparations, belloid or bellaspon.

Therapy of inhalation substance abuse and abuse of hallucinogens is symptomatic.

In addition to drugs, reflexology (acupuncture), neuroelectrostimulation, extracorporeal detoxification methods, in particular plasmapheresis, are used to alleviate withdrawal symptoms. N.N. Ivanets, I.P. Anokhina, N.V. Strelets (1997) recommend carrying out two methods of plasmapheresis: discrete, when plasmapheresis is used starting from the moment the first signs of withdrawal symptoms appear and then repeated several times, and simultaneous, when the plasmapheresis procedure is carried out at the final stages of the development of acute withdrawal symptoms. GM Mitrofanova (1995) recommends plasmapheresis on the 5-7th day of therapy.

It is advisable to use physiotherapy methods, taking into account individual indications and contraindications.

Psychotherapy occupies a major place in the treatment of drug addiction. The first examination and the first conversation with the patient should be used as the first session of psychotherapeutic influence. Subsequent psychotherapeutic conversations should be aimed at achieving positive attitudes of patients for complete abstinence from the use of drugs and other drugs that cause painful addiction, as well as for the patient's systematic passage of courses of supportive anti-relapse treatment in an out-of-hospital setting. Special types of psychotherapy are carried out after the relief of acute withdrawal symptoms until the moment of discharge. Their goal is to develop an attitude towards abstinence from drugs.

Anti-relapse treatment. When using drugs of the opium group, one of the means of specific pathogenetic anti-contradictory therapy is naltrexone hydrochloride (naltrexone), an opium receptor antagonist. The mechanism of its action is the blockade of opium receptors, as a result of which the opiates taken by the patient do not cause their inherent effects. A prerequisite the use of naltrexone in these cases is the preliminary complete relief of withdrawal symptoms. Naltrexone is taken by mouth at 350 mg per week. There are 2 schemes for taking it: 1) 1 tablet (50 mg) daily in the morning; 2) 2 tablets (100 mg) 2 times a week (for example, on Monday and Wednesday) and 3 tablets (150 mg) once a week (on Friday). The course of treatment is up to 180 days or more. Side effects (skin redness, chills, weakness due to individual sensitivity and incomplete detoxification) usually disappear during therapy. Orthostatic collapses may occur with alcohol overdose during therapy. When psychopathological symptoms of primary pathological craving for drugs appear, additional prescription of appropriate psychotropic drugs is required.

Bromocriptine and fluvoxamine can serve as pathogenetic agents of anti-relapse therapy of drug addiction caused by taking psychostimulants.

In addition to specific treatment programs, the entire spectrum of psychotropic drugs (neuroleptics, antidepressants, tranquilizers, nootropics, lithium salts, etc.) is widely used, which is determined by the clinical and psychopathological picture of the syndrome being stopped.

With the actualization of the signs of a primary pathological craving for drugs, characterized by a persistent frequency and a gradual or sudden development of affective disorders, lithium salts with the addition of antidepressants, if necessary, are the means of choice for therapy; with a predominance of asthenic disorders, nootropics are used: piracetam (nootropil) at a dose of 2-2.4 g per day, encephabol - 200-300 mg, gammalon (aminalon) - 1.5-3 g, picamilon at a dose of 0.02-0, 15 g per day; lithium salts: lithium oxybutyrate - 1-1.5 g, micalite - 2-3 capsules (0.8-1.2 g of lithium carbonate) per day, lithonite - 300-400 mg per day; antidepressants - amitriptyline, miansan, maprotil, floxiral, azafen, pyrazidol. The courses of treatment are from 2 to 12 months with interruptions from 2 weeks to 1 month.

In the presence of psychopathic disorders in the structure of the primary pathological craving for drugs, neuroleptics such as neuleptil (peritsiazine) at a dose of 10-20 mg, sonapax - 30-100 mg, teralen (alimenazine) - 15-75 mg per day, etc. mild antipsychotics is ineffective, prolonged forms of piportil or haloperidol are prescribed. Benzodiazepine tranquilizers (lorazepam, phenazepam, diazepam, chlordiazepoxide, alprazolam, etc.) are used to relieve symptoms such as anxiety, fear, anxiety. To stop "outbreaks" of actualization of the pathological craving for drugs, it is advisable to use anticonvulsants - carbamazepine (finlepsin, tegretol), diphenin, Konvulex.

An important place in anti-relapse programs should be occupied by psychotherapy and rehabilitative influences.

Treatment addiction implies a set of measures aimed at stopping the patient's taking narcotic drugs ( or other addictive substances). However, in practice, assistance to drug addicts includes many more areas.

Comprehensive assistance and treatment for drug addicts includes the following areas:

• the actual elimination of dependence;
• treatment of complications and health problems associated with drug use;
• socialization of the patient ( returning him to normal life to consolidate the result of treatment).

Drug addiction treatment is associated with many different problems that arise during the course of both the patient and the doctors. In general, drug addiction can be viewed as a chronic disease that lasts for years and gradually worsens a person's health. The main difference is that the patient in this case often does not realize that he needs medical help. While patients with other chronic diseases actively cooperate with doctors and follow the instructions of a specialist, in the case of drug addiction, such cooperation usually does not occur. Most patients experience a strong psychological dependence, which creates serious difficulties in the treatment process.

Another feature of the treatment is the conditionality of the result. The infection or inflammation can be completely eliminated and it can be concluded that the patient has recovered. In the case of drug addiction, it is almost impossible to ascertain recovery. The patient is helped to get rid of physical and psychological dependence, treat the health problems that have arisen, but after a conditional "discharge" and the end of treatment, he can ( often knowingly) return to drug use.

That is why there are many different approaches to drug addiction treatment in modern medicine. Regardless of the method used, the success of treatment will largely depend on the efforts that the patient himself will make to recover.

Basic rules of complex drug addiction treatment

To effectively treat drug addiction, doctors try to select a separate course of treatment for each patient. It depends on the type of drug, experience, general condition of the body and many other factors. However, there are a number of general rules that people try to adhere to when treating drug addiction. They are relevant to one degree or another for all patients suffering from drug addiction.

In the treatment of drug addiction, specialists are based on the following principles:

• Awareness of the problem and desire to be treated. The most important condition for effective treatment is the patient's sincere desire to get better. Psychologists and specially trained volunteers initially work with all drug addicts, who try to "push" them to start a full-fledged treatment.
• Anonymity. Most patients suffering from drug addiction experience severe psychological discomfort. They try to hide their problem from family and friends, they are afraid possible consequences at the place of work, etc. Therefore, most clinics adhere to the principle of anonymity, when the patient's personal data is known only to the attending physicians. Disclosure to certain people occurs with the consent of the patient ( if their help is needed in treatment).
• Detoxification. Detoxification is the cleansing of the drug from the body. It can be carried out using special solutions ( droppers with rheopolyglucin or hemodez bind toxins in the blood). Also, diuretics are prescribed, which accelerate the elimination of toxins in a natural way. Faster methods are plasmapheresis ( removal of plasma with toxins by centrifuging the blood), hemodialysis ( blood purification with an "artificial kidney") and hemosorption ( filtration of blood through a special apparatus that specifically binds certain toxins). The choice of detoxification method is up to the doctor, as each method has its own advantages and disadvantages. To one degree or another, detoxification at the beginning of treatment is necessary for almost all patients.
• Psychotherapy. Psychotherapy is the longest and most difficult stage in the treatment of any addiction. Here, specialists select an individual approach to each patient. This method of treatment is mandatory, as only with its help it is possible to cope with psychological addiction.
• Socialization of patients. This principle is necessary for patients who have used potent drugs ( heroin, morphine, cocaine, etc.). In these cases, treatment does not end with getting rid of the addiction. Social workers cooperate with the patient for a long time to consolidate the result.

An important point in the treatment of drug addiction is the assessment of its effectiveness. The problem is that the patient's subjective opinion cannot be trusted in this case. Some patients report a quick and complete recovery, only to quickly get out of the supervision of doctors and return to drug use. In this regard, experts recommend evaluating the effectiveness of treatment solely by objective indicators.

The criteria for assessing the effectiveness of treatment can be the following indicators:

• the emergence of a hobby;
• the ability to concentrate on extraneous activities;
• the nature of the movements;
• the degree of sociability ( with hospital staff, relatives or other patients);
• general emotional state;
• objective medical criteria ( stable blood pressure, heart rate, etc.).

Outpatient and inpatient ( in hospital) treatment of drug addicted patients

Any treatment can be divided into inpatient and outpatient. In the case of inpatient treatment, the patient is placed in a hospital, where he is under constant medical supervision for a certain period of time. This makes it possible to more thoroughly and intensively deal with his treatment. There are also options when the patient spends only the daytime in the hospital and sleeps at home.

Outpatient treatment involves visiting hospitals and clinics only for periodic consultation with doctors and for certain procedures. Most of the time the patient spends at home or at work, that is, he lives almost an ordinary life.

In the treatment of drug addicts, inpatient treatment is, of course, preferable. Constant monitoring by medical personnel keeps the patient from reusing drugs. If necessary, he will be provided with qualified medical assistance. Patients who have undergone detoxification and have eliminated physical dependence are transferred to outpatient treatment.

In general, the question of whether to treat a patient on an outpatient basis or in a hospital is decided by the patient himself at the first consultation with a specialist. The effectiveness of both methods is influenced by what kind of drugs the patient uses, his lifestyle, home environment, and psychological state. For example, in the case of using opiates at a certain stage, in any case, you will need to go to the hospital, since the withdrawal syndrome can be very difficult ( with violation of vital functions of the body). In the case of smoking or alcoholism, hospitalization is possible, but not required. This largely depends on the patient himself.

Is compulsory treatment of drug addicted people possible?

Compulsory drug addiction treatment is a very acute issue that often worries not only the patients themselves, but also their environment. In many states, relevant laws have been adopted that allow in certain cases to send a patient for compulsory treatment. This has both advantages and disadvantages.

In countries with relevant legislation, compulsory treatment is possible in the following cases:

• for persons who have committed criminal offenses;
• for persons in case of administrative violations ( maybe not in all countries);
• minors by decision of parents or guardians ( with the involvement of specialists and competent authorities).

The main disadvantage of compulsory treatment is opposition to the treatment of the patient himself. Patients often follow the prescriptions of doctors and get rid of physical addiction, but after being discharged from the hospital, they almost immediately return to drug use. Moreover, after such a break and during treatment, the body may react too strongly to the usual "dose", and the patient will simply die from an overdose.

Another disadvantage of compulsory treatment is an example for other drug addicts. Realizing that they may be obliged to undergo treatment at any time, they feel rejected by society, which poses serious obstacles to their recovery.

At the moment, most countries in the world have legal provisions and relevant laws that allow a patient to be sent for compulsory treatment. As a rule, this is done by a court decision with the involvement of competent specialists. However, leading international organizations to combat drug addiction do not recommend resorting to such measures in all cases. Isolation of the patient can protect society from potential threats, but it is almost impossible to achieve complete recovery in these cases. Even qualified psychological assistance does not always help to achieve patient cooperation in treatment. If the addict categorically does not want to be treated, there is no chance of recovery. Preferred are preventive work and activities that push people to seek medical help on their own.

What kind of doctor treats drug addiction?

In most cases of drug addiction, the main ( treating) the doctor is narcologist ( sign up) ... This specialty, in fact, is one of the branches of psychiatry, but it has its own characteristics. Narcologists work mainly in specialized clinics and dispensaries. However, their offices are also in large multidisciplinary hospitals.

Since most drugs not only cause addiction, but also disrupt the work of various organs and systems, complex treatment may require the help of other specialists. The narcologist usually prescribes basic tests to assess the functioning of the body. After that, in the event of certain violations, he sends the patient for consultation to other doctors or calls them to a dispensary for consultation. If necessary, the patient can be temporarily transferred to other departments or hospitals. For example, with severe renal failure due to drug use, the patient is placed in the nephrology department in order to eliminate the most serious threat to life.

The following doctors may be involved in counseling:

• neuropathologist ( sign up) ;
• therapist ( sign up) ;
• surgeon ( sign up) ;
• dermatologist ( sign up) ;
• gastroenterologist ( sign up) ;
• nephrologist ( sign up) ;
• cardiologist ( sign up) and etc.

The range of specialists that may be needed is very wide, since each drug affects mainly the work of a particular system or organ. The method of injecting the drug into the body is also of some importance. With the inhalation method, for example, the lungs can be damaged, and a consultation with a pulmonologist is required. When administered intravenously, blood vessels may be damaged, and the patient will be referred to a surgeon.

Stages of drug addiction treatment ( detoxification, habit quitting, rehabilitation)

Any drug dependence treatment program must include several stages. This is due to the characteristic disorders in the body that occur in drug addicted people. In one form or another, these stages are present in the complex treatment offered by any clinic or medical center.

In the treatment of drug addiction, the following stages are distinguished:

• Detoxification. The drugs that the patient used before starting treatment are removed from the body rather slowly. In almost all patients, they are present in the blood for some time. The detoxification stage involves the complete elimination of these substances from the body. Since drug use stops here, within this stage, doctors are fighting with withdrawal symptoms ( physical addiction). As a rule, the first stage lasts from several days to a week.
• Elimination of consequences and complications. Taking drugs is associated with damage to many internal organs and systems, which also need to be eliminated in the course of treatment. Attention is paid to this at the second stage. The patient undergoes a thorough examination and, as a rule, spends some time in the hospital. The duration of this stage depends on the disorders in the body of a particular patient.
• Fighting psychological addiction. This stage involves getting rid of psychological dependence. The patient works with a psychologist ( inpatient or outpatient), gets rid of habits associated with drug use, etc. This stage can take a very long time ( weeks, months). In fact, getting rid of psychological addiction completely can be considered a recovery.
• Rehabilitation. This stage is auxiliary. Its main task is to prevent relapse ( return to drug use). In the process of rehabilitation, not doctors, but psychologists or specially trained volunteers can work with the patient. They try to return the patient to normal life and introduce him into a normal society. The priority is the patient's return to normal life, renewal of acquaintances, job search, etc.

Many experts offer a more detailed subdivision of treatment into stages, but in general, the scheme is still similar to that described above. Of course, each case has its own characteristics. The preliminary treatment plan and its stages can be discussed in more detail with your doctor.

Drugs for medical treatment ( pain relievers, essential oils, antidepressants, etc.)

A wide variety of pharmaceuticals can be used in the treatment of drug addiction. The leading role in this case is assigned to those substances that help in the early stages to remove the main manifestations of withdrawal symptoms. Most often, appropriate antipsychotics are used, which help suppress psychoses that occur after drug withdrawal.

An important place is also occupied by substances similar in action to the drug that the patient was taking. Many clinics use and recommend a gradual dose reduction method. Thus, in the first days or weeks of treatment, the patient may be prescribed opiates or other substances in reduced doses. This allows you to reduce the manifestations of withdrawal symptoms and quickly establish contact with the patient ( patients are psychologically more comfortable, knowing that the drug is gradually canceled). In some clinics, certain patients with minimal doses are transferred to placebo. However, this tactic is not universally approved and is not used in every case.

Quite often, the following pharmacological drugs are used in the treatment of drug addiction:

• Antidepressants. Sooner or later, these drugs are prescribed in almost all cases of drug addiction treatment. In many patients, due to disorders in the central nervous system, sensitivity to antidepressants may be increased. Doctors carefully and individually select the dose, which, as a rule, has a good sedative ( calming) and hypnotic effect. The most commonly used drug in the treatment of drug addiction is amitriptyline.
• Lithium salts. These drugs support the normal functioning of the central nervous system well ( central nervous system), but are more often used for long courses of treatment.
• Tranquilizers. This group of drugs effectively relieves many of the symptoms that occur in the first days of treatment. However, tranquilizers are used less frequently because of the possible euphoric effect and the development of addiction with prolonged use.
• Pain medications. This group is not used very often. The pain that patients experience with drug withdrawal is partly of a mental nature. Conventional pain relievers ( non-steroidal anti-inflammatory drugs) they are not removed. They can be prescribed if symptoms are present.

In general, the range of drugs used directly to eliminate drug addiction belongs to the field of psychiatry. Specialists of this profile can objectively assess the patient's condition and prescribe the necessary medications. Very great importance has the correct dose selection. Drugs that affect receptors and neural connections in the central nervous system are perceived differently by drug addicts. Due to long-term drug use, susceptibility to such drugs can vary greatly. It often takes a long time to find the right dose at the beginning of treatment.

Special attention in the treatment of drug addiction requires the use of the following drugs:

• pyrroxane;
• clonidine;
• pyrazidol;
• GABA preparations ( gamma-aminobutyric acid);
• levodopa, etc.

These substances, if the dose is chosen incorrectly, can cause a variety of effects. Accustomed to normal person a dose of levodopa, for example, can cause a mood elevation similar to the euphoria of a drug. Beta blockers in high doses can cause severe insomnia. That is why, before starting treatment, a patient suffering from drug addiction is carefully questioned and examined.

It is also recommended not to disclose to patients full list substances that are used in the course of treatment. On the one hand, this contradicts the legislation regarding the patient's rights ( in some countries). On the other hand, in the case of drug addiction treatment, this prevents subsequent self-medication with dangerous drugs and reduces the risk of relapse ( re-exacerbation).

Drugs for symptomatic treatment are of secondary importance in the treatment of drug addiction. These can be drugs from a wide variety of pharmacological groups. Their choice depends on the results of objective research. For example, if a patient has heart problems while using drugs, he will be prescribed appropriate drugs that affect cardiac activity. This treatment is prescribed by a specialized specialist ( cardiologist, nephrologist, neuropathologist, etc.).

Is it possible to treat drug addiction at home?

Treatment of drug addiction at home, in principle, is possible, but its effectiveness is usually much lower than in the case of treatment in a specialized institution. Most narcologists agree that at the beginning of treatment, it is better for a patient suffering from drug addiction to change the environment. It helps to tune in to change and overcome psychological addiction to drugs. In addition, home treatment can be downright dangerous.

The main disadvantages of drug addiction treatment at home are:

• Lack of constant monitoring. Even patients who themselves have consulted a doctor to get rid of drug addiction may not be able to cope on their own at some point. Cessation of drug use is essential for successful treatment, and this is associated with depression, pain and other serious consequences. Under the supervision of specialists, this period is easier to transfer.
• Danger to the patient. Withdrawal syndrome in the case of drug use is often associated with serious disruptions in the body. At home, the patient may die in the event of serious complications. In the hospital, under the supervision of doctors, he will be provided with the necessary assistance on time.
• Danger to the patient environment. In some cases, drug cessation is associated with serious mental disorders ( hallucinations, severe depression, aggressiveness, etc.). At such moments, the patient is a danger even to the closest people. That is why leaving him to be treated at home is very risky.

In general, however, the treatment tactics for each patient is selected individually and must be coordinated with the patient himself. Home treatment is quite possible, but regular consultations and, if possible, observation of the patient is necessary in any case.

What is the first step a drug addict must take to recover?

In any drug addiction, the most important condition for treatment is the desire of the patient himself. Many patients sooner or later begin to realize their physical dependence, as they notice that without regular drug use they feel bad. However, to start treatment, you need to be aware of the psychological dependence. If the patient does not volunteer to help doctors and tries to follow the prescribed treatment, none of the methods will help him, and sooner or later he will start using drugs again.

If the patient wants to get rid of addiction, he can take the following steps at the first stage:

• see a general practitioner ( therapist, family doctor, etc.), who will refer him to a specialized specialist;
• go to a narcological dispensary and register;
• contact any public organization that provides such assistance ( by phone, mail, etc.).

At present, the network of organizations providing assistance to drug addicts is well developed in most countries of the world. When contacting a medical institution or one of these centers, the patient can sign up for a consultation with a specialist free of charge. After that, he will be provided with assistance in the amount that he deems necessary. In many cases, doctors have no way of getting the patient to be treated. He must voluntarily follow the advice of doctors. Some patients register at drug treatment dispensaries, but still continue to use drugs. In any case, the first step in treatment will be a voluntary appeal to a specialized specialist and qualified consultation.

Is it possible to get rid of drug addiction on your own?

In most cases, it is very difficult to get rid of the developed drug addiction on your own. The success of this approach depends on the “experience” of drug use, the development of disorders in the body, the type of drug. It has been proven that it is quite possible to get rid of the use of certain types of drugs on your own, without resorting to the help of a specialist. First of all, this concerns smoking, some types of substance abuse and a number of other pharmacological drugs. In these cases, physical dependence is less pronounced and there is no such strong intoxication of the body. The patient suffers to a greater extent from psychological dependence, but it is also very difficult to cope with it on his own.

If we are talking about the use of opiates, cocaine or other substances that cause strong physical dependence, you should not try to solve the problem yourself, as it can be dangerous. In such cases, patients already have a pronounced intoxication of the body and disturbances in the work of various organs and systems. Stopping the drug will cause withdrawal ( withdrawal symptoms), and the developed symptoms can be life-threatening. That is why the abolition of psychoactive substances in such patients should take place in stages, with a gradual dose reduction and the use of drugs that weaken the manifestations of withdrawal symptoms. As a rule, this happens in the inpatient departments of narcological dispensaries. Here, the patient is constantly under the supervision of specialists who are ready to provide qualified assistance at any time ( for example, if you have problems with breathing or heart function).

Is free anonymous drug addiction treatment possible?

Drug addiction is a very significant problem that affects society as a whole. That is why there are many public, state and international organizations that provide assistance to various types of drug addicts. Thanks to these funding sources, many clinics and rehabilitation centers may not charge patients for consultations or even treatment.

Anonymity in drug addiction treatment is very an important component for two reasons. First, it creates psychological protection for the patient himself. He knows that friends, acquaintances or work colleagues will not know about his diagnosis. Thanks to this, the fight against psychological addiction is easier. Secondly, in many states, protection against the disclosure of such diagnoses is provided for at the legislative level. About the treatment of a particular patient ( with his personal data) know the attending physician, the hospital administration and sometimes other doctors invited for consultations. Otherwise, qualified medical institutions guarantee the preservation of medical confidentiality from strangers. It should be noted that the patient still registers ( to maintain reliable statistics, improve the effectiveness of programs, etc.). However, this record is kept without the patient's personal data ( Full name, address, place of work, etc.).

Thus, in almost any country, a patient can find clinics or rehabilitation centers that can provide him with free medical care ( within reasonable limits) while maintaining anonymity.

Is there an accelerated drug addiction treatment ( in one day or faster)?

With some types of addiction, it is possible to carry out a quick detoxification of the body, which sometimes lasts 1 - 2 days ( in rare cases and less). However, this tactic of treatment is associated with serious risks for the patient, and it is rarely used. The essence of treatment is the critical withdrawal of the drug ( immediately and completely) and the introduction into the body of specific substances that block certain receptors in the nervous system ( in fairly large doses). Thus, the patient is almost immediately relieved of physical dependence, and after 1 - 2 days his body will be conditionally "clean". The residues of the drug will be removed from it and the receptors are blocked, eliminating residual effects.

In the case of ultra-rapid detoxification, the following problems are possible:

• the strongest withdrawal syndrome ( however, its duration is shorter than with other treatment tactics);
• pronounced violations in the work of many organs and systems;
• the need for treatment in intensive care under the continuous supervision of specialists;
• the risk of death.

In addition, it must be borne in mind that detoxification is only part of general treatment... Even if it is carried out in 1 day, having saved the patient from physical dependence, psychological dependence remains. The fact that the patient's body no longer "requires" the drug does not mean that the patient does not want to enter the usual state of euphoria. That is why there is no need to talk about the rapid treatment of drug addiction. Even if the detoxification was quick and successful, it takes weeks and months of work with specialists to get rid of psychological addiction. In other words, detoxification in this case cannot be equated with complete recovery.

Do patients need to be willing and motivated to start treatment?

The patient's desire for recovery plays a huge role in drug addiction treatment. If the patient independently went to the clinic and tries ( at least at some stages) adhere to the prescribed treatment, the effectiveness will be much higher. It is easier for both doctors and psychologists to work with such patients. If the patient is not interested in returning to normal life, it will be almost impossible to get rid of the psychological dependence. After the end of inpatient treatment, he will again return to drug use. No wonder one of the goals of psychotherapy during the course of treatment is the patient's motivation.

What services are provided by drug dispensaries, rehabilitation centers and other specialized medical institutions?

The agencies that help patients in the fight against drug addiction are united in a network called the drug treatment service. Within the framework of this structure, specialists of various profiles work, who specialize in the management of patients with drug addiction. The most effective institution is a narcological dispensary, which may have various departments. Here, patients can be provided not only medical, but also social or legal assistance.

The narcological dispensary operates in the following areas:

• diagnostics and registration of patients who apply to the dispensary for various help;
• anonymous consultations;
• psychoprophylactic assistance;
• collection and processing of statistical data ( number of cases, trends, morbidity structure, etc.);
• advice to other medical institutions ( if patients with drug addiction go there);
• briefing and orientation courses for doctors and other health professionals;
• participation in preventive measures to combat drug addiction ( usually in collaboration with other organizations);
• providing medical care to drug addicted patients of various groups ( by type of dependence, by severity, by age, etc.).

Such medical institutions have several departments and a rather complex internal structure. In principle, they are the most qualified centers in which they undertake the treatment of any drug addicted patient.

In addition, people who have used various drugs for non-medical purposes, as well as some people with so-called domestic alcoholism, are usually registered with a narcological dispensary. Dispensary data may come from other hospitals or government services.

Thus, the narcological service, represented by drug dispensaries and a number of other medical and preventive institutions, can provide comprehensive assistance in combating this problem for almost any patient.

What are the consequences and results of drug addiction treatment?

Talking about the consequences of drug addiction treatment is not entirely correct, since a direct consequence of treatment can only be recovery or long-term remission ( drug-free period). Various complications and serious conditions that may arise during the period of treatment are, of course, more likely a consequence of prolonged drug use and the disorders caused by them.

In general terms, addiction treatment can end as follows:

• Complete recovery. Full recovery means complete and final withdrawal from drug use and the gradual elimination of associated complications. This is possible even with highly addictive drugs. The likelihood of complete recovery is reduced if the patient has a long history of drug use. The hardest thing ( according to statistics) to achieve complete recovery in patients who have used opiates.
• Recovering from Chronic Illness. In this case, we are also talking about refusal to take drugs, but the patient remains different chronic diseases and problems. Most often these are various types of renal or liver failure, heart and immune problems. Such patients have to be observed by doctors for a long time, to undergo periodic examinations and courses of treatment.
• Long-term remission. With prolonged remission, the course of treatment is generally successful, and the patient has not taken drugs for several years. However, for one reason or another, the patient returns to his habit again. Unfortunately, the percentage of patients who receive treatment for long-term remission rather than complete recovery is very high.
• Lack of a positive result. In some cases, the treatment does not give the expected effect, and the patient returns to taking drugs almost immediately after the end of the course. As a rule, this happens if the patient himself, during the course of treatment, was not interested in a positive result ( for example, in the case of compulsory treatment). In some cases, there are individual characteristics organism, preventing effective treatment... In such cases, experts recommend repeated courses using other techniques.

A common question before starting treatment is the question of death during treatment. This option is not excluded, although this is extremely rare. In the case of heroin addiction, serious organ dysfunctions during critical cancellation can indeed lead to the death of the patient. That is why patients go to the clinic during detoxification, where specialists will carefully monitor their condition.

Analyzes and examinations for the treatment of drug addiction

To successfully treat drug addiction, doctors usually prescribe a series of tests and examinations that the patient needs to undergo. This will help not so much to relieve him of addiction as to provide the body with the necessary comprehensive support. In addition, the analyzes make it possible to identify which organs and systems are most affected by drug use. Thus, concurrent treatment of complications will be carried out.

Before starting treatment, the following tests and examinations are usually prescribed:

• General blood analysis. A complete blood count determines the concentration of various blood cells and a number of other indicators. Deviations from the norm in the analysis results indirectly indicate various disorders and diseases. For example, a low white blood cell count is characteristic of immunocompromised patients ( for example, due to human immunodeficiency virus).
• Blood chemistry. A biochemical blood test gives more complete information about the work of various organs and systems. During the analysis, the concentration of certain substances in the blood is determined. Deviations allow us to draw certain conclusions about the state of the kidneys, liver, pancreas, etc. As a rule, people who have been taking drugs for a long time have damage to these organs.
• Analysis of urine. A urinalysis may indicate a range of kidney problems and, to a lesser extent, other internal organs. The total amount of urine excreted per day by the patient is also important.
• Analysis for toxins. Sometimes the doctor has doubts about which drugs the patient was taking. However, this information is extremely important in order to start the correct treatment. Therefore, many patients are prescribed a toxin test before starting treatment. This analysis shows which toxic substances entered the patient's body. Sometimes it is possible to determine if the patient has used drugs in the past six months.
• Electrocardiography. ( sign up) Withdrawal symptoms that occur during drug addiction treatment can disrupt vital body functions. One of the main dangers is change blood pressure and various failures in the work of the heart. In this regard, before starting treatment, the patient is prescribed electrocardiography, which provides general information about the functional state of the heart.

The attending physician may prescribe other tests. It depends on the results of the preliminary examination. For example, in the case of inhalation ( inhalation) drugs may impair lung function. In some cases, it is necessary to thoroughly examine them using special tests. Ultrasound of the abdominal organs is also often prescribed.

In the case of intravenous drug administration, it is necessary to pass a number of tests for infectious diseases that are transmitted through the blood. The most dangerous of them are HIV ( AIDS virus) and viral hepatitis B. If you have any specific symptoms, other tests may be ordered. The analysis is a study of blood in special laboratories. Blood can be collected directly at the hospital. These data are necessary to prevent complications that may develop during treatment.

Addiction Treatment Methods

Currently, the world has proposed many different methods and techniques for the treatment of people with drug addiction. Unfortunately, so far none of these methods give a 100% guarantee of recovery. This is largely due to the fact that there are so many types of drugs, each of them has its own characteristics of impact on the body, and the body's response is even more difficult to predict.

Various drug addiction treatment methods often do not give the desired result for the following reasons:

• Patient lack of interest. No matter how effective the treatment is, it is impossible to cure a person from drug addiction without his desire. It's just that after the end of the course of treatment, he will start taking drugs again ( even knowing that it could cause serious harm to health). That is why the patient's interest in recovery is the main condition for successful treatment.
• The presence of complications. Long-term drug use can cause irreparable harm to health, which makes full recovery impossible in principle. Neuronal damage ( cells) of the brain can cause a decrease in intelligence, disorders at the level of other organs - loss of reproductive function, chronic diseases, etc. In the treatment of such patients, doctors have to reckon with the existing complications, which creates additional difficulties.
• Individual characteristics of the organism. Each organism is unique in some way. This applies to the structure and work of various organs and systems. That is why the effect of drugs on all people has its own characteristics. The degree of physical and psychological dependence also differs.
• Impurities in narcotic substances. Many narcotic substances contain various impurities that got there accidentally or deliberately. In some cases, these impurities are toxic and can harm the body even more than the drug itself. The appearance of unusual symptoms and syndromes in these patients greatly complicates the treatment process.
• Lack of psychological support. Many drug addicts over the years of drug use become in some way "outcasts" in society. They start to be treated with prejudice, and this attitude does not disappear immediately, even if the person no longer uses drugs. This can provoke depression, which, in turn, is fraught with relapse ( repetition). That is why, during and after treatment, patients need psychological support from relatives and friends.

Thus, the choice of drug addiction treatment method in each case is selected individually. The patient turns to a specialist, after which they jointly develop treatment tactics. The range of possible methods currently leaves a wide range of choices.

Hypnosis treatment

Hypnosis treatment is currently considered a very controversial method and is rarely used. The effectiveness of drug dependence treatment with hypnosis is questioned by most leading experts. This is due to several reasons at once.
The low effectiveness of hypnosis as the main treatment for drug addiction is explained as follows:

• Physical dependence. Hypnotic suggestion affects ( and then only to a certain extent) on the mental dependence of the patient. However, even in its absence, physical dependence remains, which is manifested by disturbances in the work of various organs accustomed to regular drug use.
• Possibility of complications. Even if, due to hypnosis, a person stops taking drugs, there is a risk of various serious complications. They may not appear immediately, but only after a while. However, eliminating them will require, of course, not only hypnosis, but a full examination and treatment by a specialized specialist.
• Low susceptibility to hypnosis. Many people with drug addiction have a rather weak susceptibility to hypnosis. Perhaps this is due precisely to the fact that many psychoactive substances ( actually drugs) often put a person into a state similar to hypnosis. Because of this, the patient, on the one hand, lends itself well to suggestion during the session. On the other hand, the effect of such a suggestion will be less stable.
• High likelihood of relapse. Statistics show that isolated treatment with hypnosis ( without using other methods) in the overwhelming majority of cases leads to a relapse. Patients sooner or later start using drugs again. In addition, the risk of concurrent development of nervous disorders and a number of mental illnesses increases.

Of course, as one of the means within the framework of complex therapy, hypnotic suggestion can also be used. With its help, you can, for example, tune a person to treatment, awaken in him a desire to cooperate with a doctor. Also, some clinics use post-detox hypnosis to reduce addiction and prevent relapse. In general, we can say that the effectiveness of such methods varies greatly from one case to another. Much depends on the qualifications of the doctor conducting the hypnotic suggestion and the patient's individual sensitivity. As an obligatory component of complex treatment, this method is not approved by international organizations.

Implant treatment

Treatment of drug addiction with an implant is one of the methods used, as a rule, as part of a comprehensive course of treatment. In fact, any implant is just a kind of delivery method for certain pharmacological drugs into the body. A substance or material impregnated with this substance is injected under the skin or into the muscle tissue of the patient, which gradually enters the bloodstream over a long time. For opioid dependence, for example, naltrexone and other opioid receptor antagonists are often used. This group of substances blocks specific receptors in the nervous system that respond to opiate intake. After taking the drug, a person with such an implant will not feel the expected effect, which will weaken physical and psychological dependence.

The implantation of an implant in the treatment of drug addiction has the following advantages:

• the procedure is done once, and the effect lasts for a long time ( several months or more, depending on the type of implant);
• when implanted into muscle tissue with good blood supply, the amount of the drug necessary for reliable blocking of receptors will regularly enter the bloodstream;
• implantation of the implant allows you to reduce or eliminate the regular use of any pharmacological drugs;
• the patient receives treatment without visiting the hospital and without interrupting his daily life;
• at least temporarily relieves addiction, since, even after taking a dose of the drug, the patient will not achieve the expected euphoria.

However, this method of treatment also has its drawbacks. For example, any implant has a certain "shelf life". It is determined by the amount of the administered pharmacological preparation. When the drug runs out, the receptor blocking effect also wears off. If the patient managed to completely get rid of his addiction during this time, he gets better. Otherwise, relapses are possible or re-implantation of the implant will be required.

It should also be noted that the implant is not a universal protection. The administration of a large dose of the drug may outweigh the effect of the drug. In these cases, an overdose with serious consequences is possible.

By themselves, the drugs used in implants are not toxic. They do not have a significant effect on the body and are well excreted naturally. Possible side effects and allergic reactions ( before implantation, be sure to do allergic test ). In addition, the patient should always remember about the implant and warn doctors about its presence. A certain amount of a drug always circulates in the blood, and the appointment of a number of other drugs in these cases is contraindicated.

The implantation itself is performed in a specialized clinic by a certified doctor ( usually a narcologist). This is done after complete relief of withdrawal symptoms and not earlier than a week after the last drug intake. A patient with an implant should periodically visit the attending physician.

Overall, the implant is a very effective and common drug addiction treatment. It is only important to explain in detail to the patient all the possible risks and limitations that it implies. this method treatment. It should also be remembered that the implant itself does not replace complex therapy. In any case, patients need to undergo a serious course of treatment to completely get rid of drug addiction.

Addiction treatment with folk remedies

Unfortunately, traditional medicine in practice can hardly provide tangible help in the fight against drug addiction. The dependence itself arises from the interaction of drugs with certain receptors in the body ( depends on the type of drug) and due to subsequent changes in the work of various organs and systems. The sensitivity of the receptors and the functioning of the body can theoretically be influenced with the help of certain medicinal plants ( in the form of decoctions or infusions). However, the effect of their use in any case will be weaker than that of pharmacological drugs with targeted action. The only plus is less toxicity and fewer side effects.

However, the main problem in the treatment of drug addiction with folk remedies is psychological dependence. Traditional medicine can hardly affect her, so the patient still returns to taking the drug.

The use of folk remedies in the treatment of drug addiction is justified only in combination with other targeted treatment methods, as part of complex therapy. In this case, medicinal plants are used for partial detoxification of the body ( elimination of toxic compounds), calming the nervous system, improving the work of certain organs. Same folk remedies can be successfully used to treat the effects of drug addiction ( in fact, these are complications from various organs and systems that appear over time Before use, you must consult a specialist.