RU2446838C2 - Method of treating drug abuse - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and is applicable in prevention, treatment and rehabilitation of individuals suffering various forms of abuse. It involves pharmacological intervention of an implant containing the opiate receptor blocker naltrexone, and pre- and post-implantation psychotherapeutic treatment. The implantation is immediately followed by the intravenous introduction of fast-release muscular relaxants to ensure a short-term effect of muscular fibrillations, apnea. If observing apnea, the patient requires respiratory aid with the use of a bag-valve-mask. For 12 months following the implantation, the patient gets a complex assistance of a drug therapist, a physician, a psychologist, a sociologist, a lawyer. The implantation covers an iliac region; a procedure of generating the muscular fibrillation effect is accompanied by the psychotherapeutic treatment with the use of directive suggestion and/or stress and cognition and/or shock hypnosis. The procedures are followed by conditioned reflex confirmation of the effect.

EFFECT: method provides reduced length of rehabilitation in the patients with treating drug addiction, high clinical effectiveness with therapeutic cost saving.

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Description

The invention relates to medicine, namely to the field of treatment for drug dependence.

A known method of treating opioid or alcohol dependence (RU patent No. 2310449, 05.17.2006), in which a system with naltrexone is implanted in the patient’s body. The indicated system doses naltrexone and delivers it to the epidural space. Treatment is carried out over a long period of time up to 365 days.

A known method for the treatment of opiate addiction (patent No. 2254130 RU, 05.17.2000), in which a device dosing the active substance is attached to the patient’s skin. As an active substance, diamorphine is used.

A known method of treatment of opium addiction (patent No. 2290947 RU, 10.27.2005), which includes the introduction of a cytokine-containing immunotropic drug. The drug is administered intravenously.

A known method of treating drug dependence (patent No. 2191039 RU, 2001.08.28). comprising four stages. At the first stage in the conversation, the patient's mood for treatment is revealed and convincing him of the curability. At the second stage, heroin is excluded and detoxified for 5-6 days. In the third stage, in case of a negative opiate test, the patient is administered an opiate receptor blocker, a placebo drug is simulated, which mimics an additional opiate receptor blocker, and an aversion is initiated in response to the administration of opiate, the duration of the stage is 1-3 months. At the fourth stage, they make a trip to the Himalayas.

It is known from the prior art (Darensky I.D. Psychotherapy and narcology, 2001, resource http: //www.psyinst.m/library.php? Pait = article & id = 1566) that during the course of psychotherapy in narcological patients muscle relaxants are administered to complicate breathing and creating a state of severe withdrawal with the introduction of naltrexone, i.e. the patient undergoes a “provocation” procedure against the background of the administration of the drug naltrexone to ensure the short-term effect of muscle fibrillation, apnea. It is also known that in the treatment of patients with drug addiction to eliminate respiratory disorders, they carry out artificial ventilation of the lungs with an Ambu bag (Ostapenko Yu.N. Features of violations of functional and laboratory parameters in acute drug poisoning and methods for their correction. Methodical recommendations (No. 49), M ., 2002, C.7).

The closest analogue is a method for treating drug addiction, including the pharmacological effect of an implant containing an opiate receptor blocker naltrexone and a psychotherapeutic effect before and after implantation, and after the implantation procedure, the procedure is accompanied by a psychotherapeutic effect, and within 12 months after implantation, the patient is provided with comprehensive support by a narcologist, therapist, psychologist, sociologist, lawyer (Kulagin A.V. Scientific basis for creating a rehabilitation system c with various forms of dependence (nicotine, alcohol, drug addiction, substance abuse) and medical and economic assessments of its effectiveness. Abstract of dissertation for the candidate of medical science, St. Petersburg, 2006.

The aim of the invention is to reduce the rehabilitation period of patients undergoing treatment for drug addiction, increasing the effectiveness of treatment while reducing treatment costs.

The goal is achieved through the use of a complex of psychotherapeutic and pharmacological procedures in the treatment of drug dependence by implanting a drug that blocks opiate receptors, for which naltrexone is chosen.

The treatment method includes psychotherapeutic preparation for treatment, during which the essence of the procedures is explained to the patient, the patient gives his consent to the treatment, a psychological “dominant” is created for a favorable outcome and long-term remission.

Further, the patient abstains from taking drugs for 7-10 days. After this period, tests are performed for the presence of opiates in the patient's body, a naloxone test is performed.

If the results of tests and samples are negative, implantation of a substance containing Naltrexone is carried out. The method is characterized in that the iliac region is used for implantation. The advantages of this choice are the sufficient development of subcutaneous fat, ease of access, the possibility of repeated implantations without gross cosmetic defects, minimal trauma to clothes, and the absence of complications. The implantation operation is carried out in a procedural or clean dressing room.

As a result, a naltrexone depot is created and opiate receptors are blocked for a long period of time.

Immediately after implantation, the patient undergoes a "provocation" procedure. In order to form a restraining psychological attitude (psychophysiological dominant), as well as leveling the “dominant use”, a provocative test is performed using muscle relaxants of short (depolarizing) action (dithilin, listenon). Relaxant is administered intravenously at a rate of 0.1-0.4 mg per 1 kg of patient weight to ensure the short-term effect of muscle fibrillation, apnea. When apnea occurs, the patient is given a breathing aid using an Ambu bag. The difference between the method is that the procedure is accompanied by a psychotherapeutic effect. Apply directive suggestion, emotional stress and cognitive effects, shock hypnosis. Next, the conditioned reflex fixation of the result is carried out.

As a result of reinforcing the “provocation” with psychotherapeutic influence, it is more likely for a larger circle of people with different mental abilities to create a new stable psychophysiological dominant that prevails over other conditioned reflex dominants. An implant with Naltrexone and further psychotherapeutic effects support this dominant.

After implantation, the patient spends 10 days in a hospital. After discharge, he undergoes a course of individual psychotherapy, and then, for 12 months, support for a narcologist, therapist, psychologist, sociologist, and lawyer is available for him.

Such comprehensive patient support enhances the effectiveness of patient social rehabilitation.

The complex use of pharmacological protection and psychotherapeutic effects ensures long-term remission in patients with heroin addiction and keeps them in the rehabilitation program at the next stages of rehabilitation.

In General, the claimed method of treatment provides the effectiveness of treatment for a wider circle of people, reducing the frequency of relapses in comparison with traditional methods of treatment, not implying an integrated approach, the continuity of treatment methods. Patients are stably kept in society, the rehabilitation period is reduced. At the same time, due to the reduction in the number of relapses and a decrease in the length of periods of stay in the hospital, the cost of treatment is reduced, despite the high cost of drugs of opiate receptor blockers.

The implementation of the invention

Before starting treatment according to the method, the essence of the procedures is explained to the patient and his consent to treatment is obtained.

Next, psychotherapeutic preparation of the patient is carried out, the purpose of which is to create a psychological "dominant" for a favorable outcome and prolonged remission.

Before the next stage of treatment, the patient refrains from using drugs for 7-10 days. After this period, with negative results of tests for the presence of drugs, naloxone samples in the body, the substance containing the drug Naltrexone is implanted. The iliac region is used for implantation. The operation is carried out in a procedural or clean dressing room.

Immediately after implantation, a "provocation" procedure is performed. For this, muscle relaxants of short (depolarizing) action (dithilin, listenone) are administered intravenously at the rate of 0.1-0.4 mg per 1 kg of patient weight. The result is a short-term effect of muscle fibrillation, apnea. When apnea occurs, the patient is given a breathing aid using an Ambu bag. The procedure is accompanied by a psychotherapeutic effect. Apply directive suggestion, emotional stress and cognitive effects, shock hypnosis. Next, the conditioned reflex fixation of the result is carried out.

After implantation, the patient spends 10 days in a hospital. After discharge, he undergoes a course of individual psychotherapy, and then, for 12 months, support for a narcologist, therapist, psychologist, sociologist, and lawyer is available for him.

Clinical examples

Patient K., a detoxification course was carried out for 10 days. On the tenth day, cognitive (explanatory sequentially logical) psychotherapy was carried out, the essence of which was to explain the mechanisms of action of drugs for implantation, ways to combat compulsive "craving", and the mechanisms of formation of a "restraining factor". After this, the patient was asked to reproduce (retell) everything he heard, and of fundamental importance is the need for understanding and logical explanation by the patient of the therapeutic mechanisms of action of the drugs. The following explains the dangers of use and the risks of overdose and death. Then a “provocation” was carried out, at the height of which (during the period of narrowing and changes in consciousness), a command was given directive to deny and not use drugs and against the background of a slight obstruction of 1 respiratory tract (due to the medication administered) and respiratory failure (when wearing a breathing mask and fear death was the maximum) an aversion to drugs was emotionally caused, and in the case of use, a fear of death was formed. Thus, a persistent psycho-emotional dominant was formed, which was further supported by a psychologist in the process of communication or conducting psychological sessions. After 120 days, this patient had a stable negative attitude to the process of drug use and at the same time the emotional background was kept even.

Patient N., 26 years old, was in detoxification for 8 days. Emotionally labile, logical constructions are not clear enough, there are minor mnemonic disorders, as a result of which cognitive therapy did not give the necessary result and therefore the patient was skeptical of the effects of therapy, therefore the emphasis in this case is on emotional stress therapy and shock hypnosis with directives, and namely: after a preliminary conversation and conducted pharmaceutical tests on the possibility of implanting naltrexone, a “provocation” was carried out in the conditions of the treatment room with more with a higher exposure and against the background of the action of listenone, respiratory restriction and a pronounced fear of death and suffocation appeared against the background of a significant change in consciousness (pronounced emotional impact in the absence / reduction of criticism of the condition and control of the situation). The doctor emotionally and imperatively conducts a direct suggestion with the establishment of rapport (emotional-psychological connection), not allowing critical assessment by the patient and logical reasoning, i.e. information is given as a given and irrefutable objective reality. Thus, the patient forms a new psychophysiological focus in the brain structures, prevailing over the dominant consumption of psychoactive substances. In the future, rapport between the patient and the doctor is supported, and with the help of a psychologist, the goals of leveling the emotional background are achieved. At the moment, the patient has a stable remission (14 months) even against the background of the termination of the action of naltrexone, because even thoughts about the possible use of psychoactive drugs cause a pronounced emotional reaction with fear of death, similar to the experiences during the "provocation".

Claims (1)

A method of treating drug dependence, including the pharmacological effect of an implant containing an opiate receptor blocker naltrexone, and a psychotherapeutic effect before and after implantation, immediately after the implantation procedure, the patient is given muscle relaxants of short action to provide a short-term effect of muscle fibrillations, apnea, and when apnea occurs the patient is given a breathing aid using an Ambu bag, within 12 months after implantation they are provided with comprehensive support by a narcologist, therapist, psychologist, sociologist, lawyer, characterized in that the ileal region is used for implantation, the procedure for creating the effect of muscle fibrillation is accompanied by a psychotherapeutic effect using directive suggestion, and / or emotional-stressful and cognitive effects, and / or shock hypnosis, after the procedures, the conditioned reflex consolidation of the result is carried out.