RU2636868C2 - Method for treatment and rehabilitation of persons with chemical and non-chemical addictions - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: activities aimed at restoration of patient's physiological functions, and patient rehabilitation are performed, involving patient's family members with family psychotherapy. At that, at the first stage of rehabilitation, methods of cognitive-behavioural, gestalt therapy, projective methods, psycho-educational approach with formation of initial motivation, patient's criticism of his/her own behaviour, and the detection of reasons for the formation and maintenance an addiction are used. At the second stage of rehabilitation, methods of the first stage are complemented by psychodynamic approach, psychodrama as per J. Moreno and B. Hellinger's arrangements, forming patient's awareness of destructive patterns of behaviour, internal motivation to maintain a healthy lifestyle, a clear division of the "healthy self" and "sick self". At the third stage of rehabilitation, methods of the previous stages are supplemented with methods of existential psychotherapy and weekly medical holidays aimed at implementation of the acquired skills and identification of difficulties in social adaptation, with a gradual increase in the duration of holidays and sessions of individual discussion of their results with a specialist and/or in a psychotherapeutic group.

EFFECT: method allows to achieve a long and sustainable remission, to generate motivation to maintain sobriety through harmonization of family relationships, compilation of a multi-axis diagnosis, and by involving family members into rehabilitation procedures.

6 cl, 4 ex

Description

The invention relates to medicine, namely to narcology, and can be used for the rehabilitation of people with chemical and non-chemical dependencies.

From the patent No. 2402974 RU there is known a method for the prevention and / or treatment of dependence on psychoactive substances, which includes genotyping of dopamine, serotonin, noradrenaline and gamma-aminobutyric acid genes of neurotransmitter metabolism systems, psychodiagnostic testing with the subsequent formation of psychological types in accordance with polymorphisms in these genes . Then prescribe dietary supplements and / or pharmacotherapy, taking into account the results of genotyping and the identified psychological types with impaired neurotransmitter metabolism. The use of the invention improves the effectiveness of treatment by correcting the imbalance of neurotransmitters, predisposing to the formation of dependence.

From the patent No. 2339411 RU there is a known method for the treatment of gambling addiction, which uses clinical, experimental-psychological, neuroimaging and electrophysiological methods. Depending on the results of the examination, psychopharmacotherapy is prescribed: normotimics, antidepressants, atypical antipsychotics are used, complex therapy according to G.N. Kryzhanovsky. Psychotherapy is carried out, including the “death funeral” method, which provides for the need, after each breakdown, to dig a full-profile grave 2 meters long, 2 meters deep and 70 cm wide and a ritual burial of death. In this case, psychotherapy is carried out under the control of family members.

From the patent No. 2210396 RU, a method for treating drug and nicotine addiction is known, in which trigger factors of behavior dependence are identified, then rational psychotherapy is carried out and the patient is set up to wait for a change in the atmosphere of the unusual nature of what is happening, verbally endowing the method with special power and the verbal symbol "psychotronic energy", strengthen the patient’s faith in the reality and effectiveness of what is happening. Delayed vegetative-somatic reactions are instilled into the patient, then shoes, watches and all metal objects are removed from the patient, placed him in the place of the room, opposite to the one he had chosen earlier. The patient is instructed to close his eyes and imitate an instrumental diagnostic scan, pronouncing aloud the information about the degree of destruction of various systems of his body with drugs or tobacco. After that, the doctor moves around the patient, changing direction, being behind and to the left of the patient. The patient is instilled with unpleasant sensations, after which they give the command to maximize the muscles of the body and keep this tension as long as possible. After the patient reaches a mild hypnotic trance, a therapeutic suggestion is carried out, consisting of two suggestive blocks - negative and positive-tuning. On the first block form aversion, awesome and negative reflexes to drugs or tobacco. At the same time, against the background of persisting muscle tension, the patient initiates experiences caused by physical and mental manifestations of the state of abstinence, the patient is instilled with individual, characteristic for his state of abstinence, unpleasant mental and autonomic-somatic reactions.

Upon reaching the state of pseudo-abstinence and aversion, the patient is inspired intolerance and refusal of drugs and tobacco. In the second block, psychological attitudes are formed on stability and resistance to trigger factors of addiction and instill an indifferent-neutral attitude towards them, a positive attitude towards a healthy lifestyle, and the term of release from addiction is repeated. Then they conduct role-based training with modeling of provocative situations against the background of suggestion of a pseudo-abstinence state. Next, family psychotherapy is carried out with the patient's relatives, aimed at eliminating mutually negative interpersonal relationships, forming an understanding and a positive perception of the patient. In conclusion, the patient is instilled with an attitude toward positive mental self-regulation. In this case, as a means of self-control, a calendar is used with the image of the attending physician and the date of the session.

The closest analogue is the method of psychotherapy of disorders weighed down by addictions, known from the source of R. Minazov Psychotherapy of personality disorders accompanied by addictions in outpatient practice. Theses of a conference. World of addictions: chemical and non-chemical mental disorders, St. Petersburg, 2012, pp. 85-86. In accordance with the indicated source, the stages of psychotherapy, including diagnosis and the actual treatment, are carried out together with family members. Psychotherapy is also accompanied by pharmacotherapy. It is advisable to increase efficiency due to more accurate diagnostics and, as a result, more accurate and less time-consuming rehabilitation.

The aim of the invention is the creation of a comprehensive therapeutic methodology for the treatment and rehabilitation of people with chemical and non-chemical dependencies with increased remission.

The method of treatment and rehabilitation of people with chemical and non-chemical dependencies consists in phased treatment and rehabilitation. In accordance with the method, the patient is provided with medical care, which includes withdrawal of withdrawal symptoms, elimination of physical attraction in the case of chemical addictions and therapeutic and preventive measures, rehabilitation in general is carried out in three stages. The goal is achieved through the use of the following approaches of psychotherapeutic diagnosis and rehabilitation.

1. Identification of comorbid mental disorders, in particular personality disorders in the treatment of patients with chemical and non-chemical dependence according to the criteria of DSM-IV-TR by the method of structured clinical interview - SCID (SCID-Structured Clinical Interview for DSM-II-R).

Testing results using this methodology reveal the presence of a personality disorder to determine:

1. The targets of psychotherapy

2. The hypothesis of the formation and consolidation of the disease

3. Patient management strategies

4. The format of work with the patient (group, individual, family or a combination thereof)

2. Issuing a multi-axis diagnosis according to DSM-IV-TR in the following axes:

Axis I. Clinical disorders, other clinically relevant problems (conditions that cannot be attributed to any mental disorder, but giving rise to observation or treatment).

Axis II. Personality disorders, mental retardation (in the category of disorders that are diagnosed mainly in infancy, childhood or adolescence).

Axis III. Somatic diseases.

Axis IV. Psychosocial and environmental problems (9 main areas, for example housing or economic problems).

Axis V. Global level of functioning.

Multiaxial diagnosis allows you to:

1. To differentiate mental and somatic diseases, which, without proper treatment, will inevitably negatively affect the patient's condition after discharge.

2. Pay attention to the psychotherapy of personality disorder, on the basis of which an addiction could form.

3. Form a criticism of the patient and his relatives to the manifestations of both addiction and personality disorder.

4. Continue pharmacotherapy (as directed) and follow up with a psychiatrist after undergoing inpatient treatment.

5. To help the patient in resolving psychosocial problems, to facilitate his employment and socialization.

3. An approach to addiction as a family disease.

Upon admission to the rehabilitation department, a psychiatrist-narcologist, psychotherapist, psychologist and social work specialist invite all family members. Within two days from the date of receipt, a full-fledged comprehensive medical history is carried out. From 3 to 7 days, individual psychotherapeutic work is conducted with each member of the family. Further, starting from 8-10 days (in the absence of contraindications), relatives are included in group family therapy. At each lesson there is a doctor and a psychologist. Similar groups are held 2 times a week. If the achieved compliance with relatives and the patient is assessed as satisfactory, then meetings are held once a week until the day the patient is discharged. The criteria for achieving compliance are:

1. The activity of the patient’s relatives, writing tasks, visiting all the prescribed events.

2. Visiting lectures for relatives and friends of the dependent person, which are held weekly.

3. Inclusion of the patient in all measures of the rehabilitation process, motivation for awareness of the disease and work with its manifestations.

4. Enthusiasm, trust, interest in recovery.

5. Responsibility of the patient and independence regarding the administration of drugs (as prescribed by the psychiatrist-narcologist).

6. The consent of the relatives to a reasonable control of the patient's condition by the relatives themselves and the therapist for 12 months.

Such tactics of managing patients with chemical and non-chemical dependencies allows us to create a psychotherapeutic alliance that promotes long-term follow-up of the patient after discharge and maintaining a stable remission. It promotes the formation of a patient's healthy motivation to maintain sobriety due to the harmonization of family relationships.

The implementation of the invention

The method is based on a systematic approach to addiction psychotherapy. The main postulate in this method is the assertion that "Addiction is a family disease." The concept under consideration implies that dependence is formed within the framework of dysfunctional family relationships, incorrect strategies of family behavior, which are copied from generation to generation, transmitted and form a vicious circle of dependence. The technique allows working not only with the consequences of the use of psychoactive substances and maintaining remission, but also with family reasons for the formation of dependence, improving the quality of life of the whole family.

The rehabilitation program according to the methodology presented consists of three stages. The names of the stages carry a semantic load and reflect the direction of each stage. The first stage is the basic, the second stage is the psychotherapeutic, the third stage is the adaptation. Methodological manuals are attached to each stage, which include basic information on theoretical material and tasks for practical application.

Upon admission to the clinic, the patient is provided with medical care, which includes withdrawal of withdrawal symptoms, elimination of physical attraction (in the case of chemical addictions) and therapeutic and preventive measures (with chemical and non-chemical addictions). These measures contribute to the restoration of physiological functions. They include general diagnostics, prescribing drugs according to indications, general strengthening procedures (administration of vitamin solutions in / drip, plasmapheresis, xenon therapy, TES-therapy, alpha-hydroxy-spa therapy), restoration of sleep and wakefulness regimen, diet development and purpose of the diet (if indicated). At this stage, the family joins in the psychotherapeutic work. Family members and loved ones attend a course of lectures on the treatment and prevention of addiction, thereby becoming involved in the rehabilitation process. After physical recovery, the stage of psychotherapeutic work begins. To restore the mental sphere at all three stages in working with patients, methods of cognitive-behavioral therapy, group psychodynamic therapy, gestalt therapy in an individual and group format, existential psychotherapy, body-oriented therapy, transaction analysis, psychodrama methods by J. Moreno and B. Hellinger constellations, projective techniques. For the diagnosis of concomitant mental disorders and personality disorders are used questionnaires SCID II, resin and others. The program includes family group psychotherapy, family counseling, individual psychotherapeutic work with family members of the patient. In the process of all psychotherapeutic measures, the patient and his relatives get the opportunity to identify the causes of addiction in the family, consider and change destructive behavioral strategies, analyze family scenarios, consider and change the boundaries of the family system as a whole and each family member separately.

Rehabilitation consists of three stages. Each stage has its own goals and objectives. The first stage is the basic one. At the basic stage, methods of cognitive-behavioral, gestalt therapy, projective methods, psycho-educational approach are used. They allow you to form the initial motivation for maintaining sobriety, work with the internal picture of the disease, critical of your behavior, find the reasons for the formation and maintenance of addiction. The second stage is psychotherapeutic. The purpose of the second stage is the study of early object relationships, the patient's recognition of destructive patterns of behavior, the formation of intrinsic motivation to maintain a healthy lifestyle, a clear separation of “healthy self” and “patient I”. The methods of the first stage are joined by a psychodynamic approach, psychodrama according to J. Moreno and constellations according to B. Hellinger. The third stage is the adaptation. At this stage, additional methods of existential psychotherapy and weekly therapeutic leave are practiced. They are intended for the practical implementation of acquired skills and the identification of difficulties in social adaptation. The duration of the holidays is gradually increasing. Upon returning from vacation, the patient has the opportunity to work with the specialist individually and / or in the psychotherapeutic group of the results. This method allows the family to gradually adapt to changes in the patient’s personality that have occurred during the rehabilitation process. As a result, a stable psychotherapeutic alliance is formed with the family, which creates the conditions for long-term outpatient monitoring of the patient, necessary to achieve sustainable remission after discharge from the inpatient department.

To restore the spiritual sphere, the program includes watching thematic films, a series of lectures aimed at restoring principles and restoring spiritual development, spiritual hours are held for believers (Muslims and Orthodox). After completing a three-month course using this technique, a volunteer movement was introduced in support of the spiritual and personal development of patients. It allows patients who have completed rehabilitation to voluntarily help those in the hospital. Therefore, patients newly admitted to the hospital can see the results of a full course of rehabilitation, and volunteers strengthen their knowledge and skills to maintain sobriety. Social workers with experience in rehabilitation with a remission of 12 months or more take part in working with patients.

The features of the presented methodology for the rehabilitation of patients with chemical and non-chemical dependencies are:

1. Identification of comorbid mental disorders, in particular personality disorders in the treatment of patients with chemical and non-chemical dependencies.

One of the methods for identifying personality disorders according to the criteria of DSM-IV-TR is the method of structured clinical interview - SCID (SCID-Structured Clinical Interview for DSM-II-R). It was published in 1987 and has since been widely used by doctors and psychologists both in clinical practice and for research purposes. Testing results using this methodology reveal the presence of a personality disorder to determine:

1. The targets of psychotherapy

2. The hypothesis of the formation and consolidation of the disease

3. Patient management strategies

4. The format of work with the patient (group, individual, family or a combination thereof)

2. Issuing a multi-axis diagnosis. To do this, the department employs: a therapist, a psychiatrist, narcologist, psychotherapist, psychologist and social worker.

A multiaxial diagnosis allows a comprehensive approach to the treatment of addiction. According to DSM-IV-TR, a multi-axis diagnosis is presented in the following axes:

Axis I. Clinical disorders, other clinically relevant problems (conditions that cannot be attributed to any mental disorder, but giving rise to observation or treatment).

Axis II. Personality disorders, mental retardation (in the category of disorders that are diagnosed mainly in infancy, childhood or adolescence).

Axis III. Somatic diseases.

Axis IV. Psychosocial and environmental problems (9 main areas, for example housing or economic problems).

Axis V. Global level of functioning.

Multiaxial diagnosis allows you to:

6. To differentiate mental and somatic diseases, which, without proper treatment, will inevitably negatively affect the patient's condition after discharge.

7. Pay attention to the psychotherapy of personality disorder, on the basis of which addiction could form.

8. Form a criticism of the patient and his relatives to the manifestations of both addiction and personality disorder.

9. Continue pharmacotherapy (as directed) and follow up with a psychiatrist after undergoing inpatient treatment.

10. To help the patient in resolving psychosocial problems, to facilitate his employment and socialization.

3. An approach to addiction as a family disease. Upon admission to the rehabilitation department, a psychiatrist-narcologist, psychotherapist, psychologist and social work specialist invite all family members.

Within two days from the date of receipt, a full-fledged comprehensive medical history is carried out. From 3 to 7 days, individual psychotherapeutic work is conducted with each member of the family. With each of them, all of the above experts work in turn. This aspect is fundamental, as it provides complete information to both relatives and specialists. Starting from 8-10 days (in the absence of contraindications), relatives are included in group family therapy. At each lesson there is a doctor and a psychologist. Similar groups are held 2 times a week. The frequency of this event depends on the level of criticism of the disease, the degree of patient awareness. If the achieved compliance with relatives and the patient is assessed as satisfactory, then meetings are held once a week until the day the patient is discharged. The criteria for achieving compliance are:

7. The activity of the patient’s relatives, writing tasks, visiting all assigned events.

8. Visiting lectures for relatives and relatives of the dependent person, which are held weekly.

9. Inclusion of the patient in all measures of the rehabilitation process, motivation for awareness of the disease and work with its manifestations.

10. Enthusiasm, trust, interest in recovery.

11. Responsibility of the patient and independence regarding the administration of drugs (as prescribed by the psychiatrist-narcologist).

12. The consent of the relatives to a reasonable control of the patient's condition by the relatives themselves and the therapist for 12 months.

Examples

Example 1

Nikolay, 27 years old, drug addict. He entered the detoxification department, accompanied by close relatives. Nikolai has been using smoking blends for the past three years. Last year he did not work. Relations with a girl with whom he met for several years, ended because of his use. Parents began to communicate with him superficially and only when necessary. The last time after use, he, having lost orientation in space and time, was out of town, was severely beaten and taken to the clinic by his parents under the threat of eviction from home.

Detoxification therapy was carried out using Trisol, Reamberin, Remaxol, B vitamins, sedatives, tranquilizers. To alleviate withdrawal symptoms, a plasmapheresis procedure No. 3, TPP No. 5 was performed.

Diagnosis of mental disorders by the method of structured clinical interviews - SCID II (SCID II) showed the presence of a narcissistic and antisocial radical.

Multi-axis diagnosis:

Axis 1. Clinical Disorders: Mental and behavioral disorders associated with the use of psychoactive substances (surfactants).

Axis 2. Personality Disorders: Narcissistic and antisocial personality disorder.

Axis 3. Somatic diseases: Peptic ulcer and duodenal ulcer

guts.

Axis 4. Psychosocial problems: Symbiotic relationships with mother and father, expressed in hyperprotection, violation of personal boundaries and indifference to the needs of the patient at the same time.

Axis 5. Violation of adaptation, expressed in the loss of efficiency due to the abuse of surfactants with severe social consequences.

Initially, Nikolai made the impression of an obedient and calm patient - he completed tasks on time and complied with the regimen.

At the same time, individual psychotherapeutic work was carried out with family members of the patient, aimed at preparing for a possible impulsive reaction of the patient. Psychotherapy of family members was aimed at working out fear in relations with him at an adequate perception of his psychological defenses, expressed in the form of aggression, manipulation.

By the middle of the first week, Nikolai began to be aggressive, sabotaged events, showed rudeness and open aggression against other patients and psychologists. He was asked to choose responsibility for his behavior and he chose isolation in the ward. After three days, Nikolai wrote a detailed analysis of his behavior and began to relate to group work differently.

In the process of family group psychotherapy, which has been carried out since the 10th day of rehabilitation, he managed to express his grievances to his parents. This caused a strong emotional outburst not only in the patient and his parents, but also in other patients. The first agreements were reached, and contacts between family members began to be built directly, and not through an intermediary, which was always the mother. The attitude of his father towards the rehabilitation of Nicholas gradually changed.

To adapt the patient to social infrastructure, periods of therapeutic leave were organized. After them, the group worked through the emerging problems in relation to the father and mother of the patient, set adequate boundaries in the relationship in which the patient was responsible for himself.

After discharge, Nikolai continued to visit the center as a volunteer. His family continued to attend lectures for relatives, individual and family psychotherapy. At the moment, Nikolai has been in remission for 9.5 months. Relations with parents are warm and friendly. I managed to restore relations with my brother, with whom I have not talked for the last 5 years. Nikolai got a job, attends meetings of the Academy of Sciences, writes steps, visits the center as a guest.

Example 2

Anna, 36 years old, was admitted to the detoxification department after another binge. Has a son of 12 years. She came to the center under pressure from her mother and older sister. Relations with her mother were characterized by changeability - from warmth and love for hatred and cooling on the part of Anna. Mother firmly occupied the role of “Rescuer” for her daughter and tried to build relations between her daughters in the family and between her father and youngest daughter Anna. Anna from the very beginning was responsible and conscious. During the course of the rehabilitation there was not a single violation of the rules. But for a long time she avoided the topic of relationships with her sister and father. In addition, she felt guilty before her son, who was a witness to her use.

In the detoxification department, detoxification therapy was carried out using Trisol, Reamberin, Remaxol, B vitamins, sedatives, nootropics, tranquilizers.

Diagnosis of mental disorders by the method of structured clinical interviews - SCID II (SCID II) showed the presence of an obsessive-compulsive radical.

Multi-axis diagnosis:

Axis 1. Clinical Disorders: Mental and behavioral disorders associated with the use of psychoactive substances (surfactants).

Axis 2. Personality Disorders: Obsessive-compulsive personality disorder.

Axis 3. Somatic diseases: Stomach ulcer.

Axis 4. Psychosocial problems: Symbiotic relationships with the mother, expressed in hyperprotection, violation of personal boundaries and indifference to the needs of the patient at the same time. Envy and jealousy of an older sister.

Axis 5. Adaptation, expressed in the loss of trust on the part of parents and son. Loneliness and the inability to establish a long relationship with a man.

Work with family members began in the first week of rehabilitation, as the patient was emotionally prepared for her. At first it was family therapy with the participation of the mother, father, older sister and son, after 3 sessions they switched to the format of family group psychotherapy for 3 sessions, where the mother and son took part as the main sources of the patient's affective reactions.

In the process of family psychotherapy, Anna formed a loyal attitude towards her older sister, who often in the past showed aggression and intolerance towards Anna. There was a desire to build a warm relationship. Using Gestalt therapy, Anna was able to respond to feelings of resentment and anger that she had kept for her father for many years. Relations with the mother became more conscious and calm. Mother attended lectures for relatives and individual psychotherapy. Thanks to this, she was able to get rid of the role of the “Rescuer” and began to engage in herself and her life. Decreased control and tension in the family became a natural result during the patient's passage through the 3rd adaptation stage.

The targets of group psychotherapy were problems that arose during treatment leave. Actualized guilt before her son and attempts to manipulate her mother’s past caused a strong emotional reaction from the patient. And the growing feeling of loneliness in connection with the unfulfilledness as a woman caused tension and attraction to drinking alcohol. Group dynamic and existentially oriented psychotherapy allowed solving current problems and stabilizing the patient's condition.

Building relationships with the opposite sex and problems of understanding with a man are those problems that the patient was also able to work out during the course of rehabilitation. Anna currently has 8 months of sobriety, she works, visits the clinic as a volunteer and undergoes psychology training in order to take the position of a psychologist in working with dependent patients. Relations with father and mother became trusting and warm. Relations with the sister also underwent changes, and they began to communicate. Relations with his son became close, he accepted the illness of his mother and learned to pronounce negative feelings, Anna got rid of feelings of guilt and builds relationships with her child, relying on the knowledge that she received in the center.

Example 3

Mikhail, 26 years old, was admitted to the clinic accompanied by his mother in a state of severe depression, thoughts of suicide related to debt obligations as a result of a long gaming episode flickered. Also noted periods of recent abuse of alcohol and drugs.

In the detoxification department, detoxification and psychopharmacotherapy were carried out using Trisol, Reamberin, B and C vitamins, antidepressants, nootropics, tranquilizers.

Diagnosis of mental disorders by the method of structured clinical interviews - SCID (SCID II) showed the presence of a narcissistic radical.

Multi-axis diagnosis:

Axis 1. The pathological attraction to gambling.

Axis 2. Personality Disorders: Narcissistic personality disorder.

Axis 3. Somatic diseases: Neurodermatitis.

Axis 4. Psychosocial problems: Symbiotic relationships with the mother, expressed in hyperprotection, violation of personal boundaries and indifference to the needs of the patient at the same time. Expressed concern about insolvency in personal relationships.

Axis 5. Violation of adaptation, expressed in the impossibility of long-term adaptation in the workforce in connection with the narcissistic radical, impulsiveness. The constant search for work causes family conflict.

At the beginning of rehabilitation, Mikhail belonged to the group and to the psychotherapeutic process itself superficially and frivolously. He complied with the internal regulations of the department, but did not take an active part. Soon he gathered a company of patients close to himself by age and social status, in which he sought leadership. Group work using the B. Hellinger placement method, carried out from the 8th day of rehabilitation, was a turning point in Mikhail's therapy. He was able to open up to the members of the group, expressed guilt towards the deceased grandfather and his shame before his mother.

Work with family members began in the first week of rehabilitation in the form of individual psychotherapy with her mother, aimed at working out her feelings of guilt before her son for growing up without a father. After the stabilization of the mother’s condition in the second week, family psychotherapy sessions began, where the mother’s feelings for her son were projected by other members of the group. Thus, both the patient and the group members worked out a sense of guilt before their mother in this group session. This helped the patient switch from a manipulation language to a direct and open dialogue with his mother.

Having completed the planned tasks according to the rehabilitation program, the patient was transferred to the adaptation phase with periods of treatment leave. During which the patient worked through resentment against the mother and guilty feelings before her. Given the patient’s narcissistic radical, this process took longer than planned. And also these targets, along with the goal of empathy, formed the basis of the post-treatment rehabilitation program drawn up with the participation of the attending physician and the supervising psychologist.

By the time he was discharged from the hospital, Mikhail had become more confident, conscious, purposeful. He visited the clinic as a volunteer until the time of employment. He currently has 9 months of remission, he visits AI groups (Anonymous Gamerunners), maintains friendly relations with other recovering clinic graduates.

Example 4

Patient Peter, 32 years old, turned accompanied by relatives with complaints of daily drinking of alcohol at a dose of 0.5 liters per day. The patient refused treatment as before. In the detoxification department, detoxification and psychopharmacotherapy were carried out using Trisol, Reamberin, B and C vitamins, and tranquilizers.

In the first week of rehabilitation, the patient's relatives began attending lectures for relatives of dependent patients in order to recognize pathological co-dependent behavior and to obtain information about the problem of dependence. After a decision was made by relatives to continue treatment in the rehabilitation department, a motivational interview was conducted with the patient in the presence of relatives in order to overcome the patient's denial of the disease and obtain consent for further treatment.

At the beginning of the first stage of rehabilitation, a diagnosis was carried out using SCID II, where personality characteristics of the narcissistic and borderline senses were identified, which made it possible to determine the targets of psychotherapy, such as emotional coldness associated with child loneliness, instability in interpersonal relationships due to loss of trust in parents in childhood due to a contradictory attitude towards the patient and other targets. The leading motivation for drinking alcohol was determined as a way to fill the “void”; accordingly, psychotherapy was aimed at finding ways of patient self-realization at the third stage of rehabilitation.

From the 8th to the 16th day of treatment, the rehabilitation department was full of sessions of family psychotherapy. Family members took an active part not only in family psychotherapy sessions, but also in conducting cognitive-behavioral group psychotherapy, where the patient was not able to play down the significance of the effect of alcohol on the life of the patient and close relatives. This helped to be more open in relations with other patients, by itself, and forced a transition from the denial of the disease to the adoption of a diagnosis. This form of family psychotherapy in combination with family group psychotherapy helped build the trust of relatives in the patient and the prospect of treatment and rehabilitation. Thus, a stable alliance was formed in the family system - a team of specialists (psychiatrist-narcologist, psychotherapist, psychologist, social work specialist) to achieve therapeutic goals. Gestalt therapy methods and projective methods made it possible for the patient to realize his own motives for drinking alcohol, bypassing psychological defenses, which accelerated the process of taking the disease.

At the second stage of rehabilitation, the diagnostic and treatment process was filled with the methods of psychodynamic group psychotherapy. To determine the tactics and conduct of the psychodynamic process, a multi-axis diagnosis was carried out, where it was revealed on Axis I - Mental and behavioral disorders as a result of the use of psychoactive substances. Axis II - Narcissistic and borderline personality disorder. Axis III - Peptic ulcer of the stomach and duodenum as one of the most common psychosomatic diseases. On Axis IV - a symbiotic relationship with the mother due to a lack of love and reflection and a compensatory sense of guilt, a co-dependent relationship with the spouse, shame in front of the children. These targets formed the basis of tactics of psychodynamic therapy, psychodrama according to Ya.L. Moreno.

The third stage of rehabilitation was aimed at finding ways of self-realization to compensate for the phenomenon of "emptiness" or existential vacuum. Why the methods of the existential-humanistic approach were used (Logotherapy by V. Frankl, Person - analysis by A. Langle). To implement the experience gained, the patient was on weekly medical leave for two days off, then during the week work was done on the errors in the format of individual and family psychotherapy. After 2 weeks, the patient was transferred to a day hospital - the next stage of smooth integration into independent social functioning. For four weeks, work was carried out on the patient's current needs in connection with emerging internal and external conflicts, as a result of new relationships with the family.

After discharge of the patient, he took part in the rehabilitation of other dependent patients as a volunteer and continued to visit outpatient psychotherapeutic groups for two months, while the patient's family continued to attend lectures for co-dependent weekly until the end of the outpatient phase of treatment.

Claims (19)

1. The method of treatment and rehabilitation of patients with chemical and non-chemical dependencies, which consists in conducting preventive measures, characterized in that they carry out activities aimed at restoring the physiological functions of the patient, and rehabilitation of the patient, involving family members of the patient with family psychotherapy, while at the first stage of rehabilitation apply methods of cognitive-behavioral, gestalt therapy, projective methods, a psycho-educational approach with the formation of initial motivation, the patient’s criticism of his own behavior, detection of the reasons for the formation and maintenance of dependence, at the second stage of rehabilitation, the methods of the first stage are supplemented by the methods of a psychodynamic approach, psychodrama by J. Moreno and B. Hellinger's constellations, forming patient awareness of destructive behavior patterns, intrinsic motivation to maintain a healthy lifestyle, a clear separation of “healthy self” and “patient self” , at the third stage of rehabilitation, the methods of the previous stages are supplemented by the methods of existential psychotherapy and weekly medical holidays aimed at realizing the acquired skills and identifying difficulties in social adaptation, with a gradual increase in the duration of the holidays and sessions of discussing the results of the holidays with a specialist individually and / or in the psychotherapeutic group. 2. The method according to p. 1, characterized in that the therapeutic measures are aimed at relieving withdrawal symptoms and eliminating physical attraction in patients with chemical dependencies. 3. The method according to p. 1, characterized in that they carry out therapeutic and preventive measures to form the initial motivation for maintaining sobriety in patients with chemical addictions. 4. The method according to p. 1, characterized in that the treatment and preventive measures are carried out with the detection of comorbid mental disorders according to the criteria of DSM-IV-TR by the method of structured clinical interview - SCID (SCID-Structured Clinical Interview for DSM-II-R) and the targets of psychotherapy, the hypothesis of the formation and consolidation of the disease, the patient management strategy, the format of work with the patient are determined, the latter being selected from a group, individual, family or a combination thereof. 5. The method according to p. 1, characterized in that they carry out preventive measures with the identification of a multi-axis diagnosis in the following axes: A) clinical disorders or clinically relevant problems, B) personality disorders and mental retardation, B) somatic diseases, D) psychosocial problems and problems caused by the environment. 6. The method according to p. 1, characterized in that they carry out diagnostics with the participation of all family members, from 3 to 7 days conduct individual psychotherapeutic work with each family member, then from 8-10 days family members are subjected to group family psychotherapy with a frequency of sessions 2 times a week, while the number of sessions is reduced to 1 time per week upon reaching satisfactory compliance with relatives and the patient, which is determined by fulfilling the following criteria: 1) the activity of the patient’s relatives, writing tasks, visiting all the prescribed events, 2) attend lectures for relatives and relatives of the dependent person, which are held 1 time per week, 3) the patient’s involvement in all measures of the rehabilitation process, motivation to recognize the disease and work with its manifestations, 4) enthusiasm, trust, interest in recovery, 5) the responsibility of the patient and independence in relation to the administration of drugs, as prescribed by the psychiatrist-narcologist, 6) the consent of the relatives to a reasonable control of the patient's condition by the relatives themselves and the therapist for 12 months.