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Basic Principles in the Treatment of Drug Habits
The basic principles in the treatment of drug habits depend on the development of medical science, on the abilities of the health service and on the society’s bearing towards the nature of the disease. The attainments of the clinical pharmacology and the consideration of drug habits as diseases, which are in need of treatment, have a positive effect and contribute to the establishment of specialized health services for prophylactics and curing of drug habits. Modern methods and means are used for abolishing the psychic and the physical dependency, for the general strengthening of the organism, and recently for the curing of the micro-social milieu.
The basic principle in the treatment of drug habits should be first and foremost the well-organized and skillfully guided bifocal therapy. The medicinal measures may ensure the desired effect only on condition that they are directed to the patient and his/her informal micro-social milieu.
The attained in-hospital remissions can be broken off only during the first days after the discharge from the health institution, if the patient comes back in his own or another drug-addicts’ group. Because of this it is necessary that the efforts of the psychiatrists should be directed to the convalescence of the environment, in which the drug-addict is going to live after he or she leaves the hospital.
Another principle in the treatment of drug habits is the necessity of individual approach. The careful examination of the personality, of the environment and the factors, which are of an importance for the creation of the morbid dependency towards the substance, determines the behavior of the psychiatrists towards the patient.
The medicinal results, to a considerably degree, depend on the accepted individual program and on its successful fulfillment. It is much essential that the stage of development of the disease should be defined during the examination of the drug-addict. When the patients are in an experimental phase the approach and the treating program considerably differ from those, which are performed to patients in a phase of an already created morbid dependency.
As early as the first examination the drug-addict should understand that the abandonment of the absorption of narcotic substances does not decrease his or her social status, on the contrary – it increases it. The drug-addict should be convinced of the necessity to take therapy. If this is achieved, we can rely on the so-called partnership – the patient has positive behavior to the medical man and takes an active part in the treatment. The approach towards the drug-addict should be stimulating and respectable. The addict should understand that he/she is accepted by the physician as a patient, who needs help. Together with this, it is necessary for the abuser to know that the morbid dependency is created with his/her participation. This is the reason, for which any good curative effect can be expected only on condition that the addict is ready to help the doctor during the realization of the medicinal process without reservation. One of the first requirements towards the drug-addict should be his/her agreement to break off the contacts with the drug-addicts’ group both during the therapy in the hospital and after he/she is discharged from it.
The treatment should be complex. It is necessary that the efforts should be directed to the elimination of the psychic and physical discomfort, to the general strengthening of the organism and to the creation of new moral values, in which the family and the positive treatment to labor will find their place. This can be achieved with good planning of the teamwork of the psychologist and the social worker under the guidance and the active participation of the doctor-psychiatrist. The complexity as a basic principle in the treatment imposes the making of efforts for the drug-addicts to be taught to work, live and communicate with people after their discharge from the hospital. It is necessary that a special attention be paid for a more active participation of the family in the re-socialization of the patients.
The continuance is another important principle in the treatment of drug habits. The confinement of the treatment only in the days of the patient’s sojourn in the psychiatry is incorrect. On the contrary – it is necessary for all drug-addicts, to which continuity and unity should be provided in the realization of the curative program in hospital out-hospital conditions. The stationary treatment should not be shorter than 3 months and if it is possible it should be accompanied in specialized narco-sections in the general mental hospitals. The main argument against the curing of the drug-addicts in specialized sections is the apprehension of creating "group with a protest behavior”.
Actually the drug-addicts create groups with a protest behavior. Such groups were created by patients, who took treatments in the general mental hospitals (for acute and chronic patients) as well as the drug-addicts in the section for alcoholic patients.
In some countries the prolonged in-hospital treatment is accepted as a rule, but in others – shorter in-hospital and longer out-hospital treatment. The drug habits are connected to a considerable extent with the culture of the country, with its social structure and organization. Because of some existing differences the organization of the treatment in every country should conform with these peculiarities, but not to accept abstract and difficult to put into practice medical models for curing the drug habits.
With the determination of each concrete medicinal program the aim of the treatment should be clearly defined. The ideal goal is the complete suspension of the absorption of drug substances, the emancipation from the morbid dependency, complete efficiency and social functioning, emotional stability and adaptation of the personality towards the requirements of the environment. The ideal goal is extremely difficult to be achieved and this happens with very few of the patients. Because of this, intermediate aims, which do not require complete abstention, have been defined recently. By the restriction of drug usage, the aspiration for better work load, economic stability, social adaptation and decreased criminality, are included in the intermediate aims.
The given ideal and intermediate goals in the treatment of the drug-addicts, as well as the necessity for it to be realized in a complex and continual way, require the differentiation of separate stages in the curative process and the determination of the volume and the content of the applied medicinal measures and means in the respective stage. So in the curative process there can be differentiated 3 basic stages, but actually no sharp limit can be set between them.
During the first stage, the efforts of the physician, should be directed to the diagnostic elucidation of the patient’s condition, to his/her confidence, to the creation of a psychotherapeutic contact and desire for treatment. Most often the first stage of the treatment is connected with the psychiatrist’s efforts to alleviate the patient’s condition during the abstinence. The patients come to the mental hospitals, in a condition of poisoning. Most often the degree of the poisoning does not require any special cares and it is limited to the application a routine means for “dispoisoning”. Usually the patients, who are in a comma or in a serious condition, are installed in the in-hospital or in the specialized toxicological sections in the nearest health center. A psychological adjustment of the patient to collaborate with the doctor is created during the first days of her/his admittance in the hospital.
Except medicines and other means for removing toxic or abstinent effects, psychotherapy is also used during this stage.
The first stage continues about 40 days and during this period an adjustment for a complete withdrawal from drug absorption should be created. The interruption of the use (sudden or gradual) is determined by the type of the morbid dependence and the condition of the patient.
The second stage continues about a year. It should provide continuity and succession in the in-hospital and out-hospital help. Usually the efforts during this stage are directed to the general strengthening of the organism, the complete over coming of the abstinent effects and the complete abolition of the psychic and physical dependency towards the substance. The main purpose is the creation of new interests and a critical bearing towards the disease. If the patient accepts the new “forced” values during this stage, a good result of the treatment can be expected.
An important place in the curative program during the second stage takes the psychotherapy and labor-therapy. The medicines are used as a subsidiary mean for abolition of the neurotic diseases and the general strengthening of the organism.
During the third stage the strongest attention deserves the maintaining of the constant labor engagement of the drug-addict with a rational use of the “spare time” in a new friendly milieu. The medicinal treatment is fulfilled as an exception and it is usually directed to the neurotic complaints of the patient, the increased fatigue and so on. During this stage, which continues about 3 years, it is necessary that a collaboration between the patient, his/her family and the doctor be maintained. The practice shows that the medical staff, the sufferers and their families should be qualified for a possible renewal of the drug abuse in the sense of a single use or a relapse (a drug abuse, during which the basic symptoms of the disease are observed). With the good collaboration between the doctor, the patient and the family the appropriate measures can be taken and the development of the disease can be suspended only with the first manifestations of relapse or in some cases with a single use of narcotic.
It is necessary to point out that in some countries, where the drug habits are wide spread, national medical programs (modules) are accepted as treatment. They differ mainly by the approach towards the patient and the means, which are used during the second and the third stage of the treatment.