4-5 June 2013 Proceedings Science Book Publishing House Yelm, wa, usa

PSYCHOLOGICAL CHARACTERISTICS OF PEOPLE

WITH ALCOHOL DEPENDENCE: TO THE QUESTION

OF THE MAIN VECTORS OF PSYCHOLOGICAL INTERVENTION IN THE HOSPITAL CONDITIONS

M. S. Sevostyanova

Tomsk Clinical Psychiatric Hospital, Russian Federation, Tomsk,

[e-mail]
Introduction

The specifics of the psychological management of patients with alcohol dependence in the hospital conditions includes: diagnostic testing, individual psychological counseling, group training, psycho-social rehabilitation and adaptation. In this case, the main sources of motivational activity to attend psychological counseling and training are "boredom", "nice to talk to you, because here around just stupid drunks and no one else», "maybe it will help me to be discharged quicker," "my doctor (psychiatrist or expert in narcology) said".

Patients with alcohol dependence demonstrate the following settings before psychological intervention: "I came here to put a dropper and stop drinking after that", "…thank you of course, but I’m also a psychologist, you don’t need to be smart for that… so you’ll not tell me something new and I have nothing to say too", "…stupidity all of this, if a person does not throw himself a drink, no one would help", "I guess it's a sign that I got here! Now, I’ve just realized all ", "…with me it will never happen again", "…it's a stress ... but you can’t give me back my wife ... (to pay my loan, find me a job, etc.) - and therefore can’t help".

There are many uncontrolled features of psychological intervention in hospital. For example, short duration (maximum of 8 meetings, including individual counseling and group training) and non-specificity of the existing methods of psychological intervention. Moreover, there is no account of psychological features of alcohol-dependent patients with a history of alcohol psychosis (with AP) and how they differ from alcohol-dependent patients without a history of alcohol psychosis (without AP). And the dependence of psychological intervention on external factors (time, droppers, physical therapy, lunch, examination by specialists, occupational therapy, etc.). So, considering the time that patients spend in the hospital, lawfully to speak only about the beginning of a long process of biological, psychological and social rehabilitation.

To mitigate these factors, preventing the efficiency of psychological intervention, is necessary to identify the specific psychological "symptoms of the target." With that, differentiate them from patients with alcohol dependence with AP and alcohol-dependent patients without a history of AP. Implementation of this objective will give a significant jolt to improve the effectiveness of psychological interventions in hospital conditions.

On the basis of practical experience, we have formulated the estimated vectors of "target symptoms" detection, particular psychological characteristics, which will be manifested obvious differences between patients with alcohol dependence without AP and AP in the history of the disease. These vectors - mental spheres of the individual - and the specific characteristics of the scientific research in each mental sphere discussed below:

1. 
   Emotional sphere:
   
   • 
     the severity of anxiety
     
   • 
     the severity of depression
     
   • 
     the presence / absence of alexithymia
     
2. 
   Personal features (including in connection with the disease):
   
   • 
     type of psychological response to the disease
     
   • 
     contents of intrapsychical conflicts
     
   • 
     the image of "I am now" in the structure of "Self-concept" ("Self-construction")
     
3. 
   Motivational sphere:
   
   • 
     stage of psychotherapeutic changes
     
   • 
     dominant motivation to drink alcohol
     
   • 
     social attitudes and psychological motivation for psychological intervention
     
4. 
   Value sphere and scope of the leading individual's needs:
   
   • 
     leading terminal and instrumental values
     

Characteristics of the studied respondents

212 male respondents aged from 22 to 50 years with alcohol dependence were involved in the current empirical research. The criteria for inclusion in the sample were informed consent and adequate perception of the situation of the clinical study. Among the respondents, 73 people had in anamnesis evidences and described cases of alcoholic psychoses in the structure of the disease. The remaining 139 respondents had episodes of occurrence of chronic alcohol dependence but without alcohol psychosis. All of the respondents at the time of the survey were hospitalized at the Substance Abuse Department of the Tomsk’s Clinical Psychiatric Hospital.

Research methods

To study the above psychological personal characteristics of respondents with alcohol dependence, we used the following methods and techniques: 1) Taylor Manifest Anxiety Scale — TMAS; 2) Beck Depression Inventory for Primary Care (BDI-PC); 3) the Toronto Alexithymia Scale (TAS-20); 4) TOBOL - the questionnaire of the Bechterev Institute invented for studying different psychological types of attitudes to the disease; 5) the questionnaire, developed by Karvasarsky entitled "The degree of conscious awareness of the psychological mechanisms leading to the disease"; 6) the Bem Sex Role Inventory (BSRI) - a measure of masculinity-femininity and gender roles - to study the gender identity and gender "I" as an important structural component of the "Self-concept"; 7) the standardized clinical interview to identify the dominant motivation of alcohol abuse; 8) URICA (The University of Rhode Island Change Assessment Scale) – special methods for studying stages of psychotherapeutic dynamics and positive changes; 9) the questionnaire, developed by Karvasarsky entitled "Different social and psychological attitudes to the disease and treatment" to study; 10) Rokeach Values Survey to study leading personal values and needs​​.

Results

The empirical results of the research are presented in Table 1.

Table 1 - The results of the empirical research

Psychological characteristics studied in the current research		Patients with chronic alcohol dependence with episodes of alcoholic psychosis in anamnesis (persons,%)	Patients with chronic alcohol dependence with no cases of alcoholic psychosis in anamnesis (persons,%)
The severity of anxiety	0-5 points (no or low levels of anxiety)	21,91	5,75
	5-15 points (average level of anxiety with a tendency to decrease)	53,42	10,7
	15-25 points (average level of anxiety with a tendency to increase)	16,43	49,6
	25-40 points (a high level of anxiety)	5,47	20,14
	40-50 points (very high levels of anxiety)	2,73	13,66
The severity of depression	0-9 points - no depressive symptoms	71,23	11,51
	10-15 points - mild depression (subdepression)	19,17	31,65
	16-19 points - moderate depression	6,84	41,72
	20-29 points - severe depression (moderate)	2,73	12,94
	30-63 points - severe depression	0	2,15
The presence / absence of alexithymia	0-62 points (no alexithymia)	75,3	11,5
	62-74 points (risk group)	15,05	38,84
	74 points or more (alexithymia is diagnosed)	9,58	49,6
Types of psychological response to the disease (This is important! One respondent at one and the same time can demonstrate a combination of several types of relationship to disease)	Harmonious	2,73	13,66
	Ergopathetic (escape into work, workaholism)	9,58	36,69
	Anosognosic (denial of illness)	67,12	10,07
	Anxious	1,36	4,31
	Hypochondriac	0	2,15
	Neurasthenic	0	2,87
	Melancholic	2,73	5,03
	Apathetic	4,1	1,43
	Sensitive	2,76	11,5
	Egocentric	6,84	6,47
Contents of basic intrapsychical conflicts (This is important! One respondent at one and the same time can manifest several expressed intrapsychical conflicts)	The conflict between the need for independence and getting help, care	57,5	5,75
	The conflict between the need for domination and submission	58,9	2,08
	The conflict between the desire to meet their own needs and requirements of the environment	61,6	28
	The conflict between the rules and the aggressive tendencies	39	69
	The conflict between their own actions and regulations.	4,1	46,7
	Conflict or discrepancy between the level of claims and the level of achievement.	8,21	40,2
The image of "I am …now" in the structure of "Self-construction" (the central features, the "kernel")		Central features were not identified by most of the respondents (97%). The most popular answers are listed below: "I’ve never thought about it" "You must know better about me! " "Silly question! How can I know this! "	Guilty Kind Does not understand himself Equitable A hot-tempered, but easily appeased Accident-prone Bad Honest
Stage of psychotherapeutic changes (Important! One respondent at one and the same time may be at several stages of psychotherapeutic change)	"Before thinking" - does not understand the nature of the problem	84,93	40,2
	"Meditation" - recognizes the problem and is interested in variants and solutions how to get rid of the problems.	8,21	24,4
	"Action" - actively changes his behavior, actions, and environment in order to overcome the problem	50,6	77,6
	"Conservation" - The patient has achieved some results in solving his problems and worries that the problem, which he considered as solved, could return	8,26	19,4
Dominant motivation to drink alcohol	Ataractic	10,9	37,4
	Hedonistic	31,5	8,63
	Submissive	30,1	26,6
	With hyper-activation of conduct	24,6	15,8
	False-cultural	2,7	11,5
Social attitudes and psychological motivation for psychological intervention	On awareness of the problem	5,4	17,2
	Behavior change	19,1	56,8
	To achieve symptomatic improvement of somatic manifestations of the disease	53,4	15,1
	For a "secondary gain"	12,3	2,8
	Other	9,5	7,9
Leading terminal and instrumental values		Financially secure life Physical and mental health Happy family life Availability of good and loyal friends Buoyancy Independence Honesty	Financially secure life Freedom Public recognition Happy family life Love Self-control Responsibility Firm will

Discussion

The analysis of the empirical data leads to the following conclusions. A typical psychological profile of the average patient with chronic alcohol dependence with alcoholic psychosis in anamnesis is as follows. This is the "alcoholic" with the average level of anxiety with a tendency to low, the absence of depression and alexithymia, denies the existence of the disease, has dominant intrapersonal conflict between the desire to meet his own needs and requirements of the environment. Doesn’t have central features in the structure of "Self-construction", knows nothing about himself, drinks usually for a company or not be an outcast, can’t deny to others. Dominant psychological setting for treatment is to achieve physical improvements, patient is not award about of his problems, doesn’t understand the goals of medical treatment and psychological intervention. Doesn’t have such values ​​as "interesting work", "knowledge" and "self-development".

On the other hand the typical alcoholic without alcohol psychosis in anamnesis has completely different psychological characteristics. He has a high level of anxiety, the average level of depression, he suffers from alexithymia. Не overcomes illness trying to work harder, he is a workaholic who has intrapersonal conflict between the rules and the aggressive tendencies and has no positive constructive central features in the structure of "Self-construction". The dominant setting of the treatment is to change behavior and he tries to change the way of thinking and action. This type of patients doesn’t have values ​​such as "physical and mental health", "creativity".

This findings help us to identify the general basic psychological "target symptoms". They are: 1) distortion and imbalance in the value sphere and scopes of the leading individual's needs (deviant values, situational egocentric orientation, frustration of needs, intrapersonal conflicts, unproductive psychological defense mechanisms, imbalances in the declarative and procedural motivation); 2) spiritual problems (lack or loss of meaning in life, immature moral values, reduction of higher senses (conscience, responsibility, honesty), an inner emptiness, self-locking); 3) emotional problems (anxiety, depression, negative emotions, difficulties with understanding and expressing emotions); 4) problems of self-regulation (impaired ability to set goals and pursue them; inadequate self-esteem, excessive or insufficient self-control, inability to engage in reflexive self-analysis, low-productive coping mechanisms, low adaptive capacity, lack of positive personal resources); 5) cognitive distortions (dysfunctional thoughts, thinking patterns, limited knowledge, myths, prejudices, inadequate installations); 6) negative life experience (negative habits and skills, deviant experience, rigid behavioral patterns, mental trauma, the experience of violence).

Based on the above "target symptoms" we can formulate the basic purposes of the program of comprehensive psychological intervention for patients with alcohol dependence. So, purposes of the program are: 1) to provide support to the existing defenses and motivational activities; 2) to make positive behavior changes and to diversify behavioral repertoire during stress with new coping strategies; 3) to create the conditions for changes through interpersonal awareness of intrapsychical conflicts. The program of comprehensive psychological intervention for patients with alcohol dependence includes: motivational section, section of the formation of adaptive behavior skills, section of the correction of negative emotional states, section of cognitive restructuring and section of the formation of an alternative assertive behavior.

Basal principles of psychological intervention are: 1) to search healthy, harmonious personality traits (with a focus on emotions); 2) the formation of a sense of self-efficacy; 3) formation of beliefs in the possibility to influence their own health and to solve the main psychological problems; 4) the development of adequate knowledge about the mechanisms of disease recurrence; 5) do not change the behavior associated with the act of drinking alcohol, but to influence on factors, which have led to the alcohol use, abuse and dependence.

There are several main objectives of the program of comprehensive psychological intervention for patients with alcohol dependence. First is to provide support to the existing protective forces of personality (the formation of a positive self-esteem; generation of additional motivational resources through the analysis of individual experience in achieving positive outcomes in the past, creation of a balance between the images "I am now", "I am perfect""Who I am in the opinion of others"; create a sense of individuality and self-acceptance of personal responsibility for their lives). Second is to create positive behavioral changes and to develop new, more effective ways of behavior (to internalize the mechanisms which control behavior and emotions to form self-control; the termination of avoidance everyday situations, that previously were avoided, resulting in desadaptation; the formation of a stable and generalized situational competence). Third is to acquire new social and psychological skills (skills of self-planning, goal-setting and implementation, allocation of time and energy; to form different abilities: to extrapolate (to assess the impact of risk, anticipate the results of activities), to cognize the structure and particular qualities of their own value-need sphere, whereby which man usually makes the decision what he really wants, to be adequately and critical in their assessment of the properties of their personality and behavior, to overcome emotional stress using adaptive coping strategies, to understand how the analysis of their own behavior (reflective analysis) impacts on decision-making systems and the formation of an adequate self-efficacy expectations. Fourth is the cognitive restructuring (to improve an ability to understand the causal links between specific conflict situation, cognition, emotional state, and maladaptive behavior; to disintegrate irrational attitudes that have been uncritically assimilated from significant others). Fifth is to improve the quality of life of the patient through the formation and improvement of communicative competence and development of a patient's ability to control his environment, especially negative addictive incentives, and their own reactions provoked by this environment (to create the motivation for social adjustment and recovery, to eliminate reactions of anxiety and fear especially while discussing psychological traumas, to develop the ability to relax).

Implementation of the program of psychological intervention for patients with alcohol dependence (with the obligatory account of psychological features, depending on the presence / absence of alcohol psychosis in anamnesis) can provide effective results. While participating in the program, the patient is learning to take personal responsibility for his physical health and psychological state and to express negative emotions using socially acceptable ways. During this program consistent adaptive cognitive attitudes and behavioral patterns are being formed, communicative competence, self-esteem and self-acceptance are being increased. At the end of the program, the patient is able to plan and set goals effectively. The motivation for social inclusion, recovery and transmission of supportive therapy and relapse prevention has been formed.

SECTION 11. Social sciences