Psychological and physiological tobacco dependence

Meaning of the concept

Dependence is a drug addiction that occurs at a certain stage of the disease, which is accompanied by a compulsive desire to achieve euphoria through general intoxication of the body, which leads to withdrawal syndrome. Pathology does not appear immediately; it has special predecessors.

1. Syndrome of changes in reactivity is the onset of the use of opiates and other narcotic substances in small doses, which is periodic in nature. Leads to a change in the body's tolerance to a psychotropic substance.
2. Mental dependence – follows immediately after a change in reactivity and is obsessive in nature, which means a person’s mental return to the feelings of euphoria from alcohol or drugs. A person may experience joy at the thought of using a substance or depression from the fact that he will not be able to relax with the help of the habit. At the stage of mental dependence, a person is able to leave a bad habit with the help of self-motivation and prioritization.

Physical dependence is expressed in an irresistible craving for substances that cause euphoria.

At the compulsive stage, it can take over not only a person’s thoughts, but also displace all necessary, vital needs, such as the need for food and water, intimacy. Drugs can fill every aspect of a person's existence and take complete control of the brain. Psychological and physiological addictions develop gradually and lead to the fact that a person who uses drugs becomes unable to comply with moral standards and rules of conduct accepted in society.

Physical pathology at the compulsive stage has a peculiarity - a feeling of satisfaction comes only from a certain type of narcotic substances, and the use of another type of psychedelics can stop the desire, but will not bring pleasure and relaxation.

Glossary of terms

In this section we have collected all the terms that you might encounter in this article. Gradually, we will collect from these explanations a real dictionary of a narcologist-psychiatrist. If some concepts remain unclear to you, leave your comments under the articles on our site. We will definitely help you figure it out.

Drug addict

- the same as drug addiction. A disease associated with the body developing a habit of receiving a certain dose of psychoactive substances.

Addict

- a person dependent on psychoactive substances, sick with drug addiction (drug addiction).

Drug

- a chemical that causes coma, stupor, or dulls sensitivity to pain in people, acting in the same way as most analgesics. From a medical point of view, the term should mainly refer to opiates and opioids, but in everyday life it is used as a general name for all psychoactive substances.

Physical dependence syndrome

- a physiological habit developed by the human body to obtain part of the necessary substances through drugs.

Withdrawal is a serious condition in drug addicts that occurs after abruptly stopping taking drugs (also called “withdrawal syndrome”).

Causes

Compulsive addiction can be caused by any psychological shock. People who are weak-willed and cannot cope with problems start taking drugs. The easiest way is to close yourself off from troubles and plunge into a state of eternal celebration and high spirits.

One of the reasons for the development of physical dependence in a person is the release of the joy hormone endorphin when drinking alcohol or intoxication from drugs.

The brain is able to remember this state, and therefore, on a subconscious level, a person will want to feel the euphoria that the drug gives him more than once or twice. After each use of a narcotic substance, the brain clearly forms a picture of what is happening and begins to produce less of its own hormone of happiness. A kind of replacement occurs: if the body receives a dose of endorphin from the outside, then why waste energy on its own production. Therefore, the effect of the drug is not only addictive, but also interferes with the normal functioning of the entire body: due to the low production of joy hormones in the body, the dose that comes from the outside must be increased or repeated more often.

When taking medications containing opioids, caffeine, codeine and other narcotic substances, be sure to consult your doctor and follow the instructions exactly.

Reasons for long-term rehabilitation for drug addicts

Rehabilitation measures are aimed at forming a stable barrier to restrain the desire to resume using psychotropic drugs. In the process of working with a psychologist, the patient realizes the full scale of the problem that he is faced with. Rehabilitation services are completely anonymous.

Destroying the false belief that alcohol and drugs will help solve psychological problems contributes to conscious refusal of them. It is important that a psychological service employee is able to get to the root of his patient’s problems, telling him the right solutions. Physical dependence must be eliminated even before rehabilitation measures.

We can come to the conclusion that as soon as a person becomes addicted, it is important to begin correct and effective treatment in a timely manner. Emotional addiction to a drug will sooner or later trigger addiction, which will gradually destroy the human body, make it incapable of immune resistance, and can lead to death.

Main Factors

Physical dependence can be caused by many factors.

• Bad heredity: if one of the parents suffers from alcohol or drug addiction, the child may adopt this tendency and be at risk.
• Severe psychological trauma. A shock such as the death of relatives or prolonged depression, which is treated with strong antidepressants, can cause dependence on barbiturates.
• Childhood psychotrauma. Children who come from dysfunctional families, who have been offended and humiliated, have every reason to seek solace in alcohol, opioids, and marijuana.
• Acute social need. If a person lacks communication and does not know how to attract friends, he may end up in a dysfunctional company.
• Improper use of sleeping pills and sedatives also causes addiction and psychophysical dependence.
• The problem associated with smoking tobacco or smoking mixtures develops gradually: at first, a person smokes one or two cigarettes a day and thinks that he is coping with the situation, but this is far from the case. Those who do not smoke at all are not addicted, and daily use leads to addiction.

Dependence on barbiturates or sedatives occurs due to prolonged misuse and overdose. Therefore, such drugs are taken strictly under the supervision of a doctor.

Opioids can cause analgesic, antitussive and other effects, but lead the body to addiction. Morphine, which is isolated from the opium poppy, can have a strong analgesic effect and is therefore widely used in medicine, but strictly as prescribed by a doctor. It is prescribed to people suffering from pain due to cancerous tumors.

What is addiction

In psychology, addiction is called addictive behavior. This is an irresistible attraction to substances or objects, expressed in the performance of certain actions, in the absence of which a person experiences psychological discomfort. The difference between addiction and hobbies is its destructive impact on the individual. An individual with addictive behavior directs all his activity to satisfy his addiction. At the same time, other aspects of the personality that have potential do not develop, and social connections are often broken. An environment of the same addictive personalities is formed, which draws the person into a vicious circle.

Dependencies are divided into two main types:

1. Chemical addictions. This is an addiction to certain substances. The need for an object of dependence is expressed by physiological reactions. This includes drug addiction, alcoholism and substance abuse.
2. Non-chemical (psychological) addictions. The need for an object is expressed in extreme psychological discomfort. In this case, psychosomatic manifestations are possible. The number of psychological addictions is growing. For example, addiction to computer games and pornography is associated with the development of Internet technologies.

Chemical and psychological addictions are interconnected. They are formed according to a single mechanism. An alcoholic and a gambling addict are very similar from the point of view of addiction. Addictions can flow into one another, for example, a gambling addict can become an alcoholic, and a person who has recovered from alcohol addiction can become addicted to gambling. An addictive personality is a person prone to addictive behavior in any form. A common feature is the desire to escape reality by changing the mental state.

Symptoms

It is difficult to recognize physical addiction on your own, because a person cannot admit his problem. The following are common symptoms of drug addiction:

• intoxication of the whole body;
• weakness and malaise during the period without the use of psychotropic substances;
• chills, fever;
• the body becomes covered with boils;
• ulcers and suppuration may appear;
• loss of teeth, hair, brittle nails;
• depression, state of apathy;
• aggression and anxiety.

How to recognize addiction

Addiction differs from infatuation in that it does not provide any benefit to personal development. It causes damage to social life, relationships with loved ones, and prevents you from revealing your potential. Passionate person:

• has a wide range of interests;
• maintains a balance between work and rest;
• has broad social connections and is on good terms with loved ones;
• makes a choice in favor of his main job, family and friends.

Dependent person:

• loses social connections, is in conflict with loved ones;
• often devotes all his free time to one activity;
• suffers failures in his career and personal life, not having the strength to give up the object of addiction;
• denies the existence of addiction;
• when the object is unavailable, he falls into dysphoric or depressive states.

If there is a suspicion that a person has an addiction, it is necessary to try to take action. The longer an addictive person is in the grip of his addiction, the more difficult it is to get rid of it.

Ways to solve the problem

If you are in the obsessive stage of addiction, you can cope with it on your own. It will take willpower and self-belief. If you start using medications using larger dosages than in the instructions, you should use a radical method - throw away all barbiturates and forget about them once and for all. If it doesn’t help, use the second method: gradually come to abstinence from the drug.

Set a goal: to break a bad habit in a week. You will need to lower your dose daily until you stop taking the drug completely.

Please pay attention to additional recommendations:

• meet more often with people dear to you, enlist their support;
• go in for sports;
• visit the cinema and theater;
• do what you love;
• get an animal.

If you distract yourself from the problem, it will evaporate on its own. Physical addiction is much more difficult to eradicate; it is important to remember that nothing is impossible. For very advanced cases of addiction, there are special hospitals where specialists in the field of addiction work.

Mental and physical dependence

The concepts of “mental dependence” and “physical dependence” were introduced to characterize the chemical substances to which attachment develops. The report of the WHO research group explains the content of these concepts as follows:

“Psychic dependence has been described as a condition in which a drug produces “a feeling of satisfaction and a mental mood that requires periodic or continuous administration of the drug in order to achieve pleasure or avoid discomfort. Physical dependence is “a state of adaptation that manifests itself in intense physical distress when the drug is discontinued... These disorders, i.e. Withdrawal syndromes consist of specific symptoms and signs of mental and physical properties that are characteristic of the action of each type of drug.”

Well-known experts in the field of addiction A.A. Portnov and I.N. Pyatnitskaya gave the following definitions to the concepts under consideration: “Mental dependence is understood as a symptom of mental (as opposed to physical) attraction and, in a broad sense, the patient’s need to change his mental state with alcohol.” . “Physical dependence means the dependence of the patient’s physical condition on the effects of alcohol, discomfort in the absence of the drug. In this case, we respond to the physical, similar to hunger and thirst, nature of attraction, the desire for a drug as a means of achieving physical comfort, as a means of normalizing the functional state of the patient.”

Some narcologists have suggested that drinking programming is part of the concept of “mental and physical dependence.” Gross mistake, the concepts are completely different. Psychological drinking programming can be formed long before the first intake of alcoholic beverages, and mental and physical dependencies appear only in the process of drinking them. It seems that the latter corresponds to the habit of alcohol and the need for it.

Alcohol habit

A habit is, according to the doctrine of higher nervous activity, a stereotype. I.P. Pavlov wrote: “Constantly repeating and in a certain sequence before the animal, external phenomena create a certain, so to speak, stereotypical activity in the hemispheres. Any new phenomenon, or even old ones, but in a new connection, thereby violating the stereotype, causes inhibition, as in our experiments with changing the order of conditioned stimuli.”

Alcoholic drinks are usually consumed on the occasion of various celebrations. Preparation for them and participation in them is a complex of sequential irritations, actions and reactions. Their repeated coincidence in time and order leads to the development of a stereotype or habit. Turning off its important components causes negative emotions and experiences. It is in connection with this that guests who are accustomed to drinking together when meeting are upset if they do not see alcoholic drinks on the table. According to I.P. Pavlov, a mistake occurs: the guests were in the mood for a drink in advance, but it did not happen. It is no coincidence, according to press reports, that some refuse to visit such hosts. There are two options for preventing the “rebellion” of alcohol lovers - 1) at the first meetings, offering them a small amount of alcoholic drinks and 2) psychologically preparing guests for a sober meeting.

I experienced the negative consequences of ignoring the habit a quarter of a century ago when I was among the alcoholics. I planned to spend the October holidays preparing the article. On November 7, in the evening, my mood began to deteriorate, my efficiency began to decline, and the closer the clock hands approached to 19.30 - the time of the usual start of feasts. Later, my conscience began to gnaw in connection with the violation of custom, the thought sat in my head: “Now all people celebrate the most important revolutionary holiday with a cheerful feast, but I turned it into a weekday, ignoring the Soviet custom - I did not mark October by drinking alcohol.” This is how my consciousness was disfigured by drinking programming! There was no craving for alcohol, I did not enjoy either the taste of alcoholic drinks or the intoxication. For ignoring him, he was punished with psychological suffering and remorse. At that time I was single, drinking alone did not appeal to me, and I considered it indecent to go to any of my many friends, since I had declined their pre-holiday invitations under a plausible pretext. At 21:00 I went to a restaurant, drank a little cognac among strangers, and thereby calmed my “civic conscience.” Of course, I could not continue working on the article, since not only cognac, but also a glass of beer always sharply reduced my intellectual performance. It is interesting to compare this fact with the following.

In 1975, when I had a decent amount of experience as a conscientious teetotaler, I was invited to the Central Naval Museum for a meeting with comrades in arms, which was organized by Colonel General V.A. Grekov. We, military sailors, supported his group blocked by the enemy on the ground during the Great Battle of the Volga. I had little doubt that there would be a friendly drinking session, so I was looking for an option to refuse that would not offend the feelings of the drinkers. Double joy awaited me - a personal meeting with comrades after 33 years, a businesslike, warm atmosphere without strong drinks. We shared our memories, looked at the main exhibits of the museum, took photographs, visited the Aurora, and signed the guest register. The sober meeting brought great joy, but if I had been programmed with drink as before, I would have been upset, like my comrade on the gunboat, who, while returning home, said indignantly: “I am surprised by the greed of a man: a colonel general, occupies a high position, which means has a lot of money, and regretted some ten for cognac. That’s not how you meet battle friends.” I reassured the 1st rank captain and proved that the meeting went well.

These facts show the dependence on the consciousness of habits and attitudes towards customs.

We overestimate the power of bad habits and customs, sometimes we look at them as something fatal. I have repeatedly managed to convince people who were not ashamed to organize drinking bouts at work on the occasion of any personal events, which is prohibited by law, but considered it almost a crime not to get their colleagues drunk. My experience shows that one competent conversation can free a person from the alcohol habit and from attachment to custom.

In recent years, there has been an encouraging phenomenon - an increase in the number of events held soberly, including meeting evenings, banquets, and weddings. One of the first such weddings was held by Komsomol worker A. Mayurov, and in a restaurant; one of the last was organized at his dacha on the occasion of the wedding of his son by Academician of the Academy of Medical Sciences F.G. Uglov. There were a lot of guests at these celebrations, they had a fun and pleasant time, everyone was happy.

In the process of consuming alcoholic beverages, not only a habit is formed, but also an addiction to them and a need for them. Addiction manifests itself in increased tolerance to alcohol. This is a general pattern that is observed in connection with repeated exposure to substances that are toxic (heroin, morphine, tobacco, etc.). A. Turov assures that the body quickly gets used to bee venom: with daily stings of 1-20 bees, after 2-3 weeks pain is noted only at the moment the sting enters, and “after three minutes there is no pain, no swelling, no swelling.” Narcologist R. Vasiliev reported on an alcoholic who drank up to 25 liters of wine per day; I had patients who consumed 2 liters of vodka daily.

With the cessation of taking poison, habit and addiction fade away. A decrease in tolerance is clearly observed in smokers: it is enough to take a break of several hours for tobacco smoke to begin to cause an unpleasant taste, dizziness, weakness, etc.

Violation of the drinking pattern does not cause a painful condition; it is observed when the need for alcohol is not satisfied.

Need for alcohol

Need is the main specific sign of an alcoholic, sharply distinguishing him from other alcoholics. There are a wide variety of opinions regarding need, but almost all authors have in common an overestimation of its importance in the pathogenesis of alcoholism.

There is a tendency to consider the need for ethanol as a partially or completely innate property of the body. There are still supporters of the hypothesis of hereditary transmission of addiction to ethanol, some directly talking about this, others indirectly - proving that animals voluntarily and willingly absorb intoxicating plants or liquids. For example, there are publications about the “drunkenness” of elephants, about the preference of rats for an alcohol solution to pure or sweetened water, etc. Higher animals, as shown by literature and our own data, are distinguished by caution in accepting new types of food and liquids. They do not have a genetic mechanism for differentiating edible from dangerous; it is no coincidence that in zoos predators and prey coexist in the same cage, and in pastures trained wolves play the role of a shepherd. I had to accustom a monkey and young rats to cream, pumpkin seeds and some other foods.

I.D.Boenko and M.M.Chirkov showed that dogs never approached an alcohol solution, even when dehydrated. In the experiments of B.M. Guzikov, white rats clearly preferred a 20% glucose solution to a 10% ethanol solution. It is possible to force an animal to consume sharply unpleasant substances using various physiological techniques. In my experiments, conducted using the method of situational conditioned reflexes by P.S. Kupalov, dogs independently drank concentrated solutions of quinine. The training was carried out as follows: spontaneous drinking of water was accompanied by the inclusion of a metronome and a silent feeder from which the animal received food reinforcement. In subsequent experiments, increasingly bitter solutions of quinine were poured into the bowl. These experiments are noteworthy in that they show the great possibilities of accustoming animals to the consumption of substances that have unpleasant taste qualities. Just as I trained dogs to a solution of quinine, in life we ​​train people to drink alcohol. Drinking alcohol is accompanied by snacking, and, as a rule, pleasant food. Snacks play an important role in accustoming people to alcoholic drinks: 1) stops the unpleasant taste aftereffect of the drink, 2) mixing with it in the stomach, slows down its absorption and 3) helps mitigate negative unconditioned reflex reactions.

In people with good insight, the distortion of natural defensive reactions to drinking alcohol can occur under the influence of psychological influences and self-hypnosis. This possibility is easily detected in people who want to get used to smoking. Specific fact. Diplomat L.T. decided, like flour, to become a smoker. Tobacco smoke caused violent defensive reactions in her. Two minutes after the next self-torture with smoke, I conducted a short suggestion, as a result of which the subject began to inhale the smoke deeply with great pleasure. Then I persuaded L.T. agree to a new session in order to restore and strengthen previous reactions. Now not only smoking, but also inhaling smoke into the mouth caused violent reactions. In addition to this, he conducted a session of anti-smoking persuasion.

Alcoholic drinks act on the body exogenously and endogenously. The exogenous effect is expressed in irritation of visual, olfactory, tactile, temperature and taste receptors, as well as receptors of the esophagus, stomach and intestines. The endogenous effect occurs from the moment alcohol enters the blood, and it begins to have a direct and indirect (through the nervous system) effect on various organs and systems, with a particularly strong effect on the brain. The simple procedure of drinking alcohol causes extremely large changes in the body, the development of many conditioned reflexes.

Is it difficult to understand where and how the need is formed? There is a tendency to assign a decisive role to some special chemicals. I.A. Sytinsky, for example, believes that addiction to alcohol has a pathological basis associated with changes in metabolism. V.I. Grigoriev and co-authors assign a large role in the pathogenesis of alcoholism to the “protective-toxic serum factor of alcoholism.” According to their data, the blood serum of alcoholics caused intoxication symptoms in sober people, which outwardly resembled withdrawal symptoms, and in drunk people - sobering up.

There is reason to believe that the decisive role in the formation of the need for alcohol belongs to the brain, mainly the cerebral cortex. It is known that a pathological need is developed not only as a result of taking alcohol and drugs, but also under the influence of many medicinal substances. I have been able to observe this with long-term use of sweetened cranberry juice as a reinforcer. A clear picture of the need for cranberry juice was observed in three subjects. Let's consider one case.

The subject A.Ch. a complex conditioned reflex was developed to the words “red light”; a total of 115 combinations of this irritant with sweetened cranberry juice were produced. The conditioned reflex could not be extinguished by the usual method; A.Ch. himself spoke well about the reasons. We present his testimony.

“I somehow got used to the fact that the words “red light” are always given with cranberry juice, so I involuntarily expected it even after your statement that the words “red light” would be given without juice. I realized the futility of this expectation; nevertheless, I could not do anything, I was waiting for the juice” (February 6).

“When I said ‘red light’ I was expecting cranberry rock. I’m so used to juice, like an alcoholic gets used to vodka” (February 8).

“In response to the words “red light,” I somehow wait for cranberry juice, although I know that it will not be given, because for the third day you have not given it. These words make me salivate. I doubted that you would not give the extract, I thought: “Or maybe the juice will be given by mistake.” When I hear the words “red light,” the idea of ​​the taste of cranberry juice somehow pops up, I feel this pleasant taste, and I involuntarily salivate. After you separated the juice supply tube from the salivary funnel, it became completely clear that it would not be given, and I stopped waiting for it; salivation and swallowing stopped. The words “red light” became completely indifferent, I felt calmer” (February 10).

“Until the tube for supplying juice to the mouth was attached to the funnel, the words “red light” were treated with indifference and the juice was not expected. When you connected the juice supply tube to the salivary funnel, my condition somehow changed, I started waiting for juice at the red light. I really like him!” (11 February).

A.Ch. noted very well: “I’m as used to juice as an alcoholic gets used to vodka.” The condition of the subjects was somewhat reminiscent of the withdrawal symptoms of an alcoholic: a strong craving for juice, increased irritability due to not receiving it, some aggressiveness, requests to give it a try, sucking juice from the supply system, despite the ban, after the experience, annoying requests for a treat... Boy A.I., after finishing the first experiment on extinguishing the salivary conditioned reflex, he watched me flush the juice supply system. As soon as I placed a container on the windowsill containing a mixture of water and the remaining juice, he grabbed it and began to drink. Couldn't take it away. It is difficult not to recognize the subjects’ attraction to cranberry juice as a need. By the way, I had it too. During the war, we officers usually drank tea with cranberry extract in the ship's wardroom. I got so used to it that while I was on a stretcher after being wounded in this non-wardroom, I asked for tea with the extract to be given to the hospital with me. I didn’t want to take the rest, including the money. It is worth paying attention to the following fact. Subject A.Ch. during the period of extinction of the salivary reflex, it calmed down in cases where the juice supply tube was disconnected from the salivary capsule, through which it was introduced into the oral cavity. Something similar is observed among alcoholics: the certainty of the inability to obtain alcohol inhibits the need, and for some it interrupts the binge. It is planned to resume experiments with cranberry juice in order to try to collect additional material to understand the physiological mechanism of the need for alcohol.

It seems that experiments with the induction of conditioned reflex intoxication shed some light on this particularly difficult question. Their essence. The researcher tells the subject about taking certain doses of alcohol or about abstaining from it. In another variant, the subject is asked to imagine that he is drinking alcohol. (See observation protocols for T.N. and V.K.).

Protocol

observations over T.N. dated March 18, 1977

(T.N. is an engineer, rarely drinks alcohol, has average understanding)

Notes:

1) The subject visited the Nectar tasting room on March 17, 1977.

2) The taster talked about different brands of cognac, and then asked to take the next portion, warm it and drink it. Each serving was 10 ml.

Protocol

observations of V.K. dated December 5, 1981

(V.K. is a student, rarely drinks alcohol, has good insight)

The observation protocols are interesting in that they show the possibility of using words to reproduce a large complex of reactions (intoxication, drowsiness, etc.) that appear in response to drinking alcohol. It is possible that in some alcoholics in this way, during the period of remission, the need and binge drinking can be stimulated. I observed one similar case when studying conditioned reflex intoxication. The subject was an alcoholic who was distinguished by good insight. Presenting him with the act of drinking vodka caused vomiting, after which he categorically refused to drink in his imagination. A few hours later he developed a strong craving for alcohol, he could not resist, and signs of binge drinking appeared. The next day I interrupted its development. It is possible that in some alcoholics, in some cases, the need flares up when exposed to conditioned stimuli.

There is reason to think; Alcoholics develop conditioned reflexes to the situation and time. For example, when A.I. Krotov arrived at the plant, he began looking for an opportunity to drink (see appendix), and I.Ts. I only drank at home. Pensioner M.K. gave herself daily feasts at midnight. Perhaps the stable frequency of binge drinking is explained by the development of a reflex for time. Protocols of observations of T.N. and V.K. show how “drinking” verbal influences have a bad effect on the subjects and how good the “sober” ones have. Similar results were obtained when using information about smoking and smoking cessation.

The “cortical center of the need for alcohol” has common features with a conditioned reflex formed on “pleasant” taste reinforcement: 1) are formed in ontogenesis, 2) interruption of reinforcement causes negative emotions, 3) its persistent cessation leads to extinction, 4) with the resumption of reinforcement extinctive inhibition quickly disappears, 5) cannot be completely eliminated.

An in-depth physiological examination of the need for alcohol is hampered by a lack of factual material. In the future, it is planned to conduct special studies with the primary use of hypnosis and suggestion methods. For a broader understanding of the mechanism of need, data from other sciences, primarily biochemistry, will be used.

Alcoholism and alcoholism

Alcoholism, as noted above, begins from the moment a pro-alcohol thought appears in a person’s head or from the time the first portion of alcohol enters the body. Each new pro-alcohol thought, each new portion of alcohol leads him further along the path of alcoholism to the finish line - alcoholism. Pro-alcohol thoughts, information, views produce drinking programming, and drinking alcohol forms the habit of alcohol and the need for it. With the appearance of the need, alcoholism ends - the drinker becomes an alcoholic.

Unfortunately, we still do not have a clear idea of ​​the main signs of alcoholism, therefore there is no scientific definition of the corresponding concept. Many people include pathological changes in internal organs as such signs, which is completely wrong. Thus, V.A. Sorokin, in the methodological recommendations “On the dangers of alcohol for humans”, intended for lecturers, writes: “Alcoholics include persons who experience a painful attraction to alcohol, persons who, as a result of prolonged abuse of alcoholic beverages, develop mental disorders and various changes in internal organs." Pathology of internal organs can be considered as complications of drunkenness, but not as a mandatory sign of an alcoholic.

There is still no consensus on whether alcoholism is a disease. Most experts decide this issue positively, but there are many who disagree. For example, on December 16-19, 1975, a conference entitled “Mechanisms of Nervous Activity” was held at Leningrad University, dedicated to the 100th anniversary of the birth of A.A. Ukhtomsky. N.N. Timofeev’s report “Mechanisms of the dominant and some issues of psychiatry” attracted great interest from the audience. The speaker rightfully rejected the recognition of alcoholism as a disease; he said: “Disease is a clinical and anatomical concept. Alcoholism, from our point of view, is a form of abnormal, deformed, often antisocial behavior. Alcoholics are persons with a violation of socio-psychological homeostasis.” The general ended his report with a progressive and humane statement: “The development of alcoholics is determined by environmental conditions. They contribute to personality deformation and the emergence of alcoholic needs and desires.

Speaking against the understanding of “treatment” of alcoholics that exists in the clinic and society, I do so only because the same methods of therapy that are generally accepted everywhere have proven that they are too ineffective; they cannot destroy the dominant that determines alcoholic behavior, and this is the main thing.

I advocate for real help for them, since I share Ukhtomsky’s views that a person should be the master of his dominants.

The basis for helping alcoholics is the science of raising an adult, which is now receiving so much attention, and issues of cultural behavior.” The report of psychiatrist N.N. Timofeev, fresh in its novelty and convincing in its argumentation, was listened to with great attention, supported and approved.

Recognizing alcoholism as a disease causes serious controversy. If an alcoholic is recognized as sick, then he should be given all the rights and privileges of a patient: during an attack of illness (binge) he should be released from work, paid for the period of incapacity for work, not punished for drinking at work and absenteeism, since these are natural consequences of the disease, etc. If an alcoholic is stricken with a disease, and he experiences a loss of control, violence, or amnesia, then the punishment for the crimes he has committed cannot be increased.

It seems to me that it is advisable to consider alcoholism as a borderline suffering, located at the intersection of several sciences, including narcology, physiology and ecology. Doctors may classify alcoholism as a borderline or conditional disease; for other specialists it will be a psychological disorder. N.N. Timofeev correctly noted in the mentioned report: replacing the word “treatment” with the word “help” will expand the possibilities of combating alcoholism. I have long been using the term dealcoholism, which refers to any deliverance from alcoholism. In 1975, during our conversation, N.N. Timofeev approved this terza and the classification of methods of dealcoholism proposed by me.

The concept of psychological programming has made it possible to find more scientific definitions of the concepts of “alcoholism” and “alcoholic.”

Alcoholism is a psychological disorder, the main signs of which are drinking programming, the need for alcohol and its absorption.

An alcoholic is a drinker-programmed possessor of a need for alcohol and a consumer of it.

N.N. Timofeev was one of the first to draw attention to the role of the dominant in the pathogenesis of alcoholism. Alcoholic dominance manifests itself in full form after the formation, one might think, in the cerebral hemispheres, of the need for alcohol. In the neurons that are its material substrate, a focus of excitation periodically arises, which is subjectively perceived as alcoholic thirst. If you do not extinguish it by drinking alcohol, the dominant intensifies, then almost completely subjugates the body, directing it to search for poison.

The dominant, as a rule, suddenly flares up after the first portions of alcohol, and therefore it is very difficult for an alcoholic to voluntarily stop self-poisoning. This reaction is by no means a specific sign of an alcoholic. It is more of a pattern, but manifests itself in other ways. It is known that a hungry person cannot stop eating, a thirsty person cannot drink water, a reader of an interesting book cannot tear himself away from it, etc.

Classification of people

Treatment of psychological drug addiction

Considering that modern medicine easily copes with physical dependence, treatment of drug addiction comes down to treating psychological dependence on drugs. This is a complex task, the solution of which lies in the normalization of all aspects of the life of a drug addict and is carried out in stages:

• First, a person must recognize the problem and accept the fact that he is addicted and needs help.
• With the help of professional psychotherapists, the drug addict must learn to take responsibility for his life.
• The drug addict must break all contacts with his previous environment and gradually return to society, starting to live a full life.

In practice, the treatment regimen for drug addiction is much more complex; it includes several months of isolation from normal life, occupational therapy, mandatory work with the drug addict’s family, and support after cessation of treatment.

In the rehabilitation center, experienced psychotherapists work with patients, as well as volunteers from among those who managed to overcome drug addiction and can show by their example that drugs are not a death sentence. Work with drug addicts and their families lasts several months, during which the patient rebuilds his personality and finds emotional support. In rehabilitation, the entire drug addiction treatment program is structured in such a way that the main focus is on the problem of psychological dependence.

The article was prepared by: Medvedev Maxim Ermingeldovich, psychiatrist-psychotherapist.
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