Methods of psychotherapeutic correction of the emotional state of drug addicts in the process of treatment and rehabilitation measures

Rublyova Tatiana ORCID: 0000-0003-0569-9116 PhD in Medicine Associate Professor, Department of forensic science, Siberian Law Institute of the Ministry of Internal Affairs of the Russian Federation 660131, Russia, Krasnoyarsk Territory, Krasnoyarsk, Rokossovsky str., 20 tat-rubleva@yandex.ru Other publications by this author

Lisnyak Marina PhD in Medicine Associate professor, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University 660022, Russia, Krasnoyarsk Territory, Krasnoyarsk, Partizan Zheleznyak str., 1 lisnyakm@mail.ru

Introduction.

Substance abuse undoubtedly leads to deterioration of physical and mental health, followed by the formation of addiction, and often the death of the patient.

Despite this, there are no fewer drug abusers. Thus, "the indicator of the general incidence of drug addiction in the Krasnoyarsk Territory in 2022 amounted to 162.0 cases per 100 thousand people of the population, which is higher than the indicator of the Russian Federation (155.5) – by 4.0 percent. Growth to the level of 2021 (4,566 people or 159.8 per 100 thousand people of the population) amounted to 1.4 percent" ^[4].

According to the data of medical and preventive organizations, "693 cases of acute poisoning as a result of the toxic effect of narcotic substances were registered in the region in 2022, which is 204 cases more than in 2021 (489), of which 509 cases resulted in a fatal outcome (registration form No. 58-1/y "Emergency notification of acute chemical poisoning etiology)"" ^[5].

In this regard, problematic issues of the organization of drug abuse prevention, including rehabilitation of various categories of drug addicts using psychotherapeutic measures, have been relevant for many years. And one of the important tasks is the search and improvement of methods and techniques to restore the health of a person suffering from addiction.

According to the researchers, "rehabilitation of people with drug addiction will be more effective if we take into account not only the physiological aspect used in the medical paradigm, but also the psychological one" ^[13].

"Currently, the most common and effective option for the socio-psychological rehabilitation of drug addicts is participation in rehabilitation programs that use various methods of psychotherapeutic and psychocorrective support in their arsenal" ^[11].

The introduction of these forms of work into practical rehabilitation activities makes it possible for a dependent person not only to change their mental habits, but to gain or restore work skills that will allow them to adapt and realize themselves in society.

For example, "techniques based on the suggestion of positive images have shown good dynamics in the formation of commitment to rehabilitation and sustainable remission" ^[9].

Cognitive training based on mnemonic techniques and exercises led to improved memory and attention in opiate addicts ^{[16, 17]}.

The methods of fairy tale therapy "were an effective tool and provided positive dynamics of psychophysiological indicators in people with drug-dependent behavior" ^{[6, 7]}.

"Along with cognitive behavioral and family psychotherapy, psychodrama can be used" ^[12], which studies the emotional sphere and object relations of drug addicts.

Recently, the methods of art therapy and art therapy based on the therapeutic use of fine arts and other forms of creative expression have aroused considerable interest in our country ^{[1, 3, 8, 14, 15, 19]}.

In therapeutic and psychocorrective practice, art therapy is a set of techniques based on the use of different types of art in a kind of symbolic form, allowing by stimulating artistic and creative manifestations of a person to correct violations of various processes ^{[2, 20, 21, 22]}.

In our opinion, the use of art therapy as a method of psychotherapeutic correction of emotional state in people with chemical dependence in the process of treatment and rehabilitation measures is very effective.

Materials and methods.

To confirm this hypothesis, a study was conducted on the basis of a rehabilitation center for people with drug addiction (Krasnoyarsk). The study sample consisted of 24 patients who had passed the detoxification period.

At the first stage, the assessment of the features of the emotional state of patients was carried out using such methods as: the study of the locus of control of J. The study of the level of anxiety (the scale of C.D. Spielberger, Y.L. Khanin); the Rosenzweig test "The technique of pictorial frustration".

The results revealed the following negative emotional states: a high level of reactive and personal anxiety, an increased level of frustration and low social adaptation, a tendency to an external locus of control, anxiety and aggressiveness.

At the next stage of the study, the authors developed and implemented a psychocorrection program with elements of art therapy in the main group (12 subjects who gave voluntary informed consent). The course of the program was 3 months and consisted of 12 sessions lasting from 90 to 135 minutes, including such forms of work as lectures, conversations, meditation, isotherapy, maskotherapy, drama therapy, etc.

The structure of the psychocorrection program and the analysis of the effectiveness of its results in the experimental group were presented in detail earlier ^[18].

At the final stage of the study, a repeated examination of patients of the experimental (group A) and control groups (group B, respondents who did not participate in the implementation of the psychocorrection program) was carried out using the same techniques as at the stage of the primary study.

Statistical processing of test data was carried out using the program "SPSS Statistics 21". The reliability of the differences between the indicators in the experimental group and the comparison group was calculated using the U-Mann-Whitney criterion for independent samples ^[10].

Results and discussion.

Comparative analysis of the study of the locus of control of J. The rotter based on the results of the secondary study between group A and group B is shown in Figure 1.

Figure 1 – Comparative analysis of the study of the locus of control of J. Rotter

Figure 1 – Comparative analysis of the study of the locus of control of J. Rotter

In this case, there is a positive trend in increasing the level of internality in group A compared to group B.

To compare two samples with each other, we use the U-Mann-Whitney criterion to evaluate the differences.

We calculate the rank sums for the sample, we get the value of Uemp = 28, we compare the value of Uemp and Ucr.

Ucr=}31 (p?0.01) and 42 (p?0.05).

Uemp<Ucr (28<42) at the significance level p?0.05). The differences in the results of the study are statistically significant (p?0.05).

Thus, a comparative analysis of the data of the secondary study using the U-Mann-Whitney criterion showed that the results of the psychocorrection program indicate a positive dynamics of changes in the level of internality in the experimental group relative to the control group.

A comparative analysis of the study of the level of reactive anxiety (the scale of C.D. Spielberger, Y.L. Khanin) based on the results of a secondary study between group A and group B is presented in Figure 2.

Figure 2 – Comparative analysis of the study of the level of reactive anxiety

Figure 2 – Comparative analysis of the study of the level of reactive anxiety

The diagram shows that there is a positive trend in reducing the level of reactive anxiety in group A compared to group B.

To compare two samples with each other, we use the U-Mann-Whitney criterion to assess differences ^[7].

We calculate the rank sums for the sample, we get the value of Uemp = 21.5, we compare the value of Uemp and Ucr.

Ucr=}31 (p?0.01) and 42 (p?0.05).

Uemp<Ucr (21.5<42) at the significance level p?0.05). The differences in the results of the study are statistically significant (p?0.05).

Thus, a comparative analysis of the data of the secondary study of group A and group B showed that the results of the psychocorrection program indicate a decrease in the level of reactive anxiety in experimental group A relative to control group B.

A comparative analysis of the study of the level of personal anxiety based on the results of a secondary study between group A and group B is presented in Figure 3.

Figure 3 – Comparative analysis of the study of the level of personal anxiety

Figure 3 – Comparative analysis of the study of the level of personal anxiety

It can be seen from the presented diagram that there is a positive trend in reducing the level of personal anxiety in group A compared to group B.

To compare two samples with each other, we use the U-Mann-Whitney criterion to assess differences ^[7].

We calculate the rank sums for the sample, we get the value of Uemp = 30, compare the value of Uemp and Ucr.

Ucr=}31 (p?0.01) and 42 (p?0.05).

Uemp<Ucr (30<42) at the significance level p?0.05). The differences in the results of the study are statistically significant (p?0.05).

Thus, a comparative analysis of the data of the secondary study using the U-Mann-Whitney criterion showed that the results of the psychocorrection program indicate positive dynamics, namely, a decrease in the level of personal anxiety in the experimental group relative to the control group.

A decrease in the indicators of a high level of reactive and personal anxiety indicates a more stable emotional state of the subjects.

A comparative analysis of the level of social adaptation (Rosenzweig test) between group A and group B is presented in Figure 4.

Figure 4 – Comparative analysis of the study of the level of social adaptation

Figure 4 – Comparative analysis of the study of the level of social adaptation

It can be seen from the presented diagram that there is a positive trend in reducing the level of social adaptation in group A compared to group B.

To compare two samples with each other, we use the U-Mann-Whitney criterion to assess differences ^[7].

We calculate the rank sums for the sample, we get the value of Uemp = 31, compare the value of Uemp and Ucr.

Ucr=}31 (p?0.01) and 42 (p?0.05).

Uemp<Ucr (31<42) at the significance level p?0.05). The differences in the results of the study are statistically significant (p?0.05).

Thus, a comparative analysis of the secondary study data using the U-Mann-Whitney criterion showed that the results of the psychocorrection program indicate positive dynamics, namely, an increase in the level of social adaptation in the experimental group relative to the control group.

Conclusion:

Summarizing the results of the study, we can draw the following conclusions:

1. Methods of art therapy at the stage of rehabilitation of drug addicts can relieve emotional stress, reduce anxiety and frustration.

2. The shift of the locus of control towards the internal type contributes to an increase in the level of responsibility for one's own actions and a decrease in the level of aggressiveness.

3. Increasing the level of social adaptation improves interaction within the group, which leads to a decrease in the number of external and internal conflicts.

4. Patients have increased internal motivation for recovery due to the support of the group, which is very important for the effective completion of the program.

In this regard, the program proposed by the authors with elements of art therapy can be successfully used to correct the emotional state in patients with chemical dependence in the process of treatment and rehabilitation measures.