Psychoprevention of chemical addiction in adolescents in the format of art therapy

Komissarova Ol'ga Andreevna Postgraduate student of the Department of Psychology and Pedagogy, Peoples' Friendship University of Russia 6 Miklukho-Maklaya str., Moscow, 117198, Russia olg.komissarova2016@yandex.ru Other publications by this author

As part of the implementation of the new priority development goals of the Russian Federation for 2012-2024, aspects of the nation's health (both physical and mental) are becoming one of the key issues. Within the framework of this initiative, new hospitals are being opened, mobile health centers and mobile vaccination rooms are being organized, new FAP (paramedic and obstetric stations) are being opened, and psychological assistance to the population is becoming more accessible, as part of which psychological offices are being created in the GKB and RCB, psychological support centers are being opened, supported and funded creation of a hotline for psychological assistance to the population (by the short number 051), where any citizen can apply for urgent psychological help in a remote format, or get advice on the possibility of face-to-face admission from a specialist in their field.

Due to a number of events that have significantly changed the worldview of citizens of the Russian Federation (pandemic 2019-2020, ITS 2022-2023), the problem of the need to develop psychological and psychotherapeutic assistance to the population has been clearly presented. Since 2019, more than 17 million people have applied for special psychological help (VTSIOM data), whereas in the period 2023 this number increased to 23.2 million people ^[1]. This trend, according to experts of the All-Russian Center for the Study of Public Opinion (VTSIOM), is associated with both an increase in the stress level of the population and a change in the living conditions of citizens (the transition to a remote or hybrid format of work in connection with the coronavirus, the introduction of measures in connection with ITS, the imposition of sanctions and, in this regard, the loss of stability, for example, the loss of jobs in departed foreign companies, etc.), and with an increase in positive feedback about receiving psychological help from citizens.

The modern market of psychological assistance demonstrates the availability of a wide range of special services provided by specialists in various fields. Thus, a number of special psychological actions can be carried out only in medical institutions, for example, assistance in rehabilitation for people with problems of various addictions, including chemical addictions. In this case, the necessary assistance to a citizen is provided not only by a psychologist, but also by a clinician (psychiatrist, narcologist, psychotherapist, clinical psychologist).

1. The problem of chemical dependence on surfactants in Russia

According to the data of the Ministry of Internal Affairs of the Russian Federation (hereinafter – the Ministry of Internal Affairs of the Russian Federation), at the moment there is an explosive increase in cases of acquiring chemical dependence among Russian citizens. Thus, according to general statistics, the number of citizens using psychoactive substances (surfactants) in the period from 2018 to mid-2023 (the reporting period is July 2023) increased by more than 24 times. At the same time, about 82% of addicts are teenagers (from 12 to 17 years old) or young people (18-25 years old), while the proportion of the adult population using surfactants is about 18% ^[3].

This trend seems disappointing due to the high risk of exposure to a new generation of surfactants – synthetic drugs that are addictive and have negative effects on people's mental and physical health from the first use. The main factors of the explosive growth in the number of surfactants can be called: the relative ease of distribution and purchase of narcotic drugs (distribution and purchase by "bookmarks" and messages posted in messengers popular with young people and adolescents, in particular, Telegram); early emancipation of adolescents and youth and a decrease in the level of parental control, which is associated with an increase in the level and the pace of life of a modern person; experiencing a teenage crisis; as well as a high level of independence of modern teenagers in the virtual and real world.

At the same time, it becomes extremely important to provide qualified and timely assistance to people suffering from chemical dependence, regardless of their age. According to the Ministry of Health, at the beginning of 2023, officially registered addicts (suffering from addictions of one type or another) in Russia amounted to about 400 thousand people ^[7]. However, most addicts prefer not to officially receive the status of an addict, as this can affect further studies, careers and building a personal life. According to the Sober Russia project, which provides assistance to people suffering from any type of chemical dependence, at the beginning of 2023, the number of people suffering from addiction to surfactants is 6.2 million people, more than 65% of whom are minors, and 82% are under the age of 30 ^[8].

2. Psychoactive substances as a phenomenon of modern society

According to Ts. P. Korolenko, addictive or dependent behavior is one of the forms of deviant (deviant) human behavior, which is formed due to the desire to escape from reality by changing one's own mental state. Escape from reality can be achieved in various ways: chemical or pharmacological (which include dependence on surfactants), or non-pharmacological (alternative). Regardless of the method of realization, the form of withdrawal from reality is accompanied by the development of subjectively pleasant psychoemotional states, which is also one of the reasons for the formation of stable addiction ^[6].

In turn, chemical or pharmacological dependence is an addiction to so-called psychoactive substances, that is, substances whose intake causes an altered state of consciousness. Chemicals can cause changes in consciousness of varying severity, depending on the type of substance, as well as the dosage used, and are accompanied by various effects and post-effects. At the same time, any chemical substances cause more or less persistent physical and psychological dependence due to the accompaniment of a state of intoxication with subjectively pleasant psychoemotional sensations and, in some cases, physical effects.

Various classes of chemical surfactants include: alkaloids (including alcohol-containing drugs and alkaloids of various types, for example, cocaine), nicotine-containing drugs and products, cannabinoids, psychostimulants, including mixed ones, opioids, depressants, hallucinogenic drugs, nitrites, volatile inhalants, new synthetic drugs (i.e.salts, spices, aids) or NSAIDs, which belong mainly to the class of cannabinoids, psychostimulants and hallucinogens ^[4].

Due to the wide composition, the actual process of forming chemical dependence on various types of surfactants undergoes various changes. Thus, some chemical surfactants have an ancient culture of use (alcohol, nicotine), which does not make them less dangerous and, similarly with other drugs, causes the formation of persistent dependence.

It should be noted that all psychoactive substances can be divided into three large groups by origin: herbal (cannabinoids, opioids), semi–synthetic - synthesized from plant raw materials (alkaloids, hallucinogenic drugs), synthetic (NSAIDs, depressants, psychostimulants) [ibid.].

The formation of a stable dependence on substances can take different periods, however, for a number of synthetic surfactants and NSAIDs, addiction can occur from the first use of a chemical substance, which makes them extremely dangerous for modern society.

Also, different groups of substances have different periods of elimination from the body and the effects of exposure on the body. Back in the late twentieth and early twenty–first centuries, semi–synthetic opioids (heroin, methadone) were among the most dangerous, but at the moment synthetic cannabinoids, psychostimulants and hallucinogens - NSAIDs are the most dangerous and widespread ^[2]. Their danger lies not only in a new mechanism of influence on the psyche and causing instant addiction, but also in the complexity of the legislative regulation of turnover and the definition of NSAIDs. Thus, in the Russian Federation, the list of prohibited NSAIDs is updated monthly, taking into account the beginning of the spread of all new synthetic analogues of surfactants. In addition, researchers, for example M. B. Ergabylov, note that not all NSAIDs are currently prohibited, and due to the reluctance of citizens to seek qualified help, there is insufficient knowledge of the clinical picture of the manifestation of chemical dependence on a new generation of surfactants, in particular, the effect on health with prolonged use.

3. Methods of psychological work and psychoprophylaxis of chemical dependence of adolescents

In connection with the above facts, specialists – psychiatrists, clinical psychologists, psychotherapists and psychologists accompanying addicts – face the question of developing rehabilitation measures for people suffering from chemical dependence, as well as measures for psychoprophylaxis of addictive behavior.

To work with underage adolescents of different age groups (older and younger adolescents – according to D. B. Elkonin), mixed techniques are used that combine classical psychotherapeutic methods, including art therapy, body therapy, group therapy, placement methods, etc.

Art therapy is a complex of psychotherapeutic activities based on the realization of the client's creative potential to solve and/or highlight his psychological problems. According to A.I. Kopytin, art therapy presents a psychologist or psychotherapist with a large arsenal of possible diagnostic and therapeutic techniques that gently affect the client's subconscious and allow him to open up without reliving the traumatic experience ^[5].

One of the techniques we use in practice is the art therapy technique "Metaphorical self-portrait". This technique is a complex drawing technique used for diagnostic purposes when working with adolescents from the age of 12. The technique can be implemented when working with both mentally well-off adolescents and children suffering from chemical dependence.

The main advantage of this technique is that the psychologist or psychotherapist receives a large amount of material for practical analysis and work with the client.

The essence of the technique is to draw 4 consecutive images by the client: I am a plant, I am a dish, I am a weapon and I am an ornament. These images are intended to demonstrate the realization of such basic human needs as the right to life, the right to desire, the right to autonomy, and the right to be loved, respectively. In the process of drawing, the psychologist asks the client questions aimed at clarifying his condition during the execution of the work and upon its completion.

Thus, the use of this technique allows you to get materials from a dependent teenager for further work of several types: the actual drawing, as well as comments of a meaningful and emotional nature.

It is worth noting that when using this psychotherapeutic technique, drawing is the main, and not an auxiliary, means of obtaining targeted information for psychological conversation.

When using this technique on an experimental group of adolescents with a total of 43 respondents (25 older adolescents and 18 younger adolescents). The heterogeneity of the sample is associated with the predominant spread of dependence on surfactants among older adolescents, which, in turn, is associated with a number of socio-demographic reasons (such as a greater degree of emancipation and independence, less parental control, an inner desire to know the "adult" world, etc.), the description of which is not the purpose of this work.

The use of special art-therapeutic techniques in combination with other therapies allowed to reduce adolescent anxiety by 23% (Taylor's method of measuring anxiety levels in the adaptation of V.G. Norakidze), increase the percentage of conscious refusal to take surfactants among adolescents by 30% (based on an interview), as well as increase the level of emotional comfort by 17% (the scale of subjective well-being N.P. Fetiskin, V.V. Kozlov, G.M. Manuilov) and increase the percentage of persistent remission in adolescents (based on control in the future 4-8-12-24 weeks, including physical tests for various surfactants and self-report diaries) by 43% compared with the use of complex rehabilitation technologies for dependent adolescents without the use of art therapy the technician.

Table 1. Comparative analysis of the indicators of adolescents of the older and younger age groups

Table 2. Correlation analysis of objective methods of monitoring the psychological state of dependent adolescents

The specificity of the use of art therapeutic techniques allows for a comprehensive effect on both the primary components of addiction (psychological and physical dependence, withdrawal symptoms, etc.) and secondary (social anxiety, emotional comfort, acceptance level) of adolescents, as well as to work out in a mild form the root causes of addictive behavior in the format of dependence on surfactants.

4. Results and discussion

The positive results of the use of art-therapeutic techniques in a complex of rehabilitation measures allow us to recommend psychotherapeutic specialists in working with surfactant addicts of various types to use art-therapeutic techniques as components of rehabilitation when working with younger and older adolescents who are dependent on surfactants.

The use of various art therapeutic techniques (starting from drawing techniques and ending with therapeutic theater techniques) allows for a positive impact on the rehabilitation of adolescents suffering from chemical addictions as part of a comprehensive psychotherapeutic model. The use of art therapy techniques allows you to correct both physical and psychological aspects that arise when getting rid of chemical dependence, increase the level of emotional comfort and subjective well-being of adolescents, as well as adjust the level of anxiety.

Due to the mild non-traumatic effect, art therapy techniques are suitable for working with adolescents at any stage of rehabilitation and will allow them to influence the subjective causes that influenced the development of dependent behavior through the implementation of a unique approach to each ward.