Presentation Transcript
A way out off fog: A way out off fog Thomas Lundqvist and Dan Ericsson
Drug Addiction Treatment Centre, University Hospital, S-22185 Lund Sweden. Phone + 46 46 178932, Email thomas.lundqvist@med.lu.se
Get a binder: Get a binder Create 20 sections
18 sessions
+ 1 session for information
+ 1 session for parents
Fill every section with themes, questions to be discussed, illustrations and homework.
Slide3: Session 11
Relaxation
Focus on emotions
Session 12
Continued focus on emotions
Guilt and shame
Session 13
Norms and values-behavior-abuse
Session 14
Juhariwindow or something more suitable
Session 15
The process of relapse
Session 16
Continued relapse prevention
Test: SOC, SCL-90, BDI scale focusing on relations.
Session 17
Assessment feedback
Look at the flipchart, repeat select the material to be used at the closing session.
Session 18 Closing session
Show the flipchart for the family and others.
Graduation and Diploma
Session 1
Illustration of THC elimination and anxiety reactions. Info about physical reaction.
Information about cannabis.
Test: SOC, SCL-90, BDI scale focusing on relations.
Session 2
Assessment feedback
Positive and negative attitudes to cannabis use
Why do you want to quit now?
What kind of help do you need?
Session 3
Acute effects of cannabis
Session 4
Chronic effect of cannabis
Session 5
Cognitive function and dysfunction
Session 6
Attitudes and patterns of use
Session 7
Drug lifeline
Session 8
Sociogram
Session 9
Lifeline
Session 10 (or when it is appropriate)
Session together with the parents The 18 sessions manual.
A short presentation of the treatment manual: A short presentation of the treatment manual Phase 2: a psychological focus lasting until the 21st day after smoking cessation. Phase 3: a psychosocial focus during the rest of the program.
This phase has no time limits. Phase 1: a bio-medical focus lasting until the 12th day after smoking cessation. It is presented as a course in quitting
Slide5: THC 100 % 50 % Weeks 1 2 3 4 5 6-8 Anxiety 3 session/week 3 sessions/week - 2 sessions/week Lundqvist & Ericsson 1988 A treatment manual for chronic cannabis users
Slide6: The chronic influence on the cognitive functions.
The impact of the enhanced subjective perception.
The need of professional guidance in the relearning process. The treatment manual focus on Critical examination of the drug-related episodic memory.
Promotion of the psychological maturation.
Enhancing the social competence and orientation to life. The self-regulation use of cannabis.
Depression and phobic reaction following cessation of cannabis.
The need to be given proposals.
The therapist is requested to:: The therapist is requested to: have good knowledge of the acute and chronic effects of cannabis. use a concrete and simple language. transform abstract reasoning into drawings and metaphors. be a leading authority in describing the detoxification process. The therapist is the prefrontal substitute.
Each discussion should contain: Each discussion should contain To make the client notice what is happening.
To make the client compare with earlier experiences.
to make the client reflect and consider the topics of the discussion.
Slide9: The structure is used in The original programme, designing a concept for each individual. A manual based program with 18 sessions in six weeks focusing
on 17-24 years old with a regular use more than six months A manual based short program with six sessions in six weeks focusing
on younger user or those who have used less than six months regularly . For those who are experimenting, there is a three session course. A guide to quitting Marijuana and hashish
Why treatment?: The causes that lie behind the self-medicational use of cannabis.
Depression and phobic reaction following cessation of cannabis.
The need to be given proposals. Why treatment?
Step 1 implies: Step 1 implies To handle and solve the anxiety reactions.
To help the patient resist the desire to escape
back into the influence of cannabis.
To coach the defective capacity for learning.
To reveal the specific thought pattern of the patient.
Topics discussed in step 1: Topics discussed in step 1 The pattern of cannabis use.
The patient´s image of himself/herself as cannabis
user related to the seven cognitive abilities.
The concept of time.
The withdrawal symptoms.
Step 2 implies: Step 2 implies To be negative to the state-dependent ego.
To be able to perceive the between what
they are today and what they want to be.
To be inspired with positive representations
of the future.
Topics discussed in step 2: Topics discussed in step 2 The home situation.
The process of change.
The patients representations of the future.
”Good feelings- bad feelings”.
The experience of ”the fog lifting”.
Loneliness and isolation.
Step 3 implies: Step 3 implies To help the patient understand the components
of a developmental process.
To elucidate the basic conflict.
To help the patient realise the difficulties
in changing identity.
Topics discussed in step 3: Topics discussed in step 3 Do the patient consider himself as a part of the society.
How does he/she function in daily life without the shelter
of cannabis.
How does he/she handle the vulnerability and sensitivity.
How does he/she plan the future life.
Slide17: A logistic framework of seven cognitive functions 1. Verbal Ability (quantitative and qualitative)
2. Logical-Analytic Ability (to make correct conclusions)
3. Psychomotility (flexibility in thought)
4. Memory (working and long-term memory)
5. Analytic-Synthetic Ability (to synthesis and create an entity
from perceived information)
6. Psychospatial Ability (orientation in space
and time continuum)
7. Gestalt Memory (to create patterns and pictures
of perceived information)
Verbal Ability Weaknesses are observed in the following areas: : Verbal Ability Weaknesses are observed in the following areas: Vocabulary appropriate to chronological age.
Finding exact words with which to express oneself.
Understanding what other people mean.
Abstract thinking and engaging in concrete thinking.
These symptoms lead the patient to feel misunderstood and lonely.
Slide19: An illustration of the screened off condition
Logical-Analytic Ability : Logical-Analytic Ability Critical and logical self-examination.
Correcting errors and mistakes logically.
Thinking before answering.
Abstract and logical solution of problems e.g., socio-analytic
Understanding of casual relationships.
These symptoms lead the patient to feel inadequate and unsuccessful. Weaknesses are observed in the following
areas:
Psychomotility: Psychomotility Weaknesses are observed in the following
areas: Establish a correct focus of attention. Maintaining attention. Shifting attention. Understanding the points of view of others. Changing opinions. Changing mental set in problem
solving and social perception.
Cannabis and attention I: Cannabis and attention I Basal basic attentional processes appear to be intact
Long-term cannabis users are less efficient when performing complex cognitive tasks
less efficient to resist distraction
Cannabis and attention II: Cannabis and attention II Long-term users ability to process information efficiently declines more rapidly under a moderate cognitive load compare to non users and short-term users.
Cannabis and attention III: Cannabis and attention III Long-term users are inefficient in:
to perform complex tasks that require cognitive flexibility
to identify of unproductive planning strategies
to learn from experience.
Cannabis and attention IV: Cannabis and attention IV Long-term users may well cope with everyday routine tasks
difficulties with verbal tasks that are novel and which cannot be solved by automatic application of previous knowledge.
Short-Term/Working memory: Short-Term/Working memory Weaknesses are observed in the following
areas: Remembering meetings, promises, and so on.
Estimating of the passage of time.
Imagining long time spans .
Maintaining the theme of a story.
Long-Term memory: Long-Term memory Poor recollection of the past,
which refers to become aware of one's identity
and existence in subjective time.
These symptoms lead the patient
to exhibit a lack of patience. Weaknesses are observed in the following
areas:
Analytic-Synthetic Ability: Analytic-Synthetic Ability Sorting out information.
Synthesising from parts to whole e.g. classifying information in a correct way and understanding shades of meaning.
These symptoms lead the patient to feel different and unique. Weaknesses are observed in the following areas:
The sense of coherence: The sense of coherence is a global orientation that expresses the extent
to which one has a pervasive, enduring though dynamic feeling of confidence that:
Psychospatial Ability: Psychospatial Ability Differentiating the time of the year and/or time of day.
Maintaining routines of the day or the week.
Having interest in what is going on.
Being aware of one's social position relative to others.
Having an accurate perception of the immediate environment.
Mental representation of localisation in space.
Structuring the daily life. Weaknesses are observed in the following
areas:
Gestalt Memory: Gestalt Memory Creating patterns and pictures of the visual world.
Remembering the relations to others.
Putting names to faces
These symptoms lead patients to feel as if they are living in a world of their own. Weaknesses are observed in the following
areas:
A typical client profile:
He continues A typical client profile has problems finding exact words to describe what he really mean.
has limited ability to enjoy reading, motion picture, theatre, music.
has feelings of boredom and emptiness in daily life, loneliness, being misunderstood.
externalises problems and avoid accepting blame. is certain that he functions adequately.
is not able to examine his own behaviour critically.
has feelings of being incapable and unsuccessful.
A typical client profile, continued: He A typical client profile, continued is unable to maintain a dialogue.
has difficulties with concentration and attention span.
has fixed opinions and pat answers to questions.
doesn't plans his day.
thinks that he's active because he has many ongoing projects, which are seldom finished.
has no daily or weekly routine.
Experimental or Recreational use Short-term: Experimental or Recreational use Short-term The cognitive input process is affected (Hippocampus): a disturbance in concentration, attention,
and storing and elaborating information.
psychologically the individual will experience
enhanced subjective perception
Slide37: may impair the ability to efficiently process complex information, due to a prefrontal dysfunction.
inability to make plans.
difficulties in temporal integration of behaviour.
Long-Term use In addition the cognitive process is influenced
Long-Term use: Long-Term use not inclined to interpret opinions
and motives of other people.
hardly any self criticism.
emotional superficiality (apathy, listless)
Why treatment?: Why treatment? The chronic influence on the cognitive functions.
The impact of the increased subjective perception as a result of the acute intoxication on the emotional system.
The need of professional guidance in the relearning process, and regaining and stabilisation of the cognitive functioning
Why treatment?: Critical examination of the drug-related episodic memory.
Promotion of the psychological maturation.
The need to enhance the social competence and orientation to life. Why treatment? continues