“I’ll never do it again”: Signs of impending collapse in an addict Narcologist Aginyan: Anxiety about others indicates impending collapse in addicts 07:58

— What happens when an addicted person stops using?

-Experiencing withdrawal symptoms or withdrawal symptoms (deprivation, hangover). Let’s say a person smoked for three years, then suddenly stopped, his brain no longer received the substances he was used to, he stopped. In addiction syndrome, withdrawal is experienced together with discomfort that can manifest itself in different ways. These may be unpleasant physical or emotional sensations. How the withdrawal syndrome occurs depends on the substance, duration of use, daily dose and other factors.

If you drink alcohol, withdrawal symptoms usually last two to five to seven days in uncomplicated cases.

There are also complications when a person loses sleep, hallucinations occur and becomes ill. In this case, hospital treatment is necessary, as there is a risk of death.

But the withdrawal syndrome always has a definite end: After that, the person feels good for a while, and then it gets worse again, usually emotionally. The person begins to notice that he begins to work poorly, cannot think clearly, is not in a good mood, develops irritability, anxiety and depression. In such a situation, we talk about post-abstinence syndrome (PAS) or subacute withdrawal.

– What kind of situation is this?

“This is inadequate brain function in people with addiction and can last for months. In the case of alcohol – from 6 to 24 months. Most often, PAS manifests itself as poor attention, impaired memory and thinking, irritability and anxiety. Additional symptoms include compulsive behavior, thoughts about use Some patients jokingly state that PAS is similar to premenstrual syndrome.

– Why is this happening?

— This question was answered by neuroscientist George Koob, who compared the brains of healthy and addicted mice that were no longer given alcohol. It turned out that there were structural changes in the amygdala of mice showing subacute withdrawal symptoms, that is, the amygdala responsible for memory and emotions.

In the 70s, scientists suggested that when the brain is in a good state, various mechanisms come into play that return it to its original state. It turns out that a person experiences mood swings, sometimes good, sometimes bad.

closed

one hundred%

Psychiatrist-narcologist, creator of a scientifically oriented rehabilitation program for addicts, Sober Marat Aginyan

From personal archive

Alcohol and other substances upset the balance of the brain and this mood curve goes down, meaning the person no longer feels good and bad, but feels bad and then worse. You won’t be in a good mood anymore, you won’t be high. All addictive substances sooner or later activate this area and it begins to work excessively, even months after cessation of use.

– How to deal with this situation?

— The best cure for PAS is sobriety, because new use resets the progress and everything starts again. It is also important to rest and talk to your doctor; he or she may prescribe medication to alleviate the condition. Sometimes people experiencing severe subacute withdrawal may experience depression, in which case it is appropriate to use antidepressants.

— What kind of crisis does a person who stops using drugs, including alcohol, experience?

– If you look at it from the eyes of an addict, this is a momentary event. Everything was fine, he didn’t use it and suddenly he had a relapse.

However, research shows that this is a process that begins long before use and manifests itself with 37 signs.

They were identified by scientists T. Gorski and M. Miller, who studied 125 cases of failure.

The first sign is your concerns about your well-being. The person has no desire to use it, but there is a feeling of emptiness and anxiety. The second is to reject this concern. The person noticed this and, as if arguing with himself, said to himself: “No, everything is fine with me.” To the third one, I say, “I will never lose my temper.” A person begins to say this in a conversation, but he was not asked about it, although there was no talk about a malfunction. It looks like an invisible being is arguing with him. The fourth is a keen concern for others. If a patient suddenly says that he is worried about his wife, daughter or brother, for an experienced narcologist this is a harbinger of an impending collapse.

There are 37 such signs in total, and all of them are not related to substance use, but to the psychological and emotional state of the person. Typically addicts keep a diary and count these marks. The more such changes occur, the higher the risk of failure.

— How does a malfunction occur, what is its course?

— Let’s imagine two brothers who are addicted to alcohol, quit drinking and have been sober for three months. One stays sober, the second collapses. It happens like this: firstly, everything is normal in life, but secondly, things are broken: there is too much work, relationships, sports.
This is a cause for concern, but usually people do not react and continue to work even harder. Then we begin to notice SIDs (seemingly unrelated decisions – literally comes from English – seemingly unimportant decisions). These are the decisions a person makes that lead him to collapse.

Then comes the so-called mini-crash, in which the quitter manages to drink a little and stop. There may be several such minor malfunctions, strengthening the illusion that they are in control of themselves. Here we are talking about the effect of interrupted abstinence (AVE – abstinence violation effect), which is another step towards a collapse. Then the relapse period ends, behavior patterns return, and uncontrolled use begins (relapse).

— Could you please give examples of decisions that led to failure?

– Here are the cases from my practice. My patient began visiting an Irish bar where he had been drinking for years. At first he only ordered coffee, then he started drinking non-alcoholic beer, and then switched to regular beer. These were all decisions that led to his downfall.

Another example: A patient drank beer while listening to YouTube for 20 years, then quit. He is happy, he does not drink, his life has improved, but after six months he began to drink kvass every day under the video, this is very similar to his previous lifestyle. Eventually kvass is replaced by beer.

Or a third example: One person stopped drinking, invited guests, and at first they all did not drink. Then he invites them to buy them a drink, but they don’t. The next step is that he himself offers them alcohol, eventually drinking with them anyway.

— What exactly pushes a person into a breakdown?

— It is customary to distinguish between personal and interpersonal determinants of a breakdown. They were proposed by A. Marlatt in his dynamic stasis model based on a complex mathematical theory of chaos.

There are six personal factors. The first of these is self-efficacy, which is the belief in your ability to stay sober. If it is strong, there is a high chance of coping with addiction.

The second is the positive expectation from use. I sit there, bored, and my brain immediately presents this picture: a glass of craft beer, a movie, beauty, and paradise. If the person only sees the good part and cannot see the results of use, the risk of recurrence of the disease is high.

The third determinant is the pulling force, which can be compared to the feeling of thirst.

Fourth, but in my opinion the most important, is motivation. If it is weak, the person is unlikely to quit.

The fifth is relapse prevention skills, and the sixth is the emotional state of the quitter.

— These are personal, but what interpersonal determinants of a breakdown are commonly identified?

— Marlatt did not have time to finalize this classification, but his followers published a number of works devoted to the fact that interpersonal factors are more important than personal ones. We are social animals and our environment affects us greatly; This may explain the high effectiveness of psychosocial rehabilitation programs based on supporting each other.

— How can you prevent failure?

— You can create a relapse prevention plan that includes environmental control, attention management, and working with addictive thoughts.
Environmental control involves eliminating anything that might tempt me to use. If I quit smoking, I need to make sure that my friends and acquaintances around me do not smoke and that there are no cigarettes at home. Drinkers often say that in the first months of abstinence, they do not go to cafes or restaurants to avoid causing a relapse.

Attention management means that if I find myself at a company party and occasionally catch myself thinking my eyes are looking at bottles of alcohol, it is better to turn my attention to something else. And there was still work with dependent thoughts.

— How should you work with them?

— There are three approaches. First, talking to oneself is challenging. We have two pieces of thought; one is for use, the second is against. And it must constantly remind us of what addiction leads to and challenge the former.

The second is not to argue with dependent thoughts, but simply to observe them, how they arise, how they develop and how they disappear.

Third, consider thoughts of use as a sign that there is another need. Some studies have shown that people generally want to drink alcohol when they are thirsty, hungry, or need to rest.

We can also use behavioral techniques. If I’m in an environment with a lot of triggers and I feel like I’m going to have a nervous breakdown, it’s better to leave that place. This can save you from a malfunction. The second is a simple conversation with an outsider, sometimes our second “sober” thought is not enough for us and we need a second person who is sincerely happy with your every sober day and you are sure that he will help. You are dealing with a strong addiction. These are just a few of the techniques.

— The longer a person stays sober, the less likely they are to have a nervous breakdown?

– Yes, but this statement needs to be understood correctly.

If 100 people quit drinking, according to various estimates, by the end of the year 80 will relapse, and of the remaining 20 in the second year of sobriety, only half will relapse, not 80%. Later, 15% of those who have reached five years of continuous abstinence collapse.

This suggests that the longer the period of sustained sobriety, the lower the likelihood of relapse. If the person does not use it for more than five years, we can say that the addiction has been overcome.

— What to do if a malfunction occurs?

– Get up, dust yourself off and move on. If a person’s breakdown did not kill him physically, this is a reason to analyze the situation, take responsibility for it, draw conclusions and continue the path to sobriety.