— You are known for your alternative perspective on alcohol addiction, and the result of your research was the formation of a new medical branch of psychiatry, clinical addiction science. How does this direction look at alcoholism?
— Modern psychiatry and narcology recognize alcoholism as a physical and mental health disorder caused by alcohol addiction. This is a toxic-psychological doctrine in which cause-effect relationships are clear and unambiguous: a person is sick because he drinks.
In our opinion, this is the same as saying “Cough is an independent disease.” However, both cough and alcoholism are merely clinical signs and symptoms. In the first case, for example, tuberculosis, and in the second, it is a mental illness that we call addiction disorder. More precisely, it is an addictive disease, a pathology of addiction.
– What is this pathology?
— Preference here is an overvalued attitude towards a subject. In psychiatry, there are two clinical concepts that help in one way or another to define the pathology of thinking: the ideational supervalue (or supergoal) and the dominant idea.
For example, we are currently conducting an interview, this is my dominant thought and I need to concentrate on my thoughts and actions without getting distracted. But after completion another idea will emerge. There is no intrusive “obsession” here.
Now – “super goal”. We think about this every day; it dominates the person’s consciousness unconditionally and constantly, regardless of external conditions. In simple terms, they sometimes talk about “obsession”, which is extremely difficult to correct psychologically. This is what psychiatrists call supervalue.
Motivations here can be very different: the desire for leadership, the desire for fame, the desire to achieve results in sports, business and much more. The situation is different when we observe the formation of a pathological addiction to psychoactive substances, including alcohol.
— Has it been revealed that alcohol is overvalued for an alcoholic?
— Yes, alcohol overeating is the first sign of incipient mental pathology. We define the clinical onset precisely by the presence of the fact of active formation of the addictive supervalue.
In people with an actively developing addiction pathology, alcohol as a supergoal quickly and dramatically overcomes this boundary of reality. A kind of distortion of meaning begins that emphasizes the importance and priority of everything related to alcohol use.
Alcohol behavior begins to determine motivation, suppress emotions, and crowd out other dominant ideas (family, work, friends). A person can no longer adequately adapt to life in a familiar society and begins to fall out of it.
— How does super value occur?
— There is always a meaning in the beginning, it stands behind everything and action. Let’s imagine a situation: a person who does not suffer from pathological addiction finds himself at a party where alcohol is actively consumed and the spirit of fun and optimism reigns.
The individual is looking for someone with whom he wants to identify. He sees his drinking friend and intuitively perceives him as a kind of unconditional authority. Moreover, he begins to enjoy the atmosphere of artificial psychological positivity. So far, a contextual identification of the concept of “intoxication” with meanings such as a good life, cheerful music, optimism and happiness has been established in general terms.
The latter is the basis for future drug domination, where these meanings remain childishly but without alternative in consciousness. A person begins to think that “happiness” lies in drug addiction, in our case, alcohol.
— How does this “infection” occur?
—Therein lies the mechanism of the so-called induced psychosis. This mental disorder of the patient arises from the delusional content of the thoughts of another person with whom he is in close communication. This often occurs between members of the same family who interact closely with each other in conditions of social isolation.
I have even encountered cases of induced schizophrenia in my clinical practice. A married couple applied to the clinic. The husband and wife simultaneously told a similar story about their belongings being stolen. This is a damage delusion. After hospitalization, after about one and a half to two weeks of “separate” existence, the husband stopped delirious. His wife, on the contrary, retained the delusional pattern that was the cause of the diagnosis.
We, who work in a clinic where patients have medication problems, state the following: At the beginning of the formation of alcoholic behavior, the alcoholic inducing factor is always present. This also applies to other types of drug addiction. Therefore, we argue that alcohol addiction is a psycho-contagious disease like any other. Simply put, an alcoholic becomes infected from another person with the truth that “alcohol equals happiness.”
— What happens after such an “infection”? A person cannot become an alcoholic overnight… Or can he?
– It can’t be done, it takes time. First, the onset of an addictive disease occurs. If intoxication creates a reinforcing effect through psychophysical sensations, the person moves on to the next stage. Included is the anosognosia component (the patient’s failure to critically evaluate his illness) and the justification of addiction component. This implies a kind of “legitimization” of choice, that is, the person says to himself: “I drink because I have no family. And I have every right to do that.” There are many reasons like this.
Then the person begins to defend, defend his own “source of happiness” and attack those who oppose him in this regard. He responds to other people’s complaints: “I understand everything and will stop at any moment.” That’s it, at this stage the disease has already occurred!
The patient tries to protect himself from doctors, relatives, and anyone who, in his opinion, prevents him from living peacefully and drinking alcohol. There was actually a “normal” person, but as a result of a developing disease, he became “obsessed” with alcohol. This is already an obvious pathology of the soul.
– Okay, but many people drink in groups and come across the image of “alcohol is happiness.” Why do some people become alcoholics and others do not?
— So you and a colleague get on the subway and one of the passengers sneezes, then your friend gets sick, but you don’t get sick. From where? You were immune. In the context of our conversation, we are talking about mental immunity.
– How is it working?
— As we have already learned, the beginning of the formation of alcoholism has a meaning. So I look at the person I like and he drinks cognac with might and main, there are candles around, there is music, smells, the environment and I think: “What a handsome man!” Subjectively, it’s a nice image, but “immunity” tells me: “Stop, stop, stop, he’s drunk enough to go crazy, he’s incompetent.” That’s it, we no longer equate alcohol with absolute happiness. Of course, in reality everything is much more complicated, but the meaning is clear.
According to the traditional view, immunity, as is known, can be congenital or acquired. The situation I described falls into the first category. The second is constructed differently. The disease that started due to innate psychopathological immunity ends, the dominant meanings that create addiction lose their validity, and we observe “conscious sobriety”. But sometimes this can play a cruel joke.
– Which one?
— We call this “reverse paranoia”, that is, the transformation of drug addiction paranoia into drug addiction struggle paranoia. In general, there is nothing wrong with this, but I think these people are also unhealthy in a sense, but these are our research hypotheses for now.
— Ordinary immunity is established from childhood in ways known to infectious disease experts. How does immunity occur in the soul?
— It also occurs from childhood. Infantilism – underdevelopment, delayed mental development, inability to make the right decision, inability to calculate the consequences of actions, irresponsibility – does not allow the organization of a strong immunity. Many things are important here: a prosperous family, communication in the context of socially positive attitudes, a high level of motivation and much more. The most important thing here is a “healthy” microenvironment.
— What to do if the “infection” of alcoholism has already occurred?
– Good question. Traditional narcology assumes that it is necessary to treat drunkenness, that is, to influence the phenomenon of drinking. In clinical terms, this is not even a cure, just a corrective effect. This is not enough.
Nowadays, methods such as motivational conversations with alcoholics are popular in our country. This is often meaningless. You cannot catch a plane with a net while it is taking off, you have to shoot it down as it takes off. You can also observe a widespread passion for detoxification (“detoxification”), which for some reason seems like a full-fledged treatment. There is a study about the result, but not about the cause.
In clinical addiction science, we say that intoxication is merely a symptom of the disease. Figuratively speaking, a person is not sick because he drinks, he drinks because he is sick.
– So how should alcoholics be treated?
— In our opinion, the treatment should be as follows. First you need to put the person into clinical remission. Next comes supportive and anti-relapse treatment: It is necessary to create a “protective shell” with the help of pharmacology and psychotherapy. The third stage is reparative treatment. This is the basis for subsequent psychological rehabilitation and social adaptation with the aim of integrating the patient into society.
The problem is also that the research material is created mainly by patients with “clinical negligence”, that is, insufficiently examined and poorly supervised patients appear here, which seriously impairs the possibility of obtaining a comprehensive study.
All this requires serious scientific and practical study. I believe that some conditions are necessary for this. A “Clinical Institute of Addiction” needs to be opened in Russia. This is the first and important step in organizing an innovative scientific and practical complex. An innovative approach is needed, inevitably leading to the recognition that “clinical addiction science” is of crucial social importance. Today, unfortunately, we face rejection of our perspective on the problem among subject-focused experts.
— Why are only “advanced” cases currently treated?
“But other patients don’t come to the clinic.” With rare exceptions. In most cases, we cannot treat a patient without official approval. Court orders or some extreme symptoms are exceptions, but the patient still needs to reach this point.
When a patient comes to the doctor and says, “I want to be treated.” This essentially means that disease activity has entered the extinction phase.
Most of the time it’s not recovery, it’s just healing. It turned out that the patient who did not want to be treated needed active treatment. A “real” patient in the active stage of alcoholism would never want to be treated.
— So how should work be structured with alcoholics who do not recognize their illness and do not want to be treated?
— Mechanisms for early diagnosis and active professional work in addiction pathology need to be researched and developed. Active prevention allows you to quickly and effectively identify the “pathogenic microcommunity”. This is where infection occurs, so it is important to remove the person from there.
Of course, new technologies are needed here for early detection and situational solution of problems. This is definitely the most responsible link in the “pathological addiction medicine” of the future. But this requires a broad complex of scientific and methodological development, which can only be achieved on the basis of a serious specialized infrastructure.
The current problem does not seem to be solved. All that is needed is a serious and qualified solution with the participation of serious and relevant experts.