A way out off fog

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A way out off fog
Thomas Lundqvist and Dan Ericsson Drug Addiction
Treatment Centre, University Hospital, S-22185
Lund Sweden.
Phone [phone], Email thomas.lundqvist_at_med.l
u.se
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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.

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The 18 sessions manual.
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
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
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A short presentation of the treatment manual
It is presented as a course in quitting

• Phase 1 a bio-medical focus lasting until the
  12th day after smoking cessation.

• 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.

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A treatment manual for chronic cannabis users
THC
Lundqvist Ericsson 1988
100

50
Phase 3 Psycho-Social focus
Phase 2 Psychological focus
Phase 1 Bio-Medical focus
Anxiety
3 sessions/week - 2 sessions/week
3 session/week
Weeks
1
2
3
4
5
6-8
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The treatment manual focus on

• The chronic influence on the cognitive functions.
• The impact of the enhanced subjective perception.
• The need of professional guidance in the
  relearning process.

• 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.

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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.

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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.

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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
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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.

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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.

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Topics discussed in step 1

• The pattern of cannabis use.
• The patients image of himself/herself as
  cannabis
• user related to the seven cognitive
  abilities.
• The concept of time.
• The withdrawal symptoms.

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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.

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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.

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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.

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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.

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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)
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Verbal AbilityWeaknesses 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.

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An illustration of the screened off condition
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Logical-Analytic Ability
Weaknesses are observed in the following
areas

• 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.

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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.

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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

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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.

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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.

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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.

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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.

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Long-Term memory
Weaknesses are observed in the following
areas

• 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.

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Analytic-Synthetic Ability
Weaknesses are observed in the following areas

• 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.

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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

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Psychospatial Ability
Weaknesses are observed in the following
areas

• 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.

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Gestalt Memory
Weaknesses are observed in the following
areas

• 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.

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A typical client profile
He

• 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.

continues
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A typical client profile, continued
He

• 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.

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Experimental or Recreational useShort-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

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Long-Term use
In addition the cognitive process is influenced

• may impair the ability to efficiently process
  complex information, due to a prefrontal
  dysfunction.
• inability to make plans.
• difficulties in temporal integration of
  behaviour.

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Long-Term use

• not inclined to interpret opinions
• and motives of other people.
• hardly any self criticism.
• emotional superficiality (apathy, listless)

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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

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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.

continues