A way out off fog

Thomas Lundqvist and Dan EricssonDrug Addiction Treatment Centre, University Hospital, S-22185 Lund Sweden.

Phone + 46 46 178932, Email thomas.lundqvist@med.lu.se

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.

Session 11RelaxationFocus on emotions

Session 12Continued focus on emotionsGuilt and shame

Session 13 Norms and values-behavior-abuse

Session 14 Juhariwindow or something more suitable

Session 15The process of relapse

Session 16Continued relapse preventionTest: SOC, SCL-90, BDI scale focusing on relations.

Session 17 Assessment feedbackLook at the flipchart, repeat select the material to be used at the closing session.

Session 18 Closing sessionShow 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 2Assessment feedback Positive and negative attitudes to cannabis useWhy do you want to quit now?What kind of help do you need?

Session 3Acute effects of cannabis

Session 4Chronic effect of cannabis

Session 5Cognitive function and dysfunction

Session 6Attitudes and patterns of use

Session 7Drug lifeline

Session 8Sociogram

Session 9Lifeline

Session 10 (or when it is appropriate)Session together with the parents

The 18 sessions 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

THC

100 %

50 %

Weeks

1 2 3 4 5 6-8

Phase 1 Bio-Medical focus

Phase 1 Bio-Medical focus

Phase 2Psychologicalfocus

Phase 2Psychologicalfocus

Phase 3Psycho-Social focus

Phase 3Psycho-Social focus

Anxiety

3 session/week

Introduction 1 + 2

Motivationalsessions x times Phase 1 Phase 2 Phase 3

Sessions 1-6

Additionalsessions

Sessions 7-10 Sessions 11-18

Sessions for family members

3 sessions/week - 2 sessions/week

Lundqvist & Ericsson 1988

A treatment manual for chronic cannabis users

• 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:

• 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

• 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.

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

• 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

• 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

• 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

• 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

• 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

• 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

• 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.

A logistic framework of seven cognitive functionsA 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 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.

An illustration of the screened off condition

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 Weaknesses are observed in the following areas:areas:

Psychomotility

Weaknesses are observed in the following Weaknesses are observed in the following areas: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

• 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

• 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

• 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

• 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

Weaknesses are observed in the following Weaknesses are observed in the following areas: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

• 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 Weaknesses are observed in the following areas:areas:

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:Weaknesses are observed in the following areas:

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

• 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 Weaknesses are observed in the following areas:areas:

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 Weaknesses are observed in the following areas:areas:

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.

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

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

• 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-TermLong-Term useuse

In addition the cognitive process is influenced

Long-Term use

• not inclined to interpret opinions and motives of other people.

• hardly any self criticism.

• emotional superficiality (apathy, listless)

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

• 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