Personal Characteristics of Chemically Dependent Individuals with
Varying Degrees of Narcotic Anosognosia
Marina Markendudi
National University of Uzbekistаn named after M. Ulugbek, Tashkent, Uzbekistan
Keywords Psychoactive Substances (PAS), Anosognosia, Internal Picture Chemical Dependence,Total and Partial
Anosognosia.
Abstract This article focuses on investigating the personal characteristics of chemically dependent individuals with
different levels of drug anosognosia. Our study revealed that the severity of anosognosia is directly linked to
the personal traits of chemically dependent individuals. Moreover, narcotic anosognosia serves as a
psychological defence mechanism and a coping strategy for dealing with addiction. The identified aspects of
the internal perception of dependence on psychoactive substances can serve as differential diagnostic criteria
when determining the appropriate psycho-correctional approaches for chemically dependent individuals.
1 INTRODUCTION
At present, due to the widespread use of psychoactive
substances in the world, chemical addiction
psychologists face a serious task - to shift from
merely providing drug-related and suggestive
assistance to chemically dependent individuals, and
adopt a comprehensive integrated approach. This
approach primarily involves bringing about positive
changes in the consciousness of people suffering from
chemical dependence and mobilizing their personal
resources to confront their addiction to psychoactive
substances. This approach focuses on addressing the
core clinical phenomenon that sustains dependence
on psychoactive substances, known as narcotic
anosognosia. Before delving into this phenomenon, it
is important to define the term "anosognosia."
Anosognosia, derived from the Greek word
"anosognosia" which means "denial of knowledge
about the disease," is a neuropsychiatric syndrome
characterized by a decrease or lack of critical
assessment of patients regarding their health
problems. It refers to the clinical phenomenon where
the patient denies, ignores, or underestimates their
own illness. The disorder was first described in 1899
by the Austrian psycho-neurologist G. Anton in blind
patients after a stroke who believed they could see,
and later observed by the French physician Joseph
*
Corresponding author
Babinsky in patients with hemiplegia who were not
aware of their motor defect. This condition is now
known as the Anton-Babinsky syndrome, commonly
referred to as anosognosia [7, p. 965]. Anosognosia
occurs in 10-17% of patients in the acute period of
stroke, about 40% in Alzheimer's disease, and 43-
76% in alcoholism and drug addiction.
Underestimation of one's own health condition may
be associated with the phenomenon of psychological
defence in chemically dependent individuals without
structural brain damage. Anosognosia is relative and
can vary over time, with a person sometimes
acknowledging their illness and other times being
unable to do so. This fluctuation in awareness is
characteristic of anosognosia [8].
Anosognosia is commonly associated with various
conditions such as neurological pathologies (neuro-
infections, stroke, cerebral atherosclerosis, poisoning
with neurotropic poisons like mercury and carbon
monoxide), mental disorders (dementia, Alzheimer's
disease, manic syndrome, etc.), somatic and
psychosomatic pathology (arterial hypertension,
peptic ulcer, tuberculosis infection, HIV, oncology,
viral hepatitis), and chronic intoxication (alcoholism,
substance abuse, drug addiction) [Ponizovsky
PA(2006), p.111]. The exact pathophysiological
mechanisms of anosognosia remain debatable, but it
is noted that the lack of critical assessment of one's
102
Markendudi, M.
Personal Characteristics of Chemically Dependent Individuals with Varying Degrees of Narcotic Anosognosia.
DOI: 10.5220/0012478100003792
Paper published under CC license (CC BY-NC-ND 4.0)
In Proceedings of the 1st Pamir Transboundary Conference for Sustainable Societies (PAMIR 2023), pages 102-105
ISBN: 978-989-758-687-3
Proceedings Copyright © 2024 by SCITEPRESS Science and Technology Publications, Lda.
own condition is not a result of decreased intelligence
or dementia.
Various theories provide insights into anosognosia.
The psychogenic theory views anosognosia as an
unconscious psychological defence mechanism
against information that causes anxiety, guilt, or
distress. Through denial, chemically dependent
individuals attempt to shield themselves from threats
to their self-perception and emotional well-being
caused by their condition. At a neurophysiological
level, anosognosia is explained by an increased
threshold of susceptibility of neocortical neurons to
signals from the limbic system structures. While
initially serving as a means of psychological
protection, anosognosia later hinders the
development of necessary adaptive mechanisms and
adequate cognitive and emotional reactions to the
disease, becoming a maladaptive form of behavior.
Psychophysiological theories consider sensory and
cognitive deficits as contributing factors to
anosognosia. Sensory disorders result from impaired
proprioceptive sensitivity and an inadequate
perception of the body and its physical dysfunctions.
Some theories propose that selective cognitive
deficits, deterioration of regulatory functions, and
impaired interhemispheric interaction may lead to the
rejection of information about the disease
[Ponizovsky PA(2006), p.52]. Lack of awareness of
one's condition can be expressed in various forms,
including total anosognosia (complete non-
recognition of the problem without any arguments)
and partial anosognosia (partial denial of the disease
based on evidence).
Substance addicts often deny the existence of their
chemical dependence and provide various
justifications for their use ("I only use soft drugs,"
"soft drugs are legal in many developed countries, so
they are not dangerous," "I can stop whenever I
want"). They tend to shift responsibility for their
addiction to those around them, usually their close
relatives.
Anosognosia is diagnosed using psychological
methods, such as questionnaires and interviews.
The purpose of this study is to examine the personal
characteristics of chemically dependent individuals
with varying degrees of awareness of their
dependence on psychoactive substances.
2 METHODS
Investigating the phenomenon of anosognosia, we
encountered a lack of literature on the study of
anosognosia among individuals suffering from
psychoactive substance dependence. Most of the
existing literature focuses on anosognosia in people
with alcohol dependence, leaving limited descriptions
of drug anosognosia and its semantic structure. The
specific manifestations of awareness impairment in
different categories of individuals dependent on
psychoactive substances remain undescribed.
Moreover, there is a lack of evidence-based data
regarding the application of new psychological
examination methods to diagnose narcotic
anosognosia. To address this gap, we drew upon the
works of E.I. Bechtel [Bechtel E.E. (1986), p.23-25]
and L.I. Wasserman [Wasserman L.I., Eryshev O.F.,
Klubova E.B. (1993), p.13-22], which explore
alcohol anosognosia as a system of psychological
defence mechanisms enabling individuals to cope
with internal psychological conflicts.
The psychodiagnostic stage of our study involved
examining the personal qualities of the subjects and
their interpersonal relationships. We employed a
combination of clinical-psychological and
experimental-psychological methods. The clinical
and psychological approach entailed investigating
patients' attitudes towards their disease through a
structured interview we developed. As for
experimental psychological methods, we utilized the
following techniques: To determine the personality
model of the subjects, we used the method developed
by J. Oldham and L. Morris to determine their "type
of personality" and the probability of disorders
associated with that type. To assess the level of
reactive anxiety (as a state) and personal anxiety (as
a stable characteristic), we employed a scale for
assessing reactive and personal anxiety developed by
C.D. Spielberger and adapted by Yu.L. Khanin. For
diagnosing mental states and personality traits, we
utilized a depression scale adapted by T. I. Balashova.
The statistical analysis of the results involved
employing mathematical statistics methods, such as
correlation analysis, factor analysis, and the method
for determining the reliability of statistical
differences using Student's t-test. We processed the
results using the SPSS 11.0 and Excel 2003 computer
programs.
Our study was conducted in narcological clinics in the
city of Tashkent and involved examining 300
chemically dependent respondents, comprising 272
men and 28 women. The age of the subjects ranged
from 18 to 65 years, with the largest age group being
23 to 40 years (comprising 65% of the sample).
Among the respondents, 20% were hospitalized for
the first time, while 75% had one to ten previous
hospitalizations. The subjects' experience of using
Personal Characteristics of Chemically Dependent Individuals with Varying Degrees of Narcotic Anosognosia
103
psychoactive substances ranged from 1 to 5 years. Of
the total sample, 160 were voluntarily undergoing
rehabilitation, and 140 were in compulsory treatment.
Regarding education, 37% of the sample had higher
education, 42% had secondary-special education, and
21% had secondary education. Psychological
diagnostics took place on the seventh day of the
patients' clinic stay, after the main symptoms of the
withdrawal syndrome had been alleviated. The
control group consisted of 300 subjects who were
students of higher educational institutions and did not
have chemical dependence.
3 RESULT AND DISCUSSION
In chemically dependent subjects with total drug
anosognosia, we observed high values in various
areas, such as personal anxiety, infantilization,
aggressiveness, sensitivity, self-confidence, and
depression. These indicators may suggest an active
suppression of events and facts that are unacceptable
to the individual. Total drug anosognosia helps
maintain self-esteem and protects the social status of
chemically dependent individuals, while also
significantly reducing anxiety and contributing to a
prolonged, relatively "quiet" course of addiction.
Furthermore, subjects with total anosognosia tend to
display a clear sense of "emptiness" in their lives and
a sense of "alienation." Chemically dependent
individuals with total drug anosognosia exhibit
extremely low scores in problem-solving abilities.
All of the above prevents the realization of the
progressive nature of the disease as a subjectively
more complex task, leading instead to simple and
accessible replacements that are acted upon.
Consequently, pronounced conflicts arise, including
strong protests, leaving home, various manipulative
behaviours, and demonstrative suicide attempts.
When contrasting the "self" of drug addicts with
complete denial of the disease, we observe an extreme
underdevelopment of semantic connections, limited
comprehension context, and relatively low activity of
thought processes. The ideas these individuals hold
about themselves are superficial and overly
exaggerated, while their understanding of drug
addiction is highly distorted. Despite their narcotic
anosognosia (denial of dependence), their ideas about
drugs are similar to their ideas about themselves. This
indicates a lack of intrapersonal conflict and critical
thinking towards their dependence on psychoactive
substances.
On the other hand, chemically dependent individuals
with partial narcotic anosognosia exhibit less
prevalence of depressive states, personal and reactive
anxiety, infantilization, and manipulative behaviours
in their relationships with others. Instead, positive
interactions with people around them are noticeable.
These individuals allow some information about their
addiction to become conscious, but the semantic
regulation of their actions appears to be simplified,
contradictory, and not well understood.
In chemically dependent subjects who are aware of
their dependence on psychoactive substances, we
observe different personal characteristics, such as
altruism, conscientiousness, devotion, activity,
acceptance, self-acceptance, and goal-oriented
behavior for personal growth. In this category,
individuals tend to allow the realization of their
dependence, and the system of their semantic
connections is more developed compared to drug
addicts with other forms of drug anosognosia. The
internal conflict that arises upon realizing their
dependence is not as relevant due to its almost
complete resolution, which becomes possible through
the complete disidentification of their ideas about
themselves and their lives from ideas about drug
addiction.
4 CONCLUSION
Concluding the study, we can assert that chemically
dependent individuals with total drug anosognosia
lack a significant internal picture of their addiction.
On the other hand, those with partial drug
anosognosia mostly have a limited cognitive
component, while the emotional aspect tends to be
positive towards the drug-dependent lifestyle,
resulting in a discord between these facets of self-
awareness and leading to an internal personal
conflict. The complete formation of the internal
picture of addiction is observed only in drug addicts
who are aware of their dependence. In this case, the
cognitive component reflects realistic perceptions of
drugs, the emotional component shows a negative
attitude towards the drug-dependent lifestyle, and the
behavioural component is focused on achieving
alternative, positive, and socially significant
objectives.
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