The dissertation is devoted to the study of the dynamics of changes in the motivational sphere of chemical addicts in the process of development of addiction and formation of remission during social and psychological rehabilitation and in the postrehabilitation period. According to the results of the research, it was proposed “3+2” vector model of chemical addiction with three psychological vectors: vector of internal conflicts development, vector of personality addiction, vector of consciousness decrease; the biological one, which includes classical narcological syndromes and neuropsycological manifestations of protracted abstinence, psychoorganic syndrome, neurobiological mechanisms of craving; the social vector, where it takes into account both the influence of the surrounding social system, and the level of social skills of the individual. The “3+2” vector model integrates the most well-known mechanisms of addiction development.
The vector of internal conflicts development consist of such mechanisms: a) strengthening of already existing internal conflicts; b) introjection of external interpersonal conflicts; c) the development of feelings of neurotic guilt and shame as a result of use; d) mental trauma with the negative consequences of abuse.
In the development of addiction on the vector of addictive splitting of personality into normative self and addictive self consistently involved: a) mechanism of fixed imagination (authors O. Filtz, K. Sedykh, S. Mikhailiv) which is responsible for addictive splitting of personality at the preverbal level of needs; b) mechanism of formation of the addictive simulacrum through addictive fantasy activity (own concept), which is responsible for the addictive splitting of the personality at the verbal level of conscious values.
In the development of addiction on the vector of reduction of the functioning of consciousness consistently involved: a) mechanism of cognitive dissonance (L. Festinger); b) mechanism of illusory-compensatory activity (B. Bratus); c) mechanism of development of the studied impotence (M. Saligman); d) neurobiological mechanisms of development of cortical dysfunction and suppression of its activity through PTSD-like mental states. For mild forms of addictive behavior, the leader can be any of these five vectors, but for severe forms of chemical addiction, the leading vector is the devaluation of the functions of consciousness and a corresponding decrease in the level of functioning of the individual.
The author's theory of one of the mechanisms of development of addictive splitting of personality is also proposed - the theory of addictive simulacrum - "virtual space" created by an individual through fantasy and being influenced of chemical agents gets a subjective sense of reality, in which the addict imaginatively realizes his motives.
It was found that in the process of the formation of remission, it is possible to identify key changes in dynamics points - three months, six months and one year of sobriety. The main formation of remission’s stages were highlighted and the regularities of the dynamics of the motivational sphere at each of them were investigated. The main conclusion is the results of a study of the mental state of addicts for periods of one to two years of sobriety, which is characterized by the development of a severe existential crisis, an increase in the system of internal conflicts, dissociation of conscious and unconscious processes, which indicates the need for post-rehabilitation deep psychotherapy.
Based on the assumption of the leading value of the vector of reducing the level of functioning of the individual in severe forms of chemical addiction, has been developed the concept of stages of addiction psychotherapy. It is shown that the personality of the addict in the process of restoring the functions of consciousness due to successful psychotherapy will progressively move from level to level of functioning - subpsychotic, low borderline, high borderline and neurotic levels of functioning - resulting in a fundamental change in the structure of the psyche. Based on this, it is necessary to have fundamentally different explanatory theoretical models for each level of functioning. Such conceptualizing models for the subpsychotic level are the system approach, in particular the model of enactivism, for the low borderline level - the cognitive-behavioral model, for the high borderline level - the humanistic-existential model, for the neurotic level - the psychodynamic model.
On the basis of the offered concept was developed the author's Integrative personality-oriented developing model of psychotherapy of addictions. This model has been tested and proved to be highly effective in the work of the outpatient center for psychological rehabilitation "Sense".
