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

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.

REFERENCES

Bechtel E.E. (1986). Prenosological forms of alcohol abuse.

M.: Medicine, P.23-25

PAMIR 2023 - The First Pamir Transboundary Conference for Sustainable Societies- | PAMIR

104

Wasserman L.I., Eryshev O.F., Klubova E.B. (1993).

Attitude to the disease, alcoholic anosognosia and

mechanisms of psychological protection in patients

with alcoholism // Review of psychiatry and medical

sciences. psychology them. V.M. Bekhterev. No. 3. P.

13–22

Impaired awareness of the disease in focal lesions of the

brain/ Grigoryeva V. N., Sagildina A. O., Karova N.

A(2011)..// Journal of Neurology and Psychiatry. S.S.

Korsakov. - p.111

Somatic anosognosia in patients with alcohol dependence/

Ponizovsky PA(2006). // Social and clinical psychiatry.

p.52.Gallagher S. Philosophical conceptions of the self:

implications for cognitive science. Trends in Cognitive

Sciences. 2000;4:14–21. [PubMed] [Google

Scholar] [Ref list]

Besharati, S., Forkel, S. J., Kopelman, M., Solms, M.,

Jenkinson, P. M., & Fotopoulou, A. (2014). The

affective modulation of motor awareness in

anosognosia for hemiplegia: behavioural and lesion

evidence. Cortex; a journal devoted to the study of the

nervous system and behavior, 61, 127–140.

https://doi.org/10.1016/j.cortex.2014.08.016

Major R. Н., (1954) History of medicine, v. 2, Springfield,

p. 965.

Personal Characteristics of Chemically Dependent Individuals with Varying Degrees of Narcotic Anosognosia

105