Summary

A total of 81 heroin addicts were examined. These were 47 males (58% of the total number of patients), aged on average 20.5 (17 √ 27) years, and 34 female patients (42%), aged on average 20.9 (18 √ 24) years. The patients had 1 to 3-year-long experience of heroin injections.
Using sexologic categories differing in social, personality, and biological sexuality levels, and also using the theory of functional systems, helped reveal damaged sexuality in our patients. Not only higher functions, but also biological functions were affected in our patients: men had decreased libido, while women demonstrated upset menstrual cycle. A specific phenomenon is described: the rhythm of sexual activity in men decreases with increasing intensity of heroin use. The reproductive level in this social group is 12%; prostitution, 41%.
It is suggested that formation of heroin dependence be considered as competition of two functional systems for the result of action: pathological system competes for heroin use, while sexuality competes for realization of libido.
It is recommended that the program for rehabilitation of drug addicts includes sexological consultation, special course in sexologic education, and training. The program may be accomplished in three stages, namely, the diagnostic stage (lasting for 1 √ 2 weeks), the active training stage (2 √ 3 months), and the stage of patient withdrawal from the program with control of treatment result (to physician's discretion). The program should be conducted by a pair of specialists in psychotherapy, comprising a general physician and a psychologist.

1. Introduction

Working out new psychotherapy programs to fight heroin addiction is a pressing problem because of the tendency to recurrence of the disease: once an individual addicts to heroin, he or she often resorts to the drug again on completion of specific treatment at a clinic or a rehabilitation center. Heroin addiction incidence in Russia increases at an amazingly rapid pace and specialists dare define the situation as close to epidemic. Hence the importance of working out new approaches to rehabilitation of heroin addicts.

Addicted individuals are a special group of community, characterized by high diversity as regards their social origin, walk of life, income, and other characteristics. What is common of them is behavior oriented at drug abuse. This behavior is a peculiar stereotype characterized by specific episodes of cyclic addiction, which come in sequence one after another. Brief description of the stereotype agrees with the concept of the triggering mechanism of pathological addiction (Friedman L. at al., 1998).

An addict develops the irresistible desire to use heroin and starts seeking for the drug; this may be a time-taking period. If heroin is unavailable, the addict usually develops the state of affect, which is followed by symptoms of the abstinence syndrome. As soon as the drug is scrounged, a short ritual of preparing the dose follows, which finally ends with injection of the drug. This is accompanied by a marked emotional stress. Shortly after the injection (or virtually during the intravenous injection) the addicted individual develops the condition which, as a matter of fact, is the purpose of dependent behavior: the drug produces a psychosomatic action and the patient falls into ecstasy attended by a pronounced vegetative reaction. This state lasts from few minutes to dozens of minutes, after which the addict feels euphoria for a few hours. This period is characterized by decreased criteria for subjective estimation of own behavior and reality (defective judgement) . As soon as the effect of the drug lessens, the patient develops a transient state of rest or quiescence: the ability of critical estimations normalizes and the desire to use heroin fades out. This period lasts from several minutes or hours to several days and even weeks, and depends on daily dose and history of heroin addiction. For months and years, intensive periods of using heroin alternate with more or less long periods of withdrawal. During this period, the patients abstain from heroin because they take the course of therapy and rehabilitation, or they may use other drugs or smoke marijuana. Or else, they begin abusing alcohol.

Observation of patients during periods of using heroin and remission, shows that in several months after an individual beings using heroin, he or she develops specific changes in personality and behavior. Patients stop attending school or office, and begin conducting asocial or antisocial way of life. They become aggressive, develop emotional rigidity, and break ties with close friend and the family.

It is important to note that when an addicted person abstains from heroin for 6 - 8 months and over, his or her individuality partly restores. The patient resumes studies, finds a job, begins associating with healthy people, gets married, etc. In order to encourage addicted individuals to treatment and rehabilitation, it was proposed to work out psychotherapy programs, in which the concepts of functional systems regulating behaviour of an individual, are given due consideration (Sudakov K., 1984). Three functional systems are differentiated, which control behavior of addicts during psychotherapy (Zharkov Y., Glushko A., 2000). It was shown that during rehabilitation of patients, it is helpful to offer them sexological counselling. This improves remission quality (Zharkov Y.,2000; Zharkov Y.2001).

It is known that sexual behavior changes in heroin addicts. For some reasons, these changes have not been widely discussed in special literature, and phenomenology is therefore the subject of interest. We shall consider behavior of heroin addicts during their sexual intercourse after using the drug, specific features of sexuality in habitual users of heroin, and some sexological characteristics of the social group of drug addicts.

Sexual reactions of male heroin addicts change in the state of acute intoxication. The intercourse becomes abnormally long and failure to ejaculate becomes not unusual. Female addicts develop anorgasmy. The patients remain indifferent to these changes, probably because motivation to coitus is other than sexual. It is important to note that heroin addicts often refuse orgasm because the highest sexual excitement disrupts the psychosomatic effect of the drug and the necessity of taking another dose thus arises. Interestingly, addiction to heroin lessens in some male subjects after experiencing an orgasm. It has been found that quality of sexual reactions depends on the dose: duration of coitus increases, ejaculation becomes attainable with greater difficulty, and the orgasmic excitement weakens with increasing doses (Koporov C., 1994).

Both men and women rapidly develop physical dependence, which is always followed by a decrease in libido. The extent to which libido decreases depends on intensity of drug use and constitutional characteristics of individual sexuality. Some addicts demonstrate total reduction of sexuality, while in others the reduction is not so pronounced. Accordingly, sexual behavior of male patients varies from full sexual abstinence to a limited frequency of sexual intercourse, which only allows him to maintain the status of a husband; in some families frequency of sexual intercourse depends on female initiative. The character of sexual relations in married couples changes. Petting begins dominating over vaginal intercourse.

As regards sexologic characteristics of the social groups of heroin addicts, it is characterized by the growing incidence of prostitution and sexual violence, AIDS and other diseases transmitted by genital contacts.

The objective of this study is to verify phenomenology of sexuality in heroin addicts and to formulate basic concepts, which might underlie the psychotherapy program including sexologic consultation.