Another session of the Physicians’ Legion was hold by Mr. Dezhakam as the master of the ceremony, Dr. Masoud as the guest speaker and Ms. Qazal as the secretary, with the agenda of “My Experience of Different Methods of Ceasing Addiction; DST Method; and the Best Method” in Taleqani Park on November 4, 2016.
I have been so much interested in the subject of the agenda. Mr. Dezhakam and I discussed about cessation and curing of addiction. Mr. dezhakam talked about his belief and then I thought what the difference between these two is. Why do addicts say cessation of addiction? Even you have written cessation of addiction on the boards on top of your clinics. Because there has been a wrong way of thinking saying: Narcotic addiction has no cures and it is a mysterious, physical, mental and social illness. It was said in the past that an addict will be cured by dying.
Therefore the narcotic addicts say, “I have ceased 20 times and I didn’t use drugs for one month, two months or one year. Psychologically and Physiologically, drug is more important than any other things . This importance (of drug) refers to the secretion of dopamine and other hormones into the body. If the drug is taken from him, he will seek it all the time. According to Mr. Dezhakam there are some people who leave our meeting when hearing the words opium or heroine in the workshops. Because they recall the memory of drug using and are always seeking it. But later some medicines, having special complications, were discovered to cure addiction (Buprenorphine was the last).
In researches done for Drug Control Headquarters we surveyed the influence of medicines and treatment methods. DST Method has features one of which is based on human and nature. We should let the sick to take OT three times a day. Because body adaptation is based on this fact and the medicine (whether opium or methadone or buprenorphen) is influential if the therapists work in this way. In my opinion Congress 60’s method is a proper method and we all witness it.
An addict wakes up in the morning and plans to use his/her drug in the morning, at noon and at night. Life is meaningless for this person. We should keep it in mind and have an exact schedule. Since we have a conscious time and an unconscious time, we shouldn’t mistake the real time for the unconscious time.
Narcotic addicts use drugs at a certain time. When it is time for them to use drugs, craving arrives. Therefore it is better to consider the unconscious time. When we prescribe one dosage of medicine for the addicts, they always have a fear of not having medicine if they go somewhere. Three-dosage-based treatment (taking medicine three times a day) makes the person more relaxed and comfortable.
If a final rifle range is 20 meters, the bullet will hit the target and won’t do any other work. Methadone does the same thing. It keeps the person for 24 hours but after 10-12 hours its effects will gradually disappear and even a large amount of methadone (20 cc) doesn’t influence anymore. I have tried it many times and it can be said that DST Method is a miracle.
In my opinion, DST Protocol and comparing it with other common methods is one of the important agenda. Based on our protocol (treatment by methadone) individuals have to refer to clinics to receive their medicine and take one dose of it in the clinic. We don’t trust them and we think they will sell the medicine if we give it to them while based on DST Protocol the individuals are trusted from the very beginning of their treatment and receive their medicine weekly.
One of our problems in treatment is that we do not assign the duration of treatment time to the individuals. But both the start and end point of treatment is clear in DST Protocol and it works well.
The important point in DST Method is the ultimate amount of medicine consumed by the person, the matter we never considered. Whenever the person wanted, we increased the amount of the medicine. If we divide the medicine dose and trust the person and give it to him/her, the result will be more acceptable.
Dr. Mohammad Ali:
There are some main problems with the previous protocol. I found out those who receive single- dose medicine divide it and use it whenever s/he likes. By dividing the medicine into three doses in a day, the individuals try to use it at certain times and know that s/he has enough medicine to use during a day.
I believe in a more important point, i.e. using medicine according to DST Method increases its effect. Using methadone and even other medicines have the same results when they are prescribed in t.d.s dosage.
Mr. Dezhakam has pointed to the methods of addiction cessation in the past. None of them survived because they were not appropriate and had no positive results. DST is an efficient method even in MMT (methadone therapy) and treatment by medicines (pills). Mr. Dezhakam said that we had ophthalmologists or other specialists but no addiction treatment specialists; and we had a look at the treatment on the surface so we need more information in this field.
We know that the start of a medicine’s effect is a definition used for all medicines. Mr. Dezhakam defines it as “shooting a bullet”. According to the protocol we mustn’t prescribe methadone more than 2 cc because of its bad effects (like: toxicity and hysteria). But we reject some individuals’ insistence on getting more methadone. I myself apply DST Method for other cases, for example, in MMT I prescribe methadone in t.d.s and follow the pattern of 8 hours between doses during 11 months of treatment.
There are many differences between what is done in clinics and what is instructed in the protocol. One of the most important things that is less paid attention to is that the patient referring to the clinic is stressed out and experiences a lot of fear and anxiety half of which is referred to the fear of withdrawal. I tell him/her that we will give you 50 cc of methadone but you need to practice mentally. If you act like this, you can go on by even 30 cc in a day. The first step is related to the realization of psychiatric and psychological disorders which is effective in this method. By reducing the amount of stress, the dosage of the medicine will decrease by itself; and the patient trusts us more.
Addiction treatment in Congress 60 is based on three sides of a triangle including body, psyche and worldview. In Congress 60, treatment is over drug cessation (quitting drugs) and balance is over treatment. The patients are cured in the first travel and reach balance during the second travel, therefore the latter is of much importance in Congress 60.
We took a look at the agenda from different angles. I have a good memory of the place we are sitting now. There was a football ground here and authorities wanted to found a site for archery. Some members said, “Let’s struggle and protest.” I told them not to do anything; I will think and find a way.
After a week I told them to register for archery. All of us registered and we took the ground back without any fight. Tehran League Archery matches started and we had just learned archery. To encourage the members I myself took part in the games, too.
When shooting with arch, I always prayed for my arrows to hit the target but they didn’t. Two of the viewers told me to change the arrows but I didn’t succeed. I should have learned shooting completely. If we know our job well we will get good results. If we don’t know the job perfectly, there are no differences in single dose, t.d.s and so on.
A chef must know his/her job well. If s/he has all the best materials and ingredients, s/he himself/ herself must cook food. We should take an important point into consideration, that is, addicts are classified into groups and we can’t prescribe the same doses for all. Single dose of medicine is for junkies not all other groups of addicts.
There were some junkies, alcoholics, homeless people that were said to take their medicine in clinics. They couldn’t refer to clinics three times a day so they were supposed to take medicine one time in a day (daily). But which addicts can use drugs just one time in a day? And which kind of drugs can be maintained in body for 24 hours? When a person uses drugs every day, it takes 15- 20 days for his/her body to be adapted to t.d.s. Dr. Mokri in Iranian National Center for Addiction Study said that patients should take the medicine once a day. I told him that it is not acceptable, s/he should receive the medicine weekly. He was surprised and I told let’s try it.
We piloted the method on 1000 people with the medicine in t.d.s. Of course we didn’t give them more than 17 cc of the medicine. When they took it, it would work for 8 hours. The most important feature of DST believes in definite cure of addiction and makes any effort to understand addiction. DST is going to make addicts understand addiction, know his/her job well, know why s/he reduces the medicine, when s/he must reduce, and what happens when s/he uses more than the certain dose.
We don’t say anything about using more than the needed medicine (extra using). I sign at least 90-100 liberation forms every week. We give the members all the information they need during their travel (treatment process) therefore they are controlled. It is difficult to carry out the same process in clinics but we do it. It is difficult at first but gradually it is possible. Some clinics have started this; they have legions and give instructions to their patients that will definitely be cured. I hope we will succeed together and get good final results.
Some clinics have started under your guidance. We ourselves started with one patient and found a legion. It was not compulsory but 15 people referred and we had to use the waiting hall. The number of CDs has reached to 40 and people themselves refer to us. T.D.S is not the main subject but there is a protocol called DST that has special features to learn. People will welcome the method if we make them believe in the method and think they are helpful. Our meetings which are coherent and disciplined are our strengths. If it goes well, the pessimistic view toward clinics will be settled. Dr. Mokri stressed on editing the protocol to help clinics more seriously.
Mr. Dezhakam answered:
There is no need to edit the protocol at all. The question is that we piloted opium tincture so that the protocol is carried out based on the pilot. If the steps of reduction last 21 days, they must just last 21 days; if OT was taken in t.d.s, it cannot be taken once a day. We cannot change what we have piloted. We have never witnessed one case of OT overdose. Our first purpose is to cure patients and the second one is for clinics to thrive. Let’s throw what we don’t need aside and help each clinic become a branch of Congress 60. Patients help clinics to continue their work. If each of them is cured, 5 more patients will follow them and will pay whatever you want. Throw aside the attitude saying addicts are poor and junkies. Just 2% of addicts are poor and the rest are rich.
Prepared by: Alireza Nik Raves
Translated by: Marjan
November 4, 2016