Category Archives: Addiction
In 2014, I was the resident psychologist on 12-episode television series called Forbidden made for the Discovery Channel. One of the strangest stories that the series reported on was ‘cane therapy’ for the ‘Twisted Treatments’ episode. Before I was interviewed for the story, I had to research the story and was also given some production notes as background material. According to the material I was provided with:
“Caning treatment was pioneered in Siberia by Dr Sergei Speransky a biologist from the Novosibirsk Institute of Medicine who together with Dr Marina Chuhrova released a research report in 2005 on whipping as a therapy. Dr Speransky and Dr Chukhrova developed the medical theory behind caning. Importantly Dr Chukhrova notes that, ‘It is not some warped sado-masochistic activity,’ but has a clear medical purpose. Apparently, there are some sound scientific principles behind these beatings. Namely the theory that pain activates the body’s immune system, causing it to perform much more effectively than under ‘normal circumstances.’ Dr Chukhrova taught [Dr. German Pilipenko] the theory as a student at university and controversially he has taken her theory and put it into practice, combining it with his own unique psychology treatment. 50-year old German Pilipenko has been caning people for nine years. In his spare time German enjoys the blissful serenity of mountain skiing in his local town. But in his professional life German has to bear the yelps, tears and groans of his patients – German canes and whips people for a living. German started to practice cane therapy in a medical clinic in 2004. Though the clinic no longer exists he’s continued the controversial practice as a private psychologist in a rented 14 square meter room in Novosibirsk’s Business Centre”.
Dr. Pilipenko is a psychotherapist and a hypnotist and claims that cane therapy can cure addictions (both chemical addictions such as alcohol and other drug addictions, and behavioural addictions such as sex addiction and work addiction), depression, phobias and neuroses. Along with Dr. Chukhrova, they have successfully treated over 1000 individuals (aged between 17 and 70 years) of their problems. The therapy appears to be arguably similar to primal therapy (which I briefly examined in a previous blog) and according to Pilipenko “can be used as a kind of anti-stress injection”. Via intense caning sessions Pilipenko not only draws physical pain from his clients but also their emotional reactions. It is the release of these emotions (as with primal therapy) is what he believes cures his patients of their addictions, stresses, depression, and anxieties. (If you are a journalist or an artist he offers the therapy free as a way of promoting his therapeutic practice). For the television programme, one of Dr. Pilipenko’s female clients (Anzhelika Alexeyev, a 22-year old, fifth-year medical student) was interviewed. The production notes I was given noted:
“Anzhelika is only at the beginning of her life, but she’s already experienced hardship and emotional difficulties. Receiving a beating from Dr Pilipenko has been her solution. She’s already visited him once but German believes there is more work to be done. [The programme will] follow Anzhelika through pain and tears as she returns for more caning. She also introduces her father to the treatment and we see her bring him for a session…Her first caning experience was at the start of [the] year…Anzhelika had been suffering stress after miraculously surviving a car crash. German’s advice was that ‘she really needed a lashing.’ She agreed. Initially at the start of the session Anzhelika wanted to leave. She suffered through the first beating in tears, though she persisted, knowing the pain was temporary. She believes the treatment has been successful in curing her trauma and stress related to the accident. In fact she is a big supporter of German’s caning and believes it helps to get rid of emotions that are deeply hidden, unacknowledged and out of control”.
Many newspaper reports have covered the ‘therapy’ over the last few years but nothing has been published on it in peer-reviewed scientific journals. According to one report on the Alternet news site:
“Practitioners Dr. German Pilipenko and Professor Marina Chukhrova say that their treatment is grounded in science: ‘We cane the patients on the buttocks with a clear and definite medical purpose’…The pair say that addicts suffer from a lack of endorphins, and that pain can stimulate the brain to release the feel-good chemicals, ‘making patients feel happier in their own skins.’ Mainstream doctors dismiss the practice, saying that exercise, acupuncture, massage, chocolate or sex are all better at stimulating endorphin secretion. Dr. Pilipenko admits, ‘we get a lot of skepticism…but so do all pioneers.’ The Siberian Times reports that ‘the reaction of most people is predictable: to snigger, scoff or make jokes loaded with sexual innuendo.’ And one recipient of the treatment, 41-year-old recovering alcoholic Yuri, says his girlfriend accused him of simply visiting a dominatrix. But he adds that although ‘the first strike was sickening…Somehow I got through all 30 lashes. The next day I got up with a stinging backside but no desire at all to touch the vodka in the fridge. The bottle has stayed there now for a year’.”
The Alternet story also interviewed another patient (Natasha, a 22-year-old recovering heroin addict with several months clean) who had been paying $100 for a two-hour session and claimed:
“I am the proof that this controversial treatment works, and I recommend it to anyone suffering from an addiction or depression. It hurts like crazy – but it’s given me back my life…With each lash, I scream and grip tight to the end of the surgical table. It’s a stinging pain, real agony, and my whole body jolts…I’m not a masochist. My parents never beat me or even slapped me, so this was my first real physical pain and it was truly shocking. If people think there’s anything sexual about it, then it’s nonsense.”
The article reported that Natasha had received 60 strokes of the cane per session (noting that drug addicts get double the number of lashes than alcoholics). Professor Chukhrova was then quoted as saying that extreme care is taken to ensure patient safety, and that:
“The beating is really the end of the treatment. We do a lot of psychological counseling first, and also use detox. It is only after all the counseling, and heart and pain resistance checks, that we start with the beating. [We use willow branches because they] are flexible and can’t be broken nor cause bleeding…If any patients get sexual pleasure from the beatings, we stop immediately…This is not what our treatment is about. If they’re looking for that, there are plenty of other places to go.”
According to Dr Pilipenko, the unusual combination of psychology and corporal-style punishment is designed to train patients in endurance, tolerance and resistance as ways of coping with stress. Pilipenko believes he provides his clients with the tools to deal with stress and problems in their lives. More specifically he claims that:
“Psychological stimulation is aimed to convince a patient that aggression, idleness and depression will cause problems in life…Usually a patient is prescribed three separate visits, before they can be cured but it might be necessary for anything up to 10 sessions, depending on the severity of the individual case”.
Dr. Pilipenko also claims that cane therapy that was practiced by monks in the Middle Ages. However, I also noted that following each caning, his clients receive both psychotherapy and hypnotherapy. This begs the question as to whether it is these additional forms of intervention that are key to therapeutic success rather than the caning in and of itself.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Alternet (2013). Weird science: Siberian psychologists caning patients “on the buttocks” in new addiction treatment. January 7. Located at: http://www.alternet.org/weird-science-siberian-psychologists-caning-patients-buttocks-new-addiction-treatment
Daily News (2014). Russian patients pay therapists to cane them in bizarre treatment. October 2. Located at: http://www.nydailynews.com/life-style/russian-patients-pay-therapists-cane-article-1.1960979
Siberian Times (2013). Beating the addiction out of you – literally. January 7. Located at: http://siberiantimes.com/other/others/features/beating-addiction-out-of-you-literally/
Stewart, W. (2013). How to beat your demons, literally: Siberian psychologists thrash patients with sticks to help them kick their addictions. Daily Mail, January 7. Located at: http://www.dailymail.co.uk/news/article-2258395/How-beat-addictions-literally-Siberian-psychologists-thrash-patients-sticks-help-kick-habits.html
Many people that I know would probably describe me as a ‘writaholic’ based on the number of articles and papers that I have had published. When it comes to addictions in academia, ‘writing addiction’ is just about the best one you can have. I don’t believe I have an addiction to writing but it is a very salient activity in my life and I am a habitual writer and I write every day. In previous blogs I examined diary writing and psychological wellbeing as well as an article on graphomania (obsessive writing). Today’s blog briefly examines some of the things that make people more productive writers (and by definition a more excessive writer). During my career I’ve published many articles on the writing process (see ‘Further reading’ below) and today’s blog looks at some of my beliefs and practices.
Before outlining some general advice, it’s also worth exploring many of the false beliefs that many of us have about writing – beliefs which may explain why many of us don’t like writing. For instance:
- Writing is inherently difficult: Like speaking, writing doesn’t need to be perfect to be effective and satisfying.
- Good writing must be original: Little, if any, of what we write is truly original. What makes our ideas worthwhile communicating is the way we present them.
- Good writing must be perfect preferably in a single draft: In general, the more successful writers are more likely to revise manuscripts.
- Good writing must be spontaneous: There appears to be a belief that writing should await inspiration. However, the most productive and satisfying way to write is habitually, regardless of mood or inspiration. Writers who overvalue spontaneity tend to postpone writing, and if they write at all, they write in binges that they associate with fatigue.
- Good writing must proceed quickly: Procrastination goes hand in hand with impatience. Those writers who often delay writing suppose that writing must proceed quickly and effortlessly. However, good writing can often proceed at a slow pace over a lengthy period of time.
- Good writing is delayed until the right mood with big blocks of undisrupted time available: Good writing can take place in any mood at any time. It is better to write habitually in short periods every day rather than in binges.
- Good writers are born not made: Good writing is a process that can be learned like any other behaviour.
- Good writers do not share their writing until it is finished and perfect: Although some writers are independent, many writers share their ideas and plans at an early stage and then get colleagues to read over their early drafts for comments and ideas.
Even when these false beliefs about writing are dispelled, many of us can still have problems putting pen to paper or finger to keypad. Insights about writing only slowly translate into actions. For most professionals, writing is only done out of necessity (i.e., a report that they have to hand in). This produces a feeling of ‘having to write’ rather than ‘wanting to write’ and can lead to boredom and/or anxiety. Furthermore, most people appear to view writing as a private act in which their problems are unique and embarrassing. Strategies for overcoming this include getting colleagues to criticize their own work before going ‘public’, sharing initial plans and ideas with others, and practising reviewing other people’s work.
It is generally acknowledged that there is no one proven effective method above all others for teaching people to become better writers. It is also a process that can be learned and can aid learning (i.e., a skill learned through opportunities to write and from instructional feedback). Although there are no ‘quick fixes’ to becoming a better writer, here are some general tips on how to make your writing more productive. I would advise you to:
- Establish a regular place where all serious writing is done
- Remove distracting temptations from the writing site (e.g., magazines, television)
- Leave other activities (e.g., washing up, making the dinner) until after writing
- Limit potential interruptions (e.g., put a “Do not disturb” sign on the door, unplug the telephone)
- Make the writing site as comfortable as possible
- Make recurrent activities (e.g., telephone calls, coffee making) dependent upon minimum periods of writing first
- Write while ‘feeling fresh’ and leave mentally untaxing activities until later in the day
- Plan beyond daily goals and be realistic about what can be written in the time available
- Plan and schedule writing tasks into manageable units
- Complete one section of writing at a time if the writing is in sections
- Use a word processor to make drafting easier
- Revise and redraft at least twice
- Write daily rather than ‘bingeing’ all in one go
- Share writing with peers as people are more helpful, judgmental and critical on ‘unfinished’ drafts
Obviously, the problem with such a prescriptive list such as this is that not every suggestion will work for everyone. Many of us know our own limitations and create the right conditions to help get the creative juices going. Some people can’t write in silence or with others in the room. By reading this short blog I cannot make you become a more productive and excessive writer overnight. However, it has hopefully equipped my blog readers with some tips and discussion points that may help in facilitating better writing amongst yourselves and colleagues.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Griffiths, M.D. (1994). Productive writing in the education system. The Psychologist: Bulletin of the British Psychological Society, 7, 460-462.
Griffiths, M.D. (2001). How to…get students to write with confidence. Times Higher Education Supplement, June 8, p.24.
Griffiths, M.D. (2004). Tips on…Report writing. British Medical Journal (Careers), 328, 28.
Griffiths, M.D. (1998). Writing for non-refereed outlets (Part 1 – Professional journals and newsletters). Psy-PAG Quarterly, 29, 41-42.
Griffiths, M.D. (1999). Writing for non-refereed outlets (Part 2 – Newspapers and magazines). Psy-PAG Quarterly, 30, 5-6.
Griffiths, M.D. (2000). Writing and getting published – My top 10 tips. Psy-PAG Quarterly, 34, 2-4.
Griffiths, M.D. (2005). Addiction, fiction and media depiction: A light-hearted look at scientific writing and the media. Null Hypothesis: The Journal of Unlikely Science, 2(2), 16-17.
Griffiths, M.D. (2010). Top tips on…Writing with confidence. Psy-PAG Quarterly, 76, 33-34.
Griffiths, M.D. (2013). How writing blogs can help your academic career. Psy-PAG Quarterly, 87, 39-40.
Griffiths, M.D. (2014). Top tips on…Writing blogs. Psy-PAG Quarterly, 90, 13-14.
Addiction is a highly prevalent problem within today’s society and there is a lot of time and many spent in trying to prevent and treat the behaviour. There has also been a move towards getting addicts motivated to want to change their behaviour. The most influential model worldwide is probably the ‘stages of change’ model by Dr. James Prochaska and Dr, Carlo Di Clemente that identifies an individual’s ‘readiness for change’ and tries to get a person to a position where they are highly motivated to change their behaviour. The individual stages of this model are:
- Precontemplation – This is where the person unaware of the consequences of his or her own behaviour and no change in behaviour is foreseeable.
- Contemplation – This is where the person aware problem exists and is contemplating change.
- Preparation – This is where the person has decided to change in the near future (e.g., New Year resolution).
- Action – This is where the person effects change (e.g., gets rid of all association items related to the behaviour).
- Maintenance – This is where the person consolidates behaviour change over time.
- Relapse – This where the person reverts to a former behaviour pattern (e.g., contemplation, preparation).
People can stay in one stage for a long time and it is also possible for unassisted change such “maturing out” or “spontaneous remission”. Various techniques can be used to help people prepare for readiness include motivational techniques, behavioural self-training, skills training, stress management training, anger management training, relaxation training, aerobic exercise, relapse prevention, and lifestyle modification. The goal of treatment can be either abstinence or simply to cut down.
The intervention and treatment options for the treatment of addiction include, but are not limited to counselling/psychotherapies, behavioural therapies, cognitive-behavioural therapies, self-help therapies, pharmacotherapies, residential therapies, minimal interventions and combinations of these (i.e., multi-modal treatment packages). The most important of these are outlined below.
Pharmacotherapy: Pharmacological interventions basically consist of addicts being given a drug to help overcome their addiction. These are mainly given to those people with chemical addictions (e.g., nicotine, alcohol, heroin, etc.) but are increasingly being used for those with behavioural addictions (e.g., gambling, sex, work, exercise, etc.). For instance, some drugs produce an unpleasant reaction when used in combination with the drug of dependence, replacing the positive effects of the drug of dependence with a negative reaction. For instance, alcoholics are sometimes prescribed disulfiram (more commonly known as Antabuse), that when combined with alcohol may produce nausea and vomiting. Other common therapies include methadone and the use of opioid antagonists (such as nalaxone or naltrexene) for heroin addiction. The methadone prevents withdrawal symptoms, block the effects of heroin use, and decreases craving. The main criticism of all these treatments is that although the symptoms may be being treated, the underlying reasons for the addictions may be being ignored. On a more pragmatic level, what happens when the drug is taken away? Often, the addicts return to their addiction if this is the only method of treatment used.
Behavioural therapy: Behavioural therapies are based on the view that addiction is a learned maladaptive behaviour and can therefore be ‘unlearned’. These have mainly been based on the classical conditioning paradigm and include aversion therapy, in vivo desensitisation, imaginal desensitisation, systematic desensitisation, relaxation therapy, covert sensitisation, and satiation therapy. All of these therapies focus on cue exposure, and relapse triggers (like the sight and smell of alcohol/drugs, walking through a neighbourhood where casinos are abundant, pay day, arguments, pressure, etc.). The theory is that through repeated exposure to ‘relapse triggers’ in the absence of the addiction, the addict learns to stay addiction free in high-risk situations. It could be argued that if the addiction is caused by some underlying psychological problem, (rather than a learned maladaptive behaviour), then behavioural therapy would at best only eliminate the behaviour but not the problem. This therefore means that the addictive behaviour may well have been curtailed but the problem is still there so the person will perhaps engage in a different addictive behaviour instead.
Cognitive-behavioural therapy: A more recent development in the treatment of addictive behaviours is the use of cognitive-behavioural therapies (CBT). There are many different CBT approaches that have been used in the treatment of addictive behaviours including rational emotive therapy, motivational interviewing, and relapse prevention. The techniques assume that addiction is a means of coping with difficult situations, dysphoric mood, and peer pressure. Treatment aims to help addicts recognise high-risk situations and either avoid or cope with them without use of the addictive behaviour. In relapse prevention, the therapist helps to identify situations that present a risk for relapse (both intrapersonal and interpersonal). Relapse prevention provides the addict with techniques to learn how to cope with temptation (positive self statements, decision review, and distraction activities), coupled with the use of covert modelling (i.e., practicing coping skills in one’s imagination). It also provides skills for coping with lapses (by redefining what is happening), and utilizes graded practice (a desensitization technique where addicts encounter real life situations slowly). Overall, CBT approaches are better researched than the other psychological methods in addiction but are probably no more effective (Luty, 2003).
Psychotherapy: Psychotherapy can include everything from Freudian psychoanalysis and transactional analysis, to more recent innovations like drama therapy, family therapy and minimalist intervention strategies. The therapy can take place as an individual, as a couple, as a family, as a group and is basically viewed as a ‘talking cure’ consisting of regular sessions with a psychotherapist over a period of time. Most psychotherapies view maladaptive behaviour as the symptom of other underlying problems. Psychotherapy often is very eclectic by trying to meet the needs of the individual and helping the addict develop coping strategies. If the problem is resolved, the addiction should disappear. In some ways, this is the therapeutic opposite of pharmacotherapy and behavioural therapy (which treats the symptoms rather than the underlying cause). There has been little evaluation of its effectiveness although most addicts go through at least some form of counselling during the treatment process.
Self-help therapy: The most popular self-help therapy worldwide is the Minnesota Model 12-Step Programme (e.g., Alcoholics Anonymous, Gamblers Anonymous, Narcotics Anonymous, Overeaters Anonymous, Sexaholics Anonymous, etc.). This treatment programme uses a group therapy technique and uses only ex-addicts as helpers. Addicts attending 12-Step groups involves them accepting personal responsibility and views the behaviour as an addiction that cannot be cured but merely arrested. To some it becomes a way of life both spiritually and socially and compared with almost all other treatments it is especially cost-effective (even if other treatments have greater success rates) as the organization makes no financial demands on members or the community. For the therapy to work, the 12-Step Programme asserts that the addict must come to them voluntarily and must really want to stop engaging in their addictive behaviour. Further to this, they are only allowed to join once they have reached “rock bottom”. To date there has been little systematic study of 12-Step groups but drop out rates are very high (typically 80-90%). There are a number of problems preventing evaluation, particularly anonymity, sample bias, and what the criterion for success is. The empirical evidence suggests that self-help support groups’ complement formal treatment options and can support standardized psychosocial interventions.
When examining all the literature on the treatment of addiction, there are a number of key conclusions that can be drawn. These include that: (i) treatment must be readily available, (ii) no single treatment is appropriate for all individuals., (iii) it is better for an addict to be treated than not to be treated, (iv) it does not seem to matter which treatment an addict engages in as no single treatment has been shown to be demonstrably better than any other, (v) a variety of treatments simultaneously appear to be beneficial to the addict, (vi) individual needs of the addict have to be met (i.e., the treatment should be fitted to the addict including being gender-specific and culture-specific), (vi) clients with co-existing addiction disorders should receive services that are integrated, (vii) remaining in treatment for an adequate period of time is critical for treatment effectiveness, (viii) medications are an important element of treatment for many patients, especially when combined with counselling and other behavioural therapies, (ix) recovery from addiction can be a long-term process and frequently requires multiple episodes of treatment, (x) there is a direct association between the length of time spent in treatment and positive outcomes, and (xi) the duration of treatment interventions is determined by individual needs, and there are no pre-set limits to the duration of treatment.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.
Griffiths, M.D. & H.F. MacDonald (1999). Counselling in the treatment of pathological gambling: An overview. British Journal of Guidance and Counselling, 27, 179-190.
Hayer, T. & Griffiths, M.D. (2015). The prevention and treatment of problem gambling in adolescence. In T.P. Gullotta & G. Adams (Eds). Handbook of Adolescent Behavioral Problems: Evidence-based Approaches to Prevention and Treatment (Second Edition) (pp. 539-558). New York: Kluwer.
King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.
Luty, J. (2003). What works in drug addiction? Advances in Psychiatric Treatment, 9, 280–288.
National Institute on Drug Abuse (1999). Principles of drug addiction treatment: A research-based guide. NIDA.
Potenza, M. & Griffiths, M.D. (2004). Prevention efforts and the role of the clinician. In J.E. Grant & M. N. Potenza (Eds.), Pathological Gambling: A Clinical Guide To Treatment (pp. 145-157). Washington DC: American Psychiatric Publishing Inc.
Prochaska, J.O. and DiClemente, C.C. (1984). The transtheoretical approach: Crossing the traditional boundaries of therapy. Melbourne, Florida: Krieger Publishing Company
Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.
United Nations Office on Drugs and Crime/World Health Organization (2008). Principles of Drug Dependence Treatment: Discussion paper. UN/WHO.