IJCRR

IJCRR - 3(12), December, 2011

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THE EFFECTIVENESS OF INDIVIDUAL AND GROUP COGNITIVE THERAPY TRAINING ON SELF-ESTEEM AND THE TENDENCY TOWARDS USING NARCOTICS OF THOSE WHO ADDICTED TO IT

Author: Shohreh Ghorbanshiroudi, Javad Khalatbari, Mohammad Ebrahim Maddahi, Mona Mousaei, Nikta Bazleh1, Mohammad Mojtaba Keikhayfarzaneh

Category: Healthcare

Abstract:The current experiment has been designed for determining the individual and group cognitive
therapy training on enhancing the self-esteem and reducing and the tendency towards using
narcotics of those who addicted to it. The experiment population included 400 individuals
dependent on narcotics according to the TR-IV-DSM diagnosis criteria in Gilan province, in
which 36 individuals were selected with random sampling and were replaced in two training
groups and one control group.
The present research is an experimental one and is designed in pre test \? post test experiment
with control group. Research tool includes Kuper Smith (1967) self \?esteem questionnaire, and
Pegrod's (2004) narcotics using tendency test.
The research hypothesis were examined using covariance analysis and the results obtained
showed that:
- The individual and group cognition therapy effectiveness on enhancing self-esteem and
reducing the tendency towards using narcotics is different in those who addicted to
narcotics. Individual cognitive therapy has no effect on increasing self-esteem in opioiddependent
individuals. Group cognitive therapy is effective in increasing the self-esteem in
opioid-dependent individuals.
- Individual cognition therapy is not effective in reducing the tendency towards narcotics in
opioid-dependent individuals. Group cognition therapy is effective in reducing the tendency
towards narcotics in opioid-dependent individuals.

Keywords: self-esteem, the tendency towards using narcotics, individual cognition therapy, group cognition therapy, narcotics dependency.

Full Text:

INTRODUCTION

Getting addicted to narcotics is a health and social problem in many country including ours. Being conterminous with a country producing poppy, the relative low-cost of this material, increasing the incidence of narcotics dependence among all classes, unlike past ones, the special problems of the country after the war and economic, social and psychological consequences resulted from, failing to take effective ways to give it up, not regulating the maintenance approaches and not specified the performance field of counter-narcotics executive officials have been created a special circumstances in the country that has followed to growing phenomenon of drug abuse. Obviously, high dependency to narcotics makes it difficult the tendency to give it up and health recovery (Eftekhar and colleagues, 2004). When using drugs was considered as a moral or legal issue by a society, creating problems for consumers or being exit from voluntary state, the sources of concern overshadows all the donors. Some drugs can have an influence on both mental state of inner perception such as mood and outer evident activities such as behavior. Drugs can create mentalpsychological symptoms caused by specified and inseparable common mental disorders ( such as schizophrenia and mood disorders) (Kaplan, translated by Pourafkari, 2003).

Drug dependency can have destructive impacts on mental, physical and safety health, family and social conditions from various perspectives and various mental and physical disorders can be attributed to this phenomenon (Branden, 1996, translated by Eghtami, 1997). One of the factors related to drug dependency is decreased self-esteem. Selfesteem is a concept much seen in psychology. This concept refers to a person‘s feeling concerning worth, the amount of credit or value, satisfaction, gratitude, interest or value a person attribute to himself (Sotudeh, 2000). Self-esteem is reduced followed by drug dependency and depression resulted from it. It refers to the value a person attributes to himself. Based on cognitive psychology, it is believed that what a person think and except about himself have an influence on his behavior in mental life. The mental incidences include expectations, beliefs and memories which are the causes of one‘s behavior. One who takes responsibility and do his best for getting succeed considers himself successful and obtains his merit, value and success by himself and others. Values, responsibilities, respect and success form related circuit. The self-value feeling is necessary in succeeding every issue and we must take responsibilities and have feeling of success after doing the right thing and respect others and ourselves (Afrooz, 1993).

The deepest form of commitment and responsibility is occurred when self-esteem is at risk. That is, if those who have high self-esteem behave in a foolish and unmerciful way have more unpleasing and uncoordinated feelings (conscience distress). If an individual has low selfesteem, he has no much uncoordinated feelings by doing a foolish or immoral act, because this action is consistent with the understanding I have about myself (Armenon, translated by Shokrkon, 1994). It is thought that addiction to narcotics is a non-conforming coping way in individuals who are not able to use adaptive coping methods in dealing with stress. Research has shown that drug use are initiated from adolescence and youth mainly characterized by stress and anxiety.

The young people who are interviewed sometimes say that using drugs is a way for coping emotions, dealing with mental stress and anxiety, feelings of loneliness or living in chaotic environments. On the other hand, 90% recurrence of addiction after giving up shows that there should still be many efforts for identifying the causes and factors of tending to this problem and the effective ways to treat it (Farina and colleagues, 2006). Teens who live in a dependent on drugs society see that older ones use caffeine for waking in the morning, smoking to deal with everyday problems, drink alcohol to relax in night and take drugs for relieving stress, depression and physical illnesses. Having reduced the parent‘s concern to school authorities and the media to drugs risks justify the unprecedented increase of using drugs among adolescents. There are usually long-term consequences of drug abuse in Adolescents. When teens get addicted to alcohol and drugs to deal with daily stress cannot learn decision making skills and other coping techniques. These adolescents show antisocial behavior with serious adjustment problems, including depression. They often initiate marital life while they are inexperienced and they mostly will be failed within. (Seligman, translated by Sayedmuhammadi, 2006).

- In an experiment performed by Adib (1995) aimed for considering the role of group counseling in enhancing selfesteem among adolescents, it is concluded that group counseling increases the selfesteem among adolescents. - The experiment performed by Fathi (2006) entitled as ? considering the effects of the two group training of social skills and cognition therapy on increasing the self-esteem among high school girl students under the Komite Emdad protection in Tehran, 16th District? have shown that social skills training and cognition therapy are effective in increasing the girl‘s self-esteem.

- Rostami (2005) concluded, in a project entitled as ? the effect of group counseling program on the quality of life and self-esteem among girls before menstrual in secondary school students in Tabriz , that group counseling makes selfesteem and quality of life to be increased. - Ebadian (2007) had an study on the effect of cognitive behavioral group therapy on young people‘s self-esteem affected to physical-mobility disabilities. For measuring the higher impact of cognitive behavioral group therapy on individual‘s self-esteem, the higher selfesteem measuring test was used which consists of three separate components as ? the scale of measuring higher depression?, ? the scale of measuring higher anxiety ? and ? the scale of measuring satisfaction of higher relationships?. The data collected were analyzed and the results showed that group therapy is effective in reducing the depression and anxiety and increasing the relationship satisfaction.

- In a research performed by Ghorbani (2004), the role of cognitive behavioral group therapy on adolescent‘s self-esteem inhabiting in hostel center in Tehran was examined, and mentioned the role of group therapy effect in increasing adolescent‘s self-esteem, and was also pointed out that group therapy has a great impact in teaching social skills, courage and problem solving skills in adolescents. - Shoae Kazemi (2007) examined the effects of heroin on the addict‘s body and soul and its relationship with the family function. The research design is an experimental one with control group. The sample consists of 15 heroin addicts referred to one of treatment centers (drug addicts) in Tehran within the years 85-86 and receiving 8 sessions of group counseling. The experiment method was conducted in view-interview group counseling which 15 addicts were concurrently chosen in this age limit homogeneously and have not receiving psychological interventions, but completed personality traits questionnaire. The variable studied were thrill-seeking, selfexpression, knowledge and insight, independence, social responsibility, flexibility and family function. But the results showed that there are no significant difference between the levels of awareness and insight among the groups. Regarding the results, it is inferred that drug therapy is not merely the suitable way for treating drugs addiction, but the progress and not recurring of the patience can be treated tough in a long amount of time with an integrated approach (holistic).

- Mobter and colleagues (2007) made a comparative study between behavior therapy and cognitive-behavioral therapy in the treatment of drug-dependent people. 57 addicts were chosen and were randomly divided into three groups named therapeutic, cognitive-behavioral and control group and are treated individually within 4-12 sessions. The researchers used several tools for mood and background information. They concluded that the cognitive-behavioral treatment has a greater therapeutic effect on the two behavioral- therapeutic groups in which 3 people were deterred from treatment. In addition, there was not a significant difference within 6 months after treatment in the two groups.

- In a research conducted by Shahraki (1995), the normal and handicapped young people‘s self-esteem were examined and the following results were achieved: 1. There is a significant relationship between self-esteem and one‘s physical viewpoint. In other words, the more a parson be happy about his appearance, the more his self-esteem in this regard. 2. The self-esteem mark is more in normal young people than the handicapped ones, which it could be because of the fact that there are some defects in handicapped ones. 3. Social self-esteem are more common in normal young people than the handicapped ones. - Back and colleagues (2000) did an study concerning the effect of focused cognitive therapy on self-esteem of those who affected to panic disorder. The results showed that the group which receiving focused cognitive therapy had a significantly reduced panic symptoms and general anxiety and increased self-esteem after 8 months than the short term cognitive therapy group. 71% of cognitive therapy group was free from fear at 8 weeks.

- Elgaz (2007) studied the effect of cognitive therapy on reducing drug use. The results showed that cognitive therapy reduces using drugs in addicted ones. - The research results conducted by Halperin and Dromond (2000) showed, regarding the cognitive-behavioral group therapy capability on improving the examination anxiety and student‘s selfesteem in which 20 ones were randomly chosen for treatment, that group intervention had a positive effect on the cases mentioned above and no impacts or changes were shown control group symptoms.

- Rosen Bloom(1999) investigated the effect of group cognitive-therapy on the treatment of cocaine-dependent individuals who are treated with metalon. The group therapy was hold in 20 sessions with 7-12 participants which lasted approximately 90 minutes in each session. There was a specific aim in each therapeutic session and the patients got accustomed with treatment design.

- The stressful situations in life, social and family problems and the way to respond to them were described in these sessions and finally in the last meeting, the experiences of patients during treatment was reflected within. This research results showed that there was a significant change during the first 6 months in both groups for drug use, but there was a significant decrease in just using cocaine during the second 6 months participated for being treated, while there was a small change in using heroin and tirodiazpin. The following hypothesis were tested according to the research hypothesis and research background.

Hypothesis 1: the cognitive-therapy training effectiveness and group cognitive therapy is different on self-esteem improvement and reducing the tendency towards using narcotics and in the individuals addicted to opium materials.

Hypothesis 1-1: training on individual cognitive therapy is effective in increasing self-esteem of people dependent on narcotics.

Hypothesis 1-2: group cognitive therapy training is effective in increasing the selfesteem on individuals dependent on narcotics.

Hypothesis 1-3: individual cognitive therapy training is effective in reducing the tendency towards using opium in the individuals dependent on narcotics.

Hypothesis 1-4: group cognitive therapy training is effective in reducing the tendency towards using opium in the individuals dependent on narcotics.

RESEARCH METHODOLOGY

The current research is experimental and a pre test- post test with control group which was chosen in experimental and control group. A pre test was conducted in the two experiment and control group before initiating treatment. Then the ? Back? individual and group cognitive therapy was implemented in experiment groups and a post test was finally performed on the two experiment groups in order to the difference resulted from the independent variables be obtained on experiment groups. A post test was conducted on the control group for comparing it with the control group.

The research statistical community included 40 people dependent on narcotics based on the TR-IV-DMS cognitive criteria in Gilan province referred to treatment center in Rasht and Bandar Anzali medical sciences and were involved in maintenance treatment with metadon, in which 12 people for individual cognitive therapy, 12 people for group cognitive therapy and 12 people for control group were chosen in random sampling.

The following tools are used for measuring the group and individual cognitive therapy effectiveness on improving self-esteem and the tendency towards using drugs in individuals dependent on narcotics in this research.

1. Koper Smith‘s Self-esteem Test

Koper Smith (1967) provided his selfesteem scale based on the revision he made on Roger‘s and Deymond‘s (1954). This scale includes 58 articles which 8 articles are pathometer. Totally, five articles are divided into four scales as general selfesteem, social self-esteem (peers), family self-esteem (parents) and educational selfesteem (schools). The grading method is 0 and 1, and the minimum mark is 0 and the maximum one is 50 for everyone. If the subjects achieves more than 4 marks of 80 pathometer articles, this would mean the test validity is low. The reliability of this questionnaire have been reported by Porshafeie (1370) as 82%. In addition, Shekarkan reported the reliability of this questionnaire for girl and boy students as 90% and 92%, respectively (Masoomi, 1999).

The reliability of this questionnaire was reported by Azizi as 84% through Cronbach‘s alpha in his MA thesis.

Golparvar‘s tendency towards using narcotics test

This questionnaire was provided by Golparvar (2004) which is made up 54 questions including 30 positive questions and 24 negative ones. The questionnaire 10 International Journal of Current Research and Review www.ijcrr.com Vol. 03 issue 12 December 2011 was responded as YES and NO questions. One grade to YES alternative and 0 grade was given to positive questions and grading was done reversely in negative questions. The test validity estimated by Golparvatr and Cronbach‘s alpha as 76% and 89%. The data were analyzed after collecting data using multivariate covariance analysis and post hoc tests.

Intervention Practices The individual cognitive therapy and group cognitive therapy periods were hold in 45- minute-8 sessions each for the two experiment group.

Research Findings The descriptive statistics indicators including mean and standard deviation are presented in following table:

It is tried, in cognitive therapy sessions in this study, at the notions be explicated through creating solidarity in groups, understanding self-esteem and the cost needed to reduce its payment and it is also tried in group therapy that false beliefs are replaced with rational beliefs about addiction, and it has been explained what a piece is paid for not having self-esteem. The individuals are trained that there must be no tendency towards using narcotics for escaping from stress and depression, because it must be inculcated that no one will be died for stress and depression and the person can be dealt with it such a little depression and stress, and it is tried to create this sense in persons that every change is possible. They should be aware that having insight to oneself and of others, identifying the specific situations, identifying the thoughts and their meanings, identifying the emerged behaviors, choices, choosing rewards are significant in this regard. It be explicated to individuals that those who have weak self-esteem are incapable to deal with their problems and are usually misused by others because of this incapability, and the most effective way for their changing is make them identified with their mistakes. The factors make positive feelings should be preserved and the ones that make negative feelings should be abandoned. The behaviors can be changed through changing false beliefs and hence selfesteem is improved step by step. The problem solving techniques are also used in these sessions, and the referents are requested to imagine the special circumstances in which the person is likely to return using narcotics ,then the therapist and patient exchange their ideas concerning these experiences and discuss ways to deal with these cases. Another significant issue is that the person should be taught to say NO and the members should use the perceptual changes in combating with using drugs. The philosophy behind the cognitive therapy is that our thinking and feelings have key and fundamental roles in our behaviors. One of the basic goals in this study was that the individuals who use narcotics were taught in that though they cannot control all the aspects round them, they are able to control in how to read and interpret things in their environments. Although cognitive therapy is a short-term period, it is proven that it can help patients overcome a wide variety of maladaptive behaviors and it can also help the drugdependent individuals in bringing the disciplinary skills, which can be useful aids over time and in the future. Since the cognitive techniques have been effective in increasing self-esteem and reducing the tendency towards using narcotics, this subject indicates that individual and group cognitive therapy can have effective use as a non-drug therapeutic method. Group cognitive therapy have especially more effective than individual cognitive therapy in this research.

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