Benefits of subcutaneous implantation
This preparation is appropriate, because it enables the individual to choose a variety of everyday activities, long journey, absence from home, and being safe from nearly the greatest problem in overcoming the opiate addiction i.e. the relapses.
Procedure
The application is simple and it is done in outpatient conditions.
The time needed for this procedure is about 30 minutes.

-> Preparation for detoxification
A. Bodily preparation
a. – laboratory examinations: blood test; HVB, HVC and HIV tests; hepatitis test;
b. – abdominal ultrasound examination; lungs X-ray; ECG;
c. – internist examination;
d. – additional examinations if necessary.

B. Psychological preparation
Types of experts treatment: During this period (7-14 days), the client undergoes a psychiatric and psychological individual treatment on daily basis, and if a member of the family is present, a family therapy is applied. The aim of this treatment is to provide support with psychiatric and psychological preparation for detoxification and drug-free life.

Premedication: After the reception, the patient is stabilized with a methadone or buprenorphine treatment until he/ she stabilizes (7-14 days). Premedication with other non-opiate drugs: antidepressants, tranquilizers, alfa agonists, ant emetics, anticholinergics and other symptomatic therapy.

Definition
Ultra Rapid Detoxification under deep sedation means to abstain from taking opiate (heroin, methadone etc.) in the period of one day. This is taken as a human and painless method of overcoming the temptation. It is used to alleviate and to shorten the period of withdrawal crisis.
Inciting abstinence crisis, under controlled conditions and permanent medical supervision, as well as its overcoming in a couple of hours, which is a human method of helping to persons who are addicts.
This is a part of a wide-range programme for treating addiction, and should not be taken as means for treating the addiction itself.
Indication
Ultra Rapid Detoxification (URD) is above all applicable to people who have strong abstinence crisis, and/ or those who do not want to consider that he/ she should abstain from taking drugs, which is often the only obstruction to start the treatment, and therefore they cannot be defoliated by using one of the classical ways.
Those who want to be defoliated by using the ultra rapid detoxification should be previously, physically and psychologically examined, so as to specify indications for URD and the further psychiatric treatment. Also they take active participation in the preparation of the programme for getting well, which is carried out for each individual separately, and we begin with it before detoxification.
The choice of the therapy depends on the individual characteristics and abilities.

-> After detoxification
Detoxification is the most significant preliminary in the long – term psychiatric treatment, concerning the opiate addiction. In other words, it is a step of seven miles that the individual must take in order to start with the treatment of the psychological addiction and prevention from repeated relapses in the period of 3 to 5 years, the period in which the drug addiction is taken as outdone.
• When detoxification is carried out and the abstinence crisis is outdone, professional support is inevitable in overcoming psychological problems as well as individual remobilization. Due to that, prolonged psychiatric and psychotherapeutic, individual, family and group treatment is realized.
It is a long-term process, lasting from three months to year and a half.
It is statistically supported that in the first month after the detoxification 50 % of the individuals relapse into taking drugs, after the third month 25% of them have a relapse, and after the sixth month of abstinence 12% of them have their repeated relapse.
• The use of opiate antagonist NALTREXONE
The Naltrexone is suitable for any addict to opiates (heroin, methadon, tramadol, etc.) who makes his/ her best to abstain from taking opiates, but never succeeds till the end. It is also suitable for people who think that they are not strong enough by themselves or together with psychiatric counseling to sustain their decision in not taking opiate drugs.
The Naltrexone is not a remedy which can affect either the mood or the process of thinking, therefore it should be used together with the psychiatric treatment and counseling.
The Naltrexone is used for the first time after a certain period of abstinence, depending on the method of detoxification that was previously carried out. If the Naltrexone is used in this way, there are just few undesirable effects, and none of them is serious.
But in case the individual is an addict to heroin or other anesthetics and takes Naltrexone, this will result in serious abstinence symptoms in couple of minutes.

-> Period of intensive psychiatric, medical and psychological treatment from 3 to 30 days

The treatment lasts from one week to six months.
• Treatment from seven to 30 days: Premedication, ultra rapid detoxification, recovery of at least 72 hours and continuation of the treatment in Your country in an institution with which a contact has been previously established. In this context are held one to two meetings a day. According to previously agreed plan meetings are held with psychiatrist, social worker or psychiatric nurse.
• Treatment from one month to six months which includes extended treatment to overcome psychological, social and medical problems.

English will be official language for communication, while there will be possibility for people with Slavic origin to communicate in their mother tongue (Serbian, Croatian, Bulgarian, Bosnian or Macedonian).

Routine checks for presence of opiates in the client’s body will be performed at the reception, as well as during the treatment with classical detoxification, in order to follow the cleansing of the body from the opiates, after which an opiate antagonist will be implanted or applied “per os”. The application of the opiate antagonist for people on URD is not prevented (counter indicated) by the presence of opiates in the body.

-> Subcutaneous implantation of opiate antagonist

An opiate antagonist – Naltrexone pellet – which lasts for three months and six months is implanted during the URD or immediately after it.
There is also a possibility for multiple implantation of an opiate antagonist, each of which would last for three months.

Treatment consists of several phases:
- Stabilization phase, when implemented psycho – pharmaco therapy and psychotherapy interventions in terms of faster mental stabilization, in the sense to reduce the signs of acute overwrought.

- Phase modification of lifestyle and increased insight into the subconscious causes and psychological aspects of emerging symptoms and relaxing training techniques.

- Reconstructive forms of psychotherapy. This treatment is in terms of reconstructive correction of an old emotional experiences and changes that will mean overcoming the psychic conflicts that occurred because of neurotic disorder. This treatment is implemented in practice in the form of individual and group sessions.

TYPES OF TREATMENT:

Psychiatric treatment:
Assessment of severity of neurotic disorder and prescribed psychopharmaceuticals.

Psychotherapy treatment:
Assessment of personality characteristics, internal conflicts and intensity, their symbolic expression through symptoms of neurotic disorder. Types of psychotherapy treatment:
- Individual psychotherapy for a period of fifty minutes and
- Group treatment once a week.

The type of treatment is proposed to the first meeting and an agreement for cooperation is made that will provide successful treatment.

As a consequence of inadequate resolution of the crisis comes to:
1. Unprepared reception of similar life periods
2. Development of inappropriate behaviors: excesses with alcohol, drugs, excessive withdrawal of mood, aggressive behavior toward themselves and others and so on.

Psychotherapy is a way effectively to resolve Your life crises.

1. Assessment of mental state and contract for further treatment.

2. Stabilization phase, which conducts psycho – pharmacotherapy and psychotherapy interventions towards faster mental stabilization, in the sense to reduce the signs of acute depressive disorder.

3. Modification phase of lifestyle and increased insight into the subconscious causes or psychological aspects of the emerging symptoms and relaxation training techniques.

4. Reconstructive forms of psychotherapy. This treatment is reconstructive in terms of correction of an old emotional experiences and changes that will mean overcoming the psychological conflicts that occurred due to depressive disorder. This treatment includes individual or group therapy.

The choice of the therapy depends on the individual characteristics and abilities

• Neurosis
• Eating problems
• Adolescence crisis
• Addiction
• Psychosis
• Life crisis and adjustment crisis when changing social milieu (death of a close person, age of discretion)
• Testify in court as an expert
• Training new staff
• Organization of lectures and seminars
• Psychodrama training group

Aleksandar Marcikik, MD, psychiatrist

Tanja Marcikik, social worker

Emilija Cabukovska, nurse

Mirjana Todorovski, nurse

 

Discretion is guaranteed!