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.

2. General Methodology

A systemic approach differs from other approaches to the scrutiny of sexuality in that it allows to establish relationships between sexologic categories. These, in turn, reveal a functional system, which, being an objectively existing system, produces the result of activity observed by the researcher. This approach proved effective in the study of factors maintaining c. As a result, a biosocial functional system controlling reproduction of human population was revealed (Zharkov Y., 1988). It has been already said that heroin addiction in Russia is estimated as an epidemic outburst. In other words, this is a biosocial process, and, in order to establish biosocial relations between sexological categories, it is quite adequate to use a systemic approach to the study of human sexuality. Here are some of these categories, which will be used in the analysis of findings obtained during examination of our patients: free love, marriage, prostitution (social categories), platonic, erotic, sexual categories (personality categories), rhythm of sexual activity, sex ratio (biological categories). The listed categories fall within the framework of systemic relations, and in order to fill them with concrete data, some special methods of examination were used.

3. Methods and Materials

All our patients were given medical examination, their addiction status was estimated, rehabilitation potential determined (Dudko T., et al., 2001), and sexologic characteristics established. Case histories included patient age, marital status, availability of sexual partner, and some other parameters. Sexologic anamnesis included information on the rhythm of sexual intercourse and addiction severity. For sake of convenience of comparative studies, a special sexology form (Vassiltchenko G., 1977) was completed. In the course of treatment and rehabilitation, the patients were examined by doctors during consultation and during their attendance of psychotherapeutic courses.

A group of 81 patients with the diagnosis of heroin addiction was given dynamic medical observation. The patients practiced intravenous injections from one to three years. The period of intravenous injections was usually preceded by a period of intranasal use of heroin, and also by use of ecstasy, marijuana, and the like. The rehabilitation potential was high or medium in these patients. The rehabilitation program commenced after abatement of the withdrawal syndrome at hospitals or in outpatient conditions. Medicines were prescribed, which included blockers of opiate receptors (for 3 – 6 months), antidepressants and tranquilizers (3 – 8 week courses), depending on indications. Parents or close friends (relatives) were involved in the rehabilitation program as well. Frequency of consultations and groups studies varied from two or three times a week to once a month. Consultations and group psychotherapy continued from 3 to 14 months. In some cases, after a two-month course of intense studies and consultations, contacts with patients were interrupted for 3 – 4 months.

4. Results and Discussion

Subjects of the study were young heroin addicts, of which 47 were male patients (58%) aged on average 20.5 (17 - 27) years and 34 females, average age 20.9 (18 – 24) years. Sex ratio, 138. Distribution of patients in age groups is shown in Fig. 1.

Fig. 1. Distribution of patients in age groups

Fourteen patients (17%) were students, 21 (26%) were on a long leave for pregnancy or other legal indications, 16 (20%) were employees (some of them were also students), and 30 (37%) patients neither worked nor studied anywhere. As to the family status, 46 (57%) lived with their parents or in families of their relatives and 35 patients (43%) lived alone. At the time of observation, 29 (36%) addicts lived in full families, 4 (5%) had no parents, parents of 48 patients (59%) were divorced; of the latter patients, 19 (23% of the total number of patients) lived with their mothers, 3 (4%) patients had only father, 20 (25%) patients lived with their mothers who married second time, and 6 patients (7%) lived with their fathers and step mothers.

Most patients (n = 62; 76%) were single: these were 25 females, i.e., 73% (34 = 100%) and 37 male patients, i.e. 79% (47 = 100%). Divorced were 5 females, i.e., 15% (34 = 100%) and 7 male patients, i.e., also 15% (47 = 100%); 4 (12%) females and 3 (6%) male patients were married by common law.

Twenty-eight addicted individuals (34% of the total number of patients) had no sexual partner within three months preceding their attendance to the doctor. Of this number, 7 were females, i.e., 20% (34 = 100%) and 21 were male patients, i.e., 45% (47 = 100%). Twelve (35%) females and 9 (19%) males had occasional intercourse with pickup partners. Eleven (32%) females and 14 (30%) males had permanent partners; 4 (12%) females had their husbands as a permanent sexual partner and 3 male patients (6%) had their wives as permanent partners. Six married couples had one child each, and 4 women had illegitimate children. The children were 6 boys and 4 girls. The reproduction level in the studied group was 12% (the number of children expressed in percent of the total number of patients).

Twelve (15%) patients were AIDS-infected; hepatitis C virus was found in 68 (84%) patients, and 5 (6%) patients had the virus of both hepatitis B and C.

Involvement into heroin addiction differed as regards sex: young males began using heroin in a group of adolescents, one of which had a long history of addiction. These were 32 cases which made 68% (47 = 100%). Girls were given the first dose of heroin by addicts to whom they felt platonic affection, or with whom they had erotic and sexual relations. These were 27 girls, i.e. 79% (34 = 100%).

As regards the rhythm of sexual activity and its relation to intensity of heroin use in male patients, we observed the following phenomenon (Fig. 2): sexual activity decreased with increasing intensity of heroin use. If the woman did not use drugs, sexual partnership usually broke during this period.