Fast Confession - addictologist Kateřina Francová: I try to be someone prisoners can lean on, I don't give up on my patients
Kateřina Francová has a degree in addictology and decided to help people. Specifically, those who are struggling with addictions - to alcohol, drugs, but also tobacco. Among other things, she works in the Pankrác jail, where she tries to provide support to people who want to change and return to the real world a little stronger. In an interview for LP-Life.com, she spoke not only about how addiction treatment works and why people repeatedly let their skeletons out of the closet.
What moment do you consider to be the turning point when a patient realizes he is an addict?
A turning point often comes when the patient is made uncomfortable. When a problem happens and someone close tells him that he sees it as an issue. Either the signal comes from the patient himself, or someone from the outside lets him know.
How can we actually tell someone is an addict? Is it even possible?
Even if you use something like coffee, you’re already handling a substance that has the potential for addiction. But most of us can stay on top of it, use it in a controlled way. Sometimes, though, overuse happens. We can observe a lack of concentration when one can't get his fix, he’s anxious and so on. At that moment, it’s already a problem. When it grows over one’s head.
What are the most common reasons patients start with drugs or alcohol?
I think it's an attempt at self-medication. It happens, for example, that one feels very intense pain and by starting to indulge, he gains short-term relief. The human brain is clever and finds out that using such a substance is actually very fast and effective pain relief. So it creates this shortcut, and from then on it actively aims to get the substance again and achieve relief. So emotional pain is a big theme. But it can also be a desire for altered states of consciousness. Getting into a state where I have both a physical and a mental experience. When using can help me to something really strong, enjoyable, and it will catapult me out of the mundane world.
In the short term, it’s not such a big problem. But how long does it take until it turns into an addiction?
Many people can handle even things that can be very addictive in such a way that they don't turn into an addiction. But a lot of people fail because it’s really extremely powerful. The need that turns into a vicious circle. It needs to be said that when dealing with such a substance, it can happen to anybody. A few weeks or months and it’s done.
Do patients come to you with a specific request or how do they usually approach you?
If I am to speak about the outpatient clinic in prison, people usually get there because they’re in withdrawal and they’re not feeling well. They have cravings and don't know how to move on. That’s a point at which they usually overcome some of their fears and shame and start talking about it. It may be the moment when they realize that they have time now and can work on it. That they simply don't want to go back to it.
You mentioned prison. While working in the Pankrác prison, you come into contact with prisoners very often. Are you ever scared?
I was very careful at the beginning. I didn't know if the fear would hit me, if I would be good at working with prisoners. Then I realize that we addictologists are there in the role of a helping profession and those patients respect us. It's about being there for them and they feel it.
What options are actually available for prisoners? How different is it from when a patient comes to your clinic?
When I started working there, I privately thought that at least there was no danger of my patients leaving. But the truth is that even in prison they have the opportunity to refuse care.
So do I understand it correctly that the patients are giving up?
Sometimes they book a consultation, where I ask about their life story, their ideas about what can be done it. We are looking for options that I can offer them. But I have limited options, it is outpatient care, and our ideas don’t always meet. So it happens that they don't come back and fall out of care.
The whole process begins with detoxification... Is that done gradually or are the doses the patient was used to immediately withheld?
Before that, an introductory meeting takes place, where we discuss how we want to proceed. Then it’s time for the detoxification you’ve just mentioned. That's the medical part of care, I can't prescribe drugs myself. If the patient's condition is not fundamentally critical, he remains in his cell but receives medication to alleviate withdrawal symptoms. It doesn’t mean that he is completely fine, that he doesn’t feel anything, it is still difficult for him both mentally and physically. However, I am in charge of the psychological part. It’s my task to guide him in the right direction.
How long, on average, does it take to overcome withdrawal symptoms?
It depends on what you’re on. If it’s a stimulant or opiate, the onset of symptoms can pass within a few hours or days. In the case of drugs or alcohol, it’s more dangerous. There you need to monitor the patient for quite a long time, maybe a week to ten days. Even after such a time, delirium or some kind of metabolic breakdown or organ failure may develop.
Is it the hardest to overcome the first symptoms or is the battle not won even after?
From what I observe, patients aren’t feeling good or sleep poorly even after a few weeks. They can't concentrate. But there are also those who go through a few days of withdrawal and feel fine and they’re handling it well. It's very individual.
What’s worse, physical or mental addiction?
It’s easy to say that the worst thing is the physical issue, when you’re totally sick, sweating, vomiting and so on. But that’s something that passes soon. One’s psyche is a whole different matter, and it can be worn out by using much more. Therefore it’s necessary to pull through, not leave after a few weeks and stay in contact. It’s important to know that there is someone you can turn to.
Can rituals help with weaning off? Something one can cling to?
When you take away a person's addiction, a huge crater remains. And the fact that one overuses a substance isn’t just negative for them. There are reasons why he enjoys it or why it helps him feel relief. One can miss it. And then, when he’s at his lowest, he can tell himself screw it, and go back to using. So, paradoxically, part of the treatment may be finding what they thought was best about their addiction.
So you need to fill that hole...
Exactly. If one has some rituals, something he starts to enjoy, it's great. It is often part of aftercare. We are looking for something to fill one's life with.
What percentage of patients have a relapse?
We see our patients until they get out, after which we’re no longer in contact with them. So we often don't know what's going on in their lives anymore. We work with them a year, a year and a half on average, at it often looks really good. But then we release them and we don't know what happens from then on.
What do you think are the most common reasons why people relapse?
Imagine that you live in a world that is colourful, very sensory interesting. The stimuli are deep, you’re opening the doorway to another dimension. Then suddenly you drop back to the everyday grey and tell yourself: I’ll get a job, pay off my debts, take care of my children. And suddenly, the ratio of joys and worries is abysmal and you’re facing disillusionment from reality. That’s when people run out of breath and seek some form of relief. And as I said, the brain already knows a shortcut to get that relief. You pour yourself a glass, have a smoke, and you’re back in the loop. It can be slow at first, once a month, once a week, but eventually, it may become an everyday thing again.
With what addiction do patients come to you most often?
Opiates predominate in the prison. Right after that, most people want to quit smoking. These people are my personal heroes, when they come to me in prison and say they want to quit. It’s the only legal drug. But they often want to prove to their family that they are serious about wanting to change.
In my private clinic, it’s mostly alcohol and tobacco.
Do you think some addictions are more difficult to manage than others?
I dare say that each of us has a substance they’d go wild with, if given the chance. For some it's alcohol, for others it's heroin. I can say that I was really surprised by how strong addiction nicotine can cause. Some studies suggest it can be compared to heroin addiction, which is generally considered a severe addiction. So tobacco can be quite insidious. It’s also because of how socially tolerated it is. Compared to, for example, shooting up.
But I feel like smoking has become relatively socially unacceptable in recent years. On the contrary, every other person smokes marijuana and society seems to have gotten used to it. Why is it like this?
When I look at the annual report on the state of drug affairs, it has long been stated that marijuana is very socially tolerated in the Czech environment, compared to some other countries. Maybe it's because of our social climate and mindset. Maybe people don't see much risk in it, or aren't aware of the risks.
Can marijuana be considered an entry drug that opens the path to harder drugs?
In the past, marijuana was considered an entry drug. It can be that for some, of course, but it's not really confirmed. If we look at it from a broader point of view, it can often be tobacco, too. In fact, drugs as such are substances that simply exist. It’s only us abusing them that gives them the positive or negative connotation. It's just that if you find a substance that fits you and helps me "survive" the everyday reality, there is a risk that you’ll become addicted.
Do you only work with adults or were there patients whose age surprised you?
Some time ago, I used to work in an outpatient clinic with teenagers who had already experimented with addictive substances. I was seeing teenagers from the age of 13 who had already become acquainted with it and often had richer experiences than many adults.
How much influence does our family background have? To what extent does it affect the child?
It does. Research even confirmed there is a gene that is responsible for the development of an individual's addiction. But just because you are born with this gene doesn’t mean you will become an addict. It also depends on other factors. Of course, the environment has a great influence on whether the gene gets the green light and manifests itself. The attitude of the parents towards such substances and how they lead the child to approach them, how the parents are able to meet the emotional and developmental needs of the child are all important factors. But even abstaining parents can have a baby that grows to like using. It's very complex and interconnected.
What are the most common myths about alcohol and drugs?
It occurs to me that it’s often about people being poorly informed about the effects and risks. When tracing the medical history of a new patient, I sometimes discover things such as that he got the first dose of heroin at the age of thirteen, from his aunt at that. In such a case, one finds it would be a miracle if such a person managed to avoid it.
What do you lean on during therapy? Do you have any special methods?
Recently, we’ve started taking patients outside. We call it "Forest Therapy". The way it works, people take a roughly three-hour walk with their therapist. You don’t meet the client in the clinic, but outside, in nature. It's a most welcome change, for the patients as well.
You get to hear tragic life stories on a daily basis. Are you able to leave it in the clinic and get it out of your head when you're not working?
We are trained to do that. Many addictologists have undergone five years of psychotherapeutic training. In any case, it is our main task to separate those things. But that doesn't mean I’m not moved by some of the stories. Sometimes I feel sad or angry. But it's part of my job not to let myself be swallowed up. Otherwise, I couldn’t be very useful to my patients.
You’ve spent a large part of your life helping people with addictions... How about you? Have you ever been addicted to something?
It never happened to me that I’d have a problem with addiction. Sometimes I have to admit: You know, I can't even imagine it.