Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

470 V. TREATMENTS FOR ADDICTIONSconcept with a traditional psychoanalytic psychotherapy (Dodes, 1988). In thefirst place, focusing on the addictive behavior specifically as an illness may beuseful, because it helps to avoid the kind of failure to address the problem thatsome have worried about with psychotherapy. Moreover, acknowledgment of adisease or diagnosis often arouses feelings about being unable to control oneselfthat may be quite important to explore (Dodes, 1988, 1990).In order to integrate a disease concept with a psychodynamic psychotherapy,Dodes (1988) suggested that the “disease” (e.g., alcoholism) be defined to thepatient as having two parts: the patient’s history of alcoholism, and the patient’sbeing at permanent risk of repeating this behavior in the future. This definitiondoes not impede psychological exploration of the meanings of the patient’s drinking.The risk of repetition of drinking that is so central to the disease idea may betroublesome for dynamic exploration only if it has the quality of something that isinexplicable in dynamic terms. However, this risk is actually the same as theregressive potential of any patient in psychotherapy. Addicts, like all other individualsin psychotherapy, never totally eliminate the potential of resuming oldpathological defenses and behaviors, and of regressing. Their risk of resuming substanceabuse is therefore just an example of this general rule.CONCLUSIONThis chapter has presented a description of individual psychodynamic psychotherapywith addicts, based on a contemporary psychoanalytical understandingof their vulnerabilities and disturbances. We emphasized disturbances in egofunction and narcissistic difficulties that affect addicts’ capacities to regulatetheir feeling life, self-esteem, and relationships. A major psychotherapeutic taskfor addicted patients is to bring into their awareness their emotional difficultiesand the way their problems predispose them to relapse into drug/alcohol useand dependence. We have reviewed implications for technique with regard tocharacteristic central issues for addicts and the need in certain cases for activeintervention. We explored strategies for establishing abstinence, including thevalue of working with self-help groups such as AA and NA. Finally, we haveemphasized a flexible approach with regard to the timing, sequencing, and integrationof psychotherapy in relation to other interventions and needs based onpatient characteristics and clinical considerations.REFERENCESBean-Bayog, M. (1985). Alcoholism treatment as an alternative to psychiatric hospitalization.Psychiatr Clin North Am, 8, 501–512.Brown, S. (1985). Treating the alcoholic: A developmental model of recovery. New York:Wiley.