Three perspectives on addiction promulgated during the 1990s are reviewed, along with many earlier contributions to the understanding of addictive illness. It is suggested that these distinct yet overlapping formulations of the dynamics of addiction form a hierarchy for each patient suffering from an addiction. Assessment of a patient's ego strength, and of the relative importance of addictive behaviors in overall character structure, allows referral to various types of treatment, including psychoanalytic therapy. Case examples are presented, including material from the psychoanalysis of a woman addicted to heroin, methadone, cocaine, amphetamines, nicotine, alcohol, and shopping.
Get full access to this article
View all access options for this article.
References
1.
Abraham, K. (1908). The psychological relations between sexuality and alcoholism. In Selected Papers of Karl Abraham. New York: Basic Books, 1927, pp. 80—89.
2.
Anda, R.F., Williamson, D.F., Escobedo, L.G., Mast, E.E., Giovino, G.A., & Remington, P.L. (1990). Depression and the dynamics of smoking: A national perspective. Journal of the American Medical Association264:1541—1545.
3.
Berridge, K.C., & Robinson, T.E. (1999). What is the role of dopamine in reward: Hedonic impact, reward learning, or incentive salience?Brain Research Reviews28:309—369.
4.
Breslau, N., Kilbey, M.M., & Andreski, P. (1993). Vulnerability to psychopathology in nicotine dependent smokers: An epidemiologic study of young adults. American Journal of Psychiatry150:941—946.
5.
Condelli, W.S., Fairbank, J.A., Dennis, M.L., & Rachal, J.V. (1991). Cocaine use by clients in methadone programs: Significance, scope, and behavioral interventions. Journal of Substance Abuse Treatment8:203—212.
6.
Dodes, L.M. (1984). Abstinence from alcohol in long-term individual psychotherapy with alcoholics. American Journal of Psychotherapy38:284—256.
7.
——— (1988). The psychology of combining dynamic psychotherapy and Alcoholics Anonymous. Bulletin of the Menninger Clinic52:283—293.
8.
——— (1990). Addiction, helplessness, and narcissistic rage . Psychoanalytic Quarterly59:398—419.
9.
——— (1996). Compulsion and addiction. Journal of the American Psychoanalytic Association44:815—835.
10.
Freud, S. (1926). Inhibitions, symptoms and anxiety. Standard Edition20:75—175.
11.
Johnson, B. (1992). Psychoanalysis of a man with active alcoholism . Journal of Substance Abuse Treatment9:111—123.
12.
——— (1993). A developmental model of addictions and its relationship to the twelve step program of Alcoholics Anonymous. Journal of Substance Abuse Treatment10:23—34.
13.
——— & Clark, W. (1989). Alcoholism: A challenging physician-patient encounter . Journal of General Internal Medicine4:445—452.
14.
Kaufman, E. (1994). Psychotherapy of Addicted Persons. New York: Guilford Press.
15.
Kernberg, O. (1975). Borderline Conditions and Pathological Narcissism . New York: Aronson.
16.
Khantzian, E.J. (1985). The self-medication hypothesis of addictive disorders . American Journal of Psychiatry142:1259—1264.
17.
——— (1994). How AA works and why it's important for clinicians to understand. Journal of Substance Abuse Treatment11:77—92.
18.
——— (1995). Self-regulation vulnerabilities in substance abusers: Treatment implications. In The Psychology and Treatment of Addictive Behavior, ed. S. Dowling.Madison, CT: International Universities Press, pp. 17—42.
19.
——— (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry4:231—244.
20.
Kohut, H. (1971). The Analysis of the Self. New York: International Universities Press.
21.
——— (1977). The Restoration of the Self. New York: International Universities Press.
22.
Krystal H. (1988). Integration and Self-Healing: Affect, Trauma, Alexithymia. Hillsdale, NJ: Analytic Press.
23.
——— (1995). Disorders of emotional development in addictive behavior. In The Psychology and Treatment of Addictive Behavior , ed. S. Dowling.Madison, CT: International Universities Press, pp. 65—100.
24.
——— & Raskin, H.A. (1981). Drug dependence: Aspects of ego function. In Classic Contributions in the Addictions, ed. H. Schaffer & M.E. Burglass.New York: Brunnel-Mazel, 1981, pp.161—172.
25.
Kushner, M.G., Sher, K.J., & Erickson, D.J. (1999). Prospective analysis of the relation between DSM-III anxiety disorders and alcohol use disorders. American Journal of Psychiatry156:723—732.
26.
Lyons-Ruth, K. (1991). Rapprochement or approchement: Mahler's theory reconsidered from the vantage point of recent research on early attachment relationships. Psychoanalytic Psychology8:1—23.
27.
Mahler, M.S., Pine, F., & Bergman, A. (1975). The Psychological Birth of the Human Infant: Symbiosis and Individuation. New York: Basic Books.
28.
Meyers, W.A. (1994). Addictive sexual behavior. Journal of the American Psychoanalytic Association42:1159—1182.
29.
——— (1995). Sexual addiction. In The Psychology and Treatment of Addictive Behavior, ed. S. Dowling.Madison, CT: International Universities Press, pp. 115—132.
30.
Miller, N.S., & Gold, M.S. (1993). A neurochemical basis for alcohol and other drug addiction. Journal of Psychoactive Drugs25:121—128.
31.
Robinson, T.E., & Berridge, K.C. (1993). The neural basis of drug craving: An incentive-sensitization theory of addiction. Brain Research Reviews18:247—291.
32.
Rosenfeld, H.A. (1965). On drug addiction. In Psychotic States: A Psychoanalytic Approach, ed. H.A. Rosenfeld.New York: International Universities Press, pp.128—143.
33.
Schukit, M.A. (1988). Genetic and clinical implications of alcoholism and affective disorders. American Journal of Psychiatry143:140—147.
34.
——— Irwin, M., & Brown, S.A. (1990). The history of anxiety symptoms among 171 primary alcoholics. Journal of Studies on Alcohol51:34—41.
35.
Shaffer, H.J., & Jones, S.B. (1989). Quitting Cocaine: The Struggle against Impulse . Lexington, MA: Lexington Books .
36.
Shedler, J., & Block, J. (1990). Adolescent drug use and psychological health. American Pscyhologist45:612—630.
37.
Sora, I., Wichems, C., Takahashi, N., Li, X.-F., Zeng, A., Revay, R., Lesch, K.-P., Murphy, D.L., & Uhl, G.R. (1999). Cocaine-reward models: Conditioned place preference can be established in dopamine and in serotonin-transporter knockout mice . Proceedings of the National Academy of Science95:7699—7704.
38.
Spezzano, C. (1999). The triangle of clinical judgment. Journal of the American Psychoanalytic Association46:365—388.
39.
Swan, N. (1999). Brain scans open window to view cocaine's effects on the brain. NIDA Notes13(2):12.
40.
Vaillant, G.E. (1983). The Natrual History of Alcoholism. Cambridge: Harvard University Press.
41.
——— (1996). A long-term follow-up of male alcohol abuse. Archives of General Psychiatry53:243—249.
42.
Volkan, V.D. (1973). Transitional fantasies in the analysis of a narcissistic personality. Journal of the American Psychoanalytic Association21:351—376.
43.
Winnicott, D.W. (1951). Transitional objects and transitional phenomena . In Collected Papers. New York: Basic Books, 1958, pp. 229—242.
44.
Wurmser, L. (1974). Psychoanalytic considerations of the etiology of compulsive drug use. Journal of the American Psychoanalytic Association22:820—843.
45.
——— (1978). The Hidden Dimension: Psychodynamics of Compulsive Drug Use. New York: Aronson.
46.
——— (1981). The Mask of Shame. Baltimore : Johns Hopkins Press.
47.
——— (1995). Compulsiveness and conflict: The distinction between description and explanation in the treatment of addictive behavior. In The Psychology and Treatment of Addictive Behavior, ed. S. Dowling.Madison, CT: International Universities Press, pp. 43—64.
48.
Zinberg, N.E. (1975). Addiction and ego function. Psychoanalytic Study of the Child30:567—588.
