Biomedical subjects
Publications and source records attributed to L M Dodes.
In this paper, the proposal is advanced that addictions may be understood analytically to be a subset of compulsions, and correspondingly that they may frequently be suitable for psychoanalytic treatment. A revision of the definition of addictions and compulsions is suggested, and some treatment implications of this revision are considered.
A review of the substance abuse literature in the 1980s focuses on deficits in self-regulating capacities, in self-care functions, and in other vulnerabilities of the self, such as an inappropriate use of defenses and problems in intimacy. Various models which attempt to explain these behaviors are described, as well as techniques of dynamic psychotherapy for substance abuse, which emphasize the building of ego functions and the internalization of self-preservation functions. Commonalities and differences of substance abuse with other intensely driven compulsive behaviors (e.g., pathological gambling or certain sexual behaviors) are also considered.
In many cases addictive behavior serves to ward off a sense of helplessness or powerlessness via controlling and regulating one's affective state. Addicts have a vulnerability to feelings of powerlessness, which reflects a specific narcissistic impairment. The drive in addiction to re-establish a sense of power is, correspondingly, impelled by narcissistic rage. This rage gives to addiction some of its distinctive clinical properties. The narcissistic vulnerability in addicts is discussed. Several brief clinical cases are provided, and the view proposed is correlated with other psychoanalytic perspectives.
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Exploratory psychotherapy with alcoholics must address the problem of requiring abstinence. This depends upon the patient's capacity to abstain. In turn, this capacity is reflected in the specific transference issue of ability to introject the therapist's caring concern for the patient and for his wellbeing.
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