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THE OBSESSIVE-COMPULSIVE CHRONIC ALCOHOLIC
EDWARD PODOLSKY
Am J Psychiatry 1960;117:236-238.
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The State University Alcohol Clinic, Dept. of Psychiatry, State University of New York, College of Medicine, Downstate Medical Center, Brooklyn 3, N. Y.

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Abstract

The obsessive-compulsive chronic alcoholic is characterized by:1. Compulsive rituals and obsessive fears.2. Rigidly controlled emotional reactions.3. Hypochondriacal trends.4. Rigid perfectionism of an obsessive-compulsive quality.5. Compulsive pseudo-attempts at suicide and homicide.6. Compulsive doubts and vacillations.7. With intensified fears, threats and frustrations he resorts to alcohol in an attempt to moderate these intolerable feelings, obsessive thoughts and compulsive activities.One of the objectives of therapy with the obsessive-compulsive chronic alcoholic is the strengthening of the ego, building up his self-confidence. This is so, in spite of the fact that he has feelings of omnipotence. Generally, it has to be pointed out to him that the use of his defenses may be justified in principle, although it is desirable that some of his methods could and should be modified.The object is to examine the patient's specific defenses quite minutely and their dynamics unveiled. Obviously, both therapist and patient search for more effective ways of dealing with urgent underlying problems. There should be an exhaustive discussion of the patient's hostility, and methods of channelling it along creative avenues should be undertaken.How is the complicating factor of alcoholism managed? In most of the cases the use of tranquilizers, Thorazine, Miltown, Sparine, etc., is of value in moderating the craving for alcohol. In the more severe cases Antabuse has proved very effective. In the therapeutic management of the obsessive-compulsive alcoholic it is essential to treat both the neurosis and the alcoholism. The combined psychotherapy-psychopharmacological program as above indicated has proved effective in most cases.

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