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Chapter 23. Psychodynamics

Hallie A. Lightdale, M.D.; Avram H. Mack, M.D.; Richard J. Frances, M.D.
DOI: 10.1176/appi.books.9781585623440.352765

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Excerpt

Psychoanalysis and psychodynamic theory are fundamental to modern psychiatric practice, including addiction treatment. Although some investigators have argued that psychodynamic treatment has only a minor role in the treatment of substance abuse (Vaillant 1995), others have shown how psychodynamic understanding can add depth to work with individuals and groups, further the rehabilitation process (Dodes and Khantzian 2004; Frances et al. 1989; Khantzian 1997), and increase the usefulness of 12-step programs (Dodes 1988). As part of a transtheoretical integrated treatment model, sophisticated understanding of psychodynamic principles can be used by the therapist to help the addicted patient recognize that he or she has a problem and then to identify what might provide effective motivation for that individual to change. This approach helps patients in actualizing their wish to change by helping them move along the continuum from contemplation of a problem, such as smoking, to contemplation of the need for change, to taking action and then maintaining abstinence.

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Table Reference Number

Sophisticated, dynamic understanding of an individual's conflicts can help motivate patients to accept that they have a problem, help patients accept a need for change, aid in treatment, and be used to maintain progress.

Psychodynamic understanding can be integrated with cognitive, behavioral, and pharmacological approaches to enhancing treatment.

More research needs to be done on how influencing the mind can affect brain function, including addictive behavior.

References

Abraham K: The psychological relation between sexuality and alcoholism (1908), in Selected Papers of Karl Abraham. New York, Basic Books, 1960, pp 80–89
 
American Psychiatric Association: Practice guideline for the treatment of patients with substance use disorders: alcohol, cocaine, opioids. Am J Psychiatry 152:5–59, 1995
 
Ballenger JC: Current treatments of the anxiety disorders in adults. Biol Psychiatry 46:1579–1594, 1999
[PubMed]
 
Bean-Bayog M: Alcoholism as a cause of psychopathology. Hosp Community Psychiatry 39:352–354, 1988
[PubMed]
 
Beck AT, Wright FD, Newman CF, et al: Cognitive Therapy of Substance Abuse. New York, Guilford, 1993
 
Beck JS, Liese BS, Najavits LM: Cognitive therapy, in Clinical Textbook of Addictive Disorders, 3rd Edition. Edited by Frances RJ, Miller SI, Mack AH. New York, Guilford, 2004, pp 474–501
 
Bleuler E: Alcohol and the neuroses (1911), in Jahrbuch für psychoanalytische und psychopathologische Forschungen; Jahrbuch der Psychoanalyse 3:848. Abstracted by Blungart L. Psychoanal Rev 8:443–444, 1921
 
Carroll KM, Rounsaville BJ, Nich C, et al: One-year follow-up of psychotherapy and pharmacotherapy for cocaine dependence: delayed emergence of psychotherapy effects. Arch Gen Psychiatry 51:989–997, 1994
[PubMed]
 
Centonze D, Siracusano A, Calabresi P, et al: Removing pathogenic memories: a neurobiology of psychotherapy. Mol Neurobiol 32:123–132, 2005
[PubMed]
 
Cloninger CR: A systematic method for clinical description and classification of personality variants: a proposal. Arch Gen Psychiatry 44:573–588, 1987
[PubMed]
 
Committee on Alcoholism and Addictions, Group for the Advancement of Psychiatry: Addiction Treatment: Avoiding Pitfalls—A Case Approach (Report/Group for the Advancement of Psychiatry, no 142). Washington, DC, American Psychiatric Press, 1998
 
Dodes LM: The psychology of combining dynamic psychotherapy and Alcoholics Anonymous. Bull Menninger Clin 52:283–293, 1988
[PubMed]
 
Dodes LM: Compulsion and addiction. J Am Psychoanal Assoc 44:815–835, 1996
[PubMed]
 
Dodes LM, Khantzian EJ: Individual psychodynamic psychotherapy, in Clinical Textbook of Addictive Disorders, 3rd Edition. Edited by Frances RJ, Miller SI, Mack AH. New York, Guilford, 2004, pp 457–473
 
DuPont RL: Addiction: a new paradigm. Bull Menninger Clin 62:231–242, 1998
[PubMed]
 
Esch T, Stefano GB: The neurobiology of pleasure, reward processes, addiction and their health implications. Neuro Endocrinol Lett 25:235–251, 2004
[PubMed]
 
Etkin A, Pittenger C, Polan HJ, et al: Toward a neurobiology of psychotherapy: basic science and clinical applications. J Neuropsychiatry Clin Neurosci 17:145–158, 2005
[PubMed]
 
Ferenczi S: On the part played by homosexuality in the pathogenesis of paranoia (1912), in First Contributions to Psycho-Analysis. Boston, MA, Richard G Badger, 1916, pp 154–184
 
Frances RJ, Borg L: The treatment of anxiety in patients with alcoholism. J Clin Psychiatry 54(suppl):37–43, 1993
 
Frances RJ, Khantzian EJ, Tamerin JS: Psychodynamic psychotherapy, in Treatments of Psychiatric Disorders: A Task Force Report of the American Psychiatric Association, Vol 2. Washington, DC, American Psychiatric Association, 1989, pp 1103–1111
 
Freud S: Three essays on the theory of sexuality (1905), in The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol 7. Translated and edited by Strachey J. London, Hogarth Press, 1953, pp 125–245
 
Freud S: Civilization and Its Discontents (1930). New York, WW Norton, 1964
 
Freud S, Ferenczi S: The Correspondence of Sigmund Freud and Sándor Ferenczi, Vol 1: 1908–1914. Translated by Hoffer PT. Edited by Brabant E, Falzeder E, Giampieri-Deutsch P. Cambridge, MA, Belknap Press of Harvard University Press, 1993
 
Gabbard G: A neurobiologically informed perspective on psychotherapy. Br J Psychiatry 177:117–122, 2000
[PubMed]
 
Galanter M: Healing through social and spiritual affiliation. Psychiatr Serv 53:1072–1074, 2002
[PubMed]
 
Glover E: On the etiology of drug addiction (1932), in Selected Papers on Psycho-Analysis, Vol 1: On the Early Development of Mind. New York, International Universities Press, 1956, pp 187–215
 
Humphreys K, Moos RH: Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous. Psychiatr Serv 47:709–713, 1996
[PubMed]
 
Keller LE: Addiction as a form of perversion. Bull Menninger Clin 56:221–231, 1992
[PubMed]
 
Kernberg OF: Transference regression and psychoanalytic technique with infantile personalities. Int J Psychoanal 72:189–200, 1991
[PubMed]
 
Kessler RC, Crum RM, Warner LA, et al: Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 54:313–321, 1997
[PubMed]
 
Khantzian EJ: The self medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry 4:231–244, 1997
[PubMed]
 
Klerman GL, Weissman MM, Rounsaville BH, et al: The Theory and Practice of Interpersonal Psychotherapy for Depression. New York, Basic Books, 1984
 
Kohut H, Wolf ES: The disorders of the self and their treatment: an outline. Int J Psychoanal 59:413–425, 1978
 
Koob GF: Neurobiology of addiction: toward the development of new therapies. Ann N Y Acad Sci 909:170–185, 2000
[PubMed]
 
Koob GF, Le Moal M: Drug abuse: hedonic homeostatic dysregulation. Science 278:52–58, 1997
[PubMed]
 
Kreek MJ: Opiates, opioids, SNP's and the addictions: Nathan B. Eddy Memorial Award for lifetime excellence in drug abuse research lecture, in Problems of Drug Dependence, 1999: Proceedings of the 61st Annual Scientific Meeting of the College on Problems of Drug Dependence (DHHS Publ No ADM-00-4737). National Institute on Drug Abuse Research Monograph 180. Edited by Harris LS. Washington, DC, U. S. Government Printing Office, 2000, pp 3–22
 
Kreek MJ, Koob GF: Drug dependence: stress and dysregulation of brain reward pathways. Drug Alcohol Depend 51:23–47, 1998
[PubMed]
 
Krystal H: Alexithymia and the effectiveness of psychoanalytic treatment. Int J Psychoanal Psychother 9:353–378, 1982–1983
[PubMed]
 
Kushner MA, Sher KJ, Bertman BD: The relation between alcohol problems and anxiety disorders. Am J Psychiatry 147:685–695, 1990
[PubMed]
 
Langeland W, Draijer N, van den Brink W: Trauma and dissociation in treatment-seeking alcoholics: towards a resolution of inconsistent findings. Compr Psychiatry 43:195–203, 2002
[PubMed]
 
Leshner A: Addiction is a brain disease, and it matters. Science 278:45–47, 1997
[PubMed]
 
Lewis HB: Shame and the narcissistic personality, in The Many Faces of Shame. Edited by Nathanson DL. New York, Guilford, 1987, pp 93–132
 
Lorand J: A summary of psychoanalytic literature on problems of alcoholism. Yearbook of Psychoanalysis 1:359–378, 1948
 
Luborsky L: Principles of Psychoanalytic Psychotherapy: A Manual for Supportive-Expressive Treatment. New York, Basic Books, 1984
 
Mahler M, Pine R, Bergman A: The Psychological Birth of the Human Infant: Symbiosis and Individuation. New York, Basic Books, 1975
 
Manji HK, Moore GJ, Chen G: Clinical and preclinical evidence for the neurotrophic effects of mood stabilizers: implications for the pathophysiology and treatment of manic-depressive illness. Biol Psychiatry 48:740–754, 2000
[PubMed]
 
McDougall J: The "dis-affected" patient: reflections on affect pathology. Psychoanal Q 53:386–409, 1984
[PubMed]
 
Meissner WW: Psychotherapy and the Paranoid Process. New York, Jason Aronson, 1986
 
Menninger KA: Man Against Himself. New York, Harcourt Brace, 1938
 
Milkman H, Frosch WA: On the preferential abuse of heroin and amphetamine. J Nerv Ment Dis 156:242–248, 1973
[PubMed]
 
O'Brien CP: Progress in the science of addiction. Am J Psychiatry 154:1195–1197, 1997a
 
O'Brien CP: A range of research-based pharmacotherapies for addiction. Science 278:66–69, 1997b
 
O'Malley SS, Jaffe AJ, Chang G, et al: Six-month follow-up of naltrexone and psychotherapy for alcohol dependence. Arch Gen Psychiatry 53:217–224, 1996
[PubMed]
 
Perry S, Cooper A, Michels R: The psychodynamic formulation: its purpose, structure, and clinical application. Am J Psychiatry 144:543–550, 1987
[PubMed]
 
Pfefferbaum B, Doughty DE: Increased alcohol use in a treatment sample of Oklahoma City bombing victims. Psychiatry 64:296–303, 2001
[PubMed]
 
Prochaska JO, DiClemente CC, Norcross JC: In search of how people change: applications to addictive behaviors. Am Psychol 47:1102–1114, 1992
[PubMed]
 
Radó S: Classics revisited. The psychoanalysis of pharmacothymia (drug addiction) by Sandor Radó. The Psychoanalytic Quarterly 1993. J Subst Abuse Treat 1:59–68, 1984
[PubMed]
 
Silber A: Rationale for the technique of psychotherapy with alcoholics. Int J Psychoanal Psychother 3:28–47, 1974
[PubMed]
 
Vaillant GE: The Natural History of Alcoholism Revisited. Cambridge, MA, Harvard University Press, 1995, pp 362–373
 
Volkow ND, Li TK: Drug addiction: the neurobiology of behaviour gone awry. Nat Rev Neurosci 5:963–970, 2004
[PubMed]
 
Volkow ND, Wang GJ, Fischman MW, et al: Relationship between subjective effects of cocaine and dopamine transporter occupancy. Nature 386:827–830, 1997
[PubMed]
 
Wieder H, Kaplan EH: Drug use in adolescents. Psychodynamic meaning and pharmacogenic effect. Psychoanal Study Child 24:399–431, 1969
[PubMed]
 
Woody GE, McLellan AT, Luborsky L, et al: Psychotherapy for substance abuse. Psychiatr Clin North Am 9:547–562, 1986
[PubMed]
 
Wurmser L: The role of superego conflicts in substance abuse and their treatment. Int J Psychoanal Psychother 10:227–258, 1984
[PubMed]
 
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Sample questions:
1.
Various psychodynamic models have been used to describe substance abuse behavior in the context of psychodynamic conflict. Among these models is the description of substance abuse as an example of narcissistic behavior disorder, wherein the patient uses substances to serve as a substitute idealized selfobject. This concept is associated with whom?
2.
Another psychodynamic explanatory model for substance abuse relates to the concept of self-medication, wherein the patient uses substances to compensate for underlying conflicts. The term escape into narcosis describing this is attributed to. . .
3.
The co-occurrence of personality disorder with substance abuse in patients is common and may make treatment for substance abuse more challenging. A substance-abusing patient who also has narcissistic personality disorder is likely to exhibit all of the following except
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