Psychoanalysis and the Treatment of Drug Addiction Essay

Drug addiction persists to present major challenge to serving psychoanalysts. There are different techniques used to treat drug addiction however this paper mainly discusses psychoanalysis as a mode of treatment for drug addiction. Even though media hype regarding the issue of drug addiction has augmented in the last few years, there has not been sufficient stress on different methods used to deal with it. Therapists, educationist, and the common public require information on the subject of treatment methods and means that are accessible to them. Gradually more, experienced psychoanalysts are getting employed in drug addiction programs (Hosie, West, & Mackey, 1997). In order to be successful, they should be aware of different methods used in drug addiction treatment and try to incorporate them into their daily practice and job. People who are in the field of drug addiction treatment, nonetheless, must try to have clear idea about using different methods of treatment (Schonfeld & Morosko, 1997). Among the various modalities used to treat drug addiction are the â€Å"twelve-step program† of Alcoholics Anonymous (AA), professional counselling and psychiatric care, family systems therapy, and therapeutic community treatment. In the past, these approaches have often been at odds with one another (Minkoff, 1995). Some of the debates have involved whether drug addiction is a disease in and of itself or is reflective of some underlying psychopathology. The proponents of the disease model have included AA (1995) supporters, who have tended to focus on abstinence as a way of controlling the disease. Adherents to the psychopathology model have mainly been mental health professionals who have advocated psychiatric and professional counselling treatment. Yeager, DiGiuseppe, Olsen, Lewis, and Alberti (1997) noted that therapeutic community treatment has become increasingly popular because traditional and more individually oriented psychiatric modalities have not been very effective. They echoed the argument made by Vaillant (1975) that clients suffering from drug addiction need milieu and group involvement with their peers. External control, containment, and structure from milieu-oriented treatment are needed before meaningful psychotherapy can begin. Stanton and Todd (2000) agreed that peer influence can play a role in less serious drug addiction problems however that long-term drug addiction generally has its origins in adolescence and that â€Å"serious drug abuse is predominantly a family phenomenon† (p. 8). They argued that family therapy is therefore the logical treatment of choice. Psychoanalysis And Drug Addiction To be exact, severe drug addiction is considered as being motivated by contradictory and unsettled relational kinematicsthat drawn from the premature systematizing relations in a individuals lives. As far as drug addiction is concerned, the terms of this disagreement discover solid look in distinguishing actions of using drugs that provide to spread it with the help of the mutual results of reinforcement and disguise. The objective of treatment is for patient and psychoanalyst to uncover the constituents of the relational ties that are embedded in the drug use, to reformulate these forces in figurative expressions, and tore-check them in the kinematics of the change, next to prospects for latest exchange. Seen this way, the treatment requirements of drug users can finely be convened by psychoanalysis, improved by other methods essential for dealing with addiction. In the past drug addiction has been shut out from psychoanalysis and this method of treatment, clearly in its insinuation, might appear merely to validate that standing. Doing psychoanalysis treatment of drug users, comparing with other treatment methods, educates awareness on these desire states and uses replacement as a remedial instrument. No matter what the stress of the theory or character of the foundation, every analysis of addictive disorder that represent on entity associations tacitly contribute to a common principle: that the action of drug use comes into view as a result of desire. Whilst created by a lot of dependent variables, an operation of severe drug use, if intra-psychically inspected, at all times corresponds to an attempt to bring about inner alteration, or outside reaction, in a exacting, approved method. Almond (1997) has described desire as â€Å"a personal condition—a feeling of total control or power—that the person endeavours to bring about with his action and/or fantasy† (p. 3). By these stipulations, an action of excessive drug use signifies a fundamental, desire condition and is a means to implement it, whether with regard to effects desired in the self or others in the outside world. Rik Loose discussed in his book â€Å"The Subject of Addiction† that psychoanalysis and addiction are counterparts of the world of science and techniques. Therefore, since, the logical dialogue centers on the issue and the drug user’s relationship to his reason of desire. In an intelligent approach, Rik Loose depicts the reason of globalization that requires our times and counters to it as a organization governed by desire and ideals. (Loose, 2002) Psychoanalysts who work with drug users know that the act of drug use is an indicative result of a procedure of previous changes. The language of diversity, acknowledged as a modern construction for intellect, allows us to spot the drug user as careworn into specific states of mind— comprising of particular influence, feelings regarding the person himself and others, feelings concerning the world—that augment the desires and cravings that are confined and apparently recognized in typical action of drug use. One might also say that, for a given drug consumer, the action of using the drug provides to intrepidly set the limits of a basic state of oneself. In fact, the preliminary investigative mission with the drug user comprises of extricating the user from attraction with the drug in order to divert the user in its place in the self-state that portends it. Astonishingly, the standing of desire in the addiction is for the most part uncared for in drug treatment. Drug users in this kind of situations are frequently encouraged to talk to other recuperating fellows when they believe themselves to be caught up in desire to take in drug. (Loose, 2002) This suggestion— regularly wielded by twelve-step companionship also, in the shape of a status offer to talk to one’s supporter every time sensing the urge to take drug—is evidently well planned (and, no doubt, useful at times). On the other hand this type of counselling is sightless to the internal truth of the state of desire that not just impels substance users presumptuous in their use of drugs, nevertheless in addition throw away understanding of other individuals in their lives to the periphery of their brain. Moreover, still as conventional treatment programs dedicate significant consideration to the issue of reversion— enlightening drug users in relation to surroundings stimuli and inner feelings (e. g. depression, loneliness) that could encourage desires to use drugs—they pay no attention to the desire aver that the course of reversion usually serve to perform. Due to this rationale, psychoanalysis has a lot to proffer the severe drug user: whilst the majority of drug treatments look forward to putting an end to drug addicting behaviour, the psychoanalytic attempt would take in this objective and stretch further to investigate the desire state that uncovers end result in drug use and in other prototypes of actions in his or her life. In effect, the methodical approach would be to treat the person’s drug use nevertheless look for to disengage such a symptomatic outburst from the original self-state, which has required to be conserved for its background and significance to the person and, for that basis, deserve consideration (Bromberg, 1998). â€Å"transformation come in an analysis,† Winnicott (1960) wrote, â€Å"when the traumatic factors enter the psycho-analytic material in the patient’s own way, and within the patient’s desire† (p. 37). This regulatory statement can also be functional to remedial work with drug users, whose desire intend, usually set free â€Å"out there,† requirement to be completely greeted into the methodical exchange. In fact, it is from the point of view of the functioning coalition— nevertheless effectively realizes with a drug user—that the analyst may sense another exchange transpiring in the transference. In it, the analyst is excluded from all events eventuating in the patient’s drug use and is left to feel helpless. Not only is the patient’s move to a state of emotional cut-off a marker of desire, so is the analyst’s helpless state. (Loose, 2002) For it is these feelings of helplessness in the analyst that point to the history of pain or trauma in the patient that may have showed the way to the user’s need for desire to start with, and to such severity. Nonetheless, certain new trends in investigative way and the significance of a relational viewpoint in understanding drug use, the ability of psychoanalysts, amplified by understanding of addiction, can be of utmost advantage to them. That is why a relational model of psychoanalytically based treatment has significance for severe drugs users. This statement may seem surprising on two accounts: psychoanalysis has often been considered useless for active drug users, and drug users have often been judged unsuitable for psychoanalysis. (Loose, 2002) Both assumptions are false, though accepted as truths in the mental health and drug addiction treatment worlds. Recent changes that have taken place in the understanding of the psychoanalytic process make relationally informed psychoanalysis an ideal therapeutic venue for drug users. These shifts in psychoanalysis have reversed its previous lack of fit for drug addiction. Any Psychoanalyst who has spent time working with drug users has heard, first-hand, accounts of the disrepute of psychoanalysis from the standpoint of addicted patients. (Loose, 2002) The traditional analytic stance that emphasized observation smacked of passivity to drug users, and the priority given to aetiology over symptoms often left patients’ drinking and drug use unattended to. However contemporary psychoanalysis has shifted its style of investigation; as Mitchell (1997) stated, it has moved away from reliance on interpretation and insight as the primary tools for achieving therapeutic change. Rather, psychoanalysis today places emphasis on an analyst’s ability to enter into a patient’s dynamics, mobilized in transference–counter transference form; together with the patient to arrive at an understanding of these experiences; and, in the process, to find new forms of relating for the patient to trust, in the place of old, constraining patterns (Mitchell, 1997; Bromberg, 1998). In short, today’s psychoanalyst is every bit an engaged participant. How does this development serve the substance-using patient? The drug user tends to be a do-er and act-er, and, on technical grounds alone, needs an active approach to feel meaningfully engaged, even adequately â€Å"gripped† by the therapeutic process. However, on another level, it is precisely the drug user’s recourse to action to express conflicting relational needs that is the target of treatment. (Loose, 2002) Reliance on action is a cornerstone of the drug user’s characterologic makeup (Wurmser, 1977, 1978). It is typically this reliance that has earned him disfavour with psychoanalysts, whose work depends so on reflection and delay. Action serves many purposes for the drug user, however it is usually its defensive function that has been highlighted by theorists. In this view, as articulated by Wurmser, action gives the drug user a powerful alternative to, or, more accurately, means of flight from, painful affects and inadequate tools of symbolic expression. Drug users are notable for limitations in their symbolic functioning: Wurmser termed their difficulties â€Å"hypo-symbolization,† describing deficits that range from a specific inability to recognize and label feelings to a more sweeping failure to engage in fantasy or exploration of their inner lives at all. In such a view, again elaborated by Wurmser, action serves as a special form of externalization, offering the person its magical, problem solving properties and the appearance of narcissistic control. However if, instead of emphasizing its defensive role, we view action as the vehicle drug users have for communicating un-symbolized experience, then it is to their actions we must look for the initial outlines of their conflicts. Drug use is then far from unwelcome in undertaking analytic treatment of a person taking drugs. It is the signature act of such a patient and, as such, contains the components of his unconscious and as yet un-symbolized life; it is the starting point of treatment. The intended course of that treatment would then be for analyst and patient to begin to uncover the relational deadlock embedded in the drug use. (Loose, 2002) Their aim is to discover that deadlock anew in the kinematicsof the transference, often at first still involving instances of drug use, and eventually to locate it within the organizing relationships of the patient’s early life, ultimately replayed and addressed free of reference to drugs, within the experience of the treatment relationship. In other words, the aim of therapeutic action would be to track, and deconstruct, the symptom from its extra-psychic form, concretized in drug use, to its intra-psychic life in the patient’s object relations (Boesky, 2000). It is here that the needs of the person consuming drug and the current state of psychoanalytic practice converge. Enactments, whereby patients draw their analysts into jointly realizing fantasized aspects of their object relations, play a recognized role in analytic practice today. Though theorists of various schools differ in their understanding of enactments, view of the analyst’s role, and sense of their therapeutic value, there is general agreement in the field that enactments are inevitable manifestations of transference–counter-transference forces at work in the analytic process (Ellman and Moskowitz, 1998). In relational theory, in particular, enactments are regarded not only as unavoidable, however also as the central medium of the work. They are the means through which patient and analyst are afforded the opportunity to revive old relational patterns jointly, as well as to reopen them to observation, understanding, and possibilities for change within the analytic relationship (Mitchell, 1997; Bromberg, 1998). By placing enactment at the heart of analytic work, relational practitioners have opened the door of psychoanalysis to substance using patients. This is so for several reasons: first, enactments provide drug users with a mode of communication tailor made to their needs to actualize, rather than reflect on, inner experience (Boesky, 2000). More important, enactments are a conduit for experience whose transitional properties uniquely serve the drug user—offering not only a bridge between the patient’s symptomatic behaviour outside the consulting room to his conduct within the treatment, however also, more generally, a bridge between action and meaning, drug and object, act of drug use and underlying relational needs. In theory and approach, then, the relational model provides the basis for the desired course of treatment for drug users. To be sure, no treatment of drug addiction could be effective by attending to the relational underpinnings of drug use alone. Severe drug use is a dangerous and potentially life-threatening problem; however derived, it nonetheless is sustained by the powerful pharmacological effects of drugs and the operation of the laws of conditioning on people’s behaviour. (Loose, 2002) Any Psychoanalyst working with a person taking drug must have a working knowledge of a range of ancillary treatment modalities commonly needed during the course of their treatment. Such approaches include use of cognitive-behavioural interventions, referrals to residential or intensive outpatient programs, support for participation in 12-step programs, use of toxicology tests, and use of pharmaco-therapies designed to counteract or inhibit drug effects (for example, disulfiram for alcoholics, naltrexone for opiate addicts). Purely speaking, then, any treatment of active drug user is, by force, integrative in practice, if, ultimately, psychoanalytic in design. However, if appropriately used, such supplementary therapies do not necessarily compromise the analytic task; in fact, it is my argument that the particular tools summoned during the course of any one patient’s treatment are—like his drug use—uniquely customized to fit his relational needs and are therefore best understood within a psychoanalytic framework.