Assumptions

A psychodynamic perspective of human psychological life problems rests on the principle that we are all more or less susceptible to various forms of human psychological vulnerabilities—at the same time, we are also more or less endowed with human psychological strengths or capacities to protect against these vulnerabilities. Without ignoring hereditary factors, especially those that affect temperament, a psychological, and in this case psychodynamic perspective attempts to understand psychological forces at work (for example, drives and feelings) that operate within the individual at the same time that there is a corresponding interest in the psychological structures and functions that observably (and just as often, less obviously) operate to regulate or control our drives, feelings, and behavior.

A psychodynamic approach to human psychology greatly depends on a developmental perspective or an appreciation of the psychological forces, structures, and functions as they develop and change over one's lifetime. Psychodynamic clinicians are especially interested in the way individuals are influenced in the earliest phases of development by parents (and other caregivers), and then in the development of relationships with other children and peers, and later in the life cycle in relationships with adults and small and large groups— all of which shape our life views and experiences, as well as our attitudes, values, and characteristic ways of reacting and behaving.

Based on these assumptions, clinicians have the opportunity, most usually in the context of treating patients, to study and understand how the degree of developmental impairments (or strengths) has predisposed toward (or protected against) psychological and psychiatric dysfunction, including addictive vulnerability. In my experience, and that of my associates, we believe that modern psychody-namic-clinical approaches are as relevant and useful for studying and treating substance-dependent individuals as they are for the many other patients who benefit from this perspective.

The psychological study and understanding of addictive illness necessarily requires the condition of abstinence (being free of drug/alcohol use). Again, there is considerable debate about the duration of abstinence required before meaningful or valid psychological inferences can be made about individuals with addictive disorders. In my experience, however, the confounding effects of acute and chronic drug/alcohol use are variable, and it is often surprising that within days or weeks—but certainly within several months of abstinence— how much can be learned about a person's makeup and psychology that predisposed him or her to use and become dependent on substances. This point about the requirement for a period of abstinence from drugs and alcohol is important to emphasize, otherwise it can be and is rightfully argued that what appear to be the psychological causes of dependence on psychoactive substances are actually the result of such a dependence. Fortunately, in recent years, the combination of modern detoxification approaches, psychoeducational/rehabilita-tion/RELAPSE PREVENTION programs, TWELVE-STEP groups, and individual and group psychotherapeutic approaches, have been increasingly successful in establishing and maintaining abstinence. This, in turn, has made psychological treatments and understanding increasingly possible.

Drug Addiction

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