PSYCHODYNAMIC TREATMENT OF ADDICTIVE BEHAVIOR

Stephen Jay Levy, Ph.D., CAS

Sid Goodman, M.A.

The social movement that created humane treatment for alcoholics emphasized a biomedical disease model. In so doing it ignored important influences of personal psychopathology, social psychology, and culture. The fields of both alcohol and drug treatment wished to create treatment modalities and methodologies separate from the prevailing psychological movements of the time: the development of Alcoholics Anonymous starting in 1935, the creation of the National Council on Alcoholism in the 1940s, the Rehabilitation movement which began in the 1950s, the Therapeutic Community movement which also began in the 1950s, and Methadone Maintenance treatment which began in the 1960s). The alcoholism movement especially wished to dissociate itself from any notion of problem drinking as "mental illness".

These efforts were successful in helping the American public, as well as insurance companies who pay the bills, to viewing alcohol and other addictions as a disease process. The prevailing treatments utilize psychoeducational and spiritual approaches. The psychodynamic approach has been sorely neglected(Goodman and Levy, 1997).

Now with the zeitgeist (due to managed care) tilting toward the "mentally ill chemical abuser", dialogue and even collaboration between the three fields seemspossible (Cohen and Levy, 1992). Now we need to move toward a true synthesis of approaches that draw upon biology, psychology, and the social milieu.

Psychodynamic treatments, such as that practiced at the Renaissance Institute in Boca Raton, Florida, are still rare in the field. This treatment deals with core ego disturbances in treatment resistant, relapse prone patients, many of whom have "failed" at previous treatment attempts. The treatment milieu understands the repetition compulsion of the addict in early abstinence. In the proper mix of support and confrontation, this psychosocial reenactment of the core ego disturbance is dealt with. The four most prominent areas of ego deficits are in 1) affect management, 2) disturbances in self-concept, 3) profound dependency issues and 4) problems in self-care(Khantzian, Halliday & McAuliffe, 1990). Intensive support is given to the patient's family to efforts made to teach them more functional ways to help their family member. Dysfunctional responses to the demands of the patient to be rescued are addressed.

This psychodynamic approach holds great promise and places responsibility for change in the hands of the patient.

Dr. Levy can be reached at drsjl@earthlink.net

Sid Goodman can be reached at Ren94@earthlink.net

References

Cohen, J. and Levy, S.J. (1992) The Mentally Ill Chemical Abuser: Whose Client?, Lexington Books, Macmillan, Inc., New York

Goodman, S. and Levy, S.J. (1997) The Biopsychosocial Model Revisited: A Psychodynamic View of Addiction, Renaissance Institute of Palm Beach, Boca Raton, Florida.

Jellinek, E.M. (1952) Phases of Alcohol Addiction. Quarterly Journal of Studies on Alcohol 13(4): 673-84.

Khantzian, E.J, Halliday,K.S. & McAuliffe, W.E.(1990) Addiction and the Vulnerable Self. The Guilford Press, New York.

Spicer, J. (1993). The Minnesota Model. Hazelden Educational Materials, Center City, Minnesota.