Posted by Dr. William Moore on March 07, 19100 at 20:06:56:
In Reply to: Re: Addiction posted by Lance Dodes, M.D. on February 14, 19100 at 22:04:11:
I only mentioned earlier, the use of alcohol (or other substance) as a defensive structure in maintainting fantasy, meaning protecting fantasy, fantasies often developed as a result of trauma (it doesn't matter when)and in the defense of trauma. When fantasies no longer 'work,' then a substitute is selected.
1. Trauma
2. Fantasies
3. Substance Abuse
2 safeguards 1 while 3 safeguards 2. 3 is selected only to safeguard 2.
We often see this in working with trauma, we want to encourage the alcoholic to give up substance (3)abusing in order to work with the (1)traumatic material-this is 3 to 1 and nothing can be accompished with this formula. Many clinicians will work with and isolatee (1) and attempt to encourage (3) from abusing. You see this very cleary in sexual assault victims who we assume abuse substances in order to deal with the trauma of sexual abuse. A saying goes 'You can bring it up (trauma), but you can't drink it down (trauma).
So assumptions are made to deal with the trauma and substance abuse. I think this is clearly not the way to go. It seems that 2 is overlooked, and yet it is in the fantasy life we find the individual character. Again, we see this in many disorders. So, my point was it is not the substance, but the individual. I do not accept that it is to acquire something lost. It is circular in nature: trauma---fantasy----substance abuse. Need to deal with all 3 yes, but we often overlook 2.