Treating Addiction As a Human Process

Passionate, professional, and unfailingly astute, Dr. Khantzian examines his patients' internal worlds, revealing vulnerabilities while uncovering resiliency and strength. This book, comprehensive in scope, abundant in clinical material, and written with clarity and intelligence, provides a depth of understanding of substance use disorders and an increased hope for recovery.

Edward J. Khantzian is Clinical Professor of Psychiatry, Harvard Medical School, and a founding member of the Department of Psychiatry at The Cambridge Hospital.

Foreword

xiii

(6)

Jerome D. Levin

Acknowledgments

xix

(4)

Collaborators

xxiii

PART I: OVERVIEW: POTENTIALS AND LIMITATIONS FOR UNDERSTANDING AND TREATING ADDICTIVE VULNERABILITY

7

(1)

PART II: THE INTERNAL WORLD OF THE ADDICTED PERSON

7

(114)

Introduction

7

(10)

1 Heroin Use As an Attempt to Cope

17

(14)

John E. Mack

Alan F. Schatzberg

2 The Ego, the Self, and Opiate Addiction

31

(20)

3 Impulse Problems in Addiction

51

(14)

4 An Ego/Self Theory of Substance Dependence

65

(8)

5 Ego Functions and Psychopathology in Narcotics and Polydrug Users

73

(12)

Gerald J. Mckenna

6 Treatment Implications of Ego and Self Disturbances in Alcoholism

85

(32)

7 Addiction: Self-Destruction or Self-Repair?

117

(4)

PART III: THE SELF-MEDICATION HYPOTHESIS OF SUBSTANCE USE DISORDERS

121

(156)

Introduction

121

(8)

8 Opiate Addiction: Theory and Treatment

129

(16)

9 Self-Selection and Progression in Drug Dependence

145

(8)

10 Psychological (Structural) Vulnerabilities and the Specific Appeal of Narcotics

153

(12)

11 The Self-Medication Hypothesis of Addictive Disorders

165

(16)

12 Self-Regulation and Self-Medication Factors in Alcoholism and the Addictions

181

(22)

13 Self-Regulation Factors in Cocaine Dependence

203

(14)

14 Self-Regulation Vulnerabilities in Substance Abusers

217

(28)

15 The Self-Medication Hypothesis of Substance Use Disorders: An Update

245

(32)

PART IV: UNDERSTANDING ADDICTIVE VULNERABILITY--PSYCHODYNAMICS

277

(190)

Introduction

277

(12)

16 A Preliminary Dynamic Formulation of the Psychopharmacological Action of Methadone

289

(12)

17 Heroin Addiction: The Diagnostic Dilemma for Psychiatry

301

(24)

Catherine J. Treece

18 Dependency and Denial Problems of Alcoholics

325

(10)

19 Self-Preservation and the Care of the Self

335

(22)

John E. Mack

20 Alcoholism: The Challenge of Conceptualization and Consensus

357

(8)

21 The Cause-Consequence Controversy in Alcoholic and Addictive Suffering

365

(18)

22 Cocaine Addiction: Is There a Psychological Predisposition?

383

(6)

Nancy J. Khantzian

23 Psychiatric and Psychodynamic Factors in Cocaine Dependence

389

(10)

24 Alcoholics Anonymous and Contemporary Psychodynamic Theory

399

(32)

John E. Mack

25 Alcoholics Anonymous--Cult or Corrective?

431

(20)

26 Trauma and Addictive Suffering: A Self-Medication Perspective

451

(16)

PART V: TREATMENT OF THE ADDICTIONS

467

(202)

Introduction

467

(10)

27 The Self-Help-Psychiatry Controversy in Addiction Treatment

477

(10)

28 Group Treatment of Unwilling Addicted Patients

487

(14)

William W. Kates

29 The Substance-Dependent Physician

501

(8)

30 Understanding and Managing Addicted Physicians

509

(10)

31 Psychotherapeutic Interventions with Substance Abusers

519

(14)

32 A Contemporary Psychodynamic Approach to Drug Abuse Treatment

533

(10)

33 The Primary Care Therapist and Patient Needs in Substance Abuse Treatment

543

(10)

34 Modified Group Therapy for Substance Abusers: A Psychodynamic Approach to Relapse Prevention

553

(16)

Kurt S. Halliday

Sarah J. Golden

William E. McAuliffe

35 How AA Works and Why It Is Important for Clinicians to Understand

569

(32)

John E. Mack

36 Group Therapy for Psychoactive Substance Use Disorders

601

(14)

Sarah J. Golden

William E. McAuliffe

37 Modified Dynamic Group Therapy: Technique and Technical Issues

615

(14)

Kurt S. Halliday

William E. McAuliffe

38 Preverbal Origins of Distress: Substance Use Disorders and Psychotherapy

629

(10)

39 Psychotherapy of Substance Abusing Patients: Engaging and Treating the Disordered Person

639

(30)

PART VI: EPILOGUE: FUTURE PROSPECTS FOR UNDERSTANDING AND TREATING THE ADDICTED PERSON

669

(1)

Credits

669

(4)

Index

673

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Treating Addiction As a Human Process

Summary

Author Biography

Table of Contents

Supplemental Materials