The Psychology and Treatment of Addictive Behavior.

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DOWLING S., ED. The Psychology and Treatment of Addictive Behavior. Madison, CT: International Universities Press, 1995. xiv + 225 pp. $30.00.Classical psychoanalysis has been quietly surging toward modernization, in part through examining many facets of contemporary clinical life, it has bypassed in the past. One of these is the psychology of substance addiction and dependence; in the minds of many theorists and practitioners, to be an addict had virtually ipso facto meant that an individual was not analyzable, and therefore the formidable tools of psychoanalysis were simply not germane. This edited volume, part of the workshop series of the American Psychoanalytic Association, turns the corner on this error and focuses the lens of classical analysis on the problems of addiction.At its best, this volume is invaluable, with chapters that present a psychodynamic view of substance abuse that any clinician can benefit from reading. The chapter by Khantzian, wherein he describes his conceptualization of addiction as an affectively based disorder typified by a failure of self-regulation, is a must read for all. Using principles extrapolated from psychoanalysis, Khantzian demonstrates the underlying layer of affect and communicative pathology common to substance abusers and how psychoanalytic theory is necessary to illuminate these phenomena. Krystal distills his years of research into trauma and substance abuse and likewise unveils underlying emotional pathology, expanding Khantzian's analysis. Of further interest is Krystal's linkage of his theory to perceptual and developmental theory. Krystal, Khantzian, and Dodes, in his chapter on psychic helplessness, are admirably successful in mobilizing psychoanalytic theories to illuminate the off-the-couch dynamics of addicts.It seems that Wurmser's description of addiction is more on-the-couch; he describes the narcissistic, obsessional, and superego conflicts seen in the analyses of individuals who abuse substances. Although one has to admire the intrepid clinical spirit of Wurmser, and although his formulations are important, it opens the question of whether he is describing the same types of people as Krystal and Khantzian.Chapters by Myers on sexual addiction and Ornstein on addiction to erotic passion, while interesting, do not seem to fit together with the other chapters. It is hard to find any common ground with substance abuse and leads one to question what is to be gained by classifying any repetitive syntonic symptom sequence as an addiction.The book is capped off by overview and discussion chapters by Jacobson, Hurst, and Meers. Of special note is Meers' heartfelt, forthright description of his years of experience treating addicts and his plea for including their treatments in the scope of contemporary analytic theory.In summary, this book is important. Although it suffers from some of the problems of edited volumes-uneven chapters, careless editing, and a lack of coherent organization-its merits outweigh its liabilities. It brings together some of the most important theorizing on addicts to be found anywhere on the contemporary scene. It advances psychoanalytic theory in two ways-by expanding its focus and by addressing the clinical needs of a group that constitutes an ever expanding and pressing social problem. Written with a clear and simple pen, it can usefully be used to teach residents and graduate students about the dynamics of addiction.Arnold Wilson, Ph.D.

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