Abstract
The effectiveness of psychotherapy in the treatment of substance abuse continues to be debated among theorists and practitioners. This paper proposes that psychotherapy can play an important role in the treatment of the addictions. However, it is critical that this psychotherapy is geared toward the special needs of substance abusers. Using research on the process of change as a guide, a psychotherapeutic approach for substance abusers is described that responds to the needs of the individual as they shift during the different phases of recovery. Contemporary adaptations of psychodynamic psychotherapy are recommended, along with the appropriate cognitive-behavioral and self-help approaches. In addition, the different clinical considerations for alcohol versus cocaine abusers are examined as they evolve during the change process.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Vaillant GE: Dangers of psychotherapy in the treatment of alcoholism, in Bean MH, Zinberg NE (eds): Dynamic Approaches to the Understanding and Treatment of Alcoholism. New York, Free Press, 1981.
Brown S: Treating the Alcoholic: A Developmental Model of Recovery. New York, Wiley, 1985.
Prochaska JO, DiClemente CC: Toward a comprehensive model of change, in Miller WR, Heather N (eds): Treating Addictive Behaviors: Processes of Change. New York, Plenum Press, 1986, pp 3–27.
Shaffer HJ, Jones SB: Quitting Cocaine: The Struggle against Impulse. Lexington, MA, DC Heath, 1989.
Miller W: Increasing motivation for change, in Miller W, Hester R (eds): The Handbook of Alcoholism Treatment Approaches. New York, Pergamon Press, 1988.
Marlatt GA: Cognitive assessment and intervention procedures for relapse prevention, in Marlatt GA, Gordon JB (eds): Relapse Prevention. New York, Guilford Press, 1985.
Weider H, Kaplan E: Drug use in adolescents. Psychoanal Study Child 24:399–431, 1969.
Khantzian EJ: Self-selection and progression in drug dependence. Psychiatry Digest 36:19–22, 1975.
Khantzian EJ: The ego, the self and opiate addiction: theoretical and treatment considerations. Int Rev Psychoanal 5:189–198, 1978.
Khantzian, EJ: The self-medication hypothesis of addictive disorders. Am J Psychiatry 142 (11): 1259–1264, 1985 (special article).
Dodes LM, Khantzian EJ: Individual psychodynamic psychotherapy with addicts, in Frances RJ, Miller SI (eds): The Clinical Textbook of Addictive Disorders. New York, Guilford Press, pp 391–405, 1991.
Khantzian EJ: Psychotherapeutic interventions with substance abusers—the clinical context. J Substance Abuse Treat 2:83–88, 1985.
Amodeo M, Liftik J: Working through denial in alcoholism. J Contemp Hum Serv, 71(3):131–135, March 1990.
Weiss RD, Mirin SM: Tricyclic antidepressants in the treatment of alcoholism and drug abuse. J Clin Psychiatry 50(7, Suppl):4–9, 1989.
Khantzian EJ: The primary care therapist and patient needs in substance abuse treatment. Am J Drug Alcohol Abuse 14 (2):159–167, 1988.
Hunt WA, Barnett LW, Branch LG: Relapse rates in addiction programs. J Clin Psychol 27:455–456, 1971.
Mack J: Alcoholism, A.A., and the governance of the self, in Bean MH, Zinberg NE (eds): Dynamic Approaches to the Understanding and Treatment of Alcoholism. New York, Free Press, 1981.
Khantzian EJ, Mack JE: Alcoholics Anonymous and contemporary psychodynamic theory, in Galanter M (ed): Recent Developments in Alcoholism. New York, Plenum Press, 1989.
Marlatt GA: Relapse prevention: theoretical rationale and overview of the model, in Marlatt GA, Gordon JR (eds): Relapse Prevention. New York, Guilford Press, 1985.
Khantzian EJ: Self-regulation and self-medication factors in alcoholism and the addictions: similarities and differences, in Galanter M (ed): Recent Developments in Alcoholism. New York, Plenum Press, 1990.
Khantzian EJ, Schneider RJ: Addiction, adaptation, and the “drug-of-choice” phenomenon: clinical perspectives, in Milkman HB, Shaffer HJ (eds): Addictions: Multidisciplinary Perspectives and Treatments. Lexington, MA, DC Heath, 1985.
Stinnett JL: Outpatient detoxification of the alcoholic. Int J Addict 17(6):1031–1046, 1982.
Hayashida M, Alterman AI, McLellan AT, et al.: Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med 320(6):358–365, 1989.
Gawin FH, Ellinwood EH: Cocaine and other stimulants. N Engl J Med 318:1173–1182, 1988.
Kosten TR: Pharmacotherapeutic interventions for cocaine abuse; matching patient to treatments. J Nerv Ment Dis 177(7):379–389, 1989.
Weiss RD, Mirin SM: Psychological and pharmacological treatment strategies in cocaine dependence. Ann Clin Psychiatry 2:239–243, 1990.
Weiss RD, Mirin SM, Griffin ML, Michael JL: Psychopathology in cocaine abusers: changing trends. J Nerv Ment Dis 176(12):719–725, 1988.
Gawin F, Kleber H: Pharmacologic treatments of cocaine abuse. Psychiatr Clin North Am 9(3):573–583, 1986.
Khantzian EJ, Treece C: DSM-III psychiatric diagnosis of narcotic addicts: recent findings. Arch Gen Psychiatry 42:1067–1071,1985.
Naranjo CA, Sellars EM, Roach CA, et al.: Zimelidine-induced variations in alcohol intake by nondepressed heavy drinkers. Clin Pharmacol Ther 35:374–381, 1984.
Amit Z, Brown Z, Sutherland A, et al.: Reduction in alcohol intake in humans as a function of treatment with zimelidine: implications for treatment, in Naranjo CA, Sellars EM (eds): Research Advances in New Psychopharmacological Treatments for Alcoholism. Amsterdam, Elsevier, 1985, pp 189–198.
Naranjo CA, Sellars EM, Sullivan JT, et al.: The serotonin uptake inhibitor citalopram attenuates ethanol intake. Gin Pharmacol Ther 41:266–274, 1987.
Rawson RA, Obert JL, McCann MJ, et al.: Cocaine treatment outcome: cocaine use following inpatient, outpatient, and no treatment, in Harris LS (ed): Problems of Drug Dependence, 1985. Proceedings of the 47th Annual Scientific Meeting, The Committed on Problems of Drug Dependence, Inc., Research Monograph 67. US Department of Health and Human Services Publication (ADM) 86-1448, Washington, DC, 1986.
Griffin ML, Weiss RD, Mirin SM, Lange U: A comparison of male and female cocaine abusers. Arch Gen Psychiatry 46:122–126,1989.
Saxe L, Dougherty D, Esty K, Fine M: The Effectiveness and Costs of Alcoholism Treatment. Office of Technology Assessment, US Government Printing Office, 1983.
US Department of Health and Human Services: Seventh Special Report to the US Congress on Alcohol and Health, DHHS Pub. No. (ADM)281-88-0002. Washington DC, Superintendent of Documents, US Government Printing Office, 1990.
Brown S, Yalom ID: Interactional group therapy with alcoholics. J Stud Alcohol 38(3):426–456, 1977.
Vanicelli M: Group psychotherapy with alcoholics. J Stud Alcohol 43(1):17–37, 1982.
Khantzian EJ, Halliday KS, McAuliffe, WE: Addiction and the Vulnerable Self. New York and London, Guilford Press, 1990.
Telch MJ, Hannon R, Telch CF: A comparison of cessation strategies for the outpatient alcoholic. Addict Behav 9:103–109, 1984.
Oei TP, Jackson PR: Some effective therapeutic factors in group cognitive-behavioral therapy with problem drinkers. J Stud Alcohol 45:119–123, 1984.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1992 Springer Science+Business Media New York
About this chapter
Cite this chapter
Schneider, R.J., Khantzian, E.J. (1992). Psychotherapy and Patient Needs in the Treatment of Alcohol and Cocaine Abuse. In: Galanter, M. (eds) Recent Developments in Alcoholism. Recent Developments in Alcoholism, vol 10. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1648-8_9
Download citation
DOI: https://doi.org/10.1007/978-1-4899-1648-8_9
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4899-1650-1
Online ISBN: 978-1-4899-1648-8
eBook Packages: Springer Book Archive