Psychoanalysis and Substance Abuse

Abstract

The twentieth century witnessed innumerable extensions of classic psychoanalysis . There have been at least three major diversions from psychoanalysis , including the defection of the big two ' Adler and Jung , as well as the interpersonal theory of Sullivan . Freud and Beyond refers to at least 38 other revisionists . Virtually all of the post-Freudians and alternative analytic theories can be considered psychodynamic in their shared belief and focus on unconscious motivation . Like Freud , post-Freudian analytic therapies attempted to elucidate the patient 's earlier infant interpersonal relationships with significant others . This work

presents a brief overview of the psychoanalytic theories and the psychoanalysis . Both case studies and clinical research are critically examined

Psychoanalysis and Substance Abuse

Introduction

Freud formulated the first major psychotherapeutic technique over 100 years ago . Since then there have been at least 40 modifications of psychoanalysis . However , since the theoretical basis with respect to the psychodynamic and unconscious underpinnings of behavior is very similar the major focus is on classical psychoanalysis . Freud 's charting of a formerly unknown part of the mind to show the role sex or sexual forces play in unconscious motivation left an impact on twentieth-century thinking that is still being felt . One is hard put to attend the theater , read a modern novel , watch a television program , or listen to everyday conversation without encountering the results of his work . When Freud uncovered the unconscious , man could no longer hide from himself Whether or not one agrees with Freudian concepts of infantile sexuality Oedipus complex , transference phenomena , one is nevertheless involved with them . Freud assigned major importance to the instinctive drives of the individual . He believed that in the course of individual development , failures to channel these drives force them to seek expression in socially and individually unacceptable ways , as for instance substance abuse . When these unpleasant manifestations are repressed , the instinctual energies are expressed as various neurotic substitute behaviors

The mood change , according to Freud , results from a redirection of thought processes in the alcoholic , the alcohol providing the impetus for regression to childhood levels of thinking . The individual thereby achieve gratification from thinking that was uncontrolled by logic . This psychoanalytic theory considers the use of alcohol as an escape from reality . The escape concept has taken hold and is described by many authors , and by the many alcoholics who acknowledge it in a self-incriminating way . Jellife (Popham 228 ) in 1919 , developed the escape theory by maintaining that alcohol permits indulgence in the autoerotic ecstasy of dreaming ' instead of facing tortures which arise from the reality ' Parland (Westerfield Lawron 378 ) in 1957 equated escape in alcoholism with escape in homosexuality

Both kinds of escape , we agree , in women as well as men , stem from desire to flee one 's normal sexual role . But we think that emphasis of the escape phenomenon as the major etiological component of alcoholism is an oversimplification . The alcoholic , like all of us , wants to escape from unpleasant reality . What but escapes are our defenses , our rationalizations ? The critical questions are why the choice of alcohol as a means , and why does the escape method cripple the whole personality

As is the case with any inquiring mind , Freud was not satisfied to rest on his formulation and in later years revised his thinking about the alcoholic (Masserman Yum 36 . He equated with alcoholism the model of repressed homosexual traits he had used to describe the development of paranoid symptoms , and these traits illustrated the prime psychological turmoil of the addict . Freud maintained that because of the unconscious homosexual wish (related to strong oral influences of childhood , a man succumbed to the pull of the public house , getting from the company of men the emotional satisfaction he could not get from his wife . It was Freud 's contention that disappointment by women (wives , mothers , lovers drove men to drink . Whenever the alcoholic 's latent homosexual feelings came to the surface , he repressed them by returning to his wife . In turn , he then suspected his wife of sexual activity with those men he unconsciously loved , thereby developing paranoid symptoms

Freud believed that the personality arises through a number of distinct phases . The individual 's pleasure impulses are first focused on sucking (oral phase . One of his first adjustments to society is represented by sphincter control , and he is both socialized and rewarded in the course of this adjustment (anal stage . Then , if he is to reach maturity , he eventually learns , through a series of subphases , to focus his pleasure on a legitimate object of the opposite sex (genital phase . While everyone experiences all these phases to some extent , major crises along the way may cause an individual to regress to and become fixated on a premature phase of development

The parallels between mental illness , alcoholism and drug dependence also extend to another point . Freud and a variety of other students have familiarized contemporary men with the idea that the symptoms of the mentally ill person often represent a solution to his personal problems In cases of hysteria , for example , an individual may control his environment with a paralyzed ' hand . The paralysis of the trigger finger of an infantry soldier suffering from battle fatigue ' makes this quite clear . If under hypnosis one suggests that the hand is all right , the individual may regain control over it . But it was often discovered that sometime later a whole new set of hysterical symptoms appeared , worse than the original symptoms . The individual may end up for example , psychologically blind rather than psychologically crippled In retrospect , it sometimes seems that the hysterical patient takes the best possible path through the maze of his personal difficulties . Or again , Freud discovered that when he had eventually uncovered and brought to the surface repressed psychological material , a virtual explosion of aggressive feeling sometimes occurred . In short , when the mentally ill person is deprived of his illness , he may suffer the equivalent of withdrawal ' symptoms

The interrelations between mental illness , alcoholism , and drug addiction are complex . A number of psychiatric syndromes result from alcoholism . The acute alcoholic psychoses include : delirium tremens hallucinosis , and acute alcoholic intoxication . In acute alcoholic psychosis , the drinker , after consuming only a small amount of alcohol may develop automatic behavior that may be violent and dangerous . Chronic alcoholic deterioration is manifest as a gradual deterioration of the moral and ethical senses and values of the patient . Korsakoff 's psychosis results in extreme memory defects . Chronic alcoholic psychosis of a paranoid type and alcoholic schizophrenia appear when persons seem normal while not drinking , but manifest paranoid and schizophrenic symptoms while drinking . Wernicke 's syndrome consists primarily of a clouding of consciousness and possible appearance of a stuporous or somnambulant state . Other psychopathologies from alcohol also may occur

Among the mental complications that occur after the use of drugs are the psychoses , paranoia , and anxiety reactions as so intoxication and by a self-destructive attitude in dealing with relationships and life situations . Alcoholism is the result of : a disturbance and deprivation in early infantile relations accompanied by related alterations in basic physiochemical responsiveness the identification by the alcoholic with significant figures who deal with life problems through the excessive use of alcohol and a socio-cultural milieu that causes ambivalence conflict , and guilt in the use of alcohol

Contemporary and later analysts utilized this Freudian formulation and elaborated upon it . For example , Karl Abraham (Conger 296 ) considered the alcoholic as severely frustrated by his mother early in life and hence forced to turn to his father for solace . This resulted in over identification with his father and the development of homosexual tendencies

Since alcohol consumption is related to increased sexual excitement Abraham formulated a popular equation : drinking prowess is the equivalent of sexual prowess . To this day a man who does not drink is viewed by many with suspicion and distrust . Abraham further pointed out that alcohol may substitute for sex , and he likened this substitution to certain sexual perversions such as voyeurism and fetishism . In perversions , stimuli that normally are a part of the foreplay of sex become its major gratification there is fixation at this preliminary sexual stage . For example , viewing the desired sexual object is but a means of forepleasure leading to culmination in sexual union . For the voyeur , however , complete satisfaction is achieved merely by the looking . Abraham believed the sexual development of the alcoholic was fixated in forepleasure (oral stimulation . Alcohol thus becomes the means of effortless gratification whereby the alcoholic exchanges women for wine

Although latent homosexuality and confusion in sexual identity may play a significant role in the evolution of problems associated with substance abuse , they do not offer sufficient impetus for the development of so devastating a condition . Much of the psychopathology of alcoholism may be tied to factors commonly seen in the patient with homosexual problems , but these are not only insufficient to be the sole etiological agent for alcoholism they are often misinterpreted . Since the fixation at the oral stage is so early in psychosexual development the alcoholic has never achieved a genital level of differentiation and is so desirous of receiving love , he does not differentiate the sex of the provider

Another important psychoanalytic component of alcoholism often advanced is the self-destructive drive of alcoholics . Menninger (Ullman 602 ) in his best seller Man Against Himself raised this much-disputed point . It was his contention that generally alcoholics unconsciously have a powerful desire to destroy themselves . Addiction is one means of expressing this unconscious urge which is the result of the child 's feeling betrayed by his parents . The frustration arising from the betrayal results in an intense rage toward his parents which in turn causes interpersonal conflict . He wishes to destroy his parents yet he fears losing them . Later in life , alcohol becomes a means of achieving both gratification and revenge against the parents . The feeling of hostility toward parents creates a desire for punishment to alleviate guilt . Therefore , Menninger viewed alcohol addiction as a form of slow suicide used to avert a greater self-destruction

The concept of self-destructive urges in alcoholism has recently been challenged by McCord (Shoben 1956 ) and his group in their longitudinal studies of pre-alcoholics and non-alcoholics . They expected to find , if the self-destructive etiological concept was correct , a higher incidence of suicidal trends in the pre-alcoholic than in the non-alcoholic . This was not borne out in their study

Irrespective of these findings about suicide , our experience with alcoholics has revealed that most of their relations , endeavors , and goals have been self-destructive . The continuous , unbroken thread always runs in the direction of the alcoholic 's unconsciously doing himself harm . Hence , it is not the alcohol wedded specifically to suicidal attempts or thoughts which emphasize the alcoholic 's self-destructive drives , but rather the directed inward . Only by taking into consideration this all-encompassing self-destructiveness that pervades every facet of the alcoholic 's personality can one understand the factor

Many theorists have elaborated on Freud 's original oral concept , and oral fixation has also been incriminated as the sole cause of alcoholism . For example , Knight (Richter , was of the opinion that the predominance of oral craving is especially significant in the alcoholic He attributes the oral fixation to specific early family experiences : an indulgent mother and an inconsistent father he sees as the most common family configuration . A child overly indulged by a permissive mother according to Knight , cannot learn self-control and reacts with intense rage to every frustration . This capacity for rage is fed by an inconsistent father who unpredictably gratifies at one time and denies at another . In such a family the attitudes of the mother and father tend to reinforce one another . This pattern of dependence , rejection , and intense desire for indulgence is built into the personality , associated with deep feelings of inferiority and guilt . During puberty , there is an intensification of envy of masculine prowess as exemplified by the father , and drinking becomes regarded as manly ' The child begins to drink , and his drinking in time becomes anti-social with concomitant defiance of parental wishes . This pathological behavior develops out of an unresolved adolescent revolt . The pharmacological effects of alcohol reinforce irresponsible behavior , and ultimately others are forced to take care of the imbiber in his passive , drunken stupor

If Knight 's contentions concerning the typical family producing alcoholics are correct , then we must prepare for an invasion of alcoholics in unbelievable numbers . In mid-twentieth-century America (and , we suspect , in other affluent societies as well , mothers are primarily directed toward overindulging the needs of their children With the commuting father in and out of the home like a surreptitious lover , his influence and attitude are limited and inconsistent Fortunately such parental influences appear not to be a major contributing factor in alcoholism

Tiebout (Williams 452 ) incriminated the unconscious need to dominate as a strong motivating force of the alcoholic . Along with this need are found hostile attitudes , feelings of loneliness and isolation , and ambivalent perceptions of inferiority and superiority . With these deprived and conflicting feelings the alcoholic , according to Tiebout strives for perfection and craves ecstatic peaks ' The striving for perfection we feel is an important concept , as it may be the means by which the alcoholic assures himself of certain and continuous failure

The Adlerian school of individual psychology ' evolved their own concept of the substance abuse . They attributed addiction to a desire of the individual to remove powerful feelings of inferiority while escaping responsibilities . To Adler (Dollard Miller 1950 ) feelings of inferiority were the root of all alcoholic problems . Inferiority might be overtly expressed or be hidden behind the screen of superiority Marked shyness , a preference for isolation , impatience , irritability anxiety , depression , hypersensitivity , and sexual insufficiency may herald the onset of an addiction . Boastfulness , malicious criminal tendency , a longing for power ' Adler maintained might be the symptoms of addiction when the superiority complex was the adaptive mechanism employed . He contended that alcoholism is the result of childhood pampering . Overindulgence and excessive coddling result in the individual 's inability to face up to the frustrations of adult reality and this in turn leads to inferiority feelings . The alcoholic then attempts to counter the demands of society by the use of alcohol . It is not difficult to see that the traits Adler listed are quite universal and in no way specific to alcoholism

An elaboration of the Adlerian view by Schilder (Wexberg 227 ) attributes alcoholism to a perpetual state of insecurity from earliest childhood This insecurity is related to parental associations . The child , in Schilder 's formulation , has been pushed deeper and deeper into an insecure abyss by ridicule , by passivity , by threat , by corporal punishment , and by degradation . Although the threats originally came from one or both parents , the child learns to expect them , and soon sees the community as threatening him in a similar way . Social tension and insecurity are thereby heightened . In adult life , alcohol dissolves this painful situation , generating feelings of social acceptability and security while the individual is intoxicated . With the disappearance of that mood , the original feelings return with increased vigor and demand renewed drinking . Schilder felt that the alcoholic suffers deeply from his social insufficiency . He is unable to establish a close relationship with other human beings and is aware of it . He claims and expects special favors , appreciation , and love . Schilder says the love the alcoholic feels for his own body and intellect he hungers for from others . The constant social tension developed from this desire is only relieved through alcohol , which permits him the feelings of being lovable and loved . The Schilder psychoanalytic theory concerning social insecurity does not answer why all socially insecure people who drink do not become addictive drinkers

This psychoanalytic theory implies that the potential for alcohol addiction exists for all individuals , that given sufficient , continuous intake of alcohol , regression may occur to make anyone alcoholic . This does not agree with many interdisciplinary observations of the problem The Jewish and Italian cultures have their fair share of introverts and extroverts and continuous alcohol users , yet as the numerous studies we shall note reveal , they have negligible alcoholism . Bjtzrk (Kinghan 324 introduces a new concept in the etiology of alcoholism when he considers addiction as a defect of superego development and therefore as a moral question . He contends that the alcoholic has a partial responsibility for his illness , which should be viewed in its sado-destructive aspects as a crime . On the surface it would appear that the municipal and state governments in the United States agree with him , since drunkenness is our most frequent criminal offense

The craving concept ' of alcoholism introduces another major theory Meerloo (Kinghan 328 ) described certain steps culminating in addiction when he maintained that the initial intake of alcohol is associated with a general urge for pleasure , elation , and release . With continued consumption of the drug , there develops an artificial ecstasy , a craving and a compulsion to repeat the experience symbolized by intoxication When craving becomes specific and is reinforced by pharmacological dependence , then addiction exists . Meerloo maintains that the personality of alcoholics is usually of the manic-depressive type . The common bonds of all addiction are a craving for ecstatic experience , an unconscious drive for self-destruction , and an unresolved unconscious need for oral dependency . Ecstasy is defined as a feeling of pleasure increased beyond a certain threshold of rationality

Isbell (Ullman 604 ) firmly believes that alcohol withdrawal symptoms are physiologically determined and it is only the coloring or shading of these symptoms that result from psychological factors . He also states that after prolonged abstinence there may no longer exists a physiological requisite for alcohol . The psychological craving arises from a combination of psychiatric and cultural factors with particular emphasis on the latter . An individual with a given set of psychological problems , raised in a culture which frowns upon alcohol , will be less likely to use it to excess than the individual with the same problems raised in a culture which openly tolerates its excess . In other words although psychiatric factors are of prime import , less exposure to alcohol will result in fewer intakes . There fore , according to Isbell the craving for alcohol occurs by chance and because of its ready availability . This contention is supported by the observation that not everyone with personality problems becomes alcoholic , since not everyone uses the same adaptive mechanisms

Lundquist (Wexberg 230 ) approached the concept of craving with the premise that alcohol is used universally because it is a tension reducer . He stated that any activity which easily lessens anxiety tends to become a habit . The ultimate strength of the habit according to Lundquist will depend on the degree of anxiety prompting a search for tension release . Therefore , under appropriate circumstances , a psychological need may intensify to such an extent as to establish a real craving for alcohol . To Lundquist the craving for alcohol is not a continuous but a variable phenomenon . Drinkers - with or without addiction - have a critical point beyond which craving will become manifest the same individual will reach his particular critical craving point with varying amounts at varying times . Consequently , craving for alcohol in Lundquist 's formulation is a learned need , and the intra-individual resistance to the craving depends on the psychic powers of resistance and on the strength of motives which can be mobilized against drinking ' He therefore maintains that the individual 's state of health and social or environmental circumstances will play significant roles in the development of a craving for alcohol .The ever-present female has been indicted in the etiology of male alcoholism . Duchkne has shown that significant numbers of male alcoholics are married to women chronologically older than themselves This phenomenon illustrates the need for mothering or a return to the breast in alcoholism . Navratil carried the female role further . He states that the mother relationship of alcoholics was either one of early deprivation or of excessive indulgence . When a wife was eventually chosen , she was usually one who was motherly and domineering . Sexual life with her was sparse , with either frigidity , lack of interest , or active dislike . Therefore , Navratil considers alcoholism a psychological disturbance of married life , rooted in a psychological disturbance of childhood

Conclusion

Sigmund Freud initially formulated psychoanalysis during the latter part of the nineteenth century . At the heart of psychoanalytic theory is the proposition that the origin of psychopathology is repressed childhood traumatic memories . The retrieval of these memories occurs by lifting the repression , which then produces beneficial results . Freud essentially considered psychoanalysis as a scientifically based methodology . Thus , he claimed that psychoanalysis was a natural science and therefore he looked for scientifically based causal explanations of psychopathology . Freud 's clinical wisdom and acumen were the basis of his scientific approach . For psychoanalysis , the validation of Freud 's theory and methods emanated from clinical observations . In this approach various experimental variables are manipulated in an attempt to analyze relationships between cause and effect . Thus , earlier events that may be traumatic to an individual may be construed as causes of later psychopathology (effects . Freud concluded that psychic trauma that may have occurred earlier in a person 's lifespan can be the reason of person 's subsequent substance abuse . Yet , while Freud 's theory and its ensuing movement have made important contributions to American thought and culture , they have also brought liabilities , chief among them the promotion of irresponsibility . This evolved perhaps logically from the belief that individuals are governed by powerful unconscious forces arising from early childhood experiences , which thereby usurp their freedom of action . That conviction has led , in the words of one writer to the golden age of exoneration ' I think there is not much hope for humankind unless we come up with an understanding of human nature which sheds light on the envious , spiteful , greedy , and destructive sides of our natures

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