You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
‘Relapse is the most common outcome of treatment in addiction’ (p. 117). Despite such trenchant opening lines (this one from a chapter on relapse prevention), this is by no means a pessimistic book. In assembling 13 chapters by various writers working in the field of drug and alcohol addiction, it attempts to construct a framework for understanding the causes and manifestations of addiction in psychoanalytic terms. The editors' aim is to reclaim this client group from the relative neglect it has received from the world of psychotherapy. (Oddly, since their high rate of diagnosis is much more recent, eating disorders seem to be exempt from this neglect.) Two main reasons are adduced for this: one is the tendency to see all substance misusers as the same, perhaps because of the convergence of their behaviours when under the influence of the drug (i.e. they are all manipulative and unreliable); and the other is the blurring of cause and effect: ‘There is a distinction between psychopathology as a background to the development of addiction, and psychopathology which results from addiction’ (Weegman, p. 84). Other obstacles to understanding, and therefore to the willingness to treat, have been the very small samples on which earlier writers based their theories of addiction, generalizing from one or two patients (Abraham 1908; Rado 1933), and their tendency to fit addiction into a single pre-existing diagnostic group (manic-depressive, borderline or narcissistic are recurring categories). Even when drawing heavily on Kohut's theories, Weegman states: ‘There is no general personality type for addicted individuals, though the wider notion of damage to and deficits of the self is one which can be applied to different personalities and temperaments. It is a structural concept’ (p. 49). Similarly, there is no one form of treatment which will suit all those who abuse substances.
The opening chapter by Arthur Hyatt Williams suggests that the drug is used as a container for a rea