On Drug Dependence: Clinical Appraisals of the Predicaments of Habituation and Addiction to Drugs

The term drug dependence was adopted by the World Health Organization in 1964 in the awareness that abuse and habituation to drugs call for attention as much as the more severe addictions which can still be considered a minor problem, at least in the statistical sense.

Psychoanalysts have contributed extensively to the understanding of the psychopathology of drug addictions but are reluctant to engage in their treatment, not only because it often leads to disappointment but also because they are aware of their inability to deal with the social implications and complications pertaining to such cases. On the other hand, social psychiatrists cannot cope with the time-consuming demands arising from the severe intra-psychic disturbance presented by the patients and by necessity they concentrate on general management. Drug-dependent individuals therefore can be considered the unwanted children of psychiatry and psychoanalysis and it is understandable that transference and countertransference difficulties aggravate the psychopathology which not infrequently is to be traced back to early states of deprivation and abnormal dependency needs. It is also essential that we should not lose sight of the fact that the physiological and psychological action of addictive drugs is seldom fully understood. It is also quite easy to forget that in treating drug-dependent subjects we are negotiating from a position of weakness from the outset. The cleverest psychoanalyst cannot match the power of marihuana in relieving anxiety, with the same degree of constancy, even if only temporarily. Furthermore, it is undeniable that the psychoanalyst in his daily practice is now frequently confronted with the casual taking of drugs and the occurrence of habituation to stimulants, tranquillizers and the hallucinogens. In this paper it is proposed to explore and describe: (i) the predicaments resulting from the abuse and habituation to certain hallucinogens (LSD and marihuana), (ii) their poten