Psychoanalytic Approches to Addiction. Angelo Smalino, ed. New York: Brunner Mazel, 1991.  122 pp..

Historically, psychoanalysis has not been seen as an effective treatment modality for the addictions. However, patients who are dependent on alcohol, drugs, food, gambling and compulsive relationships are increasingly found in psychoanalytic practices. Also, it is not unusual for the analyst to recognize previously undisclosed addiction, in patients who have entered for other reasons. If patients who either admit or deny their addiction seek psychoanalysis, then analytic theory and practice must reflect more accurately the growing knowledge we have about treating pre-oedipal condition, including the addictive disorders.

This slim collection of papers is a milestone in that analysts, until recently, have not written about the psychoanalysis of addictive disorders, This is due to the widely held belief that such patients are not good candidates for psychoanalytic therapy. The contributors to this monograph write about their experiences in treating addicted petients using various analytic approches, including classical Freudian, object-relations and self-psychology. They all conceptualize addiction as a defense whose function must be understood dynamically, for only then can it be treated properly. For example, addiction may be a defense used to ward off feelings, to avoid intimacy, and/or as failed attempt to tolerate early infantile object loss and the aggression and depression that accompany the loss.