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Dr. Esman's interesting and thoughtful paper does indeed address itself to a social phenomenon that has been directing the attention of psychoanalysts to the special concerns and implications of treatment situations in which adolescents and young adults in increasing numbers are using the various non-narcotic drugs.
In contrast with drug usage by the adolescent and young adult in the pre- and immediately post-World War II period, this phenomenon is not limited to a lower socio-economic or any other particular cultural group.
I share with Dr. Esman the impression that the use of these drugs among 16 to 25-year-olds and among the intellectually oriented, affluent and culturally sophisticated middle class is indeed widespread. Because of this, the analyst, as Dr. Esman illustrated, may at times have his attention drawn and his energies directed to the external factors in his patients' milieu.
Without minimizing the significance of environmental pressures, I believe that when the analyst can keep his focus on the identity struggle of his adolescent and young adult patient, he provides himself with the best opportunity to be able to interpret his patient's particular interest in and momentary need of the drug in question to him. I agree that the analyst must of course be prepared to follow a flexible, non-judgmental approach by assessing each case on its merits.
In the many cases where drug use is not only not anxiety-provoking but is supported by the cultural milieu, the analyst must focus his attention and direct his interpretations to the areas where anxiety or its derivatives are manifest. In this way he fosters the establishment of the therapeutic alliance, so necessary to withstand the pressures from the environment.
I believe that Dr. Esman shares my understanding that the adolescents' use of the nonnarcotic drugs is much more aligned to his own struggles in regard to “identity fusion and identity diffusion” as noted by Erikson. This seems apparent in Dr. Esman's state