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In the following account a specific theoretical schema is applied to an understanding of severe drug abuse in adolescents. The schema is based on exploratory psychotherapy and psychoanalysis of late-adolescent and adult patients who had as a prominent symptom the use of mind-altering drugs. Our method was a microscopic defense analysis—a study of the anxieties and defenses visible in characteristic patterns during therapy sessions.
This method entails a particular attention to the superego which “is in essence itself a defense structure” (Fenichel, 1941, p. 62). Particular attention is paid to shame conflicts as a part of such defense analysis. This study of predominant defenses is an effort to widen and deepen our understanding of the underlying anxiety and danger and of the type of conflict solution arrived at in the illness of compulsive drug use. First, a brief delineation of the problem.
Substance abuse in one form or another is present in all societies. With the much greater variety of such drugs now and their ready availability, drug abuse has developed into one of the