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The authors included in this addition of Psychoanalytic Inquiry join a growing assembly of theorists who raise fascinating new questions about the treatment of substance use. Taking these various perspectives into consideration, we seem to be moving toward a new clinical sensibility around treating substance users that requires what William Coburn (2014) describes as an “unrelenting respect for the complexity of human experiencing … .” This clinical attitude embodies curiosity, compassion, flexibility, and an uncompromising reverence for the individual who enters our consulting rooms. It is a sensibility that challenges us as clinicians to be unremitting in our personal awareness of our own context-embedded biases about substance use. It also requires us to be mindful of our use of stigmatizing language, and to begin to shake off some of the lingering shibboleths that are associated with the traditional models that frighten substance users away from discussing their use with anyone. Additionally, when the going gets tough with a patient whose substance use has escalated, the analyst must be aware of their own anxiety-driven propensity to slide into bifurcated, anxious either/or thinking, and “Hurry up and do something!” interventions. All of these qualities work in a relentless pursuit of what Coburn describes as “grasping the feel of complexity” that would assist a clinician to tolerate the non-linear, often chaotic details that may accompany the treatment of those patients who are not yet ready for abstinence, and who remain on the continuum of substance misuse.
Coburn writes that if one immerses oneself in a psychoanalytic complexity sensibility “[t]here is really no turning back.” I believe this to be true for the psychoanalytic treatment of substance users. If we decide to take on the challenge of learning more about substance use from these contemporary, curious, and empathic perspectives, the more the traditional substance use models cease to make sense. Is su