The Psychoanalysis of a Drug Addict

To contribute to the somewhat sparse literature on the psychoanalytic treatment of drug addicts, the writer will describe here an interesting case from his own practice. The patient, a thirty-three-year-old physician, whom we shall call Peter,* was first referred to the writer about a year before he started. His wife, who, as will be seen, dominated his life, objected to the idea that a physician should go to a lay analyst. In deference to her, he went to a man who, she had discovered, was considered the most promising young analyst in New York, even though he had not yet reached the status of institute membership.

In this first analysis, the analyst adopted a vigorous attitude toward the drug. He interpreted the drug as milk, and insisted that Peter take the drug every four hours, as though he were an infant on a rigid feeding schedule. Further, he informed the patient that he would be seen in psychoanalytic therapy three times a week and would sit up, switching to psychoanalysis and the couch when it seemed appropriate. Peter did not understand these reservations, in spite of his medical training.

In three months of this treatment Peter made considerable external progress. When he first went into treatment he had been too depressed to work. His therapy was subsidized by his family. One source of resentment for Peter was that the analyst would not reduce his fee as a professional courtesy: Another was his feeling that the psychiatrist was jealous of his (Peter's) greater medical knowledge.

Nevertheless, the immediate result seemed to be excellent. Peter recovered sufficiently to get back to work. At this point the analyst announced that the sessions would be increased to five per week, that they would switch to analysis conducted on the couch, and that henceforth the patient would have to pay the fee out of his salary. Peter deeply resented this last demand because the increased analytic fee exceeded his entire salary.