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Brickman, B. (1988). Psychoanalysis and Substance Abuse: Toward a More Effective Approach. J. Amer. Acad. Psychoanal., 16:359-379.

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(1988). Journal of American Academy of Psychoanalysis, 16(3):359-379

Psychoanalysis and Substance Abuse: Toward a More Effective Approach

Bernard Brickman, M.D., Ph.D.


This paper presents the view that traditional psychoanalytic approaches to the treatment of the addictions have been lacking in effectiveness. The author offers his own clinical experience as well as unfavorable outcome studies as support for this statement. He points to a basic methodological flaw in psychoanalytic research that he believes is responsible for the frequently held assumption that substance abuse is secondary to underlying psychopathological states and thus amenable to psychoanalytic influence. An integrated approach, incorporating research findings from other biobehavioral disciplines such as genetics, addictionology, neurophysiology, etc., is proposed as the basis for a more effective means of treating the addictions. The author strongly recommends the early establishment of abstinence as a requirement for effective analytic therapy and discusses the invaluable role of Alcoholics Anonymous and other related mutual help groups in furthering that aim. Thus, the author believes that psychodynamic approaches can proceed more effectively.


The purpose of this paper is to advance the thesis that chemical dependency encountered in psychoanalytic practice is frequently


The author is Training and Supervising Analyst, Southern California Psychoanalytic Institute; Assistant Clinical Professor of Psychiatry, UCLA School of Medicine; and Attending, Cedars-Sinai Medical Center, Los Angeles.

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