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Miller, J.R. (1994). Substance Abuse: The Role of Depression and Trauma A Case Report. J. Amer. Acad. Psychoanal., 22(4):753-764.

(1994). Journal of American Academy of Psychoanalysis, 22(4):753-764

Substance Abuse: The Role of Depression and Trauma A Case Report

Julie R. Miller, Ph.D.

Substance abuse is examined from a psychodynamic perspective with special emphasis on pre-oedipal derivatives. Specifically, addictions are a means of self-medicating psychic pain as a desperate and self-destructive means of suppressing conscious and unconscious unresolved depression and trauma while simultaneously repeating the conditions of suffering as a hopeless fantasy of mastering these same stresses. A case example underscores this theme and reinforces the efficacy of a psychodynamic approach. While socio-economic stress is a pervasive etiological agent, we are focusing on the addict as a complex individual driven by subtle intrapsychic forces which are endemic to substance abuse.

Family systems models of substance abuse have recently occupied and dominated the mental health field in terms of etiological constructs and clinical technique (Bowen, 1974; Kaufman, 1979). The psychodynamic paradigms are alluded to or inferred to in the family therapy literature (Ackerman, 1958; Kaufman, 1979; Nagy, 1967) and in sporadic articles. The task of developing a more dynamic outlook lies in reintegration, extracting from family systems theory, and integrating it into a more comprehensive view of families and their responses to interventions.

It is said that addiction serves a primary self-medicating function to escape from the pain engendered by past, current, immediate, and protracted trauma as well as providing an immunity to unconscious past trauma that must be suppressed at all costs. Not surprisingly, reports have established a consistently higher rate of major depressions among drug users than any other diagnosis (Weissman, et al., 1976). Moreover, following abstinence, and detoxification, addicts still show significant signs of depression according to the above author and her colleagues.

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