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Khantzian, E.J. (1978). The Ego, the Self and Opiate Addiction: Theoretical and Treatment Considerations. Int. R. Psycho-Anal., 5:189-198.

(1978). International Review of Psycho-Analysis, 5:189-198

The Ego, the Self and Opiate Addiction: Theoretical and Treatment Considerations

E. J. Khantzian

Until recently, the psychoanalytic literature on addiction stressed the pleasurable aspects of drug use to explain the compelling nature of addiction (Abraham, 1960) ; (Freud, 1905) ; (Rado, 1933), (1957). Although Rado and others (Fenichel, 1945) ; (Savitt, 1963) ; (Wikler & Rasor, 1953) appreciated underlying factors of depression, tension and anxiety, many of these same workers continued to place particular emphasis on the euphoric-pleasurable aspects of drug use. Most of this literature on addiction focuses on the regressive gratification of libidinal instincts achieved through the use of addictive substances. Glover's (1932) work stands in striking contrast to the other theoretical explanations of addiction. He stressed that addicts used their substance progressively (as opposed to regressively) to defend against primitive, sadistic impulses and to avoid psychosis. He seemed to better appreciate the enormous difficulties addicts have with their aggression and viewed the sexual and pleasurable aspects of drug use as defensive responses to the underlying problems with aggression.

More recent works (Chein et al., 1964) ; (Khantzian, 1974), (1975) ; (Khantzian et al., 1974) ; (Krystal & Raskin, 1970) ; Milkman & Frosch, 1973) ; (Wieder & Kaplan, 1969) ; (Wurmser, 1974) have stressed the adaptive use of drugs and have tried to incorporate a better appreciation of how the psychopharmacologic action of the different drugs interact with the personality organization of addicted individuals.

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