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Wieder, H. Kaplan, E.H. (1969). Drug Use in Adolescents—Psychodynamic Meaning and Pharmacogenic Effect. Psychoanal. St. Child, 24:399-431.

(1969). Psychoanalytic Study of the Child, 24:399-431

Drug Use in Adolescents—Psychodynamic Meaning and Pharmacogenic Effect

Herbert Wieder, M.D. and Eugene H. Kaplan, M.D.

SUMMARY

In our formulations of the structure of the symptom of drug use, we emphasize that the choice of a specific drug derives from the mutual interaction of the psychodynamic meaning and pharmacogenic effect of the drug with the particular conflicts and defects in a person's psychic structure throughout his development. For this reason, drugs are not as indiscriminately chosen or as freely interchangeable as superficial observation might indicate. When changes in drug preferences occur, as they do, they indicate that internal psychodynamic changes have occurred.

The adolescent struggle with the biological upsurge of the drives and the regressive resurgence of archaic childhood fears and wishes temporarily threaten the loss of social adaptation, sublimations, rationality, and maturity. Therefore, the adolescent is particularly vulnerable to drugs holding out the promise of magic alleviation of his distress.

The drug user's reaction to the pharmacological properties of the drug—in terms of the degree and nature of the induced regressive experience sought—affords us insight into the extent and nature of his psychopathology. The chronic need for the pharmacogenic effect, subjectively experienced as craving, is a consequence of fixation or regression to pregenital levels of functioning. The more urgent the need for continuing pharmacogenic effects, the more severe is the pathology. Borderline and psychotic patients rely on drugs in this way to shore up and supply controls and gratifications which adequate structuralization provides unaided. Drugs act as an energic modifier and redistributor, and as a structural prosthesis.

The states of intoxication produced by different drugs have certain resemblances to specific developmental phases of early childhood. LSD states were compared with the autistic phase in the sense that LSD produces a toxic psychosis the phenomenology of which resembles "cracking the autistic shell." The dreamy lethargy, the

blissful satiation, and the fantasies of omnipotence, experienced while "on the nod" with opiates, have similarities with the narcissistic regressive phenomenon of the symbiotic state. The effects of amphetamines are reminiscent of the "practicing period" of the separation-individuation phase.

Each drug in sufficient dosage will invariably and universally produce a specific state of intoxication, irrespective of individual psychopathology. However, the latter determines the person's reaction to these pharmacogenic effects. When an individual finds an agent that chemically facilitates his pre-existing preferential mode of conflict solution, it becomes his drug of choice. The drug induces a regressive state, but the drug taker supplies the regressive tendencies. The fixations and regressions that occurred prior to drug-taking and the unconscious wish to regress to a specific developmental level are among the determinants of drug choice.

These regressive tendencies are opposed by fears of loss of control and by progressive wishes for activity and mastery of both inner and outer worlds. Anxiety erupts when intoxication regressively transforms actively directed ego functions to passive ego experiences. Thus, both alcohol and marijuana in low dosages seem to lower the barrier against the discharge of drives and impulses. However, this effect of alcohol is experienced by the younger adolescents as releasing too much drive, leading to fears of loss of control. They prefer the shorter acting, less diffuse, and more controllable marijuana. The intoxications produced by alcohol and marijuana may be correlated with different developmental phases. The healthier adolescent who experiments with drugs will eventually reject his enslavement to drugs which conflicts sharply with his progressive wishes; he will then use alcohol or marijuana only casually and intermittently, in the manner of the healthier adult. Those who persist in taking drugs are persons who have suffered significant regressive disorganization and faulty structuralization in early childhood, that is, prior to taking drugs in adolescence. For this reason only the more disturbed individuals will seek the continued effects of opiates, amphetamines, or LSD. Only alcohol or marijuana can be employed casually without severe regressive consequences, although their continued, extensive use also reflects severe psychopathology.

Physical dependency and abstinence phenomena add the complication of an artificial drive structure. Secondarily elaborated into fantasies threatening abandonment and destruction, these impulses renew the search for the drug.

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