Abstract
Scientific and clinical work concerning the etiology of substance use and addiction has come a long way in the past decades. Current theories highlight the notion that addiction is rooted in deficits in neurobiological and psychological reward mechanisms, but also as a coping-oriented effort to contend with, or “self-medicate,” negative emotional experiences. As such, contemporary approaches in the dynamic psychotherapy of addiction highlight the compensatory nature of addiction, encouraging clinicians to detect the mental suffering underlying addiction and promote alternative coping behaviors. In this perspective article, the authors advocate for an integrative approach toward understanding and addressing addiction in psychotherapy, acknowledging its biological, psychological and social aspects. We propose that in addition to the regulatory process of self-medication, in which negative emotions are being suppressed, compulsive substance use may also reflect a substitutive function, in which negative emotions are being 'acted-out' through the use of drugs or alcohol. We suggest an integrative clinical approach which addresses these psychological aspects in a sequential manner and discuss consequent benefits for clinicians and patients working with and through addiction.
Highlights
Understanding Addiction: The Neuropsychological RevolutionDuring the past three decades, the understanding of addiction and its etiology has profoundly improved following scientific revelations concerning the neurobiological mechanisms underlying the compulsive nature of substance use, as well as new theoretical conceptualizations of the mental phenomenology and etiology of addiction [1, 2]
Psychotherapists who are not trained in addiction psychotherapy, or those unacquainted with this model, may focus on the self-medicating function of their patients’ addiction, while undermining other important aspects of their disorder. For those clinicians, relying predominantly on self-medication in understanding and relating to addiction in psychotherapy may serve as an intuitive and pragmatic clinical framework, yet it may be limiting due to the following reasons: [1] It often undermines the significance of impaired reward mechanisms to formation and preservation of addiction [2] it offers a somewhat narrow scope for understanding the psychological mechanisms underlying addiction, and [3] it denies clinicians a wide repertoire of interventions which may offer a therapeutic benefit while working with clients suffering from addiction
We propose an initial outline for an integrative model of addiction psychotherapy, based on “theoretical integration,” a concept in which several theoretical frameworks are combined to form a treatment approach [12]
Summary
During the past three decades, the understanding of addiction and its etiology has profoundly improved following scientific revelations concerning the neurobiological mechanisms underlying the compulsive nature of substance use, as well as new theoretical conceptualizations of the mental phenomenology and etiology of addiction [1, 2]. Psychotherapists who are not trained in addiction psychotherapy, or those unacquainted with this model, may focus on the self-medicating function of their patients’ addiction, while undermining other important aspects of their disorder For those clinicians, relying predominantly on self-medication in understanding and relating to addiction in psychotherapy may serve as an intuitive and pragmatic clinical framework, yet it may be limiting due to the following reasons: [1] It often undermines the significance of impaired reward mechanisms to formation and preservation of addiction [2] it offers a somewhat narrow scope for understanding the psychological mechanisms underlying addiction, and [3] it denies clinicians a wide repertoire of interventions which may offer a therapeutic benefit while working with clients suffering from addiction. She reported feeling highly agitated and anxious prior to and during her performances and reported using prescription tranquilizers in increasing amounts in order to relieve her anxiety
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