Abstract
BackgroundWhile traditional psychoanalysis has been criticized as insufficient for the treatment of substance use disorder (SUD), recent progress in the field of neuropsychoanalysis has generated new and promising hypotheses regarding its etiology. However, empirical research applying this framework has been sparse.Aim and ScopeThe present overview aims at developing and empirically validating a neuroscientifically informed psychodynamic framework regarding the etiology of SUD. For this purpose, this review provides a concise overview of the most relevant historical and contemporary psychoanalytic theories on SUD etiology. Furthermore, the original research summarized in this paper consists of three studies investigating connections between childhood trauma, primary emotions, personality structure and attachment, as well as their relation to SUD development and treatment.ConclusionsThe results highlight the empirical validity of the neuropsychoanalytic approach towards SUD etiology. In particular, the findings underscore the conceptualization of SUD as a disorder related to dysfunctional attachment and affect regulation abilities especially linked to increased SADNESS and ANGER dispositions, which mediated the relationship between SUD and traumatic childhood relationships. Based on these findings, a refined model of SUD etiology is proposed, which should be tested in future studies.
Highlights
Substance use disorders (SUD), commonly referred to as addictions, are commonly defined as continuing, pathological, and compelling urges to consume one or more psychoactive substances, despite detrimental effects for oneself and others [1]
This study investigated a sample of young adults aged between 18 and 39 years (M = 26 years; SD = 5.51), which included 500 (63.2% female) German-speaking participants. 37.4% of the investigated participants reported a lifetime diagnosis with a psychiatric disorder
All participants completed the German version of the Affective Neuroscience Personality Scales [ANPS; [162]; German version by Reuter and Hennig (2014; see [163]], the 16-Item Inventory of Personality Organization [IPO-16; [61]], the Childhood Trauma Questionnaire [CTQ; [137]; German version by [164]], the “Depression” subscale of the Brief Symptom Inventory [BSI-18; [165]; German version: [166]], and the Alcohol, Smoking and Substance Involvement Screening Test [ASSIST; [167]]
Summary
Substance use disorders (SUD), commonly referred to as addictions, are commonly defined as continuing, pathological, and compelling urges to consume one or more psychoactive substances, despite detrimental effects for oneself and others [1]. As stated in the World Drug Report 2017, problematic substance use and SUD presently affects about 29.5 million people [2]. The consequences of this disorder impact individual health, and significantly strain the public health systems and inflict a toll upon society not often reported upon. Etiological models related to the work of Jacque Lacan, which have been traditionally neglected in reviews concerned with this topic, might be summarized under the umbrella term structural psychoanalysis. While all of these paradigms are associated content-wise, they often differ substantially in their emphases of specific etiological aspects.
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