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Alcoholics Anonymous and Contemporary Psychodynamic Theory

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Recent Developments in Alcoholism

Part of the book series: Recent Developments in Alcoholism ((RDIA,volume 7))

Abstract

AA’s success rests on its ability to establish and maintain abstinence. This basic and essential accomplishment has tended to detract from the fact that AA is successful in good part because it is a sophisticated psychosocial form of treatment that addresses human psychological vulnerabilities that alcoholics and others share related to problems of self-regulation. The “character defects” that AA addresses are related to attitudes about self and others that are embodied in character traits and styles that make interdependence, experience, and expression of feelings and self-care problematical and difficult. AA confronts these “defects” by effectively advocating surrender, acceptance of a Higher Power, and challenging human self-centeredness. In its insistence on openness, support, sharing of experiences, and mutual concerns, AA imaginatively employs group psychology to address vulnerabilities in self-governance and problems in regulating feelings and self-care.

After a successful psychoanalytic treatment a patient is definitely less neurotic (or psychotic) but perhaps not necessarily more mature. On the other hand after a successful treatment by group methods the patient is not necessarily less neurotic but inevitably more mature. Enid and Michael Balint (1972)

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References

  1. Vaillant GE: The Natural History of Alcoholism. Cambridge, MA, Harvard University Press, 1983.

    Google Scholar 

  2. Hesselbrock MN, Meyer RE, Keener JJ: Psychopathology in hospitalized alcoholics. Arch Gen Psychiatry 42: 1050–1055, 1985.

    Article  PubMed  CAS  Google Scholar 

  3. Schuckit M: The clinical implications of primary diagnostic among alcoholics. Arch Gen Psychiatry 42: 1043–1049, 1985.

    Article  PubMed  CAS  Google Scholar 

  4. Krystal H, Raskin HA: Drug Dependence: Aspects of Ego Functions. Detroit, Wayne State University Press, 1970.

    Google Scholar 

  5. Wurmser L: Psychoanalytic considerations of the etiology of compulsive drug use. J Am Psychoanal Assoc 22: 820–843, 1974.

    Article  PubMed  CAS  Google Scholar 

  6. Khantzian EJ: Some treatment implications of the ego and self-disturbances in alcoholism, in Bean MH, Zinberg NE (eds): Dynamic Approaches to the Understanding and Treatment of Alcoholism. (New York, Free Press, 1981, pp. 163–188.

    Google Scholar 

  7. Mack JE: Alcoholism, A.A. and the governance of the self, in Bean MH, Zinberg NE (eds): Dynamic Approaches to the Understanding and Treatment of Alcoholism. New York, Free Press, 1981, pp. 128–162.

    Google Scholar 

  8. Simmel E: Alcoholism and addiction. Psychoanal Q 17: 6–31, 1948.

    PubMed  CAS  Google Scholar 

  9. Henrick I: Work and the pleasure principle. Psychoanal Q 12: 311–329, 1943.

    Google Scholar 

  10. Heizer JE, Robins LN, Taylor JR, Carey K, Miller RH, Combs-Orme T, Farmer A: The extent of long-term moderate drinking among alcoholics discharged from medical and psychiatric treatment facilities. N Engl J Med 312: 1678–1682, 1985.

    Article  Google Scholar 

  11. Alcoholics Anonymous: Twelve Steps and Twelve Traditions. New York, Alcoholics Anonymous World Services, 1955 and 1977.

    Google Scholar 

  12. Bales RF: The therapeutic role of Alcoholics Anonymous as seen by a sociologist. Q J Stud Alcohol 5: 267–278, 1944.

    Google Scholar 

  13. Bean MH: Alcoholics Anonymous: A.A. Psychiatr Ann 5: 3–64, 1975.

    Google Scholar 

  14. Bean MH: Denial and the psychological complications of alcoholism, in Bean MH, Zinberg NE (eds): Dynamic Approaches to the Understanding and Treatment of Alcoholism. New York, Free Press, 1981, pp. 55–96.

    Google Scholar 

  15. Brown S: Treating the Alcoholic: A Developmental Model of Recovery. New York, John Wiley and Sons, 1985.

    Google Scholar 

  16. Alcoholics Anonymous. New York, Alcoholics Anonymous World Services, 1939 (1st ed), 1976 (3rd ed), 1978 (4th ed).

    Google Scholar 

  17. Leach B: Does Alcoholics Anonymous really work?, in Bourne P, Fox R (eds): Alcoholism: Progress in Research and Treatment. New York, Academic Press, 1973.

    Google Scholar 

  18. Leach B, Norris JL, Dancey T, Bissell L: Dimensions of Alcoholics Anonymous Int J Addictions 4: 507–541, 1969.

    Google Scholar 

  19. Stewart DA: The dynamics of fellowship as illustrated in Alcoholics Anonymous. Q J Stud Alcohol 16: 251–262, 1955.

    PubMed  CAS  Google Scholar 

  20. Tiebout HM: Therapeutic mechanisms of Alcoholics Anonymous. Am J Psychiatry 100: 468–473, 1943-44.

    Google Scholar 

  21. Tiebout HM: Alcoholics Anonymous: An experiment of nature. Q J Stud Alcohol 22: 52–68, 1961.

    PubMed  CAS  Google Scholar 

  22. Trice HM: A study of the process of affiliation with Alcoholics Anonymous. Q J Stud Alcohol 18: 39–54, 1957.

    PubMed  CAS  Google Scholar 

  23. Zinberg NE: Alcoholics Anonymous and the treatment and prevention of alcoholism. Alcohol Clin Exp Res 1: 91–101, 1977.

    Article  PubMed  CAS  Google Scholar 

  24. Kohut H: The Analysis of the Self. New York, International Universities Press, 1971.

    Google Scholar 

  25. Kohut H: The Restoration of the Self. New York, International Universities Press, 1977.

    Google Scholar 

  26. Kohut H, Wolf ES: The disorders of the self and their treatment: An outline. Int J Psychoanal 59: 413–426, 1978.

    Google Scholar 

  27. Goldberg A et al: The Psychology of the Self. New York, International Universities Press, 1978.

    Google Scholar 

  28. Ornstein PH (ed): The Search for the Self. Selected Writings of Heinz Kohut. Vols. I and II. New York, International Universities Press, 1978.

    Google Scholar 

  29. Baker HS, Baker MN: Heinz Kohut’s self psychology: An overview. Am J of Psychiatry. 144: 1–9, 1987.

    CAS  Google Scholar 

  30. Khantzian EJ: Psychotherapeutic interventions with substance abusers-the clinical context. J Subst Abuse Treat 2: 83–88, 1985.

    Article  PubMed  CAS  Google Scholar 

  31. Rosenberg P: Support groups: A special therapeutic entity. Small Group Behav 15: 173–186, 1984.

    Article  Google Scholar 

  32. Freud S: Group Psychology and the Analysis of the Ego. In Standard Edition, Vol 18. London, Hogarth, 1955. (Originally published in 1921.)

    Google Scholar 

  33. Freud S: Civilization and Its Discontents. In Standard Edition, Vol 21. London, Hogarth, 1961. (Originally published in 1930.)

    Google Scholar 

  34. Calder K: Psychoanalytic knowledge of group processes: Panel report. J Am Psychoanal Assoc 27: 145–156, 1979.

    Google Scholar 

  35. Kernberg OF: Large group processes: Psychoanalytic understanding and applications. Paper presented at the panel on Psychoanalytic Knowledge of Group Processes. New York, American Psychoanalytic Association, Dec 18, 1977.

    Google Scholar 

  36. Scheidlinger S: Identification: The sense of belong and of identity in small groups. Int J Group Psychother 14: 291–306, 1964.

    PubMed  CAS  Google Scholar 

  37. Scheidlinger S: On the concept of the “mother-group.” Int J Group Psychother 24: 417–428, 1974.

    PubMed  CAS  Google Scholar 

  38. Brown S, Yalom ID: Interactional group therapy with alcoholics. J Stud Alcohol 38(3): 426–456, 1977.

    PubMed  CAS  Google Scholar 

  39. Vanicelli M: Group psychotherapy with alcoholics. J Stud Alcohol 43(1): 17–37, 1982.

    Google Scholar 

  40. Zinberg NE, Fraser KM: The role of the social setting in the prevention and treatment of alcoholism, in Mendelson JH, Mello NK (eds): The Diagnosis and Treatment of Alcoholism. New York, McGraw-Hill, 1979.

    Google Scholar 

  41. Spruiell V: Three strands of narcissism. Psychoanalytic Q 44: 577–595, 1975.

    CAS  Google Scholar 

  42. Khantzian EJ: A clinical perspective of the cause-consequence controversy in alcoholic and addictive suffering. J Am Acad Psychoanal 15 (4): 521–537, 1987.

    PubMed  CAS  Google Scholar 

  43. Schur M: The Id and the Regulatory Principles of Mental Functioning. New York, International Universities Press, 1966.

    Google Scholar 

  44. Tomkins S: Affects, Imagery, and Consciousness, Vol 1. New York, Springer, 1962.

    Google Scholar 

  45. Gottheil E, Alterman AI, Skoloda TE, Murphy BF: Alcoholics’ patterns of controlled drinking. Am J Psychiatry 130: 418–422, 1973.

    PubMed  CAS  Google Scholar 

  46. Pattison EM, Sobell MB, Sobell LC: Emergency Concepts of Alcohol Dependence. New York, Springer, 1977.

    Google Scholar 

  47. Mathew JR, Claghorn JK, Largen J: Craving for alcohol in sober alcoholics. Am J Psychiatry 136: 603–606, 1979.

    PubMed  CAS  Google Scholar 

  48. Ludwig AM: On and off the wagon: Reasons for drinking and abstaining by alcoholics. Q J Stud Alcohol 22: 124–134, 1961.

    Google Scholar 

  49. Schmale AH: A genetic view of affects. Psychoanal Study Child 19: 287–310, 1964.

    Google Scholar 

  50. Lane RD, Schwartz GE: Levels of emotional awareness: A cognitive-developmental theory and its application to psychopathology. Am J Psychiatry 144(2): 133–143, 1987.

    PubMed  CAS  Google Scholar 

  51. McDougall J: The “dis-affected” patient: Reflections on affect pathology. Psychoanal Q 53: 386–409, 1984.

    PubMed  CAS  Google Scholar 

  52. Khantzian EJ: Impulse problems in addiction: Cause and effect relationships, in Wishnie H (ed): Working with the Impulsive Person. New York, Plenum Press, 1979, pp 97–112.

    Chapter  Google Scholar 

  53. Krystal H: Alexithymia and the effectiveness of psychoanalytic treatment. Int J Psychoanal Psychother 9: 353–378, 1982.

    PubMed  Google Scholar 

  54. Sashin JI: Affect tolerance: A model of affect-response using catastrophe theory. J Soc Biol Struct 8: 175–202, 1985.

    Article  Google Scholar 

  55. Martin WR, Haertzen CA, Hewett BB: Psychopathology and pathophysiology of narcotic addicts, alcoholics, and drug abusers, in Lipton MA, DiMascio A, Killam KF (eds): Psychopharmacology: A Generation of Progress. New York, Raven Press, 1978.

    Google Scholar 

  56. Sifneos PE: Clinical observation on some patients suffering from a variety of psychosomatic diseases, in Proceedings of the Seventh European Converence on Psychosomatic Research. Basel, Karger, 1967.

    Google Scholar 

  57. Nemiah JC: Denial revisited: Reflections on psychosomatic theory. Psychother Psychosom 26: 140–147, 1970.

    Article  Google Scholar 

  58. Khantzian EJ: The self-medication hypothesis of addictive disorders. Am J Psychiatry 142(11): 1259–1264, 1985.

    PubMed  CAS  Google Scholar 

  59. Menninger KA: Man Against Himself. New York, Harcourt, Brace, 1938.

    Google Scholar 

  60. Tabachnick N: Death trend and adaptation. J Am Acad Psychoanal 41: 49–62, 1976.

    Google Scholar 

  61. Khantzian EJ, Mack JE: Self-preservation and the care of the self—ego instincts reconsidered. Psychoanal Study Child 38: 209–232, 1983.

    PubMed  CAS  Google Scholar 

  62. Freud S: The Claims of Psychoanalysis to Scientific Interest. In Standard Edition, Vol 13. London, Hogarth, 1955. (Originally published in 1913.)

    Google Scholar 

  63. Freud S: Instincts and Their Vicissitudes. In Standard Edition, Vol 14. London, Hogarth, 1957. (Originally published in 1915.)

    Google Scholar 

  64. Freud S: Introductory Lectures on Psychoanalysis. In Standard Edition, Vol 16. London, Hogarth, 1963. (Originally published in 1916/17.)

    Google Scholar 

  65. Freud S: An Autobiographical Study. In Standard Edition, Vol 20. London, Hogarth, 1959. (Originally published in 1925.)

    Google Scholar 

  66. Freud S: An Outline of Psychoanalysis. In Standard Edition, Vol 23. London, Hogarth, 1964. (Originally published in 1949.)

    Google Scholar 

  67. Bateson G: The cybernetics of “self”: A theory of alcoholism, in Steps to an Ecology of Mind. New York, Ballantine, 1972, pp. 309–337.

    Google Scholar 

  68. McGarty R: Relevance of Ericksonian psychotherapy to the treatment of chemical dependence. J Subst Abuse Treat 2: 147–151, 1985.

    Article  PubMed  CAS  Google Scholar 

  69. Balint E: Fair shares and mutual concerns. Int J Psychoanal 53: 61–65, 1972.

    PubMed  CAS  Google Scholar 

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Khantzian, E.J., Mack, J.E. (1989). Alcoholics Anonymous and Contemporary Psychodynamic Theory. In: Galanter, M. (eds) Recent Developments in Alcoholism. Recent Developments in Alcoholism, vol 7. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1678-5_4

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  • DOI: https://doi.org/10.1007/978-1-4899-1678-5_4

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