Countertransferential and attitudinal considerations in the treatment of drug abuse and addiction

Examining the relationship of addiction education and beliefs of nursing students toward persons with alcohol problems

This study examined the effectiveness of two methods of teaching nursing students about alcohol addiction. Each student who agreed to participate was given pretests, posttests, and 3-month follow-up tests that measured knowledge about and beliefs held toward people who abuse alcohol. Group 1 received lecture only, whereas group 2 received lecture and discussion with a person who had been sober for many years. Both groups showed improved scores in knowledge and certain aspects of beliefs, however, group 2 showed greater knowledge and more accurate beliefs overall toward this population than group 1. The introduction of a person successfully remaining sober was shown to be an even more effective teaching strategy than lecture alone.

Psicodinâmica do adolescente envolvido com drogas

O uso e o abuso de drogas pelos adolescentes é cada vez mais prevalente e traz desdobramentos sérios nos vários níveis de seu desenvolvimento e na sua família. O presente trabalho aborda as pesquisas no campo epidemiológico sobre fatores de proteção e de risco para o uso de drogas entre os jovens, que demonstram que fracassos tanto pessoais como familiares, além de eventos estressores durante a vida, estão mais associados com o uso de drogas. No entanto, a presença dos pais, a motivação pessoal e o monitoramento do adolescente, estão associados com o não uso. São descritos os principais estudos prospectivos já realizados nessa área. Em seguida, à luz do pensamento de diversos autores como H. Kohut, J. McDougall, H. Rosenfeld, C. Olievenstein, Khantzian, entre outros, apresentam-se teorias psicodinâmicas relacionadas ao problema das adições e sua evolução ao longo dos anos dentro do paradigma psicanalítico. A aplicação das técnicas baseadas nos modelos psicoterápicos de orientação analítica, em dependentes químicos, é também discutida.

Leader dilemmas and countertransference considerations in group psychotherapy with substance abusers

Leader issues and countertransference dilemmas that emerge in psychotherapy groups for substance abusers will be examined along with strategies to extricate the therapist from the impasses that emerge. Specific issues include feelings of helplessness and inadequacy when a patient relapses and resumes substance use, countertransference reactions emanating from an overlapping personal or family history of substance abuse, countertransference helplessness when the therapist is more invested in the treatment than the patient, feelings of incompetence related to partial familiarity with 12-step culture and lingo, and countertransference devaluation fostered by systemic issues in substance abuse settings.

Clinicians' impact on the quality of substance use disorder treatment

Clinicians' impact on substance use disorder treatment has been much less studied than therapy and patient variables. Yet, in this selective review of literature, a growing body of empirical work on clinicians' impact highlights several key issues that have relevance both to clinical practice and future research. These issues include clinicians' effect on treatment retention and outcome, professional characteristics, recovery status, adherence to protocols, counter-transference, alliance, personality, beliefs about treatment, and professional practice issues. Specific recommendations are offered to help improve the quality of care clinicians provide. In particular, it is suggested that greater accountability for clinicians' performance be balanced with increased support for their very difficult role. Methodological issues in studying clinicians are also addressed.

Psychotropic medication management in persons with co-occurring psychiatric and substance use disorders

Persons presenting with concurrent psychiatric and substance problems present unique challenges for diagnosis and for effective and rational treatment planning. This is especially true for psychiatrists attempting to prescribe pharmacologic interventions which will promote recovery from both disorders and improve function. In order to be effective in this endeavor it is important to have a clear understanding of the dynamics of addiction as well as the particular issues and struggles related to mental illness which will affect an individual's attitude toward and use of medication. This article discusses some of the common problems related to diagnostic decision making and initiation of medication in persons with co-occurring disorders. An algorithm for guiding these decisions is presented. Common misconceptions held by these individuals regarding medication, as distinguished from "drugs," are considered. Unique psychodynamic issues that may lead these persons to actively seek medication as a solution to their problems, or which may, conversely, lead them to an outright rejection of medication as a part of their recovery, are discussed. Countertransferential issues influencing the physician's approach to prescribing for this population are also considered. The article concludes with recommendations for pharmacologic approaches to address specific psychiatric syndromes which may present in this population.

Case presentation of a substance-abusing borderline patient. Illustrating use of the immediate transactional experience

This paper presents a severely disturbed self-mutilating person with a chronic substance abuse history. It demonstrates how use of the immediate transactional experience is an analytic model, facilitated treatment. The authentic use of the therapist's self is endorsed as mutative in facilitating personality change in the patient. Fellow professionals are encouraged to respond to this paper in the service of fruitful analytic dialogue, in the service of promoting more effective treatment of this difficult population in equally difficult times.

Treatment needs of drug-addicted mothers. Integrated parenting psychotherapy interventions

Substance abuse among women is associated with several negative maternal as well as child outcomes. This article reviews the theoretical and empirical literature on salient domains of risk and vulnerability among addicted mothers, with a view toward identifying critical components of effective intervention programs.

Variations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review

Despite the widespread use of psychotherapy for patients with substance use disorders, the effectiveness of psychotherapists conducting such treatment has received little research attention. In this paper, empirical studies of therapists' differences in patient outcome and dropout rates are comprehensively reviewed. The main conclusions are that therapists show diverse rates of effectiveness, and that such differences appear independent of both therapists' professional background and of patient factors at the start of therapy. The primary therapist characteristic thus far associated with higher effectiveness is the possession of strong interpersonal skills. Guidelines for research on therapist effectiveness are presented.

Dilemmas and countertransference considerations in group psychotherapy with adult children of alcoholics

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she "understands" because of having also grown up in an alcoholic family); (b) the "will to restore," which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a "rush to recovery" on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) "countertransference goodness and availability" as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.

Clinicians' self-reported reactions to psychiatric emergency patients: effect on treatment decisions

Masters-level social work clinicians at two urban psychiatric emergency services self-rated their cognitive reactions and conscious feelings toward a total of 783 patients. Negative self-reported affect toward patients was related to their displaying overt psychotic symptoms, having a final diagnosis of substance abuse, being impulsive, unemployed, or having a history of criminal behavior. However, clinicians' reactions did not enter into the model predicting hospitalization, which included opinion of family and friends, degree of psychopathology, suicidal ideation and lack of social supports as the major predictors of whether or not a patient would be hospitalized.