The value of relational psychoanalysis in the treatment of chronic drug and alcohol use

A view of chronic drug use that draws on central assumptions in relational theory is proposed. Namely, chronic substance use is seen as being driven by conflicting and unresolved relational dynamics that derive from the early organizing relationships in a person's life. In the case of the substance user, the terms of this conflict find concrete expression in characteristic acts of drug use that serve to perpetuate it through the combined effects of reinforcement and disguise. The goal of treatment is for patient and therapist to find the components of the relational bind that are embedded in the drug use, to reformulate these forces in symbolic terms, and to revisit them in the dynamics of the transference, alongside opportunities for new exchange. Seen this way, the treatment needs of substance users can best be met by a relational model of psychoanalysis, augmented by other approaches needed to address addiction. In particular, the relational emphasis on the role of enactment as a vehicle for the expression of unsymbolized experience, and therefore the source of the phenomena to be analyzed and understood, makes this model especially well suited to substance-using people.