Psychoanalytic perspectives on substance abuse: implications for treatment, program planning and social policy.

Current clinical and socio-political interventions with substance abusers are based on two suppositions regarding the addict: a cognitive ability to discern harm to oneself, and a corresponding capacity to discipline oneself in recognition of the punitive consequences of behavior. A psychoanalytic understanding of the addict's intrapsychic needs provides clarification of these assumptions: offering a psychodynamic explication of why the addict can not "just say no." A comparative analysis of early psychoanalytic thought and contemporary ego psychology elucidates the relationship between hysteria and the addictions, demonstrated in clinical studies with addicted patients. The clinician's use of self is delineated as a treatment tool, mirroring the need for self-exploration on societal and political levels, with implications for treatment, program planning and social policy.