Treating Addiction

EDWARD J. KHANTZIAN, MD, is professor of psychiatry at Harvard Medical School and past president of the American Academy of Addiction Psychiatry. Dr. Khantzian is a distinguished scholar, psychiatrist, and psychoanalyst, specializing in addictions for more than forty years. His other work includes Treating Addiction as a Human Process and (with Mark J. Albanese) Understanding Addiction as Self Medication: Finding Hope Behind the Pain.

• Foreword by Martin WeegmannIntroductionPart I. The Internal Terrain of Addiction Psychodynamics 1. Understanding Addictive Vulnerability: An Evolving Psychodynamic Perspective 2. Questions of Substance: Psychodynamic Reflections On Addictive Vulnerability and Treatment3. Addiction: Why Are Some of Us More Vulnerable Than Others 4. The Capacity for Self-Care and Addiction 5. The Self-Medication Hypothesis and Attachment Theory: Pathways for Understanding and Ameliorating Addictive SufferingPart II. The Self-Medication Hypothesis Revisited 6. The SMH and Addiction as a Problem in Self-Regulation 7. The Self-Medication Hypothesis Revisited: The Dually Diagnosed Patient 8. Self-Medication Hypothesis: Connecting Affective Experience and Drug Choice 9. The Self-Medication Hypothesis and Psychostimulant Treatment of Cocaine Dependence: An Update 10. The Psychodynamics of Addiction and Its Treatment: An Interview with New Therapist MagazinePart III. Treatment of Addictive Disorders11.Reflections on Group Treatments as a Corrective for Addictive Vulnerability12.More Reflections on Group Therapy (Interview by Martin Weegmann) 13. ‘Dangerous Desires and Inanimate Attachments’: Modern Psychodynamic Approaches to Substance Misuse14. Reflections on Treating Addictive Disorders: A Psychodynamic Perspective15. A Psychodynamic Perspective on the Efficacy of 12-Step Programs Part IV. Reflections and Lessons Learned16. We Are All At Least a Little Lost and Off-Putting: On Transformation17. Tragic Trends in the Treatment of Addictive Illness 18. Insights on the Insanity of Addiction 19. The Cruel Scourge of Addiction: An Addiction Psychiatrist’s Clinical View 20. Life Learned from Addictions21. Psychophobia and Getting it Right 22. The Theory of Self-Medication and Addiction

In Treating Addiction: Beyond the Pain, Khantzian (Harvard Medical School) presents a collection of his previously published, seminal articles that explore the relevance of psychodynamic theory to the current understanding of addictions and their treatment. He traces the evolution of his thinking and provides supporting evidence specifically related to the self-medication hypothesis of addiction. In contrast to some other hypotheses, including recent neurobiological formulations, Khantzian posits that addictions are rooted in suffering and pain as opposed to pleasure. In his formulation, he humanizes those with substance use disorders, acknowledging their psychological vulnerabilities, quest to alleviate pain, and resiliency in the face of challenges. Through his use of case examples and vignettes, he fosters readers' empathy for people struggling with substance use disorders. This perspective is greatly needed at a time when such people continue to be stigmatized and judged. In presenting complex ideas about addictions, Khantzian uses a conversational style that promotes understanding and openness rather than defensiveness regarding alternative views. Throughout the book, he champions the idea of a “kinder understanding of addicted individuals” alongside a more integrated, humanistic approach to treatment.Summing Up: Recommended. Graduate students through faculty and professionals.