ABSTRACT
So often in science it is not one perspective, one method of access, one model of understanding, that gives true insight, but the complementarity of opposite ways of looking at, and inquiring into, the phenomena. One version of this dialectic germane to substance abuse is the primary versus the secondary view. In the primary view, the focus is strictly on the phenomenon of the compulsive use of some mind-altering substance and its medical and psychological sequels. The focus on the specific concrete abuse dictates the treatment philosophy: “Drug abuse or alcoholism is the disease. Our main task is to remove the misuse of this noxious agent: everything else is diversion.” The secondary view sees substance abuse of any kind only as a symptom, an expression of a hidden agenda of great complexity, usually involving not just the abuser, but the immediate environment as well, and reflecting not only conscious cognition and feeling, but also the intricate layers of deeper strata. The trickiness lies in the fact that one of these views alone does not suffice. If one explores the unconscious depths, but fails to see and to treat the surface phenomena, one is bound not even to get started in effective treatment. In turn, one who just focuses on the dependency may obtain striking first success, but unless he or she goes beyond the immediately visible problem of substance abuse and studies the underlying psychopathology, will hardly be effective in the long run. The difference between these two viewpoints is a matter of method, not one of more or less truth.
