Beyond the shadow of drugs: groups with substance misusers *

At the heart of addiction lays a paradox, for, on the one hand drugs provide relief from the difficulties of life, but on the other hand produce unwanted, cumulative suffering. ¹ As attachment to and reliance on drugs increases, its very salience reduces the importance of everything, and everyone, else. Orford’s (2001) integrative model of “excessive appetites” refers to the inordinate nature of such “strong attachments” to substances which, whilst indicative of a possibly hopeful capacity to attach or invest, carry an enormous cost. Khantzian (1993, 2008) uses a contemporary psychodynamic perspective, based on his seminal idea of self-medication, and postulate a “play off” in which the drug user trades different orders of suffering and, “substitutes a kind of pain and distress which they do understand and control for a distress they do not understand and do not control. Both the pain-relieving and pain-perpetuating aspects of addiction are attempts to regulate human psychological suffering” (Khantzian & Albanese, 2008, p. 80).