ABSTRACT
The patient’s presenting symptoms focused around serious substance abuse and depression. His substance abuse began as a way of dealing with migraine headaches, among other bodily symptoms of extreme tension, which itself was related to severe anxiety in his vocational and social life. The patient, an appealing but inhibited young man, came to therapy following his third inpatient hospitalisation for substance abuse treatment. His promising career had collapsed because of his addiction to opiate medication, drugs that had actually become his secret solution to the intense anxiety, desperation to please, and frantic over-investment he experienced in his work life. While this level of driven devotion had earned him promotions and the regard of his boss, it was unsustainable, and this basic fact registered as extreme distress in the patient’s body. After a number of months of very little use of his pain-killing medication, the patient made no move in the direction of formally discontinuing the prescription.
