ABSTRACT
Luis Rodríguez de la Sierra is a psychoanalyst and psychiatrist who has worked in one of the few NHS clinics to offer psychotherapy to addicts. His chapter focuses on adolescents and young adults. Rodríguez de la Sierra points out that very few addicts ask for psychoanalytic treatment and fewer psychoanalysts are willing to take them on, yet treatment, even when of limited success, offers important insights into the nature of addiction.
This chapter looks at the dynamics that tie the addict to the drug. The drug is seen as strengthening as well as overpowering and weakening. This complex relationship distinguishes the addict from the recreational user. The use of drugs in adolescence is closely connected with failed attempts to deal with intense sexual and aggressive feelings. Rodríguez de la Sierra finds that there is a sadomasochistic relationship between the addict and his internalized objects. This has similarities with the sadomasochistic relationship between the binge drinker and his objects described in Marion Bower’s chapter (chapter three).
The risks in treating addicts are made clear in this chapter. One patient makes a serious suicide attempt, and one kills herself after 70 abandoning treatment. Rodríguez de la Sierra suggests that a very careful evaluation needs to be made of the patient’s internal and external circumstances, including the severity of the addiction and whether the addict has tried to abandon the habit before. He also suggests an important modification to the treatment, which is to appoint someone to take on a parental role to help keep the addict safe. With adult patients, the presence of a non-addicted partner can be an important ally.
