Perspectives on Substance Use, Disorders, and Addiction: With Clinical Cases

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Margaret Fetting

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    Acknowledgements

    For Nikolaos Ritsonis

    Mon homme

    Preface to the Second Edition

    I have been teaching, writing, and clinically practicing in the substance use disorders (SUDs) field for nearly 3 decades. I remain endlessly fascinated and intrigued by our individual relationships with alcohol and drugs, including during pleasurable states of intoxication, during destructive states of excess, or during lifetimes of refrain.

    My first text, Perspectives on Addiction (2012), presented readers with the knowledge base that I developed during my years of teaching graduate students in the School of Social Work at the University of Southern California, as well as other Los Angeles and European universities. Course content included many of the professionally agreed-upon areas of study in the substance use disorders field including sociocultural influences, psychoactives and the brain, models of treatment with brief and long-term interventions, evidence-based treatments, psychopharmacology, and the use of support groups.

    My 2012 text emphasized the importance of addressing, assessing, and exploring our unique relationship with substances of pleasure with the help of 12 clinical sketches. I also combined a psychoanalytic attitude and sensibility with the more traditional mindset of the substance use disorders field. Substance use disorders treatment is deepened when a nondirective, reflective analytic perspective and attitude are coupled with the sometimes inflexible and confrontational approaches of traditional recovery treatments. Perspectives suggests that the combination of these two clinical styles promotes more engaging treatment.

    This second edition of Perspectives on Substance Use, Disorders, and Addiction is a philosophical, sociocultural, and clinical text that presents a refreshing blend of ancient and contemporary ideas on the natural pleasures and potential powers of alcohol and drugs in our everyday individual and collective lives. This edition of Perspectives emphasizes each person’s unique ego syntonic or dystonic relationship with both substances and non-substance-related behaviors of pleasure. Hopefully, these perspectives will help the reader detangle some of the sentimental, overvalued, and misguided ideas that currently muddle the substance use disorders field.

    Readers of both books will notice that I have undergone an energetic evolution in my philosophical approach to substance use and its disorders since writing my first edition 6 years ago. At that time, I began living and working in Europe, and this resulted in my developing a broader conceptualization of the place of drinking and drugging in our lives, including more flexible responses to problematic or excessive use.

    Other forces influencing my evolution in thinking include the following developing perceptions: that we have overvalued the prevalence of true addiction in this country and undervalued the universal desire to escape reality with alcohol and other drugs (AOD); that we have underappreciated the fact that people will naturally have problems managing something so pleasurable and have oversold the universal prescription of abstinence for all nature of problems; that the DSM-5 spectrum approach to diagnosis introduced a radical shift in our conceptualization of problems with AOD; that, as a culture, we seem to have compulsively adopted the disease model of thinking and are having a hard time accepting and integrating more wide-reaching, inclusive, and flexible approaches; that we have neglected to integrate the thinking and experiences of other parts of the world that have a decidedly different orientation toward alcohol, drugs, pleasure, and excess; and finally, that we have not yet linked the rising rates of addiction with our individual and cultural attempt to self-medicate the disorienting anxieties generated from the impact of our 24-hour globalized world.

    Europeans’ approach to drinking piqued my curiosity, which led me to study the place of alcohol in ancient Greek culture. What I discovered was enlightening and seemed a particularly useful perspective for challenging some of the rigidity that exists in the field today. In the rough-and-tumble of polemics and politics, we have lost an appreciation of the basic fact that human beings like to escape consciousness and reality with the help of alcohol and other drugs. This desire is benign, not sinister or sinful; nor are its excesses necessarily pathological. Help or assistance with problems can be convivial and, at the same time, exact responsibility for our countenance. A symposium approach to treatment, developed from ancient philosophies as well as the current DSM-5 spectrum, is presented that is based on the “fourth drive,” psychoanalytic concepts for deepening the therapeutic relationship, harm reduction, and self-medication.

    The impact of globalization on rising addiction rates worldwide has also captured my attention. I began to study the dislocation theory of addiction that proposes that more and more individuals self-medicate to soothe the anxieties, confusions, and frustrations of trying to survive in an interconnected, overstimulating, ever-changing, technology-driven, and global free-market economy. We live in a state of vague ambiguity and seek out compulsive and addictive behaviors to quiet our fears and worries.

    The content, tone, and spirit of Perspectives invite the reader on an expedition in the substance use and substance disorders field that is exploratory-based, not pathology-based; its focus is philosophical, sociocultural, and clinical, not scientific; it is preventative, not reactive; it is educational, not formulaic; it encourages individual discovery, not predetermined solutions; it leads to well-being, not necessarily to abstinence.

    Hopefully, Perspectives will serve as a passionate contribution to our contemporary conversations on the philosophically and clinically complex field of substance use, disorders, and addiction.

    Acknowledgments

    The solitary nature of writing is dependent on the support of many. Mike Eigen, a psychoanalyst and inspiration, imagines this support as the background presence of an unknown boundless other. Many thanks to these others. What follows are some supporters I know.

    I cannot imagine this book being undertaken or completed without the intelligence, work ethic, spirit, participation, and patience of Angie Harwood, my creative assistant and frontline editor. We began working together at USC 6 years ago. We are a formidable team, living in different countries and different time zones, and also with competing needs and interests. Angie has gifted me with her creativity in conceptualization, elaboration, and editing. She is the kind of person we all need: one who is there from day one and there at the end, and by her sheer presence helping to keep all afloat the days in between.

    I also deeply appreciate Ed Khantzian for his original and courageous contributions to the substance use disorders field. He is a dedicated leader and a very generous and kind professional. His gracious support of my work continues to inspire and humble me at the same time. The field is forever indebted to his body of work.

    I am continually moved and inspired by the creative thinking and original capturing of human experience in the work of psychoanalyst Mike Eigen. I thank him for his generous support of my efforts in bringing a psychoanalytic attitude to the substance use disorders field.

    I am also deeply appreciative of the kind support of Andrew Tatarsky. His contribution to our field is truly groundbreaking.

    I also deeply value the courageous and spirited work and support of journalist and author Gabrielle Glaser and the creative clinical work of Carrie Wilkens.

    I deeply appreciate the Los Angeles Institute and Society for Psychoanalytic Studies and Deree College in Athens, Greece, for inviting me to serve on their faculty and also supporting my efforts to bring psychoanalytic concepts into addiction treatment.

    Linda Sobelman has kept my mind and heart afloat. Dominique Robertson, my dear friend, stayed close and once again provided encouraging comments on my manuscript. I’m deeply grateful for the ongoing support of my esteemed USC colleagues Doni Whitsett and Wendy Smith.

    Once again, I am blessed with the editorial grace and wisdom of Kassie Graves, associate director and publisher, College Editorial, SAGE Publications. She is a joy.

    The support of my sister-in-law, Alexandra Ritsonis, is deeply meaningful. She is the reader all writers dream of—she read every word of the first edition of Perspectives, and she also graced me with many warm and enlivening conversations.

    I am grateful for the support of my family on the East Coast, including Mark Fetting, Lacy Fetting, Ann Lacy Bollinger, Brandon Bollinger, and Joseph J. Lacy, Sr.

    I am profoundly moved by the courage of each of my patients.

    My husband, Nikolaos Ritsonis, has been in my court and by my side like no other person in my life.

    SAGE Publications gratefully acknowledges the following reviewers: Christopher K. Budnick, North Carolina State University; Jo Cohen Hamilton, Kutztown University; Dov B. Finman, Adelphi University; Jason D. Florin, College of DuPage; Dian Jordan, University of Texas of the Permian Basin; Todd F. Lewis, University of North Carolina; Sue Burdett Robinson, Hardin-Simmons University; Chris Rybak, Bradley University; and Robert Scholz, Pepperdine University.

    About the Author

    Margaret Fetting , PhD, has been teaching substance use disorders in southern California for over 25 years. She currently lives and works in Europe and the United States, and studies and observes drinking attitudes and behavioral patterns from a global perspective. Fetting has been primarily affiliated with the School of Social Work at the University of Southern California, and is a regular guest lecturer at the Los Angeles Institute and Society for Psychoanalytic Studies and visiting faculty for the American College of Greece in Athens. Fetting has created and conducted hundreds of local, national, and international workshops on addictions of all natures. She has been a keynote speaker at national conferences, including the Harvard Addiction Conference and in Learning from the Masters at Deree College in Athens, Greece. She has consulted with USC’s men’s and women’s athletic teams in the area of addiction, both with substances and eating disorders. She speaks at high schools and colleges as well. Fetting has been in clinical private practice for over 25 years in Santa Monica, where she specializes in the treatment of addiction for individuals, couples, and families. She is affiliated with Clearview Treatment Programs and Milestones Ranch, both nationally respected and multileveled treatment facilities in Southern California. She regularly writes in the field and published the first edition of her text Perspectives on Addiction in 2012 with SAGE Publications. Fetting attended Rosemont College and received her baccalaureate degree from George Washington University and her master’s and doctorate from the University of Pennsylvania.

    Introduction

    Many of us like the experience of being intoxicated, and that desire creates enjoyments for most, problems for some, and devastation for a few. Perspectives on Substance Use, Disorders, and Addiction philosophically and clinically explores these ancient desires and proposes a treatment approach for these human troubles.

    Perspectives also covers the key content necessary for developing a comprehensive grasp of a complex body of knowledge that is filled with certainties and uncertainties, science and speculation, dogma and theory, as well as opinion and silence. Perspectives provides students and clinicians, individuals with a substance use disorder, and their families with a reflective understanding of a confusing body of knowledge and invites a probing and curious mindset. It provides some passionate perspectives for you to consider.

    Substance use, disorders, and addiction touch us all. Perspectives is written and designed to have a personal, professional, educational, and treatment impact. Content is delivered with discipline and rigor, creativity and imagination, brevity as well as elaboration. Hopefully the reader will develop a novel appreciation for a human desire that pleasures, confounds, and destroys.

    Outline of the Book

    This book is divided into four progressive parts composed of 14 chapters that were developed from 25 years of teaching semester-long graduate courses in substance dependence and abuse in the School of Social Work at the University of Southern California and other universities in Los Angeles and in Europe. These chapters build on each other and are designed to become the building blocks of your own knowledge base. The content area covered, moving from bottom to top, is diagrammed in Figure I.1.

    The preface, this introduction, and the chapters in Part I ask the reader to participate in a journey of learning and reflection. The personal and professional knowledge base developed in Part I becomes your philosophical and cultural anchor for future learning and also for future professional development in this field.

    Part I presents the philosophies of Perspectives, first highlighting those that have been informed by ancient ideas and globalized stresses. Readers are then invited to consider the influences of their own cultures. Key concepts and ideas are also presented. A reflective investment seems a necessary prerequisite for mastery of a sometimes complex, contradictory, and complicated field. A personally involved reader grasps, challenges, and retains knowledge from a deep and meaningful perspective.

    Figure I.1 Progressive Knowledge Base

    Part II and Part III present a cogent yet comprehensive overview of most of the essential elements of the substance use disorders field. One of the most important contributions of Perspectives is Chapter 6, which is on assessment and diagnosis. Coupling the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) spectrum with unique clinical sketches prepares the reader to creatively and thoughtfully engage in collaborative discussions with patients or clients about the nature of their relationship with the substance, as well as their concerns and treatment ideas. Ten classes of substances and the non-substance-related addiction, gambling, are presented with 11 easy-to-access reference charts. Part III looks at the suffering behind substance use, disorders, and addiction and presents the reader with nine self-medication theories.

    Part IV includes another key feature of Perspectives, the adoption and integration of the ancient Greek symposium as a convivial and exacting learning environment for better management of drinking and its excesses. Five chapters present detailed case studies, organized by combining the DSM-5 spectrum with clinical sketches, and utilizing the application of the four guiding principles of the symposium as analytic treatment concepts for these cases.

    Chapters

    Chapter 1 is a very short but important chapter for the reader. It clearly presents my orientation in writing this book for the substance use disorders field. Most importantly, it provides the reader with the seven unifying themes of Perspectives.

    Chapter 2 explores our ancient and natural desire to seek “spirited release” with alcohol or drugs, as well as the necessity for education about the management of these sometimes potent pleasures. The philosophies and practices of the ancient Greek symposiums are presented as an approach to engage the individual in a convivial educational atmosphere that invites participants to learn to drink better or decide to abstain.

    Chapter 3 presents the new dislocation theory of addiction that passionately stresses that we link increased alcohol or other drug use with the increasing isolation, confusion, stress, and overwhelming pressure from living in a globalized world. The phrase “global weightlessness” is introduced. This chapter identifies and highlights some of these insidious global impacts and provides case examples of how we sadly soothe ourselves with addictive and compulsive processes.

    Chapter 4 considers the importance of our cultural influences in our thinking about substance use. The depth of these influences is often overlooked. Our identified cultural backgrounds, including extended families, parents, siblings, and the surrounding communities, are likely to influence our relationships with alcohol and drugs, starting at a very young age. Readers are asked to reflect on the influences of their own cultural identity with the help of the stories from many of my students from all over the world who pondered the same.

    Chapter 5 provides the reader with concepts rather than definitions of some key ideas in the substance use disorders field. Philosophical questions are posed about this international pastime, and the frequency of our participations and indulgences. The concepts presented are designed for thinking, questioning, and conversing between students and teachers, clinicians and patients, families and friends.

    Chapter 6 is designed to provide a useful, engaging, creative, and lively understanding and application of the new DSM-5 substance use disorders spectrum during assessment and treatment. This chapter is designed to help the reader transition from the decades-long use of the terms abuse and dependence, which are now deleted, to the adoption of the DSM-5 substance use disorders spectrum. Gambling as a non-substance-related disorder is included in DSM-5. The key feature of this chapter is its emphasis on individuals and their relationship with the desire for pleasure through intoxication. Fifteen clinical sketches are included for adults and youth as a way to help individuals determine their own unique patterns of desire, use, and problems, as well as their inclinations and preferences for treatment. Brief case studies are explored to enhance application of these sketches.

    Chapter 7 provides the reader with an overview of 10 classes of substances, known and unknown, as well as the newly included non-substance-related disorder, gambling. Basic neuroscience, research chemicals, medication in substance use disorder treatment, gambling, and 11 easy-to-use reference charts are included. Ongoing further study is recommended.

    Chapter 8 presents nine unique, yet overlapping, self-medication theories that propose that untreated human psychological suffering drives some people to self-medicate their pain or discomfort with alcohol and other drugs. Each theory presented provides the reader with an insightful and useful perspective on what might cause this suffering. Brief clinical applications are included.

    Chapter 9 presents a use, prevention, education, and treatment approach adapted from the ancient Greek symposium. This ancient gymnasium provided early Greeks with a forum for learning to “tipple wisely” with wine, which the Greeks considered a gift to humanity, or decide to abstain if one’s “heavy mind” leads to uncontrollable excess. The four guiding principles of the symposium approach include the unstoppable fourth drive, registering impacts, harm reduction, and self-medication. These are presented as clinical concepts to be used during treatment.

    Chapters 10 through 14 provide an application of the four guiding principles of the symposium approach to clinical case studies from my private practice. The new DSM-5 spectrum coupled with 15 descriptive sketches will help provide a full clinical picture for the practitioner. Using both will provide the reader with a rich perspective for establishing and working in a collaborative therapeutic relationship.

    Vocabulary Clarifications For reading

    The addiction field struggles with language and precision. Therefore, I have included this section to ensure that readers understand the vocabulary choices of Perspectives. Please bear in mind that I have made every effort to abide by these vocabulary decisions in Perspectives, and please excuse any mishaps.

    • The words abuse and dependence have been deleted from DSM-5. Every effort has been made to ensure that these words will only appear in Perspectives when citing someone’s work.
    • DSM-5 advises individual discretion on the adoption of the word addiction. The word addiction is used in this book. I have adopted it to refer to the approximately 3% of the U.S. population that the 2014 Centers for Disease Control study identifies as truly psychologically and physically dependent individuals. Perspectives considers that addiction follows severe substance use disorder on the DSM-5 spectrum.
    • AOD stands for alcohol and other drugs.
    • SUD(s) stands for substance use disorder(s).
    • P/SUD identifies a person with a mild, moderate, or severe substance use disorder. P/SUD is often used to include a person with an addiction as well.
    • Person with an addiction is the term I have used to identify individuals who suffer from true addiction. This expression replaces the formerly used terms alcoholic and addict.
    • Readers, students, and individuals in general are referred to as “he.”
    • A patient, P/SUD, or person with an addiction is referred to as “he.”
    • Treatment providers, clinicians, and sponsors are referred to as “she.”
    • An italicized word in the text emphasizes the importance of the content.
  • Glossary

    Addiction:

    A narrowly focused lifestyle that functions as a meager substitute for people who desperately lack a sense of psychosocial cohesion.

    Ambivalence:

    The P/SUD’s true response to his relationship with AOD. He loves it and hates it.

    Analytic Hovering:

    A psychoanalytic technique. Freud recommends that the therapist or the analyst listen to her patients with a hovering and suspended attention, and rely on her unconscious to do the rest.

    AOD:

    Alcohol and other drugs.

    Authoritative Versus Authoritarian Hint:

    An authoritative hint gives the P/SUD room to make something of his own of it, and also gives him space to dream up something from it. An authoritarian hint is more like an order.

    Authority:

    The sense of ownership that patients and P/SUDs have about the direction of their own lives and what they think is the best course of treatment for them.

    Beta Elements:

    The undigested, nameless, formless, catastrophic experiences of the infant-child.

    Blind Eye:

    Noticing something but not registering its real impact.

    Clinical Sketches:

    Fifteen descriptive clinical pictures, including substance use, misuse, problematic use at a problematic time, shadow use, and addiction. These clinical descriptors provide a picture of the individual with a nonproblematic, mild, moderate, or severe substance use disorder and addiction, the diagnostic spectrum categories of DSM-5 (2013).

    Context of Destiny:

    An ongoing relationship with an attentive and intuitive caretaker that allows the child to have ongoing contact with his real essence.

    Context of Fate:

    An ongoing relationship with an inattentive caretaker. The child does not feel safe to be or safe to explore his essence and thus feels compelled to adjust to a prescribed climate of commandments.

    Counseling:

    A form of psychotherapy that is supportive, clarifying, and encouraging. Counseling usually does not involve the in-depth working through of early trauma.

    Countertransference:

    The analyst’s or therapist’s transference to the analysand, or patient. This includes the analyst’s realistic reaction to the reality of the patient’s life, to her own life as it may become affected by the patient, and the analyst’s reaction to the transference.

    Death/Rebirth Moments:

    When an individual says no (death) to a part of his life he has outgrown and says yes (rebirth) to an unknown future. Often experienced in developmental rites of passage.

    Destiny:

    The urge within each person to articulate and elaborate his own idiom through the selection and use of caretakers (objects) in his environment.

    Dikaiosunê:

    Socrates defines this as psychosocial integration, which provides a shield against domination by master passions or addiction.

    Discounting:

    When a P/SUD discounts the existence, significance, and impact of a problem as well as the ability to do anything at all to address it.

    Dislocated Individual:

    A person overwhelmed by the disruption of living in an increasingly globalized world, including adaption to new environments, excessive communications, and the increasing demands for technological mastery.

    Dislocation:

    Refers to the rupture of enduring and sustaining connections between individuals and their families, friends, societies, livelihoods, rituals, traditions, nations, and deities.

    Dislocation Theory of Addiction:

    Does not view addiction as either a medical disease or moral failure; rather, it depicts widespread addiction as a way of adapting to the increasingly dominant and onerous aspects of the modern world. This includes a barrage of communications and a demand for technological mastery.

    Dream or Dreaming:

    To think about the patient using both conscious and unconscious thinking processes.

    DSM-IV-TR:

    Previous edition of Diagnostic and Statistical Manual of Mental Disorders (APA, 2000), which used the words dependence and abuse for alcohol and other drug diagnosis.

    DSM-5:

    Current edition of Diagnostic and Statistical Manual of Mental Disorders, released in May 2013, that deleted the terms abuse and dependence and presented a diagnostic spectrum for substance use disorders.

    False Self:

    A part of the self that is unable to feel and express vulnerability or weakness, and compensates by developing around the wishes, defenses, and dictates of others; and is unable to experience life or feel real.

    Fantasy:

    A daydream.

    Fated:

    Can be described as the feeling the child has when his spontaneous self-expressions are rejected and he feels forced to adapt to others’ commandments of living.

    Fourth Drive:

    In every age, in every part of this planet, people have pursued intoxication with plants, drugs, alcohol, and other mind-altering substances. This pursuit has so much force and persistence that it functions just like our other drives of hunger, thirst, and sex. This fourth drive is a natural part of our biology.

    Gentle Drinking:

    A form of temperate or balanced drinking.

    Global Weightlessness:

    Vagueness and ambiguity experienced by the immigrant, asylum-seeker, and global citizen, a sense of floating similar to weightlessness.

    Harm Reduction:

    An approach to the treatment of substance use, disorders, and addiction that rejects the presumption that abstinence is the best or only acceptable goal for all problem alcohol and drug users.

    Heavy-Minded User:

    In psychoanalytic parlance, an infant (later adult) who is traumatized by experiencing aspects of existence and reality before the experience and feelings of union and appreciation of the mother. This ongoing wound will never be soothed by AOD, only tolerated over one’s lifetime (Goldman, 1993, p. 95).

    Hippocrates:

    Renowned ancient Greek doctor who gave the following advice: “Should a patient be suffering from an overpowering heaviness of the brain [mind], then ‘There must be total abstinence from wine’” (Gately, 2008, p. 13).

    Holding Environment:

    Created when the mother allows an infant’s true self to develop. A therapist provides a similar space, and gives the true self another chance to emerge.

    Idiom:

    The unique nucleus of each individual.

    Master Passions:

    A term used by Socrates to refer to unhealthy devotions that involved ongoing and destructive use in excess. A person under the tyranny of his passions is one who is consumed with wine and its abundance.

    Natural History:

    The rhythm and course of one’s distinct using relationship with AOD, and the rhythm and course of one’s distinct path of recovery.

    Ordinary Passions:

    Refers to healthy devotions, habits, or preoccupations that take place in ordinary societies, families, or communities of people.

    Philopotes:

    The ancient Greek term for a lover of drinking sessions; it bore no stigma.

    Pockets of Meaning:

    Passions that are invested with importance. These are things that are valuable in a person’s life, the things people pocket and protect. These may include children, family, friends, hobbies, religion, or work.

    P/SUD:

    Person with a mild, moderate, or severe substance use disorder.

    Psychic Retreats:

    An area of the mind where reality does not have to be faced, where fantasy and omnipotence can exist unchecked, and where growth and development are sacrificed.

    Psychoanalysis:

    A form of psychiatric treatment that uses the analysand’s (patient’s) transference to the analyst (therapist) as the primary source for working through deep conflicts.

    Psychoanalytic Attitude:

    Waiting in Faith. When an analyst or therapist receives the patient’s (the P/SUD’s) infantile and unmetabolized feelings and projections and, as far as possible, refrains from reacting to them. This results in enabling the P/SUD (patient) to take these feelings and projections back and integrate them into his own thinking and emotional mind.

    Psychodynamic Therapy:

    A form of psychotherapy that considers the influence of historical traumas on one’s current life, and can be supportive, be educational, or involve deeper explorations of traumas.

    Psychosocial Integration:

    Living with a sense of belonging and significance.

    Receptivity:

    An attitude of listening without penetrating or intruding.

    Registering Impacts:

    Allowing the experiences of events and other personalities to wash over and through one.

    Relational Home:

    A secure relationship that provides a safe context for the reworking of early trauma. A therapist provides a relational home for exploring one’s relationship with AOD and decisions about treatment.

    Reverie:

    Emotional availability, fueled by fierce maternal instincts. After the baby is held and all goes well, sensations are transformed—frustration is now satisfaction, emptiness is now fullness, pain is now pleasure, isolation is now company, anxiety is now calm, and dread is now hope.

    Ruthless Usage:

    When a child of his destiny feels free to assert his needs and aggressively express his wishes. He uses members of his village of living objects for satisfaction and fulfilment of these needs and wishes. There are degrees of ruthless usage.

    Self-Medication Theories:

    Theories that emphasize and identify the psychological suffering driving the need for destructive use of AOD. P/SUDs self-medicate because they are unable to self-care.

    SUD(s):

    Substance use disorder(s).

    Symposium:

    Comes from the ancient Greek word meaning “drinking together.” A formal but hospitable educational gathering to learn to “tipple wisely” or abstain.

    Temperance:

    The philosophical doctrine that Plato promoted for healthy drinking habits. It meant subordinating the desire for pleasure to the dictates of reason, using will and discipline to avoid overindulgence and indiscriminate drinking.

    Therapeutic Action Moments:

    When treatment theories and psychoanalytic concepts are practically applied to the struggles of each stage.

    “Tipple Wisely”:

    An ancient Greek term for learning to drink with temperance.

    Transference:

    A libidinal phenomenon. The analysand, or patient, ascribes unsatisfied libidinal impulses from infancy and childhood to the analyst or therapist. Love for the analyst provides the necessary extra force to induce the ego to give up its resistances, undo the repressions, and adopt a fresh solution to its ancient problems.

    Trauma:

    A sudden, unexpected event that severely interrupts one’s sense of a continuity of being.

    True Self:

    Inherited potential that exists only in experiencing. The true self is able to experience life and feels real.

    Village of Living Objects:

    People and things that will foster the elaboration of the child’s creative strivings and provide the right conditions to evolve his idiom.

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