Treating Addiction: Beyond the Pain

In Treating Addiction: Beyond the Pain, Edward Khantzian offers a collection of his recent works on the study and treatment of substance abuse and addiction. Based on his five decades of experience in working with substance dependent individuals, this volume builds upon Khantzian’s theory of addiction as self-medication and provides insights into how addiction is rooted in human psychological suffering, and not pleasure seeking or self-destruction. Almost without exception, life histories of human discomfort, disconnection, and unhappiness leave those so burdened to be vulnerable to the appeal of addictive drugs, including alcohol. Khantzian’s sensitive teaching voice weaves together an annotated collection of previously published papers into a powerful and engaging volume of effective practice-based treatments. A timely complement to his earlier collection Treating Addiction as a Human Process, this book provides an inclusive and accessible resource for mental health professionals from any background as well as graduate students and those in training.

Table of Contents:
Foreword by Martin Weegmann Introduction Part I. The Internal Terrain of Addiction Psychodynamics 1. Understanding Addictive Vulnerability: An Evolving Psychodynamic Perspective 2. Questions of Substance: Psychodynamic Reflections On Addictive Vulnerability and Treatment 3. Addiction: Why Are Some of Us More Vulnerable Than Others 4. The Capacity for Self-Care and Addiction 5. The Self-Medication Hypothesis and Attachment Theory: Pathways for Understanding and Ameliorating Addictive Suffering Part II. The Self-Medication Hypothesis Revisited 6. The SMH and Addiction as a Problem in Self-Regulation 7. The Self-Medication Hypothesis Revisited: The Dually Diagnosed Patient 8. Self-Medication Hypothesis: Connecting Affective Experience and Drug Choice 9. The Self-Medication Hypothesis and Psychostimulant Treatment of Cocaine Dependence: An Update 10. The Psychodynamics of Addiction and Its Treatment: An Interview with New Therapist Magazine Part III. Treatment of Addictive Disorders 11.Reflections on Group Treatments as a Corrective for Addictive Vulnerability 12.More Reflections on Group Therapy (Interview by Martin Weegmann) 13. ‘Dangerous Desires and Inanimate Attachments’: Modern Psychodynamic Approaches to Substance Misuse 14. Reflections on Treating Addictive Disorders: A Psychodynamic Perspective 15. A Psychodynamic Perspective on the Efficacy of 12-Step Programs Part IV. Reflections and Lessons Learned 16. We Are All At Least a Little Lost and Off-Putting: On Transformation 17. Tragic Trends in the Treatment of Addictive Illness 18. Insights on the Insanity of Addiction 19. The Cruel Scourge of Addiction: An Addiction Psychiatrist’s Clinical View 20. Life Learned from Addictions 21. Psychophobia and Getting it Right 22. The Theory of Self-Medication and Addiction

About the Author :
EDWARD J. KHANTZIAN, MD, is professor of psychiatry at Harvard Medical School and past president of the American Academy of Addiction Psychiatry. Dr. Khantzian is a distinguished scholar, psychiatrist, and psychoanalyst, specializing in addictions for more than forty years. His other work includes Treating Addiction as a Human Process and (with Mark J. Albanese) Understanding Addiction as Self Medication: Finding Hope Behind the Pain.

Review :
In Treating Addiction: Beyond the Pain, Khantzian (Harvard Medical School) presents a collection of his previously published, seminal articles that explore the relevance of psychodynamic theory to the current understanding of addictions and their treatment. He traces the evolution of his thinking and provides supporting evidence specifically related to the self-medication hypothesis of addiction. In contrast to some other hypotheses, including recent neurobiological formulations, Khantzian posits that addictions are rooted in suffering and pain as opposed to pleasure. In his formulation, he humanizes those with substance use disorders, acknowledging their psychological vulnerabilities, quest to alleviate pain, and resiliency in the face of challenges. Through his use of case examples and vignettes, he fosters readers' empathy for people struggling with substance use disorders. This perspective is greatly needed at a time when such people continue to be stigmatized and judged. In presenting complex ideas about addictions, Khantzian uses a conversational style that promotes understanding and openness rather than defensiveness regarding alternative views. Throughout the book, he champions the idea of a “kinder understanding of addicted individuals” alongside a more integrated, humanistic approach to treatment. Summing Up: Recommended. Graduate students through faculty and professionals. I would recommend Khantzian’s book to beginners and practitioners alike. It shows beginners the person behind this disorder, while serving as a reminder for experienced practitioners of the human suffering associated with drug misuse. Few patients suffer as much as those with addictive disorders and few doctors understand the pain and suffering these patients go through as much as Dr. Khantzian. This book is a must read for all healthcare professionals and families helping their patients deal better with their aching souls. It has been my joy and privilege to work with and learn from Ed Khantzian for more than a quarter century. These collected works flesh out the many facets of the self-medication hypothesis, as I have heard Ed clearly and patiently articulate them over the years. At its heart, the approach to understanding and treating people suffering with addictions that Ed has pioneered is empathic and compassionate. It sees beyond the stigmata of addiction to the vulnerability and suffering at its core. Reading this book is bound to make us all better companions and caregivers of those we know and love who struggle with addiction. This is a masterful, humanistic perspective on addiction and its treatment from a thought leader who helped define the very nature of this field. It’s a must read for anyone who wants an understanding of where we have been and where we are heading with treatment.