Critical aspects of the psychodynamics of substance abuse and the evaluation of their application to a psychotherapeutic approach.

A model of psychotherapy is proposed which integrates psychodynamic theory, AA and other 12-step groups, family therapy, and dual-diagnosis issues into a phase-specific method. This therapy is done in three stages: (1) dryness (assessment and detoxification); (2) sobriety (achieving stable abstinence); and (3) wellness (using sobriety as a basis for personal growth and intimacy. The utility of an evolving concept of countertransference and new studies demonstrating the efficacy of psychotherapy are also discussed. Several challenging research questions are presented which, if answered, would assess the efficacy of this model.