Treece C, Khantzian E J
Psychiatr Clin North Am. 1986 Sep;9(3):399-412.
In this article we have brought to bear on the complex problem of substance dependency the psychodynamic perspective: a model that views the problem from the inner experience and psychological structure of the individual drug user. Chronic drug dependence has been associated with a range of personality styles and psychopathologic conditions but most frequently with character disorder and vulnerability to depression. Regardless of specific symptoms or personality styles, certain characterologic features are repeatedly observed to characterize substance-dependent individuals. These include problems in affect management, narcissism, object relations, judgment, and self-care. These developmentally and structurally determined problems generally predispose individuals to drug dependence because they are the basis of the distresses that are relieved by drug-taking; they specifically predispose to drug dependence because, in various ways, the taking of drugs and the experience of their effects are syntonic with existing modes of defense, adaptation, and self-concept. The actual vulnerability to substance dependency can vary considerably both between individuals and for the same individual at different times. For many, a necessary precipitating event involves a severe crisis in which usual adaptive capacities are diminished and narcissistic vulnerability is intense. Once drug taking is initiated in a susceptible state and the user has experienced adaptive benefit from the experience, a variety of other processes are set in motion that often lead to the state of dependency. These processes include both regressive effects that can exacerbate the original character problem and progressive effects that promote stable functioning. In both cases, however, this may interfere with further maturation of character, particularly when onset of use occurs in adolescence. Dependency involves the gradual incorporation of the drug effects and their experienced need into the defensive structure building activity of the ego itself. Undoing a dependency involves dealing with the unconscious and conscious components of this outcome. The user must be able to relinquish behaviors and drug effects that have come to be experienced as a valued (even if also hated) part of the self-capacity to function, cope, and be comforted in distress.
在本文中，我们运用心理动力学视角来探讨物质依赖这一复杂问题：该模型从个体吸毒者的内心体验和心理结构来审视这一问题。慢性药物依赖与一系列人格类型和精神病理状况相关，但最常与性格障碍以及易患抑郁症有关。无论具体症状或人格类型如何，反复观察到某些性格特征是物质依赖个体的特点。这些特征包括情感管理问题、自恋、客体关系、判断力和自我照顾方面的问题。这些在发展和结构上确定的问题通常使个体易患药物依赖，因为它们是通过吸毒得以缓解的痛苦的基础；它们特别容易导致药物依赖，是因为吸毒及其效果体验在各种方面与现有的防御、适应和自我概念模式相契合。个体对物质依赖的实际易感性在个体之间以及同一个体在不同时间可能有很大差异。对许多人来说，一个必要的促发事件涉及严重危机，此时通常的适应能力减弱，自恋易感性强烈。一旦在易感状态下开始吸毒且使用者从这种体验中获得了适应性益处，就会启动各种其他过程，这些过程往往会导致依赖状态。这些过程包括可能加剧原始性格问题的退行性影响和促进稳定功能的渐进性影响。然而，在这两种情况下，这都可能干扰性格的进一步成熟，尤其是在青春期开始使用毒品时。依赖涉及将药物效果及其体验到的需求逐渐纳入自我本身的防御结构构建活动中。戒除依赖涉及处理这一结果的无意识和有意识成分。使用者必须能够放弃那些已成为自我功能、应对和在痛苦中获得安慰能力中被重视（即使也令人厌恶）部分的行为和药物效果。
