Psychodynamic factors in the development of drug dependence.

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.