Treating chronic pain in patients suffering from addictive disorders: The psychodynamics

Psychodynamic treatment of addictive disorders centers on helping patients understand the meaning of the manifest symptoms in context to the individual's life. Such intervention is aimed at finding ways to master maladaptive modes of coping and to improve overall quality of life. Many addicts also have physical problems that become chronic, leading to compulsive use of pain medication, disturbed body image, and curtailed function. In these patients, the addiction is often found to be the most overt or dramatic expression of a complicated psychiatric picture. Psychodynamic interventions aim at teasing apart the vast array of potential developmental antecedents of the illness, including childhood and adult traumas, losses that have not been fully mourned, the impact of parental missteps, failed attempts at completing age-appropriate separation-individuation processes, and lack of affirmation of the self at crucial developmental periods. Worthy of note is the natural nexus between Twelve Step philosophy and psychodynamic psychotherapy. When a patient begins to face the powerlessness and character defects talked about in The Steps, he is outlining a distinctly psychodynamic formulation for himself designed to relieve him or her from emotional pain. When addicts are challenged with morbid states that impede progress, psychodynamic psychotherapy is uniquely suited to help the patient on his way to recovery by utilizing all the tools at his disposal in the form of medications, motivation for diet and exercise, talk therapy, and the use of support groups.