A Drug Addicted Man’s Psychoanalytic Observation

History and Background

Willie came from a middle-class home, with the chance and love. According to Willie, his first drug experience was when he was eight years old. At some point in surgical procedure he was given liquid cocaine for the reason that he could not be intubated. He keep in mind, intensely, the feeling of let loose, the closing stages of the fear, the perception that he was dominant and nobody could stop him. More often than not he bears in mind how emotions that he had fight back for years to manage – and possibly hide from – disappeared.

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Street drugs started for him just about the age of 12 when he was introduced to marijuana. The principle that marijuana is not a first step drug is false, because almost immediately he found himself searching for superior, more powerful highs. As is usually connected with this sort of behavior, he fell in with a crowd of people with similar interests. He was first apprehended, for auto theft, was at the age of 14. He remembers how the related adrenaline turns out to be part of the high he was at all times looking for. It is without overstatement that he can say that his desired drug was “more”, more of whatever someone had to recommend, whatever it took to give him a superior high.

From marijuana he rapidly adapted to pills, mushrooms and acid. And at the same time as alcohol was in no way his drug of choice, in all he could find was booze then he would drink himself into unconsciousness. For an addict there is by no means sufficient. He at all times had to have more and it wasn’t long before that he would do almost everything to get that next fix. Theft, dishonest, deceitful – manipulation became subsequent character if it got what he sought after.

By the time he was 19 his addiction was in full power. His employer reassigns him to California and there, on the very first night, he was introduced to cocaine. The feeling after utilization was that he had for himself met God. It only takes seven months for the drug and the life to catch up with him: he was under arrest for possession. He was unhealthy, malnourished and frightened, yet upon discharge and leaving the country he was not prepared to give up.

He moved to British Columbia where his craving turned back to marijuana, prescription medication and alcohol. You see obsession is but an indication of underlying issues. Thus his drugs were not based on preference but rather on availability. Eventually he cleaned up his act enough to fake living a normal lifestyle. At the beginning of 2003 he was part owner of a company, owned a home, was married and was supposedly “doing well”. That is when he met the drug called crack. By the end of 2003 he had given up everything for his addiction – family, friends and other relationships. Work meant nothing to him next to getting high.

By the end of that year he was homeless, penniless, a hundred pounds underweight, had burned all his relationships and was living in a shelter. For the first time in his life he truly understood poverty. He sees no need to further describe all the gory details. According to him they are painful and often still cause sleepless nights of guilt and remorse, not so much for himself but rather for the pain I caused those around him.

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Mental Status

Willie is a typical looking man who came to one interview dressed tidily and to another looking wrinkled and unshaven. His effect was typically suitable and extensively ranging but he occasionally smiled while relating disappointing events. In this association, when asked to examine what he is experiencing, he backs off from his concerns by diminishing, rationalizing, or centering on other’s feelings or purposes. He does not appear disheartened, nor is he suicidal, but there is a heaviness and seriousness to his mood. He demonstrated no indication of thought disarray, severe acting out, or other severe psychopathology. He is very clever and has good decisions.

Formulation

When taking exams, Willie’s cognitive performance is severely hampered. He gets puzzled, blanks out, and is convinced that he is incapable to continue. That is, Willie’s ego is besieged by anxiety in this condition, leading to extremely dysfunctional reactions. Otherwise, his ego functioning, together with reality testing is mainly unimpaired.

Willie has trouble containing and modulating the fierce anger he harbors against all authorities. He has managed to do so but at considerable cost in terms of psychic energy expended. That is, he needs to be constantly vigilant against the possibility that he will flout authority in some inappropriate way, such as lashing out and even killing someone. One way he defends against the anxiety generated by this danger is by acting in an overly compliant manner with his perceived attackers.

Willie not only has to struggle to contain his rage against authority but also to cover over and displace his sadness at not having received the nurturance and care he wished for. He does so by minimizing and rationalizing his own needs and projecting his despair of having his dependency needs met onto others. Another way in which he contains troubling feelings and impulses is by focusing on work areas that are “sensible, logical and orderly” –hence, his interest in computers where the messiness of feelings can be readily avoided. His effort is to keep in control at all costs. His drive/defense configurations are characteristic of an obsessive-compulsive personality, although they are not severe or pervasive enough to constitute a personality disorder.

In relating to others, Willie tries to act as if everything is fine and compliantly to meet their expectations. He wants to look good and keep the peace, and this picture of a cooperative, helpful person constitutes his internal representation of self. His view of others is that they make demands to fulfill their own needs but not his or others and take advantage of him. Thus, the internalized relationship between self and other can be characterized as that of giver to taker or victim to victimizer.

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Willies sense of self is coherent and fairly stable, but also quite negative and, in some ways, false. It is negative insofar as he is subject to strong feelings of shame about his work or his actions and to lowered self-regard. It is false in that he tries to be the perfect son, husband, in so doing, suppresses his own identity. Willie wants to be himself, speak up for himself, and take care of his own needs, but instead he feels that he lives at the whims of his wife, family, friends and other relationships. As such he is not a fully individuated person.

Diagnoses

  • Axis I 304.80 Polysubstance Dependence
  • Axis II 301.22 Schizotypal Personality Disorder
  • Axis III Recent injury to hand, organ failure secondary to alcohol intoxication
  • Axis IV Legal problems, interpersonal isolation, unemployment, injury
  • Axis V GAF – 45 (current)

Discussion

Drug addiction is explained as an illness (Tagliamonte, 1999) with the basic signs and indications (desire and relapsing behavior) relating to the field of psychiatry and behavioural science (Lowinson, 1992). Furthermore, psychiatric indications are often well-known in states of toxic condition and withdrawal, and appearances of post-withdrawal are frequently characterised by unrelenting discomfort. Moreover, independent psychiatric injury resulting from self-regulating brain characters are often joined to addiction, which creates the case one of dual diagnosis (Maremmani, 2006).

The depressive characteristics of heroin addicts are linked with anxiety rather than with suicidality, and a leading depressive-anxious state is connected to a lesser intensity of drug addiction history. On the other hand, psychomotor excitement and psychosis foresee the occurrence of polysubstance abuse and a definite dual diagnosis. Thus, it is very significant for clinicians to be capable to recognize main as well as insignificant psychomotor excitement and psychotic indications in heroin addicts presenting for management, since it is likely that these patients are influenced by one more independent mental disorder (dual diagnosis) that be worthy of precise clinical attention and treatment.

In comparison, the occurrence of depressive characteristics in the clinical appearances of heroin addicts shows to be an undependable pointer of common psychiatric severity and appears to be an ordinary comorbid state of the regular addict, also developing at minor stages of addiction severity, along with the premature course of the addictive illness. Depressive-anxious indications are more probable to be similar to addiction as a non-specific type of psychic disorder, while psychomotor anticipation and psychotic ones are possible to have dual diagnosis (Maremmani, 2007).

References

Friedman, R.S., & Lister, P (1987). The current status of psychodynamic formulation. Psychiatry, 50, 126-141.

Lowinson JH, Ruiz P, Millman RB, Langrod JG. (1992). Substance Abuse. A Comprehensive Textbook. Baltimore , Williams & Wilkins.

Maremmani I, Perugi G, Pacini M, Akiskal H. (2006). Toward a Unitary Perspective on the Bipolar Spectrum and Substance Abuse: Opiate Addiction as a Paradigm. J Affect Disord. 93:1–12. Web.

Maremmani, I. Pacini, M. Pani, P.P. Perugi, G. Deltito, J. and Akiskal, H. (2007). The mental status of 1090 heroin addicts at entry into treatment: should depression be considered a ‘dual diagnosis’? Ann Gen Psychiatry.

McWilliams, N. (1999). Psychoanalytic case formulation. New York; Guilford Press.

Morrison, J. (1997). When psychological problems mask medical disorders; A guide for psychotherapist. New York; Guilford Press.

Summers, R. F. (2003). The psychodynamic formulation updated. American Journal of Psychotheraphy; 57, 39-51.

Tagliamonte A. (1999). Heroin Addiction as normal illness. Heroin Addict Relat Clin Probl. 1:9–12.

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