Psychoanalytic Views of Alcoholism; A Review

As a framework in considering alcoholism, basic concepts used in explaining the psychodynamics of addictions are outlined. Growth and dependency, character formation, management of conflicts, psychic structure and ego defenses are briefly discussed. In the following discussion of etiological factors in alcoholism emphasis is placed on the various stages in the alcoholic's emotional development, his corresponding love choices and the ego defenses at his disposal, rather than on a unitary etiology. Some circumstances and consequences attendant upon the alcoholic's failure to grow are then presented: mismanagement of early dependency situations, relation to parents, fixation at or regression to the oral, anal or phallic—oedipal stage. Examples of different types of alcoholics based on three distinct stages of their emotional development are given. New developments in psychoanalysis relevant to research in alcoholism are then reviewed. Recent studies of automatism and repetitive behavior in animals and man which permit derivation of some parallels between instinctive behavior and the addictions are suggested as new approaches to understanding alcoholism. Another refinement of psychoanalytic theory, ego autonomy or the assignment of an independent supply of energy to the ego, is discussed in some detail and the far-reaching consequences of assuming its existence in the interpretation of alcoholism are explored. Recent theories of genetic specificity of ego defenses, ego strength, stimulus barriers, individual differences in perceptual organization, motivation and pleasure are reviewed and suggestions are made for a reexamination of the stereotyped behavior of alcoholics in light of these new observations. Finally some speculations relevant to the relationship between instincts, stores of psychic energy and the effect of alcohol on ego integration are discussed. In review and evaluation of psychoanalytic contributions to the treatment of alcoholism, attention is given to the current shift in therapeutic emphasis from one geared for the resolution of childhood conflicts to one geared for strengthening ego functions and enhancing the alcoholic's self-confidence. Some of the newer methods of therapy which utilize such psychoanalytic insights into the alcoholic's needs are briefly described. A brief evaluation of the contribution of psychoanalysis to anthropological studies of drinking behavior and personality theory follows. A final section suggests caution and criticisms and new directions for research. [Bibliography of 255 references.]