Aggression and Emptiness: Case Study of a Young Man Coping with Substance Abuse

This case study discusses the treatment of a young adult with a severe addictive disorder with psychoanalytic psychotherapy in an inpatient setting without morphine substitution treatment. The patient was admitted to an inpatient psychotherapy facility after having completed the process of detoxification. At the time of documentation, the treatment had been going on for six months, showing excellent results concerning abstinence from substance abuse and his ability to adhere to daily routines. The patient
refrains from taking any medication. At the beginning, therapy sessions were characterized by a pronounced feeling of emptiness and oppressing speechlessness. Initial progress could be made when, after an unannounced cancelled session, fear of loss and longing for lost good objects became an important issue in the subsequent sessions. Following this incident, the patient leaves his session early cutting off contact with this therapist for a short period of time. In the following however, it becomes possible for him to articulate aggressive impulses and thoughts about terminating therapy. Experience with inpatient treatment without substitutional medication of patients with addiction disorders has shown that a specific frame is required both from the patient and the team. Early interpretations of pathological defence mechanisms and negative transference dynamics, as well as being aware of instances of repetition compulsion in therapy are essential in therapy. With this case study we aim to challenge the prevailing opinion that individuals with opiate addictions have to be treated primarily with substitutional medication and inpatient psychotherapy is not necessary.