Psychotherapy of nine successfully treated cocaine abusers: techniques and dynamics

The author reviews a series of nine cocaine abusers successfully treated with long-term, in-depth, dynamic psychotherapy begun on an inpatient drug abuse unit and continued after hospitalization. He finds his patients to have been victims of unrecognized psychological trauma in childhood. He argues that the cocaine abuse, in addition to functioning as a form of self-medication, was functioning as a component of a repetition compulsion in which old psychological traumas were symbolically recreated in the post-drug dysphoria. In a retrospective assessment, the author delineates four steps he used in the treatment process: 1) he looked for traumatic or abusive conditions; 2) he established emotional contact; 3) he helped the patient to appreciate how the abuse had affected him; 4) he helped the patient to master the traumatic experiences. A clinical vignette and the relevant literature on the psychodynamics of cocaine abuse are discussed.