A psychoanalyst in methadonia

This paper argues that the contemporary psychoanalytic model of addiction is compatible with the biochemical deficit model of Dole and Nyswander, the basis of methadone pharmacotherapy. The author explains the self-object function of methadone in the repair of self-deficits, specifically in the area of affect regulation, and he expands the dynamics of self-repair to the relational and programmatic "context of care" of methadone maintenance. Clinically, the problems of resistance and transference are examined as they arise and are resolved within an intersubjective counseling relationship. The treatment process in methadone maintenance is then reconceptualized as the gradual transformation of the central organizing principles of the addicted person as a result of the experience of psychophysiological stability, complemented by acceptance and empathy within a secure context of care. In closing, the need for an individual, self-focused approach to deciding between maintenance and detoxification is suggested.