[Psychodynamic aspects of treatment of heroin dependent patients with methadone substitution]

In the methadone treatment evaluation study in North-Rhine Westfalia a high psychiatric comorbidity with opiate substance abuse was diagnosed. The formulation of diagnoses according to operationalized criteria (e.g. DSM-III-R) is usefully supplemented by a psychodynamic structural diagnosis in order to get an integrative concept of the psychic problems of the patient. With an example of an opiate addict with narcissistic personality disorder the interplay of drug abuse and behaviour in substitution treatment respectively and the patient's psychic problems is demonstrated and discussed within the theoretical framework of ego-psychology and object-relation-theory. Though many patients in substitution treatment are not motivated for formal psychotherapy, the daily contacts with the patients can be usefully structured according to the principles of psychotherapy of preoedipal or ego-structural disorders.