%0 Journal Article
%T Deficits of Affect Mentalization in Patients with Drug Addiction: Theoretical and Clinical Aspects
%A Svetoslav Savov
%A Nikola Atanassov
%J ISRN Addiction
%D 2013
%R 10.1155/2013/250751
%X Traditionally treated with wariness, drug addictions have provoked a serious interest in psychodynamically oriented clinicians in recent decades. This paper discusses the development of contemporary psychodynamic conceptualizations of addictions, focusing specifically on mentalization-based theories. The concept of mentalization refers to a complex form of self-regulation which includes attribution of psychological meaning to one¡¯s own behavior and affective states, as well as those of the others. We hypothesize that drug-addicted patients have severe impairments in mentalizing, associated with developmental deficits, characteristic for the borderline personality disorder and psychosomatic conditions. Psychodynamic models of mentalization and their corresponding research operationalizations are reviewed, and implications for a contemporary understanding of drug addictions and psychotherapy are drawn. The authors propose that mentalization-oriented theories provide an adequate conceptualization, which is open to empirical testing and has clear and pragmatic guidelines for treatment. 1. Introduction We know that the onset of drug addictions is determined by a complex combination of constitutional (biological), social, and psychological factors. Physiological components play a crucial role in the maintenance of psychological anxiety, associated with physical abstinence, but they are not the one and only etiological factor behind this disorder and they can not entirely explain the motivation for subsequent relapses [1]. It is clear that every psychoactive drug induces a specific state of intoxication, but individual psychopathology largely defines the subject¡¯s reaction towards the pharmacological effects [2]. Bearing in mind these assumptions, we review a series of developments in the understanding of substance abuse starting with classical psychodynamic approaches based on drive/conflict models. Then, we present comprehensive theories of affect regulation which we see as a starting point for the transition to modern mentalization-based conceptualizations. We describe the shift from the initial emphasis on instinctual gratification to the investigation of ego development and pathology. We show how contemporary psychodynamic clinicians and researchers can increasingly rely on mentalization based theories to explain personality pathology. We outline some of the implications of this shift for evidence-based practice. There is clear evidence supporting neurobiological and neurocognitive adaptations to specific drug exposure, the natural history of addiction
%U http://www.hindawi.com/journals/isrn.addiction/2013/250751/