The Hidden Dimension: Psychodynamics in Compulsive Drug Use

Abstract

This is a vast book, in its intellectual breadth and its extensive review of pertinent literature. The author has been director of a major medical school alcohol and drug abuse program but is also scholar, physician, philosopher, and psychoanalyst. In describing the intrapsychic experience of the compulsive drug user, Wurmser makes his most important contribution. The author emphasizes and supports with clinical evidence the finding that addicts, except for a few alcoholics and cigarette users, have serious psychopathological conditions that antedate their excessive drug use and that dominate treatment difficulties. The single diagnosis most frequently represented is the "borderline personality organization," extensively described recently by Kohut and Kernberg. In Wurmser's own Methadone Maintenance Program population, 10% of patients were frankly psychotic; 30%, severely paranoid or depressed; 30%, episodically deeply regressed; and only 30% had moderate psychopathological conditions controllable with methadone and the milieu of the treatment facility alone. Through examination