Journal of Substance Abuse Treatmenl, Vol. 5, pp. 131-137, 1988 Printed in the USA. All rights reserved. 0740-5472/ 88 $3.00 + .OO Copyright 0 1988 Pergamon Press plc zyxwvutsrq ORIGINAL CONTRIBUTION Psychotherapy of Nine Successfully Treated Cocaine Abusers: Techniques and Dynamics FREDRIC SCHIFFER, MD Harvard Medical School at the McLean Hospital, Belmont, Massachusetts Abstract - 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 psychologi- cal traumas were symbolically recreated in the post-drug dysphoria. In a retrospective assessment, the author delineates four steps he used in the treatment process: I) he looked for traumatic or abu- sive 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. Keywords-Cocaine abuse, drug abuse, psychotherapy, psychodynamics. INTRODUCTION zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA IN THE PAST decade there has been a dramatic increase in the prevalence of cocaine dependence (Adams & Durell, 1984). Several psychological treatment ap- proaches have been used to address this problem including behavioral (Anker & Crowley, 1982), sup- portive (Rounsaville, Gawin, & Kleber, 1985; Siegel, 1982), and dynamic (Resnick & Resnick, 1984; Spotts 8~ Shontz, 1984) psychotherapies. There remains how- ever, a need in the literature for further discussion of the techniques of in-depth, long term psychotherapy of cocaine abusers. I have been treating cocaine abusers with long- term, in-depth, dynamic psychotherapy begun on an inpatient unit, the Drug Dependence Treatment Unit at McLean Hospital, and continued after hospitaliza- tion. Here I will report my observations on a series of nine patients who have done well for at least a year following entrance into our program. I will also dis- The author wishes to thank Roger D. Weiss, zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA MD, for his helpful assistance and comments. Requests for reprints should be sent to Dr. Fredric Schiffer, McLean Hospital, 115 Mill Street, Belmont, MA 02178. cuss some of the common psychodynamic themes that I found in these patients, and compare them to those in the literature. METHOD Most patients entering the substance abuse program at McLean are referred to a therapist for a detailed psy- chological evaluation. This report is limited to those patients who were so referred to the author. All had been employed and had medical insurance. Each voluntarily entered the four-week, locked unit, drug free program. The patients consisted of 8 males and 1 female. All were white. The mean age was 30 +- 5 years (range 25-37). All were high school graduates; 3 graduated also from college. Four patients had blue collar jobs and 5 had white collar jobs. All nine patients were reasonably cooperative and intelligent, and each in the past had acquired some sig- nificant work skills and relationships. At the time of admission, however, all suffered severe impairments at work and most had severely disturbed interpersonal relationships. None had legal charges pending. All re- ported using greater than 3 grams of cocaine per week 131