Sergio Ignacio - Academia.edu (original) (raw)

Papers by Sergio Ignacio

PloS one, 2016

Patients who seek dental treatment may have bipolar disorder, and lithium carbonate (LC) is the d... more Patients who seek dental treatment may have bipolar disorder, and lithium carbonate (LC) is the drug of choice used in the treatment of this disorder. Taking into consideration the controversial results found in the literature, and the possible influence of LC on induced tooth movement, the objective was to evaluate tooth movement induced in rats after administration of lithium carbonate. One hundred and ninety-two rats were divided into 3 groups. In the L group, the animals received daily 60mg/kg of LC, they were not subjected to orthodontic movement, and they were euthanized after 33, 37, 44 or 51 days. In the LM group, the LC was administered for 30 days and during the subsequent 3, 7, 14 and 21 days, corresponding to the period of induced tooth movement, and they received a spring that produced a 30cN force. In the SM group, saline solution was applied. Measurements were made of tooth displacement, the numbers of osteoclasts and serum lithium phosphate (PO4), alkaline phosphatas...

In order to establish a new nosology of addictive disorders, the neurobiology of withdrawal and c... more In order to establish a new nosology of addictive disorders, the neurobiology of withdrawal and craving are reviewed, followed by a review of the psychoanalytic literature on addictive neuropsychodynamics. New information allows us to refine our understanding of addiction. One type of addiction is a character type; a second is a biological disorder. Addictive character is a repetitive, stereotyped response to helplessness via compulsive behaviours. Physical addiction is due to an upregulation of the ventral tegmental dopaminergicpathway with lifelong drug craving and drug dreams. Both disorders have overlapping features including idealization of the addictive behaviour, a denial system, and resort to addictive behaviours under stress. DSM-type diagnostic criteria are proposed. The nosology helps to clarify the relationship of non-drug to drug addictions. For example, gambling or shopping addiction exists only as a psychological addiction, whereas alcohol or opiate addiction can be either psychological or physical or both. Use of the refined diagnostic concepts aids in treatment planning and in understanding the relationship of addictive disorders to other forms of psychopathology. Afin d'établir une nouvelle nosologie des troubles de la dépendance, on examine d'abord la neurobiologie du sevrage et de l'état de manque, avec ensuite un survol des publications psychanalytiques sur la neuropsychodynamique de la dépendance. De nouvelles données nous aident à raffiner notre compréhension de la dépendance. Un type de dépendance relève du caractère, alors

Treating Addiction as a Human Process contains the collected works of Edward Khantzian, thirty-se... more Treating Addiction as a Human Process contains the collected works of Edward Khantzian, thirty-seven articles or book chapters published between 1972 and 1997. Khantzian has added three new chapters, made minor modifications to previously published works, and provided introductions to each of the five sections. His target audience includes patients and their families, as well as students and clinicians. His goal of inclusiveness, both in terms of material and readership, makes this a valuable sourcebook.

Dr. Khantzian has done a masterful job of summarizing the psychodynamic literature on addiction. ... more Dr. Khantzian has done a masterful job of summarizing the psychodynamic literature on addiction. Khantzian states, "With some notable exception, it is surprising and unfortunate that since the 1970s there have been so few contributions from psychoanalysts addressing the dynamics of SUDs [substance use disorders]." If we add the statistics from McGinnis and Foege (1993) that drug addiction is responsible for 25% of all deaths in the United States (nicotine 19%, alcohol 5%, illegal drugs 1%) and obesity (food addiction) is responsible for another 14% of U.S. deaths, it becomes obvious that addiction is a pressing issue for psychoanalysis. Either many patients undergoing psychoanalytic therapy have active addictive issues and their therapists lack a good theoretical basis for understanding their issues and consequently ignore them, or these extremely common patients are being systematically turned away from psychoanalytic therapy because we lack a good theoretical basis for understanding their issues. I suspect both are true.

The literature There is a paucity of literature on the psychoanalytical study and treatment of dr... more The literature There is a paucity of literature on the psychoanalytical study and treatment of drug addiction. In Britain, the main literature (e.g.

I read Professor Khantzian's target paper with some disappointment, and I was unhappy when I was ... more I read Professor Khantzian's target paper with some disappointment, and I was unhappy when I was asked to be a discussant. His observations cover a great deal of ground but do not, to my mind, make an appropriate basis for an exchange of views between psychoanalysts and neuroscientists on the vexing question of addiction. Indeed, his "psychodynamic perspective" seems to minimize some crucial psychoanalytic concepts. Unconscious mental functioning receives scant, if any, attention, outside the following sentence: Contemporary psychodynamic theory in application to SUDs paralleled developments in modern psychoanalytic thinking by laying less emphasis on drives and unconscious conflicts, but placing greater emphasis on appreciating the importance of affects, on the development of ego and self structures, and on the quality of and capacity for relationships and connection to others. "Less emphasis" could well be read as "little emphasis" without doing any disservice to the general purport of the text. (SUDS-"substance-use disorders"-seems the preferred term to drug addiction nowadays, but seems to me insufficiently explicit.) The point about affects calls for immediate comment. Freud's views on affects have been effectively and cogently discussed in this Journal by Solms and Nersessian (1999); also, the point that, without a concept of drives, there is no psychoanalytic concept of either thought or affect has been emphasized by others, including the writer (Yorke, 1999a, 1999b). For Freud, a drive can only be known through its mental representatives, of which the quantitative aspects are perceived as affects (the qualitative ones are thoughts). In psychoanalytic thinking there can be no affects without drives, about which Khantzian borders on the dismissive. And what is meant by "self structures"? If Khantzian means self-representations, these are conceived, psychoanalytically, as complex mental organizations, conscious and unconscious, to which all parts of the personality make contributions-a statement equally true of object representations. The latter are not mentioned in spite of their ready interaction with, and reciprocal influence upon, self-representations. Whatever Khantzian's "psychodynamic theory" is, it is clearly not based on psychoanalytic thinking, modern or otherwise. That said, it is gratifying to observe in the paper one significant point with which I am in agreement: when discussing drug addiction, we are not concerned with a homogeneous group of disorders. But WARNING! This text is printed for the personal use of the PEPWeb subscriber and is copyright to the Journal in w hich it originally appeared. It is illegal to copy, distribute or circulate it in any form.-42it is doubtful, to say the least, whether these conditions can be properly considered in terms of "painful emotions" that cry out for control, and the "drug of choice" used to this end. But Khantzian is firmly of the opinion that drugs act in specific ways that make them especially suited for specific purposes. "Opiates," he avers, are very effective in countering and muting intense anger and rage and appeal to individuals who endure such feelings, and/or suffer with psychiatric conditions in which such affects dominate. (High or obliterating doses of alcohol can have similar effects" on the basis of "a hypnotic action.) … Depressants in low to moderate doses have appeal to individuals who are tense and anxious.… Khantzian does not base his entire understanding of inappropriate drug use entirely on these suppositions, but they provide an essential basis for his self-medication hypothesis. Our neuroscientific colleagues will no doubt have some very

Three perspectives on addiction promulgated during the 1990s are reviewed, along with many earlie... more Three perspectives on addiction promulgated during the 1990s are reviewed, along with many earlier contributions to the understanding of addictive illness. It is suggested that these distinct yet overlapping formulations of the dynamics of addiction form a hierarchy for each patient suffering from an addiction. Assessment of a patient's ego strength, and of the relative importance of addictive behaviors in overall character structure, allows referral to various types of treatment, including psychoanalytic therapy. Case examples are presented, including material from the psychoanalysis of a woman addicted to heroin, methadone, cocaine, amphetamines, nicotine, alcohol, and shopping.

All of us depend on concepts to understand and respond to complex problems. Alcoholism and addict... more All of us depend on concepts to understand and respond to complex problems. Alcoholism and addiction certainly are no exception, and, in fact, concepts and theories have abounded to explain this maddeningly elusive and tragic problem in our society. But we have not achieved a consensus on what the various concepts and the approaches that grow out of the concepts teach us. Despite all of our disclaimers that alcoholism/addiction is no one thing and that it has multiple determinants, we almost invariably, if not necessarily, fall prey to considering our own formulations, concepts, and data to the exclusion of other perspectives. Nowhere is this more evident than in the controversy over whether psychological or psychiatric dysfunction is a cause or consequence of substance abuse. Unfortunately the cause-consequence debate mirrors and recapitulates old controversies in the philosophy of science in which polemics over nature-nurture, psyche-soma, and environment-heredity dominate, which are counterproductive and reflect linear and reductionistic reasoning. Findings from genetic, neuropsychological, longitudinal, and diagnostic studies are cited to suggest that the effects of chronic and heavy drug/alcohol use produce the psychopathology associated with substance dependence. These arguments are bolstered by observations of alcoholics and addicts who respond favorably to Alcoholics Anonymous/Narcotics Anonymous and experience marked amelioration of their psychological suffering when they abstain from alcohol and drugs.

As the causes of drug dependence are multiform and exceedingly complex, I shall refer to them onl... more As the causes of drug dependence are multiform and exceedingly complex, I shall refer to them only briefly in this essay. Many readers, perhaps, have some idea as to what causes drug addiction, and concurrently will hold definite views on how to prevent or treat it.

A psychoanalytic formulation of the addictive process is likely to be of value only in the contex... more A psychoanalytic formulation of the addictive process is likely to be of value only in the context of a clear and meaningful definition of addiction, so the definition I introduced in earlier papers is repeated here (Goodman, 1990, 1991b). Addiction was defined as a process whereby a behavior that functions both to produce pleasure and to provide relief from internal discomfort is employed in a pattern characterized by recurrent failure to control the behavior and continuation of the behavior despite significant harmful consequences. The definition was accompanied by a set of diagnostic criteria for addictive disorder, arranged in a format similar to that of the DSM-III-R (see Appendix).

shares an emotion-regulation-centered depth-psychological perspective on addictive processes. Rat... more shares an emotion-regulation-centered depth-psychological perspective on addictive processes. Rather than critique his even-handed coverage, I would merely supplement his views with some current neuroscientific perspectives in the area. There is still a vast chasm between these approaches, and the needed bridges can only sustain commerce if there is substantive building from both sides with concrete empirical predictions that can be evaluated in laboratory and clinic. To some extent that has already happened, with the recognition by both sides that certain evolved psycho-neuro mechanisms of the brain, such as the mesolimbic and mesocortical dopamine SEEKING pathways (ML/MC DAp), are essential in all kinds of appetitive urges, including ones related to most drugs of abuse (

We may expect as an aftermath of World War II the same psychological sequelae which followed Worl... more We may expect as an aftermath of World War II the same psychological sequelae which followed World War I. After the first World War there was noted an enormous increase in character disorders, particularly in addictions. Postwar mental disorders document the failure of the 'war ego' to reconvert into a 'peace ego' because of a shattering of ego and superego relationships. In war superego functions are disrupted, ego regressions enforced, and barriers of repression thus removed. If no neurotic or psychotic mechanisms are evoked as defenses, criminality results as the direct continuation of the war ego in civilian life. During the war, working and fighting for victory was the common goal for civilians and soldiers alike, serving as a collective ego ideal, counteracting the blunting of the individual superego. Postwar disillusionment with the ideal of victory robs it of its significance and effectiveness as a stabilizing factor within individual psychological systems, thus depriving the individual egos of the supporting superstructure of a community spirit. The unified nation again disintegrates into dissenting groups with disparate aims of self-interest. The cessation of groups with disparate aims of self-interest. The cessation of armed conflict is a narcissistic trauma for all; deprived of the protective participation in an inspiriting brotherhood of man, no longer able to identify himself with the nation as a whole, the disenchanted citizen finds that the bitter fruit of victory is a return to individual, social, and economic insecurity. The less the individual ego is capable of reconstructing itself by a withdrawal of aggressive energies (increasingly precipitated by frustration), the greater the need that the nation as an entity undergo a process of structuralization. Failing this, the individual

Since 1905, when Freud drew attention to the constitutional intensification of oral erotism in me... more Since 1905, when Freud drew attention to the constitutional intensification of oral erotism in men who have a marked desire for drinking and smoking, there have been many detailed contributions to the problem of drug addiction. Rado (32), Daniels (33), Benedek (5), Robbins (37), Fenichel (12) and others confirmed Freud's observations in stressing oral factors in addiction. The relation of drug addiction, particularly alcoholism, to latent homosexuality was investigated by Abraham (1), Freud (16), Ferenczi (13), Juliusburger (25), Tausk (44), Kielholz (26), Hartmann (22), Riggall (35), and many others. Kielholz (26) and Simmel (42) connected narcissism with drug addiction, while Abraham (1) and later Simmel (43) recognized the importance of aggressive factors. This view was confirmed and developed by Edward Glover, who stressed the early aggressive drive and an early oedipal nuclear conflict in drug addiction (20) and related his findings to Melanie Klein's views on aggression and the early oedipal complex (28). There were also attempts to define drug addiction as a disease and understand its relation to other diseases, neuroses or psychoses. Freud (17), Rado (32), Simmel (43), Benedek (5), Weijl (45), and more recently Federn (10), have stressed the relation of drug addiction to mania or depression; others, like Edward Glover, have described the paranoid element. It is interesting that the more important and detailed psychoanalytic papers on the problem of drug addiction were written before 1939. One of the reasons for the scarcity of psychoanalytic contributions during the last twenty years may be the recognition that the treatment of drug addiction in psychoanalytic practice is a very difficult problem.

In contrast to early psychoanalytic theory, which stressed pleasurable/aggressive drives and the ... more In contrast to early psychoanalytic theory, which stressed pleasurable/aggressive drives and the symbolic meaning of drugs to explain their appeal, a modern psychodynamic perspective of substance-use disorders (SUDs) places greater emphasis on intolerable painful or confusing affects that make addictive drugs compelling. A psychotherapeutic relationship rooted in a psychodynamic approach yields valuable data on the nature of a person's distress and deficits in psychological (ego/self) structures that predispose individuals to addiction. An evolving psychodynamic perspective, spanning 30 years, is presented wherein addictions have been considered as (1) a special adaptation, (2) an attempt to self-medicate painful or confusing emotions, (3) an overarching problem in self-regulation, and finally (4) a reflection of disorder in personality organization. This evolving perspective more likely than not should and does complement and resonate with other perspectives. A modern psychodynamic perspective of SUDs adds an important dimension to unraveling the biopsychosocial equation involved in understanding addictive vulnerability. Substance-use disorders (SUDs) are among the most pervasive and devastating psychiatric disorders and public health problems of our times. Until recently they have also been considered refractory to treatment. Three developments over the last half-century, however, have given rise to the prospect that addictive problems are better managed and treated. First, although lacking much significant data to substantiate its efficacy, the enormous growth and acceptance of Alcoholics Anonymous (AA) suggests that it has made a major impact on helping alcohol-dependent individuals. Second, the "heroin epidemic" starting in the 1960s forced clinicians and investigators to see, evaluate, and treat many opiate-dependent individuals. Finally, the widespread influx of cocaine into our society over the past two decades and the concurrent abuse and dependence on other addictive substances over this corresponding period have forced us, as a society and as scientists, investigators, and practitioners, to address these problems. Many of the treatments that have emerged have proven to be effective.

Although all human beings crave certain things, why do some develop such intense cravings that th... more Although all human beings crave certain things, why do some develop such intense cravings that they will not or cannot stop trying to satisfy them even at the risk of self-destruction? What determines the particular object, substance, or situation that is so desperately craved? In the case of drug addictions and alcoholism, the causal strands of such cravings may be said to involve a complex interaction of the substance craved, social or cultural influences, and personal psychopathology, but the precise way in which these factors interact continues in many respects to baffle us. We have been largely unable translate our presumed knowledge into effective treatment or prevention. Medical, legal, economic, and sociocultural problems seem to confound the therapeutic process. The frequent failure of treatment efforts directed toward social rehabilitation, and of the counseling and methadone programs developed during the sixties and early seventies, has led to a renewed interest in applying psychoanalytic perspectives to the psychodynamics of drug and alcohol abuse (Blaine and Julius, 1977). The present study aims at contributing to the psychodynamic understanding of addiction. This paper will emphasize certain psychological characteristics which may be found in severely addicted persons. Addicted persons who come into psychoanalysis, to be sure, constitute a very limited sample (Yorke, 1970). Recreational

UNTIL NOW, THERE HAS BEEN very little systematic exploration into the etiology of drug abuse. Gla... more UNTIL NOW, THERE HAS BEEN very little systematic exploration into the etiology of drug abuse. Glasscote et al. (1972) described the situation most aptly: It may be fruitless to make the effort to identify a group of universal causes of susceptibility. In any case, while there has been some interest in determining what drug users are like, by means of interviews and standardized tests, there has been little systematic effort to delineate and quantify causes. On the other hand, there has been much hypothesizing about the conditions, events, and circumstances that lead to drug abuse, most of which fall into three categories: the physical, the internal or intrapsychic, and the social and environmental [p. 19]. A study to fill at least part of the gap is envisioned here: viz., to delineate in a systematic way the etiology of drug abuse on the basis of large-scale clinical experience with all types of this phenomenon.

The term drug dependence was adopted by the World Health Organization in 1964 in the awareness th... more The term drug dependence was adopted by the World Health Organization in 1964 in the awareness that abuse and habituation to drugs call for attention as much as the more severe addictions which can still be considered a minor problem, at least in the statistical sense. Psychoanalysts have contributed extensively to the understanding of the psychopathology of drug addictions but are reluctant to engage in their treatment, not only because it often leads to disappointment but also because they are aware of their inability to deal with the social implications and complications pertaining to such cases. On the other hand, social psychiatrists cannot cope with the time-consuming demands arising from the severe intra-psychic disturbance presented by the patients and by necessity they concentrate on general management. Drug-dependent individuals therefore can be considered the unwanted children of psychiatry and psychoanalysis and it is understandable that transference and countertransference difficulties aggravate the psychopathology which not infrequently is to be traced back to early states of deprivation and abnormal dependency needs. It is also essential that we should not lose sight of the fact that the physiological and psychological action of addictive drugs is seldom fully understood. It is also quite easy to forget that in treating drugdependent subjects we are negotiating from a position of weakness from the outset. The cleverest psychoanalyst cannot match the power of marihuana in relieving anxiety, with the same degree of constancy, even if only temporarily. Furthermore, it is undeniable that the psychoanalyst in his daily practice is now frequently confronted with the casual taking of drugs and the occurrence of habituation to stimulants, tranquillizers and the hallucinogens. In this paper it is proposed to explore and describe: (i) the predicaments resulting from the abuse and habituation to certain hallucinogens (LSD and marihuana), (ii) their potentially addictive qualities, (iii) the role of the therapist in the challenging situation of the specific resistances related to the taking of hallucinogens and the early appearance of material of a quality and fluidity usually reserved for the later stages of an analysis. LSD-25 (Lysergic Acid Diethylamide) is a colourless, odourless substance which is taken orally, usually on a lump of sugar. Occasionally, but only for research purposes, it is administered by injection. 1/700 millionth of bodyweight of an average man or 25 micrograms is capable of producing physiological and psychological changes. One hundred micrograms represents the average dose taken by the casual mind-explorer. Subjects with psychological disturbances tend to take higher doses. Five hundred micrograms can be regarded as a very high dose. The drug was first produced by Sandoz (Switzerland) in 1938. A new substance with similar properties but several times more potent has just been produced. Unauthorised possession is a criminal offence. As the drug is produced without much difficulty with limited laboratory facilities, black market supplies are immense. LSD may affect literally every function of the body and mind. Brief mention of the most notable responses will be made in the presentation of the individual case histories. Those who are interested should consult Masters' and Houston's work: Varieties of Psychedelic Experience(1966), generally acknowledged as a reliable source of information on this complex subject. With regard to the therapeutic qualities of psychedelic drugs, as well as their capacity to cause profound and lasting changes in personality, character and emotional directions in "normal" individuals, neurotics, psychotics, alcoholics, criminals, etc., extraordinary claims have been made often as a result of one single psychedelic "trip". Cannabis resin is the plant from which hashish and marihuana are derived. Its use, known for

PloS one, 2016