Saturday, January 12, 2019

Substance Abuse is an attempt at Affect Regulation

First, a Happy New Year! to the readers after a holiday break from posts here on Contemporary Psychoanalytic Musings.

This morning, January 12, 2019, the Tampa Bay Psychoanalytic Society hosts me-- Lycia Alexander-Guerra, MD-- and a colleague, Paulina Robalino, LCSW, to speak about how psychoanalytic psychotherapy contributes to substance abuse treatment in a talk “A Psychoanalytic Dimension to Substance Abuse Treatment.” My premise is:
Substance abuse is an attempt to affect regulation. The inability to self regulate affect is a  result of failure in infancy and childhood of sufficient experiences with mutual regulation. Psychoanalytic psychotherapy is about mutual regulation and therefore is an important adjunct to treatment of people with substance abuse problems.

Joyful and loving interactions with others stimulate feel good chemicals in the brain (dopamine, serotonin, oxytocin) and the soothing or calming of distress/stress prevents ‘priming’ of the autonomic nervous system -- with its sympathetic and parasympathetic fight-flight-freeze reactions-- by reducing cortisol. Affect regulation (e.g. up-regulating a lethargic, passive infant, or down-regulating a distressed infant) of adverse childhood experiences protect from (decrease the risk for) all kinds of maladies: cardiac and pulmonary disease, cancer, depression, anxiety disorders like PTSD, and, substance abuse.

Psychoanalytic psychotherapy today recognizes the the importance of right brain communication, attachment, and affect regulation in bringing about a more coherent, cohesive, continuous sense of self. By participation in mutual regulation of affect, both members of the analytic dyad have the physiological experience of increased dopamine and oxytocin, ‘exercising’ the brain to more easily produce these neurotransmitters, and increasing the capacity for self regulation. An improved sense of self and an increased capacity for self regulation are important assets on the road to recovery.

1 comment:

Richard Nikla, MA, LMHC, CAP said...

As identified, substance abuse and addiction are related to childhood relationships with the caregiver as well as immediate family, and friendships in shaping an independent self. This process also shapes the brain and reactions to bonding and stress through negatively shaping gene expression. That interaction shapes the persons coping, learning, relationships, and goal setting for present and future endeavors. What is important is for the therapist and client to establish and engage in a coherent relationship, that involves the client identifying their past and its relationship to their present and future. During this process it is important for the client to shape a positive relationship with themselves, recognizing the addictive habits they have created, understanding the motivation of these addictive habits, understanding the triggers, developing sometimes regained or new positive habits, and shaping goals and motivation to change the direction of their addictive habits in order to live a coherent life. This change in their life style involves continuous efforts and recognized accomplishments in establishing and maintaining a new purpose in life.
As addiction is a process of the emotional brain bypassing the frontal cortex, it is important for the therapist to engage the client in emotional well-being. These changes in habits are initiated in the emotional part of the brain, and developed into habits in the frontal cortex, which has been previously off line due to stress and life style. Recovery is a continuous process of positive encouragement and lifestyle changes, turning on and off genes changing and reshaping gene expression.