A community-reinforcement approach to alcoholism

Several theoretical approaches to alcoholism exist. An opérant reinforcement approach was used in the present study to develop a new procedure that rearranged community reinforcers such as the job, family and social relations of the alcoholic such that drinking produced a time-out from a high density of reinforcement. The results showed that the alcoholics who received this Community-Reinforcement counseling drank less, worked more, spent more time with their families and out of institutions than did a matched control group of alcoholics who did not receive these procedures. This new approach appears to be an effective method of reducing alcoholism. An analysis in reinforcement terms is presented of the etiology, epidemiology, and treatment of alcoholism.     

Improvements in the community-reinforcement approach to alcoholism

This study evaluated a modified Community-Reinforcement program for treating alcoholics. The previously tested Community-Reinforcement program included special job. family, social and recreational procedures and was shown to reduce alcoholism. To increase the effectiveness of the program further, the present study incorporated a Buddy system, a daily report procedure, group counseling, and a special social motivation program to ensure the self-administration of Disulfiram (Antabuse). The alcoholics who received the improved Community-Reinforcement program drank less. worked more, spent more time at home and less time institutionalized than did their matched controls who received the standard hospital treatment including Antabuse in the usual manner. These results were stable over a 2-year period. The program appeared even more effective and less time-consuming than the previous program. The present results replicate the effectiveness of the Community-Reinforcement program for reducing alcoholism and indicate the usefulness of the additions to the program.     

Skid-row rescue missions: A religious approach to alcoholism

The focus of this study is on the religious service at which many skid-row rescue missions require attendance to receive benefits. Data were obtained from an observation study of thirty-seven skid-row rescue missions in Los Angeles and Seattle, interviews with ten mission directors, and mission newsletters. The missions use material benefits to attract potential converts. The theme of spiritual conversion is predominant in the mission service (sermons, songs, testimonies). Mission personnel feel they have been called by God, often have backgrounds similar to the people they serve, and view the skid rowers' problems as primarily personal and spiritual. Skid rowers resent the use of religion as bait, view their problems as primarily structural, and use the missions only as a last resort. The missions need to be compared to other alcoholism rehabilitation and religious institutions. A key component to their continued existence is outside Christian supporters.     

Belgrade systemic approach to the treatment of alcoholism: principles and interventions

This article describes an ecosystemic approach to alcoholism (ESTA) developed in Belgrade, Yugoslavia. The fundamental principle is that alcoholism is a problem of the whole context, involving the index patient, the family and wider systems including the work system.
The treatment programme, which integrates contemporary principles of the treatment of alcoholism with family-systems ideas covering biomedical-psychological-sociocultural levels, is also described and illustrated by a detailed case example.     

Psychoanalytic approaches to biblical religion

A brief look at four studies of biblical religion from a psychoanalytic point of view (spanning the time from Freud'sMoses and Monotheism to the present) alerts us to the many ways biblical religion both reflects and mediates the dawning realization that for the well-being of humanity it is of decisive importance that sons do (in spite of all emotional obstacles) identify with their fathers and fathers do find ways of loving and caring for their sons (the eldest son in particular).     

Jung's Contribution to Psychoanalytic Thought

My response to the discussions is organized from an evolutionary perspective on the development of theory within psychoanalysis. After briefly stating the premises of the paper, I discuss each commentary. I experience Aron's discussion as more evolutionary than Benjamin's or Ellman's. It seems clear that we all have our own agendas. The reader is invited to try them on for size in the spirit of ongoing dialogue that characterizes this journal.     

Combination pharmacotherapy in alcoholism: a novel treatment approach

Combination pharmacotherapy has proven effective in a number of psychiatric disorders, including depression and schizophrenia. However, compared with other affective disorders, few studies have explored the use of combination therapy in alcoholism, and the majority have been limited to animal models. There is evidence to support a role for combination therapy in alcoholism. For example, several neurochemical systems, including the dopaminergic, serotonergic, and opioidergic, appear to affect alcohol intake. Studies in several different types of alcohol-preferring rats have suggested that coadministration of agents to target more than one of these systems simultaneously may produce beneficial effects on alcohol intake, while avoiding problematic effects, such as alterations in food or water intake. Data from preliminary clinical studies have shown trends toward combination therapy reducing alcohol intake in humans. While such findings are encouraging, they must be explored further in larger, randomized, double-blind trials.     

Psychoanalytic approaches to artistic creativity.

Study of data and findings from clinical and applied psychoanalysis suggests a number of common factors encountered with uncommon frequency and intensity in creativity. In this paper, early childhood experiences, sensorial perceptions, body feelings, loneliness, reactions to loss, and body imagery of several artists are discussed. Problems relating to body image in creativeness are explored.     

Psychoanalytic Companioning

In this paper I offer an integration of object relations and relational conceptions of clinical interaction and suggest a register of psychoanalytic companioning. I suggest that when working with patients and states where there is no self-other definition and therefore no mutuality, the path to healing and growth is via companioning the patient into the darker, more regressed and unformed states of illusion and merger rather than via the promotion of separateness and relatedness, which, I propose, will accrue from within the companioning register. The analyst works from within an unobtrusive relational position. I offer a case example of my work in this register and suggest that this offers a different register of the use of the analyst’s subjectivity: one that is receptive, “cooperative” (Trevarthen) and responsive to the patient’s internal world and objects, rather than analytic and knowing. I consider the dimensions of intersubjectivity that cohere with the dimensions and levels of the patient’s mentalization as outlined by Leciurs and Bouchard (1997).     

Contribution of Hungarian Psychoanalysts to Psychoanalytic Psychosomatics

How is psyche related to soma? What tricks does the mind play on the body—and vice-versa? In psychoanalysis, few have probed these questions more deeply than analysts from the Budapest school. Their work began in Hungary and was carried forward in other countries, following their forced emigration. In this study, I touch upon common features of Ferenczi's and Groddeck's thinking about psychosomatics. I explore the work of Sándor Ferenczi, Lajos Lévy and Mihály Bálint among others, and the attraction between avant garde Hungarian intellectuals—mainly writers influenced by Ferenczi—and Georg Groddeck.