We are actually, since more than a decade in a deep redefinition of psychological taxonomies because the socio-biological developments of neurofunctional sciences. After a provocative start, sociobiology inaugurated in fact a large period of technical inovations in deep investigations concerning neurotransmitters, neurobiochemistry, neurofunctional imaging. As a results, the previous interpretative empirical sciences, if having evidenced many interesting insights , may have lost themselves in theories and smoother clinically applied approaches toward neuropsychiatric patients have now to redesign many of their doctrine.
But does that has change so much the therapeutic approaches ? - Not so. Dialectic and reasoning had developed and are so close now to complexities that they simulate somehow well reality's complexities. Strong advances of basic neurosciences also reached the limits of the "whole body unit" and complexities of managment of details. And even if many psychiatric illnesses have been demonstrated, in fact, more neurologic disturbance, the development of neuropharmacology has not reached yet a degree of perfect matching with the supposed neurobiochemical ground of these neurologic disorders. Making that many of the therapeutic ressources developed by psychology, behaviorism, a bit more sophisticated cognitivism still apply as good partners to psychopharmacology.
What seems to be happening too is that previous theories have smoothed; Some had been enough lucky for good coincidence with new neurosciences discoveries, meanwhile some more modest empathic psychotherapeutic practices, focused on the patient effective practices (not so the theories she/he should follow), like cognitive behavioral therapeutics; have introduces some simplifications meanwhile also blurring the borders of dogmatisms.
Here with no other purpose than providing some few friendly complements to further documents on addiction as introductions to them: few keys for an impossible summary (for modest readers) on clinical psychology, for positioning it in the register of addictions. Thus an intent to table the basic sorts of clinical psychologic personalities, since we cannot put here all DSMIV-r.
|Intent of Psychiatric - Psychologic clinical Nosography (source: adapted orginally nfm)|
|Kinf of Anxiety||fragmenting||object loss||castration||substitute|
|Relation to object||denied or fusional||anaclitism or "passage à l'acte" (intent to commit)||childhood lockloops||(social) abnormal|
|Main (self-) defense||reality denial and/or projection||non-separation or depressive inhibition||repressed & displaced||hidden (realized)|
|- acute psychosis||- depressive states||- nevrosis||- collections (intermediated)|
|- acute delirium and / or confusion||- borderline||· anxiety (nevrosis)||
- psychopatics (against oneself)
|- maniaco-depressive||- impulsive||· hystrionic (ex-histeria)||- sociopathic (against others)|
|Addiction risk||high||very high||mild||low|
|Pain/suffering||- pain overfull||- confused||- suffering||- enjoyed ?|
|Agressivity (self/against)||high (both)||mild ? (both?)||low (self)||high ? (others)|
|Clinical tableaux||- chronic psychosis||· dependence||· phobia||· some sexual perversions|
|· chronic delirium (or paranoias)||· impulsions||· obsessive (compulsive)||· collections (kleptomania)|
|· schizophrenia||· di(sperceived) morphism||· boulimia||· anorexia|
|· out categories||- psycho-somatic disorders|
|- deficit disorders|
Working with addicts intent to impulse "more positive pathways for the patient". Professional or volunteers cannot avoid their own criteria. Neither it is always sure that these criteria as safe or/and the conditions of addict is what he/she,after all, want or just stay behaving so just because his/her own fault. Anyone anyhow dream of a better life, but it is the way of the patient that will be anyhow much more pregnant to her/him than any care, more than any tale on "what to do". So caregivers will not do without patient's essential will, in his/her sort of survival. Better if both care giver and care taker see further steps more positive and more sustainable.
In addiction therapeutic relation is a permanent balance between trust and distrust. On a formal or non formal contract basis, often poorly made with "big formal things", while eventually strongly made with timish and small little leading to stronger comitments; it is to mind the patient as a whole, whatever the kind of professional we can be (therapist of from order forces), with non collaborative relations. Not to be suprised to discover that the addict, the addict-dealer, or the market are not as dumb as common voters would prefer. In the cooperative therapeutic relation: balance is also of trust and distrust, potential manipulations and so on; but made more easy with the tools (and its limits) of sincerity, control, fairness that can be included by the caregiver in the game. Care nevertheless the asymmetry conditions: the patients with their lies, manipulations on their side and dosage, contract, medicines by side of therapists), since this assymmetry does not ensure the best way-out from addiction nor the proper service to patients.
Patients have "regular life", life or survival needs, for many deeply disturbed but not as simplified as imagined by people afraid by addicts. They can have all the traits of psychology but often deal with more psychiatric difficulties. They have goals, strategies, not just and only for getting out their disturbing consumption. And they will have to plan, shape, frame, have project and strategies, decide, where an very important contribution of therapist will consist in supporting them and where most of the meritshould be for the patient.
|Individual - Patients Strategies: an Intent of it systemics (source: anfm)|
|direct strategies||strategies for memorise||create mental association, use pictures and sounds, revice act for learning|
|cognitive strategies||practice, receive and send message, analyze and thinking, create structure, reception, production|
|compensation strategies||guess intelligently, compensate limits|
|pain||avoidance, overcome, suppress|
|indirect strategies||metacognitive strategies||focus on learning, organize and plan learning, assess learning|
|affective strategies||control anxiety, encourage, feelings assessment|
|social strategies||ask, cooperate, open to others|
|suffering strategies||prepare, fear, depress, prevent (noxiously)|
For example of "personality disorders" especially sensitive to drugs abuse consumption: 1) borderline and 2) impulsive. They are at the fringe between nevrosis and psychosis that is, with the huge difficulty not to known if one or the other. Difficulty then for having psychotherapeutic strategy, since they are easilly contrary. Personality disorder general criteria shows: 1) Frantic efforts to avoid real or imagined abandonment (do not include suicidal or self-mutilating behaviour); 2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation; 3) Identity disturbance-markedly and persistently unstable self-image or sense of self; 4) Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating); 5) Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour; 6) Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability,or anxiety usually lasting a few hours and only rarely more than a few days); 7) Chronic feelings of emptiness; 8) Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights); 9) Transient, stress-related paranoid ideation or severe dissociative symptoms.
Impulsive type: the general criteria of personality disorder that must be met and, at least, 3 of the following must be present, one of which is (2): 1) A marked tendency to act unexpectedly and without consideration of the consequences; 2) A marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized; 3) Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions; 4) Difficulty in maintaining any course of action that offers no immediate reward; 5) Unstable and capricious mood.
Borderline type: the general criteria of personality disorder must be met, and at least three of the symptoms mentioned above in criterion must be present, and in addition at least 2 of the following: 1) Disturbances in and uncertainty about self-image, aims and internal preferences (including sexual); 2) Liability to become involved in intense and unstable relationships, often leading to emotional crises; 3) Excessive efforts to avoid abandonment; 4) Recurrent threats or acts of self-harm, 5) Chronic feelings of emptiness. Culture: the "high-risk" situations or factors preceding relapse include: 1) Stress. Whether due to discrete negative life events or everyday hassles, stress greatly increases vulnerability to relapse; 2) Negative emotions. A wide range of `negative' emotional states can precipitate relapse. These include anger, anxiety, depression, frustration, or even boredom; 3) Positive emotions. Good feelings that come from socializing can sometimes trigger relapse; 4) Interpersonal conflict. Relapse is often associated with conflict with family members and other individuals. This may particularly manifest as lack of trust by family members. The anger or frustration may act as a strong precipitant for relapse; 5) Use of other substances. Use of any one intoxicant drug can trigger cravings for the primary drug of abuse or undermine self-control. 6) Presence of drug-related cues. 7) Environmental cues (e.g., drug paraphernalia) elicit strong craving in some people who are trying to maintain abstinence, and may even cause a `conditioned' withdrawal syndrome. 8) Active lever. Responses on this lever lead to drug infusions during drug self-administration training. During extinction training and tests for reinstatement, responses on this lever are not reinforced by the drug and serve as a measure of “drug seeking”. 9) Between-session reinstatement procedure. A procedure in which drug self-administration training, extinction training, and tests for reinstatement of drug seeking are conducted on separate daily sessions. 10) Between-within session reinstatement procedure. A procedure in which drug self-administration training is conducted over days, and then extinction training and tests for reinstatement of drug seeking are examined on the same day following different periods of drug withdrawal.