Book excerpt: For many practitioners, sifting through the diverse and complex methods available for treating substance abusers can be just as daunting as working with the addict. Drawing on over 30 years of experience, Edward Kaufman has developed a pragmatic approach to treatment that systematically integrates techniques from a variety of influences--from object relations and cognitive-behavioral therapy to structural family therapy and the Twelve-Step movement. Covering the myriad problems encountered with alcoholics and addicts, he presents a workable approach that can be utilized by a broad audience of therapists at varying levels of training in psychotherapy and/or substance abuse. Each of the chapters provides the details necessary for understanding and treating the substance abuser with psychodynamic therapy. The book outlines the personality and psychopathology of addicted persons, taking into account psychodynamic theory, codependent patterns, and risk factors that may predispose individuals to substance abuse. Recognizing the gender specificity of certain issues, the book then describes topics relevant to addicted women, with discussion of personality traits, gender-specific considerations for psychotherapy, feminist therapy, and how women fare in Twelve-Step groups. A chapter on defense mechanisms focuses on denial, projection, and rationalization, and another chapter describes the three most common personality disorders among addicted persons--antisocial, narcissistic, and borderline. Illustrating the approach with case histories, the author describes his three-phase psychotherapeutic method. The first phase--assessment to abstinence--involves evaluation, motivation, detoxification, incorporating the family and social network, developing a method for abstinence, and delineating a workable treatment contract. The second phase--early recovery (sobriety)--focuses on methods for helping an abuser remain drug and alcohol free. Relapse prevention strategies and a variety of coping methods are outlined, and methods are presented for teaching abusers to recognize situations that may provoke their use of drugs, the reasons for relapse, and the psychodynamics of their addictions. Finally, the third phase--advanced recovery (intimacy and autonomy)--addresses such issues as the ability to love in an intimate way, self-sufficiency in work and creativity, and the development of relaxing, pleasurable leisure skills. The therapist's role in transference and countertransference, and the substantial value of interactional methods to create change, particularly in clients with personality disorders, are examined. The book's final chapters focus on the integration of group and family therapy with the proposed individual therapy model. A phase-related model of group therapy is presented, and multiple-family and couples groups are discussed, with a synthesis of several family therapy approaches that emphasize structural and psychodynamic family techniques. Valuable to a wide audience of mental health professionals working with substance abusers, this book will help the addiction therapist to utilize psychodynamic constructs more effectively, and the psychotherapist to incorporate the tools of such programs as Alcoholics Anonymous. It is also ideal as a primary text or supplemental reading for courses dealing with the treatment of substance abuse.