Abstract : The concomitance of mental health and addiction disorders is a problem in routine medical clinical work. What can we do for patients that are « neither/nor » : those who are neither taken into Addiction Care Unit nor by Mental Health Care structures. We propose that the explanation for this situation seems to be linked to a causal approach in the clinical judgment of medical Doctors. Their model is based on pharmacopsychosis. A medical Doctor has to stop his usual causal judgement so as to put in place an integrated care plan instead of a sequenciel one. He needs to switch from a pharmcopsychosis model to a double pathology model.
Summary : the author proposes, through his experience and his meetings with patients “addicts” some reflexions to think and set up a reception institution adapted and specific to this population in the context of institutional therapy practices A reminder is mentioned on the major fact that “it is the relationship that heals” when it is based on an ethical position always reinterpreted in the light of human sciences and neuroscience.
From a patient pun « legitime défonce » (mixing self-defence and to be stoned ) expressing his right to take psychoactive substances, as a solution to protect himself from an unfair and absurd world, we examine the ecological function that addiction can have for the subject, and in particular how this notion echoes the notions of reversed debt and destructive entitlement. This is extremely fruitful at the relational level, but also to better understand the barriers that prevent someone from quiting his addiction. In a harm reduction perspective, accepting that someone take drugs can help the person find the time and the way to change without too many complications.
During addiction’s consommation, time would be supended for the addictive person. Care at the day’s hospital Addictions et Psychiatry of Elan Retrouvé Foundation could help at a restarting for the patient. Thanks to a « pré-admission » time with therapeutics groups (speaking and collage) and regular interviews, the person could find back a people statut and find back the societal time.
Starting from the way psychoanalytical theory has death instinct and its non-pathologiocal evolution, the article examines the evolution af addictions, espacially how these can be sublimated into an identity solution. Clinical examples illustrate this. Reversely, starting from the clinic and the protocol of psychotherapy for drugs addicts as was elaborated in the 90’s, the author shows that the main theorical principles for treating such patients – ever before addictology existed as much – are still valid, as regard the notions of temporality, sdis-sonance or approximation.
Since the 19th century some psychoanalysts post freudian consider the game ((gambling) as an addiction, notably Otto Fenichel, who relies on Thérèse Benedek, who takes up the idea of Edward Glover. The play (game) studied by Winnicott is something else but Freud interest in it also concerns the development of the child to adult, so the development of the psychic apparatus. We study here how the game concerns the psychics’ obect, returned so to the notion of object all its problematic, that is to say its linguistic materiality.
Abstract: This communication tries to show the interest of projective methods for anorexia nervosa in adolescence. Beyond the diagnostic, feminine sexuality in adolescence, depressive position and temporality are discussed. These propositions are illustrated with a clinical case: Colombe, anorectic 16 years old young girl.
Addictive behavior is not always a problem of dependence. For some particularly sensitive people, alcohol and drug abuse can be a way to regulate anxiety and negative emotions. The substance fosters dissociation and makes it possible to regain the sense of strangeness, disconnection and depersonalization already experienced during traumatic events experienced in childhood. This dissociative behavior can take different forms and must be differentiated from addictive behavior during the treatment. After presenting our theoretical presuppositions on overexcitability (Dabrowski, 1964) and trauma-related dissociation, four clinical vignettes and speech from the therapy sessions of these four women will illustrate our point.