April 16, 1982

Dynamic Approaches to the Understanding and Treatment of Alcoholism

Author Affiliations

Veterans Administration Medical Center Kansas City, Mo


edited by Margaret H. Bean and Norman E. Zinberg, 214 pp, $15.95, New York, Free Press, 1981.

JAMA. 1982;247(15):2159. doi:10.1001/jama.1982.03320400069049

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The five contributors to this book are psychiatrists and psychoanalysts associated with the Cambridge (Mass) Hospital and Harvard Medical School. Despite their common backgrounds, they do not agree about the cause and treatment of alcoholism.

Vaillant, drawing from his prospective study of psychologically well college sophomores followed up 30 years later, concludes, contrary to assertions by many psychoanalysts, that the "alcohol personality" is a consequence, not a cause, of alcoholism. He further argues that in-depth psychotherapy (psychoanalysis) does not help and often harms alcoholics by deflecting attention from their major problem, alcoholism.

Bean argues that psychotherapy can be beneficial if the therapist recognizes and appropriately confronts the alcoholic's denial system. Unfortunately, her practical insights and discussion of alcoholic denial are mixed with a heavy helping of psychoanalytic jargon, which detracts from the chapter's overall lucidity.

Zinberg, after reviewing various definitions of alcoholism, emphasizes that the treatment strategy and goals for