Although substance use and abuse may impact brain and behavior, it is still unclear why some people become addicted while others do not. Neuroscientific theories explain addiction as a series of between- and within-system neuroadaptations that lead to an increasingly dysregulating cycle, affecting reward, motivation, and executive control systems. In contrast, psychoanalysis understands addiction through a relational perspective wherein there is an underlying failure in affect regulation, a capacity shaped early developmentally. Considering recent findings suggesting the neurobiological overlap of addiction and attachment, it may be possible to integrate both perspectives into a developmental model through the lens of attachment. The goal of the present review is to evaluate the value of neurobiological and psychodynamic perspectives to inform our understanding of addiction, particularly substance-use disorders.
In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. A recent article proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment. This article aims to explore the potentials of the Open Dialogue (OD) approach for engaging in less psychiatrizing forms of psychosocial support. While OD may not be an all-encompassing solution to de-psychiatrization, this paper refers to previous research showing that OD has the potential to 1) limit the use of neuroleptics, 2), reduce the incidences of mental health problems and 3) decrease the use of psychiatric services. It substantiates these potentials to de-psychiatrize psychosocial support by exploring the OD’s internal logic, its use of language, its processes of meaning-making, its notion of professionalism, its promotion of dialogue and how OD is set up structurally. The conclusion touches upon the dangers of co-optation, formalization and universalization of the OD approach and stresses the need for more societal, layperson competencies in dealing with psychosocial crises.
Although it is known that mothers with substance abuse disorders struggle
to provide adequate parenting to their children, little is understood about the
mechanisms behind this. This cross-sectional study uses an attachment
perspective to examine whether reflective functioning mediates the relationship
between mental representations of caregiving and maternal sensitivity, in an
ethnically diverse sample of 142 substance-abusing mothers (M
[SD] = 29.83 [5.79] years of age) and
their toddlers (M [SD] = 24.04 [15.15]
months of age). Data were baseline measures from two randomized controlled
trials. The three variables of primary interest were positively correlated. As
expected, there was a significant relationship between mental representations of
caregiving and maternal sensitivity that was largely explained by reflective
functioning. Confounding and alternate explanations were not supported by a
secondary data analyses. The findings underscore the importance of reflective
functioning in positive parenting within this high-risk population of mothers,
and they provide support for the development of attachment-based
interventions.
Motherhood has been deemed a normal crisis, given the significant psychological, biological, and neural changes surrounding pregnancy and the postpartum period. These challenges can become more complex as they are closely related to the parent's own selfdevelopment and sense of self-efficacy grounded in their personality prior to parenthood. The normal crisis of motherhood may be further complicated by addiction. Considering the evidence of the negative impact and poor developmental outcomes of children born to mothers with substance use disorders, special attention must be paid to addiction in this context. This paper is a review of evidence on the challenges of parenthood, particularly when affected by addiction. We explore the centrality of object relations in personality development and parenting practices and discuss the problem of maternal addiction from multiple perspectives, particularly Blatt's (1991a) two-polarities model of personality development.
Open dialogue (OD) is a multi-component therapeutic and organizational intervention for crisis and continuing community mental health care with a therapeutic focus on clients’ social networks. The development and implementation of this model of care in the United Kingdom requires considerable contextual adaptations which need to be assessed to support effective implementation. Program fidelity–the extent to which core components of an intervention are delivered as intended by an intervention protocol at all levels–is crucial for these adaptations.AimsTo develop, pilot, and implement a program fidelity measure for community mental health services providing OD and ‘treatment as usual’ (TAU) or standard NHS crisis and community care.MethodsMeasure structure, content, and scoring were developed and refined through an iterative process of discussion between the research team and OD experts. Measure was piloted in the 6 OD and 6 TAU services participating in a large-scale research program.ResultsInitial data suggests that the Community Mental Health Team Fidelity Scale (COM-FIDE) is a potentially reliable and feasible measure of the fidelity of community mental health services and specific OD components of such services.
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