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Yıl:2001; Cilt: 2; Sayı: 3>> Özet
TAM METİN
Bağımlılık Dergisi; 2001;2(3):127-132
Alkol bağımlılığına psikodinamik bir bakış
E Göka, AD Başterzi
Ankara Numune Eğitim ve Araştırma Hst. I. Psikiyatri Kliniği
Bugün alkol bağımlılığının multifaktöryel etyolojili ve heterojen bir hastalık olduğu kabul edilmektedir. Tedavide de her hastanın gereksinimine göre esneme gösteren, psikodinamik yönelimli yaklaşımları da içine alan kombinasyonlar denenmektedir. Alkol bağımlılığının psikodinamik yönelimli bireysel psikoterapisi için öncelikle buna dair psikodinamik temeller gözden geçirilmelidir. Bağımlılık üzerine birçok görüş öne sürülmüştür. Bireysel psikoterapiye başlamadan önce ayırıcı tanı ve komorbid durumlar saptanmalı, eşlik eden fiziksel hastalıklar belirlenmelidir. Bu değerlendirme alkol alınmayan 6-8 haftalık bir kesilme periyodunun ardından yapılmalıdır. Psikodinamik yönelimli bireysel psikoterapi ancak alkol bağımlılığının tedavisinde kullanılan diğer tedavi modaliteleriyle birarada kullanılabilir. Klasik psikoanalitik tedavi ise bu alanda kontrendikedir. Psikodinamik yönelimli bireysel psikoterapi için en temel endikasyon varolan bir intrapsişik çatışmanın saptanmasıdır. Tedavi kontratında amaç abstinens olarak belirlenmelidir. Tedavi, “içemem”, “içmeyeceğim”, “içmem”, “toplumsal içiciliğe geri dönebilirim” aşamalarını içerir. Bu dönemde aktarım ve karşıaktarım yorumlanır. Sonuç olarak; alkol bağımlılığı tedavisinde pek çok başka tedavi yönteminin yanında, dinamik yönelimli psikoterapi seçeneği de göz önünde tutulmalıdır.
Psychodynamic View To Alcohol Dependency
Alcohol dependency is accepted as a heterogenous and multifactorial etiological disease. The combinations which were changed according to needs of each patient and contain the psychodynamic- oriented approaches have been tried in the treatment. The principles of psychodynamics related to the psychodynamic-oriented individual psychotherapy for alcohol dependency should be reviewed. Many ideas about dependency were suggested. The differential diagnosis and the comorbid psychiatric states and the physical diseases should be detected before starting the individual therapy. This evaluation should be performed after the withdrawal period for 6 and 8 weeks. The individual psychodynamic-oriented psychotherapy can only be used with the other treatment modalities in the treatment of alcohol dependency. But the classical psychoanalytical treatment is contraindicated in this field. The most important indication for the psychodynamic-oriented individual psychotherapy is existence of an intrapsychic confliction.

Aim of the treatment contract should be determined as abstinency. The treatment contains the levels for “I can’t drink”, “I won’t drink”, “I don’t drink” and “I can return back to the social drinking”. Transference and counter-transference are interpreted in this period. As a conclusion, choice of psychodynamic-oriented psychotherapy should be considered in the treatment of alcohol dependency as well as other many treatment methods.

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