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Faculty Publication: Associate Professor of Social Work Sara Bressi

April 8, 2024

Standing in the Chasm: Therapeutic Action for Substance Use and Addicting

Author: Sara Bressi

Source: Psychoanalytic Social Work, DOI: 10.1080/15228878.2024.2310634, January 2024

Type of Publication: Article

Abstract: Substance use in the United States, as a chief cause of premature mortality and core barrier to public health, emerges as a clinical focus of services provided in community-based, residential, and inpatient settings by social workers and other behavioral health clinicians. While evidence-based interventions for substance use and addicting are available, social workers struggle to integrate these modalities and stand in a chasm without an overarching understanding of substance use or guiding principles for therapeutic action. In effort to disrupt moralistic and essentializing models of substance use, this paper models use as a relationship with a non-human caregiver as an action toward survival and offers relational principles for therapeutic action to ground predominant treatment modalities. A multiple self-states model of the mind is employed to orient clinicians to an originating state of helplessness in those addicting and suggests the use of countertransferential helplessness in the clinician as a primary path into the work with this population.