The alcoholics described so far in this chapter were not suffering from additional clear-cut psychological illness. But alcoholism can be the most evident disturbance in a patient whose principal disorder is, in fact, neurosis. The alcoholism is not primary and the form of the drinking is not distinctive. Very varied patterns are adopted. Alcoholics with neurosis drink to reduce their subjective distress, to diminish their emotional conflicts. Their drinking represents an attempt at cure of the symptoms of the underlying condition. However, as it usually exceeds what is acceptable socially, it worsens their inter-personal situation. They use alcohol to try to counteract their symptoms which stem from disturbed inter-personal relationships, but unfortunately their friends and relatives have to put up with the added embarrassments of the drinking superimposed on the pre-existing psychological difficulties. So the drinking is self-defeating. Yet they may persist in it for many years, knowing no alternative. Physical dependence develops in time, with resultant addiction. However, if proper attention is paid to the underlying psychological disorder the alcoholism may be relinquished by the patient. The treatment in such a case must aim to deal with the psychological disorder, but proper therapeutic contact with the patient is not possible until the drinking has been interrupted.
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