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opioid-abstinence syndrome, and probably the two phenomena are mediated, in part, by the same central nervous system pathways. Hence, the occurrence of anxiety for whatever reason long after detoxification may result in relapse.

ROLE THEORY (p. 225)
Winick

The reasons for relapse, in terms of this theory, would reflect the person's inability to sustain the role of the nonuser. Each period of abstinence may represent a trying out of the nonuser's role, for varying periods of time. lt is likely that the most common pattern of cessation of drug dependence involves experimentation with the nonuser's role until it is consonant with other aspects of the person's life.

An earlier formulation of the theory argued that drug-dependent persons "matured out" when there was a lessening of the role pressures which had led to the beginning of regular drug use (Winick 1962a). The process of "maturing out" was slow and typically involved a stopstart pattern of drug use until the person felt comfortable with the role of the nonuser.

ln the original study which led to the formulation of the "maturing out" theory, based on a national sample, the mean age of "maturing out" was 35 (Winick 1962a). The narrow clustering of age at "maturing out" in different samples at different times suggests that there are underlying regularities in the process. Ethnicity, sex, residence, access to and salience of drugs, attitudes toward drugs in an area, and the extent to which nondrug-related roles are plausible and reinforced, contribute to cessation of drug use, as does the extent to which the user experiences less role strain and/or deprivation.

DEFENSE-STRUCTURE THEORY (p. 71)
Wurmser

Since the underlying conflicts usually are not resolved, and the propensity to affect regression and ensuing defense by denial remains, any new, usually inevitably recurring disturbance of the narcissistic equilibrium gets the specific circular process of drug use once more into motion. Quite often one can find a displacement from the drugwithdrawal-related discomfort onto all distress. The process is this: When l was anxious (etc.), drugs relieved the otherwise unmanageable feelings. When the drugs ceased their effectiveness (e.g., in acute withdrawal), all the suppressed feelings came back, usually with increased vehemence, and coupled with all the added unpleasantness of withdrawal. Now, whenever l feel intense affective distress l also feel the typical withdrawal symptoms. Such microconversion symptoms based on displacement (from anxiety, shame, etc., onto physical symptoms once accompanying their resurgence) in form of chills, diarrhea, the "yen," etc., weeks or years after detoxification from physical addiction, can be observed in many compulsive drug users. The drug

is seen as a specific relief for both: affective distress and the conversion symptoms in the form of pseudowithdrawal.

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