I want to share this article with you from my intensive study group, The Virtual Edge of Psychotherapy: Transformation in Technoculture. 
In the article Cybermourning: Grief in Flux From Object Loss to Collective Immortality Stephen Hartman describes how in cyberspace loss may transform into a collective space with potentiality for online immortality.
There is much to consider regarding this idea as well as other points in the article. Please let me know what you think.

Hartman, S. (2012) Cybermourning: Grief in Flux From Object Loss to Collective Immortality
Psychoanalytic Inquiry 32: 454-467
Abstract 
This essay examines features of cyberreality that are reconfiguring loss and mourning. In turn, it queries a transformation in the nature of object loss that is taking place on the internet. As we move from a reality based on the acceptance of loss and limit to one of infinite access, concrete losses may be less necessary to mourning than forms of access that propel the object's capacity for collective re-use toward immortality.
To continue icpla.edu/wp-content/uploads/2014/01/Hartman-S.-Cybermourning-Grief-in-Flux-from-Object-Loss.pdf

In my psychotherapy practice I work with many patients needing help with substance abuse problems and sex addiction. The vulnerability towards problematic drug or alcohol use or to sexually “act out” (ex. anonymous sex, hours of internet pornography, phone sex, chatrooms, sex clubs etc.) when there is a loss, a difficult day or uncomfortable emotions is familiar ground. Somewhat underestimated is the enormous challenge for many with “good feelings,” accomplishments, success and their links to drug abuse or problematic sexual acts. 

Patients expect setbacks, loss and negative affect to be formidable threats to relapse or moderation boundaries, and are prepared for this. Positive experiences, sensations and even feeling connected to another on the other hand, are often underestimated in how they can lead to problematic behavior. For many there’s less experience with how to digest and integrate such emotions and experiences, and patients may be powerfully drawn to drug use or set of problematic sexual behaviors. 
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In treatment we can examine the range of bodily sensations and pulls of a craving borne out of positive affects. What we think of as positive emotional states may have well established links to compulsive behavior and substances as a means to unconsciously regulate ones affective state. 

I see a lot of couples in my practice with substance use problems. Couples where one partner is sober and the other uses substances moderately is a complex presentation that deserves attention. For this discussion sober means complete abstention from the drugs or alcohol they had problems with in the past. Moderate use here  can be social, responsible use with possibility of intermittent misuse (ex. an incident of having one too many) or recreational use.

Identifying triggers and vulnerabilities to using is an important part of the sober partners relapse prevention. It can feel too threatening for a sober person to be around others using drugs or alcohol, particularly their primary partner.  Complications can arise when the moderate using partner wants to use substances when they’re together or outside the relationship.

There are many configurations of this couple and feelings that can arise.  The moderate user may feel conflicted and guilty regarding their use. They may not be completely honest in the interest of avoiding conflict or hurting their partner.  The sober partner may feel envious, distrustful and frustrated. They may have used together in the past and the sober partner’s use became unmanageable while the others did not. This can be a good time for the moderate user to evaluate their use. Is it a problem? What function is it serving for them?  In addition, whether the sober partner was already sober when they met or becomes sober after being in the relationship can bring different challenges.

There needs to be room in the couples treatment to hear the feelings and struggles of each partner regarding substance use.  Individual drug use patterns are complicated on their own, but here we must pay special attention to the different levels of use and abuse within the couple, and the ongoing effects use has on the other.  While one’s relationship to drug use can change over time so can our relationship with our partners drug use.  Couples are complex and bring their history, expectations and projections to the relationship. Evolving relationships with drugs and alcohol is often an important aspect of my work with couples.

I was fascinated to learn about Dr. Olivier Ameisen's struggle with alcoholism and his recovery using Baclofen in his book, "Heal Thyself: A Doctor at the Peak of his Medical  Career, Destroyed by Alcohol and the Personal Miracle That Brought Him Back" (Ameisen, 2009). Dr. Ameisen, a prominent French doctor came to the U.S. in the 1980's and was part of the cardiology team at New York Hospital and Cornell University Medical College.

Baclofen, as you may know is a muscle relaxant.  In line with Dr. Ameisen's experience it has more recently been used and researched for the treatment of alcohol dependence and withdrawal. It has also been used for cocaine and opiate dependence.

In my work helping clients with alcohol use I have come across some clients who had Baclofen prescribed for muscle spasms but found that it decreased their anxiety and alcohol cravings dramatically. There has been a few times that I have seen it prescribed by a psychiatrist "off-label" for alcohol cravings. In some instances psychiatrists were reluctant to continue a previous doctors's presciption for Baclofen although the patient reported its help with abstention of alcohol and lack of side effects.  This may be related to doctor's traditional prescribing practices despite efficacy for patients according to Ameisen.

There are many factors to consider here and more research is likely needed. I am not a medical doctor and could not speak to the physiological complexities involved with Baclofen's use. I am only sharing my interest as a psychotherapist specializing in substance abuse and am open to hear your thoughts and experiences. Below are summaries of Dr. Amiesen's self-case report and a double-blind, placebo-controlled study, both published in the journal, Alcohol and Alcoholism.


Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose baclofen: a self-case report of a physician

Dose–Response Effect of Baclofen in Reducing Daily Alcohol Intake in Alcohol Dependence: Secondary Analysis of a Randomized, Double-Blind, Placebo-Controlled Trial

6/9/13 In Defense of Addicts (Originally published on Psyched in San Francisco, by Andrew Sussman)
And really substance users and abusers as well.. Just last night I was in consultation with another therapist. Knowing that I specialize in working with clients struggling with drugs and alcohol he made the comment, "It must be difficult working with addicts as they're so unreliable." I asked if he could clarify and he further described his opinion that addicts are hard clients as they have problems with relationships, use substances to avoid feelings and situations, lie and he expected that most of my clients expressed such behavior regularly. When I asked what he meant by "addicts" it was clear that there was no differentiation with those that use or abuse drugs and alcohol and clients that may be physically and or psychologically dependent. 

I found myself feeling frustrated and tried to explain that he was referring to a wide array of problems and clients  that I have not found to be particularly unreliable.  Sure, I have instances where my clients were using heavily or for some other reason, testing our treatment relationship. In my experience this can happen with any client and can be a useful part of our work.  This colleague is also someone that refers most of his substance using clients to me and doesn't have the experience nor interest in working with this population as I do.  In many respects I consider him a solid, experienced and insightful clinician. The conversation went on for some time and as a result I wanted to share some reflections. 

- Therapists tend to specialize these days and even highly trained reputable therapists may have little to no training in substance abuse, use and addiction. 

- Arriving at an agreed upon definition of addiction has not been easy for any of us. It is something that the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), psychotherapists and science in general has struggled with. When one entity or individual has a definition or model, it is tempting to assume they have also arrived at the truth and the correct model (Shaffer, 1994).

-Clients that use substances to varying degree are often clumped together and labeled as addicts.  There is a widespread simplistic, all or nothing view towards drug and alcohol users that tends to objectify them. In my opinion this can miss the diversity, strengths and actual degree of substance problems with each client.

-From my extensive experience working with drug and alcohol users in private practice and several treatment programs I have not found this population to more unreliable or uncommitted to treatment than other clients.  Clinicians sometimes experience what they might call "resistance" with this population. I think the difficulty may be the expectation that such clients commit to the clinicians and treatment programs' goals (generally immediate abstinence) rather than co-creating mutually agreeable goals that can be revisited together in treatment.

-12 step programs continue to be enormously helpful for many drug and alcohol users. They provide much needed support, structure, and spirituality for people worldwide. The A.A. teaching that all addicts are the same may help some stay sober when in the throes of craving and rationalizations, but like any teaching, it never applies to everyone. 
Over the years I have worked with many clients whose differentiation from "all addicts" was pivotal in their treatment and in finding a relationship with substances that worked for them.  In my practice I have found that sometimes we determine the relationship to substances is complete abstinence, sometimes moderated use and often it evolves. I have found that coming to know the meaning and utility of the substance use is often an important aspect of the therapy.
Andrew Tartasky, (2002) a harm reduction psychotherapist in New York points out that substance use problems come from a variety of sources, psychological, social and biological and that these are unique to each individual. He stresses the importance of understanding this with each client for treatment to be successful.

-Questions regarding meaning and utility of using substances and addiction in the field of psychotherapy can go back to Freud.  Johnson reports that the father of psychotherapy was "ostentatiously and lasciviously addicted" (Johnson, 2003, p. 3), idealized cocaine and nicotine, and refused to give them up eventually leading to his death from nicotine. 
Freud's fascination with cocaine was expressed in his letters to his fiancée Martha Bernays in 1884, "In my last severe depression I took coca again and a small dose lifted me to the heights in a wonderful fashion. I am just now busy collecting the literature for a song of praise to this magical substance." (Byck, 1974, p. 10-11). He refers to cocaine and a host of other substances regarding its help with his social anxiety in his letters to Martha in 1886 as he wrote, "I was quite calm with the help of a small dose of cocaine…and accepted a cup of coffee from Mme. Charcot; later on I drank beer, smoked like a chimney, and felt very much at ease without the slightest mishap occurring." (Byck, 1974, p. 164-165).  It's easy to understand the field's discomfort with how best to take on drug and alcohol use considering Freud's relationship to them.

Perhaps my reflections here lead to more questions than answers. There's no one panacea for substance use problems or human suffering and I think that's a good thing. It leaves the door open for finding our own path and types of therapy that are a good match for our clients and us. Definitions of substance use, abuse and addiction need to evolve alongside therapies that meet clients' actual goals. This diversity also fosters continued creativity and learning.