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Robert Waelder and W.R. Bion share an interest in articulating elemental landmarks within the psychotherapeutic terrain wherein primitive ideation may become transformed into a reclaimed reality orientation. The present paper extends their interest through clinical and literary example. It surfaces an aspect of Bion’s therapeutic calculus, implicit but unstated, in the temporal arrival at multiple and continuously changing “d” structures within the ongoing process of therapy. By recognizing the joint contribution of therapist and patient within these creations in time of arrival at approximations to the depressive position, the authors illustrate the weaving of “white hole” matrices, affording temporary relief from the dread of annihilative anxiety that reclaim the patient’s capacity for non-psychotic self-orientation. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to suggest that the emergence of substituted cathinones or M-cat drugs (notably mephedrone and methylone) and their rapid proliferation of use, amongst drug users in the UK from 2009 onwards, signals changes in the habits, preferences and lifestyle choices made by certain drug users, whilst also indicating a pronounced increase in the levels of co-morbid mental health conditions experienced by another, yet often distinct, group of users. Design/methodology/approach – This latter group of users, it is suggested, tend to initiate use of psychoactive substances (including tobacco and alcohol) at a younger age. In addition, it is suggested, they often present to treatment and criminal justice services with a history of chronic childhood relational trauma, as a background against which severe patterns of drug abuse has evolved. In this light the lack of significant supplies of social capital, as a protective factor against the development of chronic drug use, is further considered in the paper that follows though a brief literature review and qualitative clinical case reports. Findings – Novel psychoactive substances ( Newcombe, 2013) appear so seductive, for a certain group of users, because they seem to provide a temporary form of cognitive and emotional anaesthesia, enabling users to self-medicate, often against experiences of profound psychological trauma and contemporary lives that are typically experienced as boring, hopeless and pointless. The euphoric effects of psycho-stimulants such as mephedrone are particularly appealing to individuals attempting to escape a subjective sense of daily dysphoria and may on this basis lead to, rather than recreational use, more persistent patterns of drug use. However, in contradistinction to this group of users, another recreational – mainly weekend leisure – group of users continues to evidence a voracious appetite for psycho-stimulant substances. Originality/value – It is suggested that this second group of users has been particularly influential in substitute displacement towards the emergence of legal highs, due to the poor quality and illegal status of street drugs such as cocaine, amphetamine sulphate and MDMA (ecstasy). [ABSTRACT FROM AUTHOR]