After studying your list of subjects, I have decided to look
into the disease of addiction.
Addiction is a subject that I have a close relation both
personal and professional. Addicted to alcohol for fifteen years I
reached my bottom. September, 10th 1964, I finally admitted, to myself, that my
life had become unmanageable I needed help. I contacted AA (Alcoholic
Anonymous) and attended my first meeting that day; I have been sober ever
since. Having achieved a level of success in AA, I begin to work with addicted
individuals on all level of recovery and continue to do so today.
Most recovery program for addition recommends behaviorism as
the treatment of choice. I agree that is the more direct and appropriate route
for the elevation of symptoms commonly experienced by addicted individuals. However,
after symptoms been elevated, those individuals, including myself, desire a
more profound understanding of addiction and why the path of drug use as a
coping mechanism while other approaches are available, I chose psychodynamic
approach to understand why I use and abuse alcohol in an attempt to tame my
Psychodynamic therapy focuses on unconscious processes as
they are manifest in the client's present behavior. The goal of psychodynamic
therapy is client self-awareness and understanding of the influence of the past
on present behavior. In this brief form, the psychodynamic approach enables the
client to examine unresolved conflicts and symptoms that arise from past dysfunctional
relationships and manifest themselves in the need and desires to abuse
The theory supporting psychodynamic therapy originated from
psychoanalytic theory. There are four schools of psychoanalytic theory, each of
which has influenced psychodynamic therapy. The four schools are: Freudian, Ego
Psychology, Object Relations, and Self Psychology.
Freudian psychology based on the theories first formulated
by Sigmund Freud referred to as the drive or structural model. The essence of
Freud's theory is that sexual and aggressive energies originated in the (id)
unconscious and modulated by the ego.
Ego Psychology derives from Freudian psychology. Its
proponents focus their work on enhancing, and maintaining ego function in
accordance with the demands of reality. Ego Psychology stresses the
individual's capacity for defense, adaptation, and reality testing.
Object Relations psychology articulated
by, Melanie Klein, W.R.D. Fairbaim, D.W. Winnicott, and Harry Guntrip. According to this theory, humans are shape in
relation to the significant others surrounding them. The struggles in life
focus on maintaining relations with others, while at the same time
differentiating from others.
Self- Psychology founded by Dr. Heinz Kohut during the 1950s.
Dr. Kohut observed that the self refers to a person's perception of his
experience of his self, including the presence or lack of a sense of
self-esteem. The self is perceived in relation to the establishment of
boundaries and the differentiations of self from others or the lack of
boundaries and differentiations.
Recent studies indicate that many addictive behaviors serve
to ward off a feeling of helplessness and/or powerlessness via controlling and
regulating the addict's affective state. Researchers further found that addicts
have a vulnerability to feelings of powerlessness, which causes a specific
narcissistic impairment. The drive to re-establish a sense of power is driven
by narcissistic rage (Khantzian, E. J. 1985). Additional views of addition have
emphasized ego defensive functions and defense deficit. The most frequent
observation has been that substances are used for the purpose of managing
intolerable affective states. A recent study also suggested that normal
developmental process of differentiation and verbalization of affects that is
often impaired in addicts. Researches have also noted specific affective states
which addicts attempt to manage through the use of drugs, including aggressive
feelings, anxiety, depression, rage, and shame (milkman and Frosch 1973).
While there are many valuable psychoanalytic perspectives on
addition, I find in all of them an insufficient attention to the role of power,
helplessness, and rage.
Yes, I agree, there is a clear paradox here. While I am
suggesting a role, in addition, for an unconscious process of restoring a sense
of control, addictive behavior itself is inherently a matter of being out of
control; simultaneously, it seems, addition reflects both ego functioning and a
loss of elements of ego functioning. The paradox is real, but also can be
understood as the result of conflict between a deeper need to ward off
perceived helplessness and powerlessness, and other, healthier elements of the
personality which become overwhelmed (Freud, S. 1926).
As a recovered addict, I understand and experienced this
paradox of being in control and feeling out of control. I can also give
testimony to the feelings of helplessness, powerlessness, and uncontrollable
rage. These experiences are, in fact, central for addicts. It is no accident
that Alcoholic Anonymous and Narcotics Anonymous (NA) make the need to tolerate
powerlessness the focus of their twelve "steps" of recovery: "We admitted we
were powerless over alcohol "" (Twelve Steps and twelve Traditions, 1952).
Toleration of helplessness is also the essence of A.A
"serenity prayer," which focuses on the wish to be granted "the serenity to
accept the things we cannot change" (Living
Drugs may be used to re-establish a sense of power quite
apart from their pharmacologic effects. Some alcoholics, for example, begin to
feel relief from tension at the point of ordering a drink, or the point of
taking the first drink, even before there is any pharmacological effect. I
remember feeling a "warm glow" deep inside once I had decided that I will have
a drink, this was especially true during moments of conflicts and indecisions.
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William(Bill)Smith, Ph.D. an author, psychotherapist,consultant and personal coach. My practice focuses on online counseling, phone and face-to-face session with survivors of personal trauma,childhood abuse, relationship concerns, and individual (more...