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.
This suggests that something has been accomplished by the act alone of obtaining the drug. This is the signal satisfaction of an attempt to re-establish an internal state of mastery. The act of initiating the chain of events which will lead to alteration of the addict's affect, one had confirmed the ability to alter and control one's affective state, and re-affirming a sense of internal potency.
Sober 1975). Addicts characteristically experience feeling a sense of claustrophobia the feeling of being, helplessly, closed in and imposed upon.
FREUD, S. 1926 Inhibitions, symptoms and anxiety S.E. 20
KHANTZIAN, E. J. 1985 the self-medication hypothesis of additive disorders: focus on heroin and cocaine dependence Amer. J. Psychiatry. 142 1259-1264