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Addiction: Monkey On My Back

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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 psychologically demons.


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 substances.

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   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.

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   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.

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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).


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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...)

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