A Psychodynamic Way of Understanding Addiction

My hope is that, through reading this blog series, you have gained a deeper understanding of some of the many theoretical models of addiction, and how different factors may contribute to the development of addiction in individuals. The mere fact that there are so many potential the cage, mast, & audit screening tools to assess if you have an alcohol use disorder explanations for how addiction does develop should tell you that addiction and recovery are intensely personal processes for the individual struggling with it. In terms of addiction therapy, the psychodynamic approach provides motivation to stop drug-seeking behaviors.

Thus, unconscious personal experiences have a profound effect on present mood and behavior and can potentially contribute to problems with self-esteem, relationships, and addiction. Freud sought to understand what drives and influences human behaviors, and delved deeply into his patient’s early childhood experiences to discover the source of a person’s issues. The idea was that a person’s motives, feelings and decisions are driven by past experiences that are stored in the unconscious.

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This review has considered the value of synthesizing neurobiological and psychodynamic perspectives to better understand addictions, identifying potential pathways to the initiation of substance use, as well as mechanisms that may maintain substance use and abuse. The neurobiological approach allows biological mechanisms to be identified that may contribute to substance abuse and dependence; the psychodynamic approach provides an alternate framework for understanding relational and representational aspects of addiction within a developmental perspective. Attachment theory may present a unique opportunity to bring together these lines of enquiry, enabling an integrative developmental model of addiction with early experiences laying the foundation for psychological as well as neurobiological trajectories to substance use, abuse, and dependence. Fostering secure attachment bonds through sensitive parenting during childhood or through psychological interventions later in life may represent a unique opportunity to promote healthy socio-emotional and motivational growth across the lifespan.

The psychodynamic theory, while theoretical, also plays an immense role in psychotherapy. It can be utilized to treat mental health issues of patients, such as depression and anxiety symptoms. On the contrary, when an individual recognizes castration, and thus the notion of rules, impossibility, and otherness in society, two alternatives become available to deal with the resulting frustration. The first alternative is to repress the castration, as is the case of the neurotic structure. Such an approach would defy the rules of jouissance (e.g., by only using drugs in social gatherings) but with a resulting quota of guilt or shame for challenging The Other (i.e., social contract).

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Psychoanalysis is considered as a theory, a treatment, and a way of thinking about human motivation. A psychoanalytic perspective includes conscious and repressed, unconscious motives and desires. Psychoanalysis is traditionally conceived as an opportunity for a motivated person to reflect deeply about everything he or she is feeling and thinking without editing or censoring. In my experience as a clinician, I have found that many people do not know the negative implications stress can h… Our role as counselors is to meet the individual where they are, treat them as unique individuals with unique goals, listen to them and their goals, and help them achieve those goals by eliciting the motivation to change that already lies within them. Neither addictionresource.com nor AAC receives any commission or other fee that is dependent upon which treatment provider a visitor may ultimately choose.

• The anxiety acts as a signal, causing the ego to mobilize repression, along with a broad range of other defenses , in order to block or disguise the anxiety-provoking wish.
• Psychological growth requires self-acceptance, which is a state of mind that marks the end of the life-consuming struggle to transform oneself into the person one wishes one were .
• This neuroscience perspective offers the opportunity to understand more regarding the physical and chemical mechanisms behind addictive processes.
• The first alternative is to repress the castration, as is the case of the neurotic structure.

A vital component of the sessions is building a stable relationship where the recovering addict is relaxed and comfortable and able to share their deepest thoughts. Taken together, these theories consider addictions as originating during the earliest stages of human interaction, whereby constitutional vulnerabilities –paired with demanding environments– lead to a more overarching failure in the individual to recognize, understand, contain, and what to expect when you give up alcohol regulate difficult affective states. The psychodynamic approach may provide particular insight to what protects, predisposes, and maintains substance abuse from a longitudinal and intrapsychic point of view; however, the individualized nature of its methodology make it difficult to test its hypothesis on the wider population. Therefore, attempts at grounding psychodynamic theories on replicable methodologies and objective data are important.

What is the Psychodynamic Model for Addiction Treatment?

These imaginary representations are imbued with real (i.e., conscious) and fantasized (i.e., unconscious) qualities of significant others and relationships. Throughout development, these internal objects and their imaginary interaction with the external world model and guide future social interactions by means of associative learning . The failure of primary caregivers at providing proper care and affection is thought to be experienced by the infant as a “nameless dread” , or as having lost the object’s love (Freud, S., 1917; Klein, 1940). This highly distressing internal state is thought to thwart the infant’s ability to integrate the good (i.e., nurturing, soothing) and bad (i.e., distressing, frustrating) qualities of the internal object. Individuals with addiction may reach out for an “external regulator” (i.e., drug) to emulate the soothing qualities of the good object and “wall-off” the distressing bad object (Kernberg, Diamond, Yeomans, Clarkin, & Levy, 2008; Krystal, 1978).

In beginning to address this notion, the goal of the present review is to evaluate whether the consideration of neurobiological and psychodynamic perspectives provides insight to our understanding of addiction, particularly substance-use disorders . First, addiction will be discussed from a neurobiological perspective, based on recent neuroscientific findings and with a critical consideration of two central neurobiological theories of addiction –namely the “Opponent-process” (Solomon & Corbit, 1974) and the “Incentive-sensitization” (Robinson & Berridge, 1993) theories. Second, addiction will be explored through a psychodynamic lens to understand some subjective and relational aspects of the disorder. Finally, the value in synthesizing neuroscience and psychodynamic perspectives to our understanding of addiction will be considered, particularly in relation to attachment bonds. Addiction can be understood from multiple perspectives and here we have focused on addiction through the lens of neurobiology and psychoanalysis.

Past actions and the unconscious thought processes related to them can cause a recovering addict to perform harmful activities, which could, in turn, lead to a relapse of drug or alcohol use. By discovering the links between the past and the present, the therapist and client gain new insight into why certain harmful use of alcohol behaviors occur at present. Importantly, incentive sensitization compels persistence in substance use irrespective of whether the individual dislikes the substance and its negative consequences, if they are attempting to abstain, or even in the absence of withdrawal symptoms (Robinson & Berridge, 2004).

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Therapists help identify the defenses an individual has developed to avoid the unpleasant effects of this conflict. As the client-therapist relationship matures, past experiences re-emerge and can be analyzed. The relationship between the client and therapist is of paramount importance in this form of treatment for drug addiction. Psychodynamic therapy techniques are adapted from psychotherapy; however, they are less intense in terms of frequency of visits. They are conducted in the individual, group, or family setting and at an institutional or organizational level. There are multiple theories of the neurobiology of addiction, and two prominent theories include the Opponent Process theory and the Incentive-Sensitization theory.

For those seeking addiction treatment for themselves or a loved one, the addictionresource.com helpline is a private and convenient solution. The psychodynamic theory was first postulated by Sigmund Freud to better understand and explain the behavior of humans. This theory has been added to by other notable psychologists, such as Carl Jung, Anna Freud, and Erik Erikson. They now incorporate other similar theories, such as those conceived by Carl Jung, Erik Erikson and others, to become what is now referred to as psychodynamic theory. Sigmund Freud developed the theory of psychoanalysis, which features a long-term type of psychotherapy. The psychodynamic model was based on the theories of Freud and refined by peers that moved his theories in new directions, such as Karen Horney, Alfred Adler, and Carl Jung.

Ultimately, vulnerability to said mechanisms is potentially transmitted to the next generation via parent-infant interactions, parental reflective functioning, as well as parental genetic and maternal perinatal contributions. As such, holistic treatment alternatives targeting these factors in both the child and the mother have been recommended (Neger & Prinz, 2015; Suchman, Mayes, Conti, Slade & Rounsaville, 2004). Attachment- and mentalization-based interventions have gained popularity as effective treatments for patients with SUDs (e.g., Dawe, Harnett, Staiger, & Dadds, 2000; Söderström & Skarderud, 2009; Suchman, DeCoste, Castiglioni, Legow, & Mayes, 2008). These interventions are effective in improving emotional bonds, maternal reflective functioning skills, and mother-infant interactions so as to reduce the likelihood of addiction and maladaptive attachment styles in future generations (Pajulo & Kalland, 2013; Suchman, et al., 2008, 2011, 2013).

Inability to deal with external events could lead to feelings of helplessness and powerlessness. Lacking the capability to cope with negative states, patients will erect powerful, sometimes intransigent, defenses in a desperate effort to avoid feeling them. The person using a defense is generally trying to accomplish the management of anxiety and maintenance of self-esteem. Keeping the unacceptable feelings out of awareness result in the development of a “false self.” The price for this protection is inability to develop resilience. Before delving into the theory behind psychodynamic therapy, let’s first explore the definition of addiction.

For instance, cocaine and methamphetamine block dopamine reuptake, which leads to increased dopaminergic activity from the VTA to the NAcc (Niehaus, Murali, & Kauer, 2010). Other substances, including opioids, marijuana, alcohol, and benzodiazepines, work indirectly with this reward neural system, by interacting with the opioid system or with GABAergic interneurons that inhibit the dopaminergic neurotransmission from the VTA to the NAcc (Nestler, 2005; Volkow et al., 2011). Despite data implicating dopamine and related pathways in SUDs, there have also been data questioning how central dopamine is to addictions, with arguably the strongest data in humans being for stimulant addictions (Nutt et al., 2015; Potenza, 2013).

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For Freud, the goal of psychoanalysis was to strengthen the ego, and to give it more control over the id and more independence from the superego. He believed that most mental disorders (e.g., anxiety) were due to the effect of unrestrained feelings. Increased awareness through psychoanalysis can help the individual to become less self-punitive and be able to tolerate their emotional experiences.

Taken together, and according to incentive-learning principles (Bouton & Nelson, 1998), it is possible that before drug-related cues become meaningful enough to ‘incentivize’ drug use, they first need to be paired with the consequences of drug-use via repetition and reinforcement. Notwithstanding the specific mechanism, it seems that an important factor leading to substance dependence may be the context in which the individual and its addiction are embedded. Second, an object-relations perspective proposes that to understand addiction vulnerability, a focus on the relational and representational aspects of development is needed, wherein, over time, the mind develops in relation to others, primarily with early caregivers. Through experience, these interactions become embedded in the child’s internal world as mental representations or internal objects (Beres & Joseph, 1970; Kohut, 1979; Stern, 1983).

The psychodynamic approach to addiction therapy looks at how past events, thoughts and circumstances shape a patient’s present behaviors. It is believed that these factors result in unconscious processes that cause a person to act in a particular manner. Psychodynamic therapy—whereby a clinician helps an individual process and heal from their pain, become more aware of their unconscious thoughts, and analyze deep feelings about their past experiences—can be incredibly beneficial when working with a person with a history of trauma. Many people who use substances do so to cope with uncomfortable memories of past traumatic events, so it is critical to help these individuals develop alternative, more adaptive coping mechanisms to utilize when they are in need of support. The key principle of the therapy is that unconscious maladaptive beliefs develop due to past experiences and cause behavioral difficulties in daily life. During sessions, the therapist attempts to reveal and resolve the unconscious conflicts that drive the triggers for substance abuse.

The structure of the treatment depends on understanding the psychological thought process of the client in great depth. Experiences in the client’s past, such as unresolved conflicts or problematic relationships, can manifest in the present without the person consciously realizing it. The therapy is helpful for people battling substance abuse because it identifies the underlying cause of addiction. During the sessions, the therapist works through the recovering addict’s emotions to reduce the chances of succumbing to alcohol or drugs. This type of psychotherapy seeks answers to an addict’s current behaviors by delving into the past. The underlying principle of the psychodynamic model is that whether people are aware of it or not, the past influences the present.

The second alternative is to disavow or “pretend” as if castration never took place, resulting in the perverse structure where the individual bends the rules of jouissance to their own benefit despite The Other; for example, by knowing exactly when or how to use drugs to avoid testing positive in a drug test from work. In both cases, addiction would be understood as an act of rebellion against castration, by self-administering an extra quota of jouissance (i.e., plus de jouir) with substance use (Bazan & Detandt, 2013; Lacan, 1969; Loose, 2002). Therefore, addiction in neurosis and perversion may be understood as overindulgence in the hedonic properties of drug-taking behaviors in an attempt to avoid acknowledging, and effectively dealing with, frustration. Some forms of frustration may be social norms and boundaries, social rejection, loneliness, or loss (Bazan & Detandt, 2013; Loose, 2002). Stimulating drugs have a direct effect on dopaminergic neurotransmission from the VTA to the NAcc (Nestler, 2005; Volkow et al., 2011).