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Essential Papers on Addiction
The most important writings on the psychoanalytic understandings and treatments of drug and vice addiction
Drug abuse, alcoholism, compulsive gambling, and other destructive addictions plague our society. Theories of addiction locate its cause variously―in factors related to the substance, the addict's personality, or to the addict's environment. Arguments about effective treatment programs are fierce.
Essential Papers on Addiction presents the most important writing and the various sides of the debate on the psychoanalytic understanding and treatment of addiction. Daniel Yalisove outlines the history of the treatment of addiction and introduces important psychoanalytic concepts used in understanding addicts. The book includes case studies which illustrate the course of addiction and presents the work of the most influential theorists in the field.
Divided into eight sections focusing on historical work on addiction, psychoanalytic theories of addiction, transference and countertransference issues in treating addiction, psychoanalytic treatment for the addictions, psychoanalytic therapy and disease concepts, and psychiatric illness and addiction, this definitive volume includes contributions by the most experienced and renowned experts on the subject. Contributors include S. Freud, E. Glover, S. Rado, R. P. Knight, L. Wurmser, N. E. Zinberg, H. Krystal, D. Jacobs, R. Fine, J. Gustafson, C. L. Brown, M. L. Selzer, V. Davidson, J. Imhof, R. Hirsch, R. E. Terenzi, M. E. Chafetz, A. Silber, R. J. Rosenthal, E. M. Pattison, M. B. Sobell, L. C. Sobell, J. E. Zweben, E. Simmel, B. Brickman, E. J. Khantzian, R. D. Weiss, S. M. Mirin, A. T. McLellan, and H. J. Richards.
Drug abuse, alcoholism, compulsive gambling, and other destructive addictions plague our society. Theories of addiction locate its cause variously―in factors related to the substance, the addict's personality, or to the addict's environment. Arguments about effective treatment programs are fierce.
Essential Papers on Addiction presents the most important writing and the various sides of the debate on the psychoanalytic understanding and treatment of addiction. Daniel Yalisove outlines the history of the treatment of addiction and introduces important psychoanalytic concepts used in understanding addicts. The book includes case studies which illustrate the course of addiction and presents the work of the most influential theorists in the field.
Divided into eight sections focusing on historical work on addiction, psychoanalytic theories of addiction, transference and countertransference issues in treating addiction, psychoanalytic treatment for the addictions, psychoanalytic therapy and disease concepts, and psychiatric illness and addiction, this definitive volume includes contributions by the most experienced and renowned experts on the subject. Contributors include S. Freud, E. Glover, S. Rado, R. P. Knight, L. Wurmser, N. E. Zinberg, H. Krystal, D. Jacobs, R. Fine, J. Gustafson, C. L. Brown, M. L. Selzer, V. Davidson, J. Imhof, R. Hirsch, R. E. Terenzi, M. E. Chafetz, A. Silber, R. J. Rosenthal, E. M. Pattison, M. B. Sobell, L. C. Sobell, J. E. Zweben, E. Simmel, B. Brickman, E. J. Khantzian, R. D. Weiss, S. M. Mirin, A. T. McLellan, and H. J. Richards.
552 pages, Paperback
First published July 1, 1997
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May 23, 2026
Richard J. Rosenthal, "The Psychodynamics of Pathological Gambling"
In my work with these covert gamblers I came to appreciate what it meant for them to be challenging fate, or needing to test their luck. There has been a tendency to ocnfuse these terms, and, along with chance, and destiny, to use them interchangeably. I proposed a hierarchy, based on the continuum of developmental conflicts which need to be solved on the way to adulthood, with a progressive sense of mastery in moving from Chance, through Luck, and then Fate, to Destiny.
Being dependent on others for that which should reside within himself, the narcissistic individual is always testing, challenging, in order to find out where he stands, or has the right to stand. He is not seeking punishment out of some sense of guilt, although there is plenty of that too, so much as he is involved in a kind of omnipotent provocation, a deliberate flirting with danger in order to test his power and prove that he is in control. In a sense, he is trying to control the uncontrollable, very much like the gambler who is seeking certainty. There is another similarity between the narcissistic personality and the problem gambler; both are preoccupied with the need to find loopholes, to be exceptions to the law. Breaking the law, and getting away with it, is equated with a kind of moral superiority.
Hence we find striking similar dynamics between the narcissistic personality and at least some of our pathological gamblers. Both Taber and myself have discussed this more extensively. In our treatment approaches, we have focused on the various methods of self-deception: the lying, the power games, the idealization of destructiveness and other value reversals, and the vicissitudes of omnipotence. However, other therapists working with narcissistic patients have viewed the fragile sense of self-identity, not as a result of primitive defense mechanisms, as used for the resolution of specific conflicts, but as the result of some inherent weakness of deficiency. According to this line of reasoning the narcissistic personality is psychologically vulnerable to unregulated swings of central nervous system-autonomic nervous system arousal or depression. The patient then turns to a variety of stimulating and numbing activities (and substances) in a desperate attempt to self-regulation. These are chosen, not for any symbolic meaning, but for their energy-regulating potential. Such activities, in addition to gambling, would include the usage of alcohol and various drugs, overeating, excessive sleeping and television watching, jogging and physical exercise, sex, or other stimulating and numbing activities.
Rickles summarized four common symptom clusters found in the narcissistic personality disorders: (1) the under-stimulated self who is consistently occupied with stimulating activity to avoid internal emptiness; (2) the fragmenting self who loses a sense of continuity or self in time and cohesiveness in space, resulting in profound anxiety and hypochrondriacal concerns; (3) the over-stimulated self who constantly harbors tension-producing, grandiose fantasies but guards against involvement with longed-for merger experiences because of a threat to self-equilibrium; and (4) the over-burdened self that lacks the self-soothing capacity that protects one from the traumatic spreading of unchecked disturbing emotions. In each of these situations, he noted, one finds a precarious system for the modulation of arousal and dependency gratification. This deficiency in self-regulation leads to a variety of somatic disorders, as well as the attempts at self-cure listed above.
In my work with these covert gamblers I came to appreciate what it meant for them to be challenging fate, or needing to test their luck. There has been a tendency to ocnfuse these terms, and, along with chance, and destiny, to use them interchangeably. I proposed a hierarchy, based on the continuum of developmental conflicts which need to be solved on the way to adulthood, with a progressive sense of mastery in moving from Chance, through Luck, and then Fate, to Destiny.
Being dependent on others for that which should reside within himself, the narcissistic individual is always testing, challenging, in order to find out where he stands, or has the right to stand. He is not seeking punishment out of some sense of guilt, although there is plenty of that too, so much as he is involved in a kind of omnipotent provocation, a deliberate flirting with danger in order to test his power and prove that he is in control. In a sense, he is trying to control the uncontrollable, very much like the gambler who is seeking certainty. There is another similarity between the narcissistic personality and the problem gambler; both are preoccupied with the need to find loopholes, to be exceptions to the law. Breaking the law, and getting away with it, is equated with a kind of moral superiority.
Hence we find striking similar dynamics between the narcissistic personality and at least some of our pathological gamblers. Both Taber and myself have discussed this more extensively. In our treatment approaches, we have focused on the various methods of self-deception: the lying, the power games, the idealization of destructiveness and other value reversals, and the vicissitudes of omnipotence. However, other therapists working with narcissistic patients have viewed the fragile sense of self-identity, not as a result of primitive defense mechanisms, as used for the resolution of specific conflicts, but as the result of some inherent weakness of deficiency. According to this line of reasoning the narcissistic personality is psychologically vulnerable to unregulated swings of central nervous system-autonomic nervous system arousal or depression. The patient then turns to a variety of stimulating and numbing activities (and substances) in a desperate attempt to self-regulation. These are chosen, not for any symbolic meaning, but for their energy-regulating potential. Such activities, in addition to gambling, would include the usage of alcohol and various drugs, overeating, excessive sleeping and television watching, jogging and physical exercise, sex, or other stimulating and numbing activities.
Rickles summarized four common symptom clusters found in the narcissistic personality disorders: (1) the under-stimulated self who is consistently occupied with stimulating activity to avoid internal emptiness; (2) the fragmenting self who loses a sense of continuity or self in time and cohesiveness in space, resulting in profound anxiety and hypochrondriacal concerns; (3) the over-stimulated self who constantly harbors tension-producing, grandiose fantasies but guards against involvement with longed-for merger experiences because of a threat to self-equilibrium; and (4) the over-burdened self that lacks the self-soothing capacity that protects one from the traumatic spreading of unchecked disturbing emotions. In each of these situations, he noted, one finds a precarious system for the modulation of arousal and dependency gratification. This deficiency in self-regulation leads to a variety of somatic disorders, as well as the attempts at self-cure listed above.
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