Ten Misconceptions About Addiction
by José Alberto Zusman

1. Addictions by themselves are the real and only cause of addiction 
No. Despite what many think, addiction never corresponds to a one-way street that goes from the outside in. There is no drug that, by itself, causes addiction. It is necessary for there to be an encounter between an unbearable internal pain and something external that brings some kind of relief, albeit temporarily. An emptiness that is, in large part, the result of a continued and traumatic lack of early synchronicity between infant and caretakers, or due to an intense traumatic experience at a later stage in life. It is under this aspect that Edward Khantzian (5) sees all addiction as a process of self-medication.

2. Once you choose one type of addiction you will never choose another one
Not always. Though many defend this thesis, what I have found in my practice, with my patients and with those who are brought to me by colleagues under my supervision, is that when a person abandons one addiction, they frequently go in search of another to replace it. As long as the source of internal emptiness persists, the person will continue to seek an external comfort that relieves the addiction. Therefore, it is not unusual for an alcoholic to cease drinking and begin smoking or gambling or giving in to uncontrollable sexual activities. Though an addict may have an addiction of their preference, they will search for the best relief that the addiction object provides at each moment. The addict’s only hope to truly abandon the realm of addiction is to develop a trustworthy and reliable connection with another human being.

3. Addiction is something you use to live better 
Never. Although many believe that the addict aims to reach a better world without having to make any effort, in reality, the addict is a very lonely and desperate person who, without considering the risks and consequences that might ensue, seeks alternatives to survive the attacks of their internal toxic objects which threaten and torment their very existence. That is why addicts, even knowing the risks involved, continue on their addictive path. Because they deny that they have a problem and do not search for proper help. Therefore, one cannot say that addiction is the result of a choice, but rather the end product of a lack of choices.

4. Addiction promotes a special kind of connection that fulfills the addict as no other can
No. Johan Hari (3), a British journalist, states that addiction is the opposite of connection. The addict is a lonely person who is incapable of establishing firm bonds with other human beings. Isolating the addict, therefore, only reinforces their defences and accentuates their pain and difficulties.

5. Addiction is a shortcut to happiness 
No. Addiction rapidly puts the addict into a state of intense euphoria but never happiness. The stimulation serves only to temporarily keep the addict away from their pain. Every addiction brings with it a lie and a deception from its beginning. A false impression is created of having magically reached a place of affective fulfillment, which, once the effects wear off, only confirms the endless nightmare in which the addict lives. According to Joyce Macdougall (4), addicts live in a world of transitory, concrete objects that lead nowhere, without purpose or evolutionary perspective - unlike Winnicott’s transitional objects that lead human beings towards a world of symbols, abstract thinking and culture. 
6. Addiction is necessary to put shy people close to other people 
On the contrary, addiction only further distances addicts from other people. An addict, even when in a group, does not relate to those around them. The addict cohabits but does not interact. Worse yet, human contact may often worsen the chronic difficulty in forming bonds, and accentuate the pain that the addict already carries inside.
7. Every compulsive behavior is a form of addiction
No. The opposite is true. According to Lance Dodes (6), every addiction is a form of compulsion, but not every compulsion is an addiction. A patient who needs to undo intrusive thoughts through acts is not an addict. They are more interested in undoing the magical consequences of their thoughts, and do not seek the excitement that an addiction would provide. One of the overwhelming advantages of understanding addiction as a compulsion is to insert it into the psychoanalytical field, which offers the addict a chance to benefit from more adequate tools for their treatment, such as the unconscious transferential communication that takes place between patient and therapist.
8. Addiction is the same as dependency

No. As I understand it, using Fairbairn (2) as a base of reference, every human being lives within a spectrum of dependence, from its most infantile presentation to its adult form. Addiction, on the other hand, is a malignant process which excludes human beings from this essential evolutionary spectrum that is basic to life, leaving them a prisoner of a concrete world with no escape. Addiction, therefore, is a disease that should be understood and treated as such.

9. Once addicted always addicted
Not always. Although many think that this is true, it is not. If it were morphine, which is the most powerful known analgesic, it would turn patients into addicts, and it does not. According to Gabor Maté (1), the largest uncontrolled open-air experiment, the Vietnam War, showed that most heroin-addicted soldiers, once back home, gave up heroin spontaneously without the need for any specific treatment. That was also reproduced in the lab with the rat park experiment conducted by Bruce Alexander, in which rats addicted to morphine gave it up spontaneously when put in a more agreeable environment. So, addiction is always related to an inability to cope with an immense internal pain and relinquishing the struggle for life.

10. Addiction is not suitable for psychoanalytically-oriented treatment 
No, it is just the opposite. Addiction should be treated by a multi-disciplinary team in which the psychoanalyst plays a very important role. While other members of the treatment team may fight the symptoms or the physical consequences of a certain addiction, psychoanalysts may go after the specific transference, positive or negative, that is being established; identify the roots of its malignant origin and help the addict to establish a healthier relationship with themselves and with other human beings. Through a meaningful relationship it may be possible to turn an internal toxic object into something less harmful. As Balint puts it beautifully in his concept of basic fault, the missing part comes from an experience of mismatch in the beginning of life that may accompany the whole of the patient’s life. This lack of a proper human connection may be one of the main origins of their internal painful void. The psychoanalytical tools may be indispensable for a possible recovery from this kind of pathology.


(1) Gabor Maté (2010). In the Realm of Hungry Ghosts. North Atlantic Books.   
     California( USA).
(2) Fairbairn: then and now (2014). Routledge Publishers. New York.
(3) Johann Hari (2015). Chasing the Scream. Bloomsbury USA. New York.
(4) Joyce McDougall (1995). The Many Faces of Eros.W.W. Norton Company, Inc.
      New York.
(5) Khantzian, E.J. -TreatingAddiction as a Human Process (1997). Jason Aronson.
     New York.
(6) Lance Dodes (2003). The Heart of Addiction. HarperCollins Publishers. New York.
(7) Michael Balint (1968/1979). Tavistock Publication. London.

José Alberto Zusman

Training Analyst and Professor at the SPRJ
Chair of the IPA Addiction Committee 
PhD in Psychoanalysis at UFRJ


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