Psychoanalytic psychotherapy is an approach that allows individuals to achieve a deeper awareness of themselves, their unconscious desires, motivations, and conflicts. This insight provides the individual with a choice to disrupt negative behavior (such as substance abuse) and change his/her lifestyle into a healthy one. Of course, one might choose not to put the gained insight into meaningful use, but in many cases they do.

The focus of these therapies is the transference relationship between the therapist and the patient. Psychodynamic therapy typically occurs once or twice a week and has a focus or predetermined goal. Psychoanalytic psychotherapy, on the other hand, is more exploratory. The frequency is typically 3 to 5 times a week and the transference relationship is quite intensive.

The psychologists’ community holds the view that the patient needs to be ‘clean or dry’ before they can start psychoanalytic psychotherapy. In fact, treatment is to be stopped if the patient uses again. The reason for this is simple – the therapeutically-induced distress created by psychoanalytic psychoanalysis can be easily alleviated by abusing more substance by an active user instead of letting it induce a change in behavior.

We all have habits that we are used to, and we may be even somewhat addicted to them and depend on them to get rid of distress, but for some, this is a deeply entrenched and all-consuming compulsion. Addictive behaviors are desperate attempts to achieve short-term relief from an extreme emotional need or anxiety. Psychoanalytic psychotherapy is similar to exposure therapy for obsessive-compulsive disorder in that it aims at inducing a difficult experience in order to get used to it and be able to deal with the anxiety it causes. Furthermore, it does not focus overtly on presenting symptoms but more so as a second- or third-line psychotherapy approach for addicts, especially when they have stopped using and are trying to stay abstinent.

Addiction is a tendency to use repetitively and hence without thought, providing immediate relief or at least a distraction from something that feels unbearable. It becomes a repetitive cycle that offers a retreat from real life and gives an illusion of complete control.

Most persons with addictive disorders are not able to think about changing anything and don’t volunteer for psychotherapy. They are brought into these sessions typically through a rehab program.

Psychoanalysis provides a space to these addicts to allow for thinking and provide containment of overwhelming anxieties. When working with addictive states psychoanalytically, the emphasis is on the whole person and his defense mechanisms. Persons suffering from an addiction tend to protect themselves from extreme pain by developing a narcissistic defense mechanism. A skilled psychotherapist tackles with all these aspects when practicing psychoanalytic psychotherapy. That way, it can be a very powerful adjunct treatment secondary to cognitive or dialectical behavioral therapy for patients of substance abuse disorder.