In the wide, confusing world of addiction treatment, addiction is variously characterized as a neurobiological disease; a learning disorder; a spiritual problem; a character flaw; or even a moral failing. This confusion can obscure what psychoanalytic practitioners already know:  addiction is fundamentally a psychological problem.  It is an imperfect compromise formation – a displacement; or, in classical terms, a “psychoanalytic symptom.”  As a symptom, addiction masks overwhelming feelings such as helplessness, despair, or rage. Thus, via projective mechanisms, addicts can evoke similarly powerful feelings - including panic - in their families, their friends, and their therapists.   
 
By conceiving of addiction as a powerful symptom, and taking a harm-reduction approach to the actual substance use, we can bring to bear psychoanalytic understanding of compromise formation, projective mechanisms, and counter-transference. We can offer addicts what we offer all of our psychoanalytic patients: a therapeutic relationship which will, over time, help them toward greater self-esteem, self-efficacy, and agency; expanded affective tolerance and range; and the ability to create and participate in more meaningful relationships with themselves and the people around them.  
 
Dr. Gibson is trained in adult and addiction psychiatry. He is a Clinical Associate Professor of Psychiatry at the University of Washington, School of Medicine, and is a Clinical Associate in the Adult Psychoanalytic Training Program at SPSI. He is in private practice in Seattle.
 
"Don’t Panic – But Don’t Think Only in Symbolic Terms when Dealing with Addictions” - Discussant Ronald Levin, M.D.

 
Dr. Levin is a Training and Consulting Analyst at SPSI and was Director of SPSI from 2010 to 2013.  He has an interest in evolution, primitive functions of the mind, and clinical process.