Addiction is a complex phenomenon that has long puzzled scientists and healthcare professionals. This blog post delves into a neuropsychoanalytic perspective on addiction, drawing upon Freudian concepts and modern neuroscience to offer a comprehensive understanding of how addictive drugs hijack the brain’s natural systems, leading to compulsive behaviors and profound psychological changes.
The Drive to Seek: A Neuropsychoanalytic View of Motivation
At the core of this understanding is the concept of “drive.” While traditional psychoanalysis has sometimes viewed drives as narrowing our understanding of people, modern neuroscience, particularly in the field of addiction, has increasingly focused on motivation and drive. Neuropsychoanalyst Jaak Panksepp’s model, derived from animal experimentation, introduces the “SEEKING system” as a central pathway involved in motivation. This system, originating in the ventral tegmental area (VTA) of the midbrain and extending through the lateral hypothalamus to the nucleus accumbens, is crucial for the pursuit of biological rewards like food and sex, as well as more cognitively and experientially based rewards such as friendship and social status.
The SEEKING system possesses a remarkable capacity for “supraordinate flexibility,” meaning it can shift activity between different motivational systems based on internal and environmental cues. This flexibility challenges earlier, more rigid “drive models” and aligns with the Freudian concept of drive as a constant internal pressure to engage in work.
Wanting vs. Liking: A Critical Distinction
A key distinction in understanding addiction, previously explored by Robinson and Berridge (1993) and elaborated upon by Johnson (2008), is the difference between “wanting” and “liking”. This aligns with Freud’s concept of libidinal drive and Panksepp’s observations of the endorphin/opioid system. The pleasure system, connected to the drive system via opioid receptors in the VTA and nucleus accumbens shell (NAS), intensifies drive by potentiating glutamatergic and dopaminergic processes.
Crucially, using the SEEKING system as a proxy for Freud’s drive system addresses the criticism that psychoanalytic drive theory leads to an “asocial, one-person psychology”. Panksepp’s model, encompassing instinctual drivers like CARE, PLAY, LUST, and PANIC, offers a biologically based framework for understanding the innate drive toward forming relationships – indeed, we “SEEK relationships”.
The Neuroscience of Libidinal Investment: Cathexis in the 21st Century
Freud introduced the concept of “cathexis” as mobile instinctual energy that could be attached to people, body parts, ideas, or even dream elements. Modern neuroscience provides a basis for understanding the mechanisms of libidinal investment. For instance, dopamine release in the nucleus accumbens of mother rats following pup exposure, and the disruption of maternal behavior by lesions in the VTA or nucleus accumbens (the drive/SEEKING system), highlight the neurobiological underpinnings of attachment. Furthermore, dopamine (D1) receptors are essential for rats to develop place conditioning for opioids, and opioid receptor antagonists block the development of partner preference after mating. This suggests that both drive and pleasure are necessary for attachment. Without the dopaminergic system’s drive, libidinal investment cannot occur. The formation of a sexual bond, for example, requires not just the drive but also the memory of a pleasurable experience.
Beyond the core drive and pleasure systems, other neural systems like the medial orbital frontal, amygdalar, and hippocampal memory inputs, as well as hormonal systems, interact to influence preferences and attachments. Oxytocin, for instance, potentiates endorphin release during mating and is crucial for partner preference, as evidenced by studies comparing prairie voles (with an oxytocin system) and montane voles (without). In essence, cathexis is a complex interplay of drive, pleasure, memory, and hormones, but drive remains foundational.
The Addiction Enigma: When Wanting Becomes All-Consuming
A significant insight from this neuropsychoanalytic framework is that in “physical” addiction, addictive drugs fundamentally alter the drive system, leading to an urgent “wanting” of the drug, regardless of whether the intoxication is pleasurable. This aligns with the neuroscience consensus that addiction begins with an alteration in the mesolimbic dopamine system. Addiction, from this perspective, represents the usurpation of the neural processes that drive our pursuit of essential life-sustaining elements like food, water, sex, and relationships. This also implies that cathexis for drugs can compete with cathexis for loved ones.
Resurrecting Drive Reduction: Freud’s Unsung Wisdom
The concept of “drive reduction” has often been dismissed in modern neuroscience, partly due to a misunderstanding of Freud’s original ideas. Berridge (2004) argued against drive reduction, noting that animals who only “SEEK” do so endlessly, and animals who are only gratified (e.g., by gastric feeding) still pursue food. This confusion, the author argues, stems from conflating “SEEKING/drive” and “gratification” within the behaviorist term “reward”. By separating these two components, a clearer understanding of drive reduction emerges.
Freud, in his 1923 paper “The Ego and the Id,” offered a nuanced description of drive reduction. He posited that unpleasurable sensations, arising from internal processes, are inherently impelling and drive toward change and discharge, implying a heightening of energetic cathexis. Conversely, pleasurable sensations have no inherent impelling quality, implying a lowering of energetic cathexis. Drive, he explained, can exert force unconsciously until resistance to the compulsion arises, at which point it becomes conscious as unpleasure.
Therefore, drive reduction requires both the insistent building of drive and the pleasure of complete gratification, operating sequentially. In addiction, mere exposure to the drug only briefly diminishes desire, followed by an urgent increase in craving. Animals that can self-stimulate their drive center (lateral hypothalamus) will do so until death, highlighting the endless, fruitless attempts to achieve drive reduction when only the drive component is activated. Conversely, pure gratification without SEEKING activation is ultimately unsatisfying, as seen in pornography addiction or masturbation, where only one half of the drive reduction process is engaged.
The hypothesis here is that drive involves the activation of the VTA dopaminergic SEEKING system, and drive reduction necessitates both the activation of this system and genuine gratification—be it food, sex, or a relationship—culminating in complete relaxation. Addictive behaviors, by offering only a brief and incomplete reduction of drive, lead to relentless drug seeking. Understanding how drive and drive reduction function in individuals to alter behavior requires incorporating the Freudian concept of will.
The Ensnared Will: Addiction’s Deceptive Grip
Freud defined “will” as a derivative of the drives, the impulsion that sustains all psychical activity. Often, individuals are impelled to act by unconscious drives, leading to behaviors they don’t consciously “want” to do. The common phrase “willpower” can even be a denial of true intention, as people struggle against urges they consciously wish to resist. Psychoanalysis, in this context, aims to bring these real, often unconscious, motives to conscious awareness.
The repeated stimulation of neuronal pathways leads to cathexis, a process now understood as long-term potentiation, involving structural changes in the brain influenced by neurotransmitters, neuropeptides, and hormones. This interplay of innate biology, development, and experience shapes individual interests and patterns of relatedness. When the urgent needs generated by the drive system, with their fixed “tastes” in objects and relationship patterns, confront external reality, the outcome can be either gratification or neurotic frustration. When will leads to frustration, individuals often feel their lives are amiss but struggle to pinpoint the problem. Psychoanalysts frequently interpret conflicts between conscious and unconscious goals, recognizing these as “intrasystemic id conflicts” involving motivational systems. For example, one might consciously love their mother while unconsciously wishing to destroy her, a conflict that generates anxiety.
The Neurobiology of Craving: How Drugs Hijack the Brain
The mechanism of physical addiction across various addictive drugs involves an alteration in dopamine neurotransmission from the VTA to the NAS. Craving, the psychological manifestation of this dopaminergic drive activity, is induced by drug exposure. After repeated exposure, these chemicals become intensely “wanted,” similar to natural reinforcers like food, water, sex, and relationships.
The neural pathway doesn’t end with the NAS; it connects to limbic and frontal centers. As subcortical stimulation leads to long-term potentiation in higher centers, and drugs become wanted, drug cues recognized by amygdalar, hippocampal, and frontal activation trigger neural firing. This, in turn, increases craving by stimulating more dopamine release, effectively making the higher centers “turn up craving” when drug availability is perceived.
The document proposes two mechanisms for inducing craving: “upper” and “downer” pathways. “Upper” drugs like cocaine, methamphetamine, and nicotine directly increase VTA to NA firing. “Downer” drugs, such as marijuana, alcohol, opioids, or benzodiazepines, are less direct, deactivating an interneuron braking system that inhibits VTA to NAS dopamine. This difference accounts for the higher frequency and intensity of craving and difficulty in abstinence associated with “upper” drugs.
Once addicted, individuals experience ferocious unpleasure during abstinence, a resistance to the compulsion. These chemicals effectively usurp the individual’s will. For example, a smoker with fantasies of cancer or heart disease is arguably not following their own will, but rather the desire of the cigarette manufacturer. This phenomenon is likened to rats infected with toxoplasmosis, where their behavior is subtly altered by changes in dopamine/SEEKING, serving the parasite’s agenda. Similarly, human children, on average starting nicotine at 13, have their behavior altered in service of cigarette sellers.
Drug-Induced Relationships and the Alliance with the Seller
Addictive drugs lead individuals to “want” them due to brain changes, and through associative learning, the purveyors of these drugs also become “wanted”. The intense emotional, urgent, and energetic state of drug craving makes the seller, by providing the drug, a desired and cathected object. This can manifest as a romantic yearning for drug providers, with patients expressing “love” for their dealers, even considering them “best friends”. This suggests a transference from drug sellers to the therapist, mediated by the drug, leading to cathexis.
As addiction progresses, secondary brain changes occur, including the routinization of drug seeking through reorganization of pathways involving the nucleus accumbens core and diminished prefrontal inhibition. The longer addiction persists, the harder recovery becomes. Furthermore, initiating brain changes with one drug can lead to faster adaptation and craving for a second addictive drug, as seen in the increased likelihood of illicit drug use among those who start smoking cigarettes before age 15.
The permanent craving induced by addictive drugs makes evolutionary sense; drives are built into animals to ensure the constant pursuit of survival-related items. Recognizing cues for these items should trigger craving to intensify the search. However, this survival mechanism has a critical drawback: the constant pressure to act can conflict with social considerations. Just as the Oedipus Complex represents a conflict between sexual drive and social reality, drug-seeking, once entrained into the drive pathway, creates a constant pressure to procure the drug experience regardless of negative consequences. Lust, whether for love or drugs, can be dangerous, highlighting the internal conflict life provokes.
Drives are deeply unconscious, making “craving” difficult to describe directly. An unconscious basal state can be altered by dopamine neurotransmission when drug cues activate frontal or limbic centers, bringing the previously unconscious drive into awareness. Similar to how fundamental needs provoke dreams, so too does the hunger for drugs, making drug dreams a unique aspect of physical addiction and a means to make unconscious craving conscious through interpretation.
Psychological Consequences and the Denial System
Once drugs impact neural pathways, a reorganization of thinking occurs. Addicted individuals experience profound discomfort as the drug leaves their system, feeling an absolute compulsion to consume more to alleviate the unpleasure of craving, leading to endless drug seeking. This intense unpleasure drives them to extreme lengths to obtain the drug, even though the relief is fleeting.
The ego deploys defenses to manage this new drive state. Like Freud’s metaphor of the horse and rider, the addicted person urgently wants the drug, but their ego is aware of the liabilities. This leads to a series of psychological explanations, often termed “denial,” that justify continued drug use and obscure reality. However, denial is not a single defense; rather, a variety of defenses are arrayed against the drive for addictive chemicals. These can include projection (“I’m using because she/he treated me badly”) or minimization (“Going to work late because I was hung over isn’t a big deal”). Each person’s denial system is a unique set of explanations, making little sense to an outside observer who cannot feel the internal drive. To foster empathy, one can imagine the struggle to resist cravings for food while on a diet, recognizing similar defensive mechanisms.
The denial system of the physically addicted person is rooted in their craving for the drug and their allegiance to the seller. This seemingly odd claim, that the drug is not the sole object, brings us back to Freud: human relationships are grounded in the gratification of drives. Just as attraction leads to involvement, gratification, cathexis, and loyalty in sexual relationships, the SEEKING system’s functioning with addictive drugs creates allegiance to the drug seller. Cigarette manufacturers exploit this, aiming for users to “fall in love” with their brand. The fact that addicted individuals rarely report their dealers, despite potential fear, underscores the powerful role of cathexis. Warm feelings towards dealers, even coexisting with fear, are a defense mechanism known as “idealization”.
Craving directly provokes idealization, which becomes an indispensable part of denial. This defense, as described by Klein, involves a fear of the object (drug/drug seller). Addicted individuals are terrified by their own behaviors, yet consciously perceive drug use as wonderful. Smokers idealize smoking as making them slim, rebellious, or expressive of emotion and sexuality, mirroring media portrayals. Alcoholics may pride themselves on their drinking capacity, and heroin users may view their drug as “cooler” than others. Legal drug advertising often connects drugs to ideal behaviors like social dominance or pleasure in sports. This idealization is contagious, explaining the social spread of behaviors like cigarette smoking. A 16-year-old idealizing their ability to smoke without coughing communicates a “cool” image to a 12-year-old, who then tolerates the aversive aspects until tolerance, craving, and denial take hold, perpetuating the cycle. The defense of idealization is uniform across addictive drugs.
Treatment Implications: Navigating the Split Cathexis
Freud’s concept of “narcissistic neuroses,” where libido is withdrawn from objects and thus hinders psychoanalytic treatment, can be extended to “addictive neuroses”. In addictive neuroses, libido is split, cathected partly to the drug/drug seller and partly to other people, including the analyst. This results in a “splitting of the transference,” where the patient engages in ordinary dynamic interactions in therapy but keeps addictive urges outside the session. The patient wants to engage with the analyst but has another cathexis unrelated to the analyst, believing drug-related behaviors are separate from other relationships. Their libidinal investment is dissociated. This explains why some addicted individuals claim their psychoanalysis did not address their addiction; the relationship with the drug/drug dealer remained unexamined. Such an approach can inadvertently make patients more adept at maintaining relationships while continuing drug use.
Treating addictive neuroses, which lie between transference and narcissistic neuroses, requires modifications to traditional psychoanalytic technique. The goal is to develop conscious conflict about drug use within the therapeutic relationship. Patients unconsciously know their trouble stems from their relationship with the drug and dealer, and that they cannot fully engage with the analyst while maintaining that involvement. Their beliefs supporting the drug relationship exist to diminish anxiety about harmful drug use.
Therefore, treatment often involves two phases. In the first, transference is not explored because it is split. Attacking the drug/dealer relationship directly is ineffective due to the strong cathexis established through repeated relief of unpleasure by drugs. The analyst’s interventions are limited to clarifications and confrontations that intensify conscious conflict between the desire to use and the resulting symptoms, thereby working on the denial system. Only after the patient progresses through stages of change, driven by increasing dismay about consequences, and stops using, does the second phase of treatment begin.
Addicted individuals are akin to children in a divorce, loyal to both parents but understanding that allegiance to one implies disloyalty to the other. This explains their lack of openness and honesty with the analyst. Recognizing this as a “split transference” rather than mere lying fosters interest and a technical challenge for the clinician. While the therapeutic alliance is crucial, therapists who accurately intuit the underlying neuropsychodynamics might achieve better outcomes, even if they can’t explain why. Empirically testing neuropsychoanalytic concepts through naturalistic comparisons of outcomes could validate this approach.
During active addiction, drug use is procedural, automatic, and unconsidered. The first phase of neuropsychoanalytic treatment aims to sharpen the conscious conflict between the unconscious drive to use and the ego’s alarm at the consequences. Caring is communicated, and denial is undercut. By talking about the urge to use drugs, previously unformulated experiences become conscious problems requiring psychotherapy. If the ego serves the id, patients will resist talking about addiction because it interferes with drug acquisition. This impairment in ego functioning, often manifesting as “nothing comes to mind” or missed appointments, can be interpreted as manifestations of craving. The analyst should not accept idealization at face value but listen until the negative or frightened aspects of the patient’s thinking emerge, facilitating conscious ambivalence.
When the denial system is sufficiently interpreted and the patient stops using, the split transference collapses, and issues previously diverted into drug use enter the transference. This can manifest as intense hostility or profound anaclitic depression, which then can be explored and ameliorated within the therapeutic relationship. Often, the underlying reasons for addiction relate to an inability to use aggression effectively in relationships or to depend on others. Without exploring these dynamics, relapse is likely.
Public Health Implications: Combating Addiction with Neuropsychoanalytic Insight
Addiction, rooted in a deeply unconscious brain system, makes drugs “needed” commodities. The property of addictive drugs to hijack the will by creating dysphoria and craving during abstinence drives addicted individuals to extreme lengths to obtain them. The sheer scale of addiction is staggering: 26% of the world’s population smokes cigarettes, and 13% consumes substantial amounts of alcohol daily, representing billions of people and enormous profits for the drug industry. The illicit drug industry alone accounts for 8% of world trade, comparable to the oil and gas industry.
The lethality and morbidity associated with these substances are equally alarming. Tobacco accounts for 9% of global deaths, and alcohol for 4%. Alcohol is the third leading global risk for disease burden, and tobacco is fifth. Cigarettes kill about half of their users. This “irrational” economic activity is accounted for by the capture of the SEEKING system by nicotine and other addictive drugs. If a seller can induce initial exposure, the alteration in the drive pathway makes the drug urgently wanted despite danger. Drug purveyors exploit sophisticated psychological understanding of idealization and splitting to attract and manage customers. Historical examples include Edward Bernays and A. A. Brill, who worked for American tobacco companies to attract new smokers.
The question “Whose will are they following?” becomes critical. Addicted individuals, despite knowing the harm, are following the will of the seller, who profits immensely. This holds true for any industry producing chemicals that alter the drive pathway, regardless of legal status.
Just as we form relationships based on cathexis and fall in love with those who meet our needs, the addictive drug industry succeeds by capturing the will and cathexis of its victims. This insight offers valuable tools for combating addiction through public health initiatives. Policies informed by the concepts of will capture, cathexis, idealization of drug use, and the financial implications of such commodities could lead to vastly different governmental approaches. Examples include nationalizing the addictive drug industry to divert profits and properly inform the public about how addictive drugs work, or selling substances like heroin and methamphetamine in state-controlled settings with drug counselors to reduce harm.
The analogy of Toxoplasma gondii controlling the rat’s brain, and its collateral damage in humans, highlights how protagonists of the addictive drug industry control the addicted customer, sometimes with unintended consequences. Physicians, for instance, may be mystified when their attempts to help patients with pain or anxiety using opioids or benzodiazepines result in addictive behaviors. Patients, initially grateful, may become manipulative and hostile in their drug-seeking. This framework suggests that without understanding how drugs alter the will, physicians might inadvertently be seeding their patient population with medications that become urgently wanted, emphasizing the need for more careful prescribing.
Conclusion
By integrating developing concepts about the brain effects of addictive drugs with psychoanalytic observations, a robust new understanding of addiction emerges. Addictive drugs hijack the will by transiently increasing dopamine firing in the SEEKING pathway, creating a new drive to obtain the drug. This leads to the formation of psychological defenses, the “denial system,” which promotes gratification while shielding the individual from the anxiety of addictive behaviors. Idealization of the drug is a widespread defense, and addicted individuals cathect the drug seller due to repeated gratification of this drive, essentially “falling in love” with the drug and its purveyor.
Treating actively addicted patients requires navigating this “split cathexis”. The therapist must find a balance between ignoring the addiction and directly opposing the cathexis with the drug/dealer. Clarification and confrontation are key interpretive tools until drug use ceases. After cessation, the therapist must explore underlying hostile/aggressive urges and dependency needs that were previously encapsulated by the addictive behavior. Often, the very reason for addiction stems from an inability to effectively use aggression to navigate relationships or to depend on others. Without a thorough exploration of these dynamics, the patient remains vulnerable to relapse. This neuropsychoanalytic model offers a profound and practical framework for both understanding and treating the pervasive challenge of addiction.
Sources:
Addiction and will by Brian Johnson (Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, USA)
Published: Frontiers in Human Neuro Science HYPOTHESIS AND THEORY ARTICLE
Published: 11 September 2013
doi: 10.3389/fnhum.2013.00545