Psychoanalytic Evaluation of Addiction and Habituation

The World Health Organization has defined addiction as a periodic or chronic intoxication produced by the repeated consumption of a drug with a tendency to increase the dose and the development of physical dependence and an abstinence syndrome. Habituation is defined as a condition resulting from the repeated consumption of a drug because of overpowering desire, the development of psychic dependence, with detrimental effects to the individual. Because of difficulty distinguishing between these two states, the World Health Organization has more recently suggested substitution of the term drug dependency for both addiction and habituation. The term drug dependency is to be qualified by the drug involved. In his opening remarks, Eli Marcovitz suggested that psychoanalytic psychology could make a contribution to the understanding of the multiple psychologic, pharmacologic, and social factors to be considered in the understanding of drug dependency and that observation of drug-induced states could in turn contribute to psychoanalytic theory.

Early psychoanalytic formulations were that fixation occurred at early libidinal stages of development. Freud first described masturbation as a primary addiction. He later attributed smoking and drinking to oral erotism. Narcissistic and sadomasochistic components were then recognized. This was followed by an appreciation of the role of anxiety, guilt, repression, and the defenses against these, including regression, introjection, and projection. Although there are significant differences, common psychological factors permit us to describe a spectrum of dependency: thumb sucking; nail biting; eating of skin, hair or mucus; attachment to a transitional object; compulsive masturbation; extreme forms of dependence upon one or a series of love objects; compulsive eating; compulsive smoking; alcoholism and the various abuses of stimulants, hallucinogens, and narcotics. These behaviors serve multiple purposes: they relieve anxie