Drug Dreams: An Introduction

It is not often that a clinical contribution goes beyond clarifying the immediate clinical context and makes a significant contribution to theory and to interdisciplinary research. Brian Johnson's paper on the drug dreams of a psychoanalytic patient addicted to a variety of drugs makes that kind of contribution. What he has shown clinically is that long after the addiction has been resolved by the analysis the drug dreams persist in great numbers. Since Johnson is that rare psychoanalyst who is aware of findings in related fields, he saw that this persistence of drug dreams is similar to what has been reported by psychobiologists who have found that repeated exposure to drugs results in a sensitization of a specific neural pathway in the brain that forms the substrate for intense motivations. Berridge (Berridge and Robinson 1995), one of the main discoverers of this relationship, named this neural system the ‘wanting’ system, the single quotes intended to distinguish this system from ordinary wanting. The ‘wanting’ system operates unconsciously and results in peremptory and irrational behavior responsive to arbitrary cues in the environment, as compared to ordinary wanting, which is conscious, controllable, and rational. Moreover, the activation of this ‘wanting’ system functions independently of experienced pleasure and unpleasure.

A few years ago, I ventured the hypothesis (Shevrin 1997) that drug addiction is related to powerful drives—in the psychoanalytic sense—that I referred to as cravings to distinguish them from more tamed motivational derivatives. I drew on the Berridge research to support the claim that these drives are independent of affect state and are unconscious, very similar to ‘wanting’ in Berridge's terms. This hypothesis was offered in the context of a critique of theoretical positions advanced by Kernberg and Lichtenberg, among others, that