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The field of psychoanalysis has had a long-standing and conflicted relationship with the problem of addictive disorders (Gottdiener 2008; Levin and Weiss 1994). Many psychoanalytic writers have discussed ways in
which psychoanalytic theory has brought understanding to this problem, and some writers have discussed ways in which psychoanalysis, conducted with or without parameters () or modifications (Rothstein 1998), has been successfully applied clinically (see, e.g., Dodes 1996; Dowling 1995; Johnson 1999, 2001; Levin and Weiss 1994; Petrucelli and Stuart 2001; Shaffer and Burglass 1981; Weegman and Cohen 2002; Yalisove 1997). Even so, there have always been members of the psychoanalytic community who think that psychoanalysis has little to offer toward understanding or treating people with addictive disorders (Levin and Weiss 1994).
Despite the conflicts that psychoanalysis has had with the problem of addictions, the self-medication hypothesis—a psychoanalytic theory of addictive disorders developed by Edward Khantzian in 1985—has had considerable impact on the fields of psychoanalysis and addictionology. Since the emergence of the self-medication hypothesis, the idea that people abuse drugs, gamble excessively, and so on in order to self-medicate a personal problem has become commonplace; indeed the term self-medicating is often used by patients in treatment. The self-medication hypothesis is even widely cited and used—with alterations—by clinicians and theoreticians working from the cognitive-behavioral perspective (see Blume, Schmaling, and Marlatt 2000).
In one way, the self-medication hypothesis is similar to other psychoanalytic models of addictive disorders, in that it states that most people who develop an addictive disorder do so because they are using it to reduce or eliminate unpleasure. Smoking a joint, chugging whiskey, or repeatedly pulling the lever of a slot machine are ways to gain some measure of control over what we feel.
Compared with other psy