The analysis of an adolescent boy abusing alcohol, marijuana, and other drugs is used to discuss unconscious object relationships that can underlie substance dependence. Differentiating experimental from dangerous substance use is particularly challenging in the treatment of adolescents. The boy's escalating substance use is viewed both as an effort to numb himself and to “speak” through symptoms of problems he could not yet name. I utilize Rosenfeld's (1960/1966) view of the relationship of drug addiction to an identification with an ill or dead object to explicate the boy's psychodynamics. In this case, my patient was identified with both an ill mother and a neglectful father. Aspects of containment by the analyst that contribute in different ways to an adolescent's capacity to think about their self-destructiveness are discussed, along with the need for confrontation and the meaning of ancillary care when an adolescent's substance abuse become life threatening.