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Dear Sirs,
‘Debates such as this one may prompt other colleagues to get involved’ suggests de Paula Ramos at the end of his letter (2004b) that addressed the comments of Dodes (2004) regarding de Paula Ramos (2004a). I am the senior author of Pinheiro et al. (2001), cited in de Paula Ramos (2004a). I want to take up his challenge and contribute to this debate. My investigations on drug addiction started more than 20 years ago with work on psychoanalytical psychotherapy for addicts (Fleming and Vaz, 1981). I have also researched the relationships of familiar triads: father, mother and chemically dependent offspring (Fleming, 1995). My data showed that, in families with an addict child, there is an enmeshed relationship between mother and child (revealing a persistent symbiotic object relationship), as well as a pathologic alliance between father-mother and offspring. I have recently proposed that there is a ‘primitive structure’ underlying addiction and stressed the role of vulnerability to helplessness feelings and intolerance to mental pain (Fleming, in press). I do agree with Dodes when he proposes that addictive behaviours are an effort to reverse intolerable feelings of helplessness. I am also in agreement with him when he states that drug addicts constitute a heterogeneous group. Nevertheless, I have to disagree with him when he concludes that ‘no single psychodynamic formulation could possibly apply to such a heterogeneous group’ (p. 1507). In fact, the psychodynamic formulation proposed by de Paula Ramos, though certainly not to be applied to the whole universe of chemically dependent patients, is useful to address a large number of psychopathological structures and dynamics that are present in drug-addiction patients. His formulation agrees with my own research and clinical experience (Pinheiro et al., 2001, 2003). We concluded that the balance