Response to Commentaries

It is indeed an honor to have been invited to present an evolving contemporary psychodynamic perspective of addictive vulnerability for this issue of Neuro-Psychoanalysis. With the exception of Dr. Yorke's response, it has also been validating and instructive to have the benefit of the responses of Drs. Koob, Johnson, Panksepp, and, to a somewhat lesser degree, Dr. Morrison. As I indicate in my concluding remarks, I believe there is more complementarity than competition between the paradigms of neuroscience and psychoanalysis, and we need not and should not compete.

For the most part, I welcome this opportunity to respond in kind to the commentaries on my paper by Drs. Koob, Johnson, Panksepp, Morrison, and Yorke. I say, “for the most part,” in that in some respects it feels daunting to adequately do justice to the thoughtful and scholarly input of my colleagues. In another respect some of the responses by Dr. Yorke, and to a lesser extent, Dr. Morrison, could degenerate into quibbling over whose pet psychological slant is better or more relevant for understanding the addictions.

Given that the principal aim of Neuro-Psycho-analysis is to stimulate discourse between neuroscience and psychoanalysis, I will give priority to the responses of Drs. Koob and Panksepp. For starters, I was gratified with Dr. Koob's clarity and precision in capturing the essence of my perspective. This is important to me for two reasons: First, too many of the published criticisms of the self-medication hypothesis (SMH) have not got it right, thus spuriously arguing against its merits. Second, in Dr. Koob getting it right, it has made it possible for me, him, and the reader to consider its relevance to neuroscientific findings and to consider further the other “half of the story”—namely, what are the neurobiological consequences for addiction-prone individuals who self-medicate their self-regulation problems? One immediate and reassuring revelation to me of Dr. Koob's response is that both per