The author concludes that the psychoanalytic treatment of addiction has proved ineffective largely because clinicians view addiction as a symptom or manifestation of psychopathology rather than as a disorder in its own right. She argues that it is a perversion. Four common aspects of addictive disorders thwart a psychoanalytic approach: denial, secrecy, conditioned responses, and the use of the substance as a fetish object. The last allows patients to maintain an illusion of self-reliance that counters the emergence of a therapeutic alliance. As substance dependence replaces realistic human dependency, addicts isolate themselves from actual relationships. The psychopathology one observes in these patients is not amenable to interpretation; it is frequently secondary to, and not the source of, the addictive process. In the author's experience, psychoanalytic treatment combined with a twelve-step program to achieve abstinence offers the possibility of a successful outcome. An extensive literature review and bibliography document the history of the psychoanalytic treatment of addiction.