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The central argument of Louis Berger's third book, Substance Abuse as Symptom, is similar to that of his second book, Psychoanalytic Theory and Clinical Relevance. There he complains that psychoanalytic practice has not been “logically entailed” by psychoanalytic theory. One might expect, then, that Berger would attempt in a sequel to show how, by contrast, his own ideas about practice do in fact follow from his version of psychoanalytic theory. In general, Berger's arguments are bifocal. In each instance, he discusses a particular theoretical or practical approach that does not work or is not logical and then presents an approach he believes can be supported. For example, he argues against “a logical positive mentality” enshrined in what he calls “state process formalisms” and advances a case for a theoretical position that, drawing heavily on the philosophers R. Bernstein and C. Prado, he calls pragmatic.
In Psychoanalytic Theory and Clinical Relevance Berger argues very strongly against what he calls the medical paradigm, which emphasizes pure knowledge, an adherence to practices borrowed from medical theory and research, and the ambition to make psychoanalysis a general psychology. In Substance Abuse as Symptom, a central target of Berger's attack is the medical model for dealing with substance abuse. The case against this model is argued in great detail in the book's first half, which also includes an exhaustive review of the literature. Berger shows how there has developed in the United States a substance abuse treatment industry with a bureaucracy and a system of hospitals and institutions that governments, drug companies, and physicians have a vested interest in maintaining.