An assumption made in this paper and explored for its clinical implications is that an act of chronic drug use often marks or serves to implement an underlying omnipotent self-state. Psychoanalytic work with substance users, as compared with other approaches, trains attention on these omnipotent states and makes use of the transferential exchange as a therapeutic tool. States of omnipotence are particularly examined here in the context of recent attention to dissociation as an organizing force in the personality, and in the configuration of the transference—countertransference of the treatment relationship. A case illustration is used to apply current thinking on dissociative and projective processes, and their role in enactment in the therapeutic exchange, to illuminate the frequent interplay of omnipotence and helplessness in analytic work with substance-using and other patients.