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Psychoanalysis has been relatively ineffective in dealing with problems of addiction because it has tried to fit addicts into the procrustean bed built for neurotics. In approaching patients who have addictive problems and in considering the adolescent with an eye to the prevention of such problems, a number of issues must be taken into account—affect tolerance, the capacity for self-care, and certain post-traumatic residuals—that do not have the same relevance for neurotics. I recognize that substance dependence is a multifactorial problem, and I am highlighting here only some of the significant factors.
The addicted individual's pursuit of the drug is so conspicuous that it overshadows the other side of what is really a biphasic problem. The addict is attempting to take in a substance which seems necessary for his well-being, but he is forever losing it almost as fast as he can get it. The most amazing fact about the “fix” is that, at the very moment when a heroin addict attains his bliss from the injection, he is likely to engage in some act of riddance such as