In recent decades, a sprawling system of addiction treatment programs has been established. These programs are based on certain widely held beliefs and ideas about the etiology and proper treatment of this problem. To be effective clinicians with this population, it is essential for us to examine and understand the assumptions upon which our work rests. Louis Berger's book, Substance Abuse as Symptom: A Psychoanalytic Critique of Treatment Approaches and the Cultural Beliefs That Sustain Them, offers just such an opportunity for clinicians.

In a provocative discourse, Berger challenges most of the concepts that form the foundation of our government's national policy and the clinical community's response to the problem of addiction. Berger takes the position that both addiction in the individual and our cultural adherence to a medical model explanation of addictive etiology are symptoms of a more serious underlying disturbance. This disturbance can only be understood fully using a psychoanalytic