Substance use in the United States, as a chief cause of premature mortality and core barrier to public health, emerges as a clinical focus of services provided in community-based, residential, and inpatient settings by social workers and other behavioral health clinicians. While evidence-based interventions for substance use and addicting are available, social workers struggle to integrate these modalities and stand in a chasm without an overarching understanding of substance use or guiding principles for therapeutic action. In effort to disrupt moralistic and essentializing models of substance use, this paper models use as a relationship with a non-human caregiver as an action toward survival and offers relational principles for therapeutic action to ground predominant treatment modalities. A multiple self-states model of the mind is employed to orient clinicians to an originating state of helplessness in those addicting and suggests the use of countertransferential helplessness in the clinician as a primary path into the work with this population.