Suffering is at the heart of addictive disorders. It is not primarily the result of marketeering, peer pressure, or the availability of drugs, neither is it the result of pleasure-seeking or self-destructiveness. The suffering that addicts attempt to ameliorate or perpetuate with their use of drugs reflects major difficulties in self-regulation mainly involving four dimensions of psychological life: feelings, self-esteem, relationships, and self-care. This point of view is based on three decades of accumulating evidence derived from clinical work with substance-dependent individuals. Prior to this more recent understanding of substance dependence, our thinking about or reactions to addicts has been governed by early drive theory which stressed pleasure-seeking or destructive motives. Freud's dual instinct theory indicated that libidinal and aggressive drives were prime motivators in the addictions as they were in psychological life in general. Our collective unempathic if not pejorative view of addicts partly evolves out of this early