The craving for safety.

Phillip Seymour Hoffman’s death has cast a spotlight on the nationwide prevalence of heroin use and abuse. One aspect of the craving, or addiction to opiates that has not been stressed so far in the psychoanalytic literature is the psychic pain these drugs alleviate.

It has been recognized that heroin use is often preceded by drugs like oxycodone and vicoden recommended for physical pain. The peaceful high can become addictive. Based on my experience as a psychoanalyst and psychoanalytically oriented psychotherapist with 6 years spent working at a clinic specializing in drug related problems, I have seen that ongoing psychical trauma suffered in childhood and the anxiety that accompanies it play important roles in the craving for relief. From high paid CEOs to street addicts and ex addicts I learned first hand the back stories to drug abuse.  

To illustrate: Lily grew up in a traumatic environment. Divorced parents, neglect, occasional physical abuse was taking its toll on school work and causing psychosomatic symptoms. One day she discovered cherocol – a cough medicine with codeine. She was 7 years old and this began a lifetime of opiate abuse, sporadic at first, but increasing over time. At age 30, fearful of losing her children, she came to the clinic and began psychoanalytic psychotherapy. Cognitive Behavioral Therapy or other short term therapies would not have helped uncover a story that needed to be told. Over a 5 year period she revisited a painful childhood that gradually alleviated the pain that had been never been verbally expressed. Expressing the hurt, anger, and fear to a non judgmental therapist trained to listen with patience and respect was a brand new experience. She learned that her feelings could be tolerated and would not harm the therapist. The bond she and her therapist formed along with the insight she gained gave her a second chance to experience life as safe without heroin.

A young man, starting his internship found that his lack of energy was threatening his performance. His access to adderol led him to amphetamine addiction. Psychodynamic psychotherapy after rehab enabled him to deal with what had been debilitating depression. Talking about the death of his mother in early childhood helped him mourn this devastating loss and lifted the depression that had been ruining his life.

Hans Loewald, a psychoanalyst in the 1960s, along with Wilfred Bion, Donald Winnicott, Stephen Mitchell,  and others have dramatically changed psychoanalytic thinking and practice since Freud.

No longer the blank screen or mirror, today the psychoanalytic therapist is recognized over a period of time as a new object (person) who provides a sense of safety that can be internalized. Such internalization can compete with and eventually assist in diminishing the real or perceived dangers of childhood that have never been articulated.

A sense of safety is what heroin gives the user. Energy is what amphetamines provide. Safety and energy are inalienable rights that too few feel.  How tragic that we resort to dangerous drug use to feel power and security and how equally tragic that psychodynamic therapy continues to be misunderstood and stigmatized by many.

How much convincing do we need to see that the whole world is plagued by narcotics and stimulants – from the playground to the university, from the congress to the sports arenas, from the armed services to wall street. The side effects of drug dependency are equally life threatening as public transportation becomes unsafe due to addicted drivers; entire families are effected; and the drug wars rage on.

Although not all unhappy children resort to drugs enough do and if society were more empathetic and knowledgable about the roots of emotional pain, there would be more support for prevention and treatment. After all these years, the public remains blinded to and dismissive of mental pain. Causing that blindness is denial, ignorance, guilt and shame and until we address this we will remain in the dark with more drug use and abuse.

The intergenerational transmission of trauma is real. Psychodynamic family therapy is often helpful in breaking the patterns that become life threatening.

The trained psychopharmacologist is useful for certain conditions but medication must be accompanied by talk therapy for lasting change to occur.

Rehab centers can begin educating their patients to avail themselves of psychoanalytic psychotherapy that sometimes leads to psychoanalysis in order to prevent relapse.

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