Heart of Addiction
Displacement
Lance Dodes
Lance Dodes, M.D. is a Training and Supervising Analyst with the Boston Psychoanalytic
Society and Institute and assistant clinical professor of psychiatry at Harvard Medical
School.
He has been the Director of the substance abuse treatment unit of Harvard’s McLean
Hospital, Director of the Alcoholism Treatment Unit at Spaulding Rehabilitation Hospital
(now part of Massachusetts General Hospital) and Director of the Boston Center for
Problem Gambling.
He annually chairs the discussion group The Patient witih Addiction in Psychotherapy and
Psychoanalysis at the fall meeting of the American Psychoanalytic Association.
Dodes in the news...
Reversing Helplessness: Factor 1
Take an action that we know will make us feel better
It’s an understanding approach
Making the unconscious / conscious and then doing something about it
I make sense of my behavior
Addiction
Virtually every addictive act is preceded by a feeling of helplessness or powerlessness.
Addictive behavior functions to repair this underlying feeling of helplessness.
It is able to do this because taking the addictive action (or even deciding to take this action)
creates a sense of being empowered, or regaining control-over one’s emotional experience
and one’s life.
Vignettes: Regaining Control
Vignettes (cont.)
Paradox
Addictive behavior behavior is out of control, but addiction serves a deeper purpose of
regaining control - at least internally
But off course - you eventually create more out of controlness
Dodes believes that helplessness is common, but everyone experiences it a
bit differently, it affects us differently, and the circumstances that makes
become helplessness and the dynamics behind them are psychodynamically
unique.
Explaining the Drive Behind Addiction: Factor 2
Helplessness leads to a feeling of anger / rage
These feelings come in subsidiary forms
Identify what things make us feel intolerably helplessness
Root these out, have them expressed
Displacement: 3rd Factor
Addiction results from a redirection of energy to a substitute or displaced action because
another more direct, action is not considered permissible.
Key is to find that displacement - what is being displaced?
When actions are taken directly to deal with helplessness, there is no addiction.
The Man Who Had No Time
Intro:
Frequented Tony’s Bar most days
Recent Visit to Doc shook him up - You’re drinking every day again Given Dodes #
Ted did not drink for two days afterwards - but returned to drinking for two days
afterwards.
Ted Meets with Dodes
Ted - been to a lot of treatment “I Know that I am an alcoholic”
Comes down to will power / stick with the program don’t drink
Lost 12 year marriage as a result of drinking (painful)
Lost job as an financial advisor
Arrested for DUI’s
Considered suicide on a few occasions
Ted Meets With Dodes:
Psychodynamic History
Still drinking when sessions began (wasn’t causing crisis)
Only child (father computer programmer mother was research assistant / medical lab)
Ted done well in school (straight A’s elementary through high-school and in sports
(football team)
Pushed himself to achieve “I had to accomplish things...Uphold something for the family”
Impressive achievement in college gave him wide selection to schools
Went to a college that fit his Dad’s standards - doing the right thing
Began to drink there “heavily” for the first time
Ted and Dodes (cont.)
College was when alcohol really started to interfere... In a way, the problem was really
time”... If I’d taken even a quarter of the time I spent drinking to do the studying I should
have done (shaking head in disgust)... And after College, just drank more”.
Taking about marriage, fights, spoiled special occasions, failed career as a financial advisor,
accounts he’d let slide...
He kept returning to the time he had lost. “If only I could have that time back”
Psychodynamic Insights
Instead of talking about time lost to drinking, Dodes began to learn that Ted regretted other
kinds of “time” losses
There’s never enough time to do things- things I really want to do...Never time for myself,
time to do stuff that’s really mine
Insight 1) Realization that Ted was not in control of his own life.
Insight 2) Further sessions revealed just how burdened Ted had become (i.e., taking
work home)
Insight 3) Pressure coming from the inside “I always should be doing more”
Insight 4) Work hard as an “adult” and “be good” pattern lived out as a child
A Core Insight
Pressure to perform at work = VALIDATION
Getting caught in head
Takes on new project >>> Feel stressed at work
“When I am going to have my time”
I started slapping around papers - then said “F - IT”
TED IN A NUTSHELL
Choice to drink gave him control over his past feelings of helplessness
Ted started to feel better about his helplessness the “moment” he decided he was going to
drink
His rage drove the behavior... Dodes states... “Qualities of rage at helplessness - an intense,
narrowed focus, a loss of usual judgement, and a temporary blindness to consequences - are
precisely the characteristics that describe addiction...
Summing Up Displacement
Addictive behavior at its core has an element of emotional health
We all fight against helplessness - it is psychologically essential -
Suffering with an addiction then, does not make you psychologically sicker or less mature
than people with a wide variety of other problems
We can learn to use addictive drive as a signal that something emotionally wants to be
heard, felt, and metabolized
For Thursday Read Staying in the Action PDF and Chapter 17 Relaspe Prevention for
Alcohol and Drug Problems