Controlling the uncontrollable. Self-regulation and the dynamics of addiction

ABSTRACT

The multidisciplinary research on addictions generally promotes the assumption that addictive behavior is caused and maintained by the external psychoactive substance, which accordingly is considered to be ‘addictive in itself’. The present article challenges this widespread assumption by engaging in a detailed examination of the psychodynamic structures of addiction. Tracing addictive behavior back to problems in affect regulation, the article discusses the object, motivation, dynamics, and developmental origins of addiction. Linking the problem with the topic of transitional object relations, the article eventually argues that addictive behavior amounts to a desperate pursuit for self-control. The tragedy of the addict is that he or she only manages to replace one sense of uncontrollability with another.

KEYWORDS:

• Substance dependence
• transitional phenomena
• incorporation
• repetition and binding
• idealization and ambivalence
• egosyntonic and egodystonic behavior

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. DSM-V separately discusses alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants (including amphetamine-type substances, cocaine, and other stimulants), tobacco, and ‘other (or unknown) substances’.

2. Also the DSM-V admits, in passing, that addictive behavior might not just fuel but also feed on deficient self-regulation: ‘individuals with lower levels of self-control, which may reflect impairments of brain inhibitory mechanisms, may be particularly predisposed to develop substance use disorders, suggesting that the roots of substance use disorders for some persons can be seen in behaviors long before the onset of actual substance use itself’ (DSM-V, p. 481).

3. My focus on the psychological dimension of addiction is not supposed to be an argument for the primacy of psychological explanations over physical (neurobiological, chemical, etc.) explanations. I will leave untouched questions concerning the physical side of addiction, not because I would not find them to be relevant, but because I think that also the psychological dimension of the problem deserves to be understood in its own terms. Partly for same reasons, I won’t be discussing the societal factors in addictive behavior. For a critical discussion, see, e.g., Alexander (2008, pp. 173–204).

4. We could also quote a passage from Johnny Cash’s autobiography: ‘every pill I took was an attempt to regain the wonderful, natural feeling of euphoria I experienced the first time, and therefore not a single one of them, not even one among the many thousands that slowly tore me away from my family and my God and myself, ever worked. It was never as great as the first time, no matter how hard I tried to make it so’.

5. Self-medication may also be recursive, as it were. In the words of Johnny Cash: ‘Amphetamines are hard to handle, and once you’re into them to any extent you find out very quickly that you have a pressing need for other chemicals. I soon had to drink alcohol, usually wine or beer, to take the edge off my high if it got too sharp or knock myself out after being up for days, and after a while I got into barbiturates, too.’

6. Again, the temporal scope is crucial: the addicted person might presently want to use the drug, while she might be displeased about being the kind of person that is addicted to drug use. Frankfurt’s ideas on ‘willing’ and ‘unwilling’ addicts relate to this matter (see Frankfurt, 1999, p. 99, 1988, p. 51ff): the wants might be different depending on whether the subject considered is the momentary self or the diachronical self. Frankfurt writes as follows: ‘An addict who struggles sincerely against his addiction is contending with a force by which he does not want to be moved and which is therefore alien to him. Since the conflict is not wholly within his will, he is not volitionally divided or ambivalent. The unwilling addict is wholeheartedly on one side of the conflict from which he suffers, and not at all on the other. The addiction may defeat his will, but does not as such disrupt its unity’. (ibid.;  see also Schlimme, 2010; Waller, 2004, p. 115ff)

7. For discussion on this, see Dodes (2009); Foddy & Savulescu (2010b); Horne (2010); Nordenfelt (2010); Segal (2013); Sinncott-Armstrong & Pickard (2013).

8. In the psychoanalytic tradition, this issue has been elaborated in terms of ‘functional object relatedness’ (Tähkä), ‘relatedness to subjective objects’ (Winnicott), and ‘relatedness to selfobjects’ (Kohut) (see Taipale, 2017).

Additional information

Funding

This work was supported by the Kone Foundation (Koneen Säätiö) (FI).

Notes on contributors

Joona Taipale

Joona Taipale is a Ph.D., an Adjunct Professor in philosophy, and a Kone Foundation Experienced Researcher. He is the author of Phenomenology and Embodiment (Northwestern University Press 2014), and he has published several articles in philosophy, psychoanalysis, and developmental psychology, on topics ranging from empathy, social cognition, and interpersonal understanding, to psychopathology, intersubjectivity, and selfhood. His most recent publications include “Self-regulation and beyond. Affect regulation and the infant-caregiver dyad” (Frontiers in Psychology 2016) and “Social Mirrors. Tove Jansson’s Invisible Child and the importance of being seen” (Scandinavian Psychoanalytic Review 2016).