Steven D. Brown (2012): Alcoholics Anonymous and Psychoanalysis: Collision or Collaboration?
This is a psychoanalytic study of addiction and especially alcoholism as defined as a pre-oedipal and narcissistic disorder of the mind. The subject of and historical relationship between addiction and psychoanalysis is considered through an examination of the literature, and the treatment of three alcoholic patients who recovered while engaged simultaneously in analysis and Alcoholic Anonymous. This paper will consider the theory and treatment of addiction by looking at the divergences and similarities between Alcoholics Anonymous and psychoanalysis. Data was compiled from a study of three psychoanalytic patients, focus group surveys of persons in AA recovery, and a review of classical and contemporary psychoanalytic literature on addiction, AA literature, and other research of addiction.
Freud, who had personal and professional experience with addiction, assigned its genesis to the presence of an “instinctive character” and bi-sexuality. He also speculated that addiction functioned as a substitute for masturbation. Early psychoanalysts theorized about addiction extensively, linking it with perversion and schizophrenia. Psychoanalysis was not, however, recommended for the treatment of addiction or other conditions where the ego is compromised by narcissistic pathology. The counterindication of psychoanalytic treatment for addicts, and the new prominence of the disease model, which emerged through the work of Jellinek, (1941), (1962), may explain the lack of contemporary psychoanalytic and other dynamically oriented articles on addiction.
From a psychoanalytic point of view, the primary objective of AA is to provide remediation for the problem of narcissistic disconnection for persons who not only rely on alcohol as a defense but also enact hopelessness and disconnection through many other means. AA is primarily a spiritual solution. A higher power is the remedy for self-destructiveness and path towards the commencement or resumption of object relations. As in modern analysis, the AA Twelve Step program also relies on group participation for recovery from narcissistic pathology. AA understands and defines addiction not only as a disease, but also, as in analysis, as a problem of impulses or excessive instinctive drives.
This paper demonstrates that as in analysis, AA relies heavily on introspection in its methodology. The connections between modern psychoanalysis and AA, which involve the resolution of preoedipal conditions, group treatment, and management of narcissistic resistances, represent a significant advance in the treatment of character pathology, addiction, and psychosis.