Addiction and paranoid process: psychoanalytic perspectives

Multiple aspects of the problem of drug abuse and addiction are formulated in terms of the dynamics of the paranoid process, specifically emphasizing the complex interactions of introjection, projection, and the paranoid construction. The effect of projection is to modify the experience of the drug substance so qualities and capacities, often powerful and magical, are attributed to it, allowing it to serve as an external agency contributing to the maintenance of internal introjective configurations and correspondingly to the preservation of an inner sense of self-cohesion. The projective dynamics deal primarily with the vicissitudes of aggression and narcissism, and are given a sense of organization and meaningful integration by the cognitive elaboration of the paranoid construction. They also serve to locate the drug-taking behavior in a larger matrix of familial, social, and other environmental influences, which tend to give support to the projective system. The interaction of these projective psychological dynamics with the pharmacological action of drug substances completes the drug equation and helps to shed further light on the selection of specific drug substances as having addictive potential.