My friend's teenage brother had a very serious drinking problem. He was staying out late, coming home drunk on school nights, and crashing the family car. The problem was so serious that the whole family: the father, mother, 3 sisters, and brother all went to therapy. Once in therapy, the therapist focused on the mother. The therapist spent several sessions asking the mother how she raised her son and asking the son why he resented his mother. After several sessions focused on mother-child conflicts, the therapist told the entire family that Mom was the cause of Kevin's drinking.
There are several theories of addiction. All of them are imperfect. All of them are partial explanations. Yet, each therapist holds certain biases. These biases influence their therapy - as in the case of my friend's brother. For this reason, it is important to be aware of and question addiction theories. The therapist who told my friend's mother that she caused her son's drinking was influenced by psychoanalysis.
According to Freud, the originator of psychoanalytic theory, personality consists of three components: the id, the superego, and the ego. The id is instinctive, impulsive, and childlike. It wants immediate satisfaction of needs, urges, and cravings. In the case of the alcoholic, the id craves alcohol. The superego is sometimes thought of as the parent or conscience. It is the moral component of the personality. The superego knows "right" from "wrong" and its function is to control the impulses of the id. Finally, the ego is similar to the adult and it mediates the id and superego.
Anxiety is a driving force in psychoanalytic theory. Anxiety signals a threat but it can overwhelm the ego. When anxiety is overwhelming, a person relies on defense mechanisms such as denial, avoidance, rationalization, regression, projection, etc. as mentioned in my previous post. Denial, especially, is common among substance abusers who frequently deny having a problem.
One contemporary psychoanalytic view of substance abuse is that it is a defense against anxiety (Thombs, D. 2006). Addicts abuse alcohol or other substances to protect themselves against overwhelming anxiety and other painful emotions such as loneliness and depression. A common acronym in addiction circles is H-A-L-T, meaning Hungry, Angry, Lonely, and Tired. These are emotions leading to vulnerability and subsequent substance abuse. Unfortunately, when alcohol is used to avoid anxiety evoking situations, the abuser never grows up. He/she never develops appropriate coping mechanisms. Instead, they just grab the bottle (Or.....perhaps, this is an oral fixation?). For example, the solitary drinker who stays in bed all day watching TV avoids going for a job interview, making friends, and learning how to deal with rejection. The alcohol is used to dampen anxiety and avoid threatening situations.
To Kevin's therapist, it was his mother who over-protected him, indulged his id, and cause his excessive drinking. Several sessions later, Kevin still hadn't stopped drinking, was still avoiding responsibility for his behavior but the rest of the family was blaming Mom and she felt very, very guilty.
Thombs, D. (2006). Introduction to Addictive Behaviors.New York: Guilford Press.