A developmental model of addictions, and its relationship to the twelve step program of alcoholics anonymous.

A shift in the psychoanalytic literature is seen to have taken place in the 1960s, when psychoanalysts abandoned the psychoanalysis of patients suffering from addictions. This was due to poor outcomes, and assertions such as Kohut's, that addiction was not analyzable. The author asserts that there is a similarity in the psychological part of all addictions, and that this is seen in his work with addicted patients, including psychoanalysis of addicted patients. Addiction is presented as a pathological solution to a fixation during separation-individuation. This conceptualization helps to explain why such varying previous psychoanalytic formulations have been offered. The addictive solution to a fixation during separation-individuation is compared and contrasted to a similar fixation seen in patients suffering from borderline personality disorder and patients suffering from pathological narcissism. The developmental model presented clarifies how denial of addiction can be an interpersonal expression of an intrapsychic defense.