Addictions and Alcohol: What Becomes Anesthetized, What Repeats, What Seeks to Be Said

Sometimes alcohol enters the session before the patient speaks. A faint smell, a slightly clouded gaze, a fatigue that spills out of the body. At other times, nothing is visible, yet the narrative carries a particular tension: a way of staying upright by leaning on something that quietly destroys. From a psychoanalytic perspective, addiction is never a simple excess. It is a psychic arrangement, a device constructed to survive what cannot be symbolized. Joyce McDougall wrote that certain addictive behaviors function as “theaters of the body,” where psychic suffering shifts into action when words are missing. This idea illuminates what we observe clinically: alcohol becomes a substitute language, a way of speaking without speaking, of crying out without sound.

Self-medication is often the first gesture. Not to feel better, but to silence. To silence an anxiety that is too sharp, a void that is too deep, a pain that cannot find words. Alcohol becomes a psychic anesthetic: it suspends, slows, dissolves. It allows a person to get through a day that would otherwise be unbearable. It is the tree that hides the forest: behind the substance lie a history, a loneliness, a shame, a trauma, an impossibility to say. The product is not the problem; it is the sign. It indicates that an internal conflict is seeking an outlet, that an excess of psychic life is overflowing the subject’s capacity to contain it.

For some patients, alcohol represents a kind of deliverance. A way to release tension, to make the world less hostile. For others, it becomes a gentle disappearance, a slow suicide that does not aim at death but at not feeling. Addiction becomes a dangerous compromise between living and erasing oneself. It allows survival in the face of what would otherwise be intolerable, yet gradually distances the subject from themselves.

Dependence does not concern the substance alone. It can shift toward the family. Some patients organize their psychic life around a familial system that keeps them in a position of fragility: a partner who monitors, a parent who controls, a child who observes. The family becomes both support and trap. It tries to protect, yet it may reinforce dependence by occupying too central a place in the patient’s regulation. For relatives, it is often a nightmare: worry, anger, exhaustion, guilt. They oscillate between wanting to help and wanting to flee, between the fear of losing and the fear of staying.

Their involvement is a delicate question. Some families must be included in treatment because they provide an essential environment for stabilization. Others must be kept at a distance because their presence reinforces mechanisms of dependence or control. Children are often involuntary witnesses to these scenes. They see, hear, feel. Their place must be considered carefully: neither exposed nor erased. They sometimes carry the silent weight of what unfolds between adults.

Relapse is part of the journey. It is not a failure but a moment of truth: something could not be symbolized, something resisted. The analytic work then consists of understanding what overflowed, what was missing, what could not be spoken. Institutions play an essential role in these moments: specialized centers, addiction clinics, day hospitals, support groups. These spaces offer a containing frame where speech can circulate differently than through shame or solitude. They allow patients to encounter other stories, other ways of struggling, other ways of standing upright.

For the clinician, the question of position is central. Should one accompany, witness, contain? Should one restrict, confront, set limits? Psychoanalysis invites a stance of engaged witnessing: being present without punishing, without moralizing, while naming what is unfolding. Addiction does not need sanction; it needs meaning. It needs a space where the patient can speak what they attempt to anesthetize, what they try to avoid, what they cannot symbolize. The clinician does not save; they accompany. They open a space where the subject may meet themselves, sometimes for the first time.

Addiction is a struggle, but it is also a story. A story that asks to be heard, unfolded, put into words. A story that cannot be resolved by willpower alone, but through patient, slow, sometimes chaotic work. For families, institutions, and clinicians, the task is to hold together a space where psychic life can regain its place, where the subject can reclaim what escapes them, where dependence can be thought before being fought.

References

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.

McDougall, J. (1989). Theaters of the body: A psychoanalytic approach to psychosomatic illness. W. W. Norton.

Orford, J. (2001). Excessive appetites: A psychological view of addictions. Wiley.

Wurmser, L. (1974). Psychoanalytic considerations of the etiology of compulsive drug use. Journal of the American Psychoanalytic Association, 22(4), 820–843.