Alfred Adler Institutes of San Francisco and Northwestern Washington

Theme Pack 3: Substance Abuse

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Narcotic Abuse and Alcoholism1

By Alfred Adler [1932]

Chapter VII in The Collected Clinical Works of Alfred Adler: Volume 7

The psychological style of life of drug addicts and alcoholics presents me with a difficult task. Because I do not often have the opportunity to deeply examine the psychological development of a drug addict or an alcoholic in order to develop his style of life, his underlying melodic theme, when I recall the cases I have treated, I do not come up with much material. Therefore, do not expect from me a great many case histories of patients, but instead the results of intensive work on particular cases. Also, I shall not spend time with descriptions or indications of damage done to the body, the social behavior, or the strain that burdens the entire population needed to care for the sick, etc. Rather, I prefer to mention those aspects that appear important to me as an Individual Psychologist to free a patient who somehow became addicted, whose life was returned to him to become active and productive, and whose capabilities were restored after being fully or partly forfeited. We should not be surprised that Individual Psychology places so much value on that point since we would not even bother with that problem if we could not show that the relationship of the individual to the tasks of life is disrupted by addictive substances. The drug addict or alcoholic admittedly is not too severely depressed by his symptoms since he does not focus on them and pays them little attention. On the other hand, we can understand the problem of narcotics and alcohol only when we regard the relationship of the whole person to his responsibilities to society, responsibilities which remain more or less constant. This is the position of Individual Psychology with regard to all problems that concern psychological dysfunctions. Therefore, Individual Psychology contributes to discussions on this problem, looking for the type of person who by failing to “accomplish” anything turns to drugs and alcohol. Unquestionably, some people will absolutely not become morphine addicts or alcoholics, although the possibility of their inclusion among addicts is affected enormously by outside pressures. However, we must keep in mind the stress between the individual's self-image and the task confronting him. Since we are still discussing general diagnosis, I would like to characterize the general schema of Individual Psychology and how we plan our approach to recognizing such a

1 The first part of this publication appeared in issue No. 14, July 10, 1931, of the periodical “Fortschritte der Medizin” (Progress in Medicine), Med. Verlag Hans Pusch

G.m.b. H., Berlin, following a lecture (held in the Berliner Aerztehaus on March 25,
1931). Re-printed as “Rauschgift” in the Internationale Zeitschrift für
Individualpsychologie, Vol. X, p.1-19, 1932.
2 New translation by Gerald L. Liebenau, 2004.

person. The controlling factor for us is establishing the conditions under which the abuse began. If we succeed and gain an exact insight into how that beginning occurred, then we can answer the following question: For what kind of situations was the patient unprepared? This question assumes that a person has already progressed some distance in his life and now encounters a problem that he seeks to avoid. However, this avoidance is a conspicuous fact that the patient himself understands and describes. In all these cases, people seek relief from a particular situation. From this, we can already draw other conclusions. These are not people who confront difficulties with courage, patience, and experience, but people who in difficult situations first look for relief.

What type of person tends to deal with problems, which everyone faces and has to solve, by finding an easy way out in order to avoid them? True, some morphine addicts and alcoholics intoxicate themselves before facing a problem and then somehow still solve it. This type of person is not rare, and particularly in the case of morphine addicts, we often find accomplished people in high positions, who are far above the average, but who attain success in life with the poison in their bodies. If we want to understand how such people think, unbiased, without any preconceptions, we have to say that they believe, or act as if they believed, that their success comes from a combination of morphine and the strength from within them.

Others are stuck; they can no longer progress. Under the influence of morphine they leave their problems unsolved, push them aside, turn them off in their drugged condition. They keep taking increasing doses of morphine and eventually become incapable of working and living.

In every case we see an individual who feels uncertain, lacks self-confidence, and seeks relief; a person who looks for relief through intoxication in which he meets poorly or fails any tests of his ability to function. This ability to function should probably be established by a physician in every case. Yet, we encounter very little on this subject in general case histories. However, under careful questioning, we would bring out one significant problem encountered by that person in his development, a problem into which we now gain a clear insight. That is his vulnerable point; his capabilities no longer extend to that point; he is not well prepared to deal with that particular task. And now, the additional problem arises for us to examine why he is not prepared to meet that particular task. In that respect, Individual Psychology helps us look back into his early life and search there for clues to explain his unsuccessful preparation. A sufficient number of points of departure will develop from such an examination. If we wish, we can organize them schematically: Questions regarding the relationship between “I and thou” which deal with friendships, truthfulness, loyalty, the ability to establish relationships, etc. For example, the lone drinker confronts us with the question of community. The question of work can be very threatening if someone strives impatiently after the highest quality and god-like attributes in order to be exceptionally successful, to satisfy excessive ambitions, to try to triumph over everyone else, which naturally leads to exceptional, long-term stress. We find such stress as the trigger in many other cases of neurosis: functional neuroses spreads into the body, and into inferior organs; anxiety neuroses and phobias reach into the emotional spheres; obsessive neuroses into the thought process in the first instance to prevent steady accomplishments; in hysteria the motor spheres are affected; in suicide the total turning off of life as an indirect attack against others, etc. When we then look back, we find at every step manifestations and expressions that teach us that these individuals are not prepared for full achievement. Here we see the prototype, the kernel of a whole personality that can already be discerned in the first four or five years of life, although it probably was formed earlier without our being able to trace it back to the original germ cell. This uniqueness that contains all possibilities for functioning in later life, all capabilities expressed in one's attitude toward life, an opinion about one's capabilities, and the probable limits within which one's activities will take place. If we compare this prototype, which I call the psychic constitution of a person, with the demands of future problems, we can predict with some accuracy the development of dangerous tensions. The child with an organ inferiority, or one who was spoiled or neglected, is not prepared to solve problems encountered in society, work, or love. The structure found in such a prototype can be seen as a mood and attitude of inferiority, uncertainty, etc.

Once we establish that the individual who has succumbed to narcotics displayed poor preparation in childhood to face the duties of life, then we naturally must ask ourselves: What does it mean to be properly prepared for the duties of life? I already mentioned the relationship between “I and thou”, and problems at work, where one's preparedness and experience can be observed early on to determine the attitude toward the outside world, and the ability to manage problems. I still have to address the task of romantic relationships where we can also establish, as in the case of all three tasks, that for success a certain degree of interest in the other person is essential. An individual cannot answer the question of the relationship between “I and thou” in a normal manner, or master the problem of friendship, when that interest is not already present in the prototype and does not extend itself to the problems of life. He cannot resolve the problems at work when he lacks interest in cooperation, playing along, accomplishing something, which must be understood as doing something useful for the general good; and he cannot be useful when he has no concept for it, when he doesn't have it in him to do something for others. Naturally, he cannot solve the problem of love when he has no interest in it, when he doesn't have the means to give of himself to a person of the other sex. When the interest is not inherent in him--of which he can be totally unwitting--to work on behalf of others, to regard as his duty the continuity of the community, when such striving is not in his style of life, or to express it better, if I failed to develop that propensity toward community in the prototype, I cannot approach the primary questions of life that require social interest, the action line of the feeling of community. This should allow us to understand why Individual Psychology places such importance on recognizing the situation that demonstrates, as in a test of someone's ability to function, that the individual is not capable of solving a problem that constantly asks for social interest. This social interest cannot be removed as if separate from the total image of the individual; it is much more the theme we have in all forms of expression. For example, when we look, we see only that object for which we have an interest. When we listen, the basic theme again is this communal feeling in the degree of connectedness, in the manner in which we speak to each other and make contact. Of course, we also find that underlying theme in the development of the mind, the common sense, which requires that every situation, every person is seen as we expect it to be seen by every other person. Thereby, a person becomes a part of the whole in his judgment about things, problems, people, etc. In short, all the capabilities required to solve a problem depend on the degree of interest in it and, as we have seen, that problem can be solved only when the individual brings to it a sufficient degree of interest.

Now comes another question: Who is not really prepared to possess communal feeling, social interest? Of course, this can be answered briefly by saying he who thinks more of himself than of others; he who takes and does not give; he who sees life as if its sole duty is to make him comfortable, and he who does not expect life's difficulties to concern him. We can see that in all such styles of life unsolvable problems produce psychological stress which manifests itself in the inferiority complex: “I am not sure of myself; I cannot solve the problem,” in various forms of neuroses, and in the manifold forms of aberrant behavior. We shall establish that such persons lack the necessary degree of community feeling, and from the beginning of their lives they were not prepared for connectedness. Now, we arrive at the principle that applies to all morphine addicts and alcoholics: A minimal development of the general interest in people. On this point, our examination resolves into an easily comprehensible and usually accepted fact: he who subjects himself to narcotics proves with that alone that he does not value sufficiently the question of the general good. How this lack of concern developed was examined and established by Individual Psychology quite extensively, deeply, critically, and I might say, skeptically. We shall find that as children, drug addicts and alcoholics had an exaggerated tendency to think soley of themselves and to exclude others. Some of them had suffered early in life from physical ailments. Such ailments could have occurred because they were born with inferior organs which burdened them physically, and so that later in life they encountered greater difficulties than the average person. Understandably, children who experienced difficulties, already carried a heavier burden at the outset did not view life as a paradise but as a torment, to varying degrees, but to a sufficient extent to experience life as difficult. Physicians, such as Czerny, already have pointed this out, and it is also statistically evident that later in life such children frequently reflect aberrant behavior.

In 1907 and later, I pointed out how frequently children with inferior organs suffer and how they confront life with certain antagonisms accompanied by hypersensitivity. Such hypersensitivity shows that the child did not adjust properly, could not see himself as a part of the whole, has a tendency to evade, and has difficulty with things that others find easy. If we are here on the right track here, then in terms of that characteristic we should be able to understand all those who are ailing and lack preparation. True, this characteristic is merely a part of the whole, and we must not permit ourselves to relinquish our perspective of that whole; we must continually encompass the whole personality. However, we can conceptualize the personality only inductively by passing from specific manifestations to the higher idea of the whole. This unity of the personality is not easy to describe, and cannot be expressed in one statement. I shall be satisfied for now by pointing out that it appears in the inferiority complex when a problem arises for which the personality is not prepared, and which in its psychological hypersensitivity it expresses itself as abnormal.

Another characteristic we encounter in drug addicts as well as in their psychological constitution, the prototype, is impatience. If we wish to understand the meaning of a trait, we must look at it as movement. Every character trait involves a social relationship. The particular way that a person relates to another, to duties, etc., has been given the term character trait. The abstract term for a firm position taken by an individual is valid actually only in “the context of this world,” the trait cannot be innate because it represents a social relationship, an abstract expression of a concrete relationship. The “possibility” for character traits must already be present in the embryo, but whatever develops from those possibilities is determined in the first four or five years when the social relationship was already practiced during that time and under almost consistent circumstances. From that point forward, the archetype in its stabilized form continues to advance to face social problems. This is how we come to examine the characteristic of impatience. It is not a quality in a person who feels strong. The strong person can wait. The strong person in general is not easily affected by emotions. The stronger a person the greater his self-confidence, and the less likely that he is impatient, hypersensitive, or emotional. Impatience reveals fear that the person may face defeat or a loss when success is not immediate. On the other hand, impatience means more: a demand for satisfaction. We can speak of a “craving for sweets.” All persons whose archetype displays a lack of interest in others have this craving for the pleasure principle without the underlying theme of social interest. Thus, we naturally find aside from impatience, the craving, the hypersensitivity, and also an egocentric behavior whereby the person thinks only of himself and his personal superiority. We then arrive at another basic trait, which probably can be found in all those who are addicted to narcotics. They have a pathological ambition that our society cannot easily satisfy. However, ungratified ambition is exceedingly painful, in particular for a person who also shows tendencies toward hypersensitivity, impatience, craving, and who thinks only of himself so that he is vulnerable everywhere. This vulnerability combined with an inferiority complex is much more difficult to endure for such a person than for someone who has an interest in others and who knows that he is responsible not only for what is agreeable but also what is disagreeable, and that life presents him with tasks that require his cooperation for their resolution.

These are results in any general diagnosis of a failure and, therefore, inadequate when we examine a particular person in whom we shall always encounter something unique. The impatience of one person addicted to drugs is not the same as the impatience of another addict. In order to deal with a particular case we can use the general diagnostic at the outset, but we must then apply a special diagnostic. We can follow the path that Individual Psychology has shown us, and which I mentioned when I spoke of the inferior organs that cause life to become burdensome. Of course, such a person will be careful, a characteristic that we find in every person afflicted with defects. We shall also encounter a lack of courage. Courage properly understood means to feel at home somewhere, to feel as if belonging to this world with all of its pleasures and pains. For that reason, everyone who fails lacks courage; instead of courage we find cunning. All who have failed, including drug addicts and alcoholics, live as if they were in a hostile environment. They also are suspicious, have problems connecting with others, and anticipate aggression and depreciation. They look at another person as an enemy. I remember a drug addict who during his withdrawal treatment from narcotics, practiced at one time, constantly spoke of me as a bad person, yet before that was my friend or at least appeared to have been my friend. During the narcosis, his true opinion came out. We also find a tendency toward jealousy, which is apparent not only in alcoholics, but also frequently in cases of drug addicts. They live as if they were among enemies and don't feel as if they belong among us, which means nothing other than the lack of social interest.

We expect failures in the development of one large group of children: the alcoholics, and morphine and cocaine addicts. They formed their prototype under conditions of extreme pampering when they became dependent on others, made someone else take care of them, and took advantage of that person's social interest for their own benefit. As a rule, the mother was exploited. The characteristic of pampering was thoroughly studied by Individual Psychology so that we can establish on the basis of the child's relationships, if he were pampered, or seeks to be pampered, regardless whether he displays those characteristics openly or not. A pampered child also grows up as if he lives among enemies. Having become used to the presence of one person, every other situation appears unacceptable. For that reason, we find in pampered people that every change for them is a severe invasion of their person. Under those conditions, every pampered person succumbs to spiritual stress affecting his thoughts, feelings, motoricity and activity. Obviously, pampered people lack social interest since their interests are only in themselves. Again, thousands of variations are very unpleasant for someone who would like to make it easy for himself. However, while I don't wish for us to think of such cases as simple, we would not want anyone to be frightened by the difficulty of an Individual Psychological examination.

We can easily explain in general terms the pampered child in his social setting. When I ask whether a pampered child is orderly, the answer is certainly negative. The pampered child in his parasite existence would like others to clean up after him. When I ask whether the pampered child can bear to be separated from the person who pampers him, the answer again will be “no.” Such a child is extremely sensitive to every new situation, is impatient, tense, tends to feel sad, angry, fearful, is impatient and for those reasons not prepared to solve problems without hesitation and without some excuses. This type of child in thousands of variations, is the primary candidate for failures, and for becoming an alcoholic and drug addict. This is the kind of child, and adult, who is most easily deceived by a friendly approach. This child always seeks warmth and when shown warmth is immediately won over. He is the kind who in his search for warmth seeks to get close to another in order to win him over, a dependent person, whom we find time and again among failures as well as among the alcoholics and the drug addicts.

A third type also has to be examined. He is the person who also grows up as if he lived in a hostile environment, which means that he searches for his way of life under a burden. These are the neglected, the hated children who have never known social interest, who do not know that there is such a thing as social interest and who, therefore, experience life as something hostile and antagonistic. They constantly speak of unrest in society and blame society, but take no steps to improve the social climate for the common good. They are always ready to take and never give. We occasionally find this type also among the alcoholics and the drug addicts, although less frequently because such a pure type is not often found. This type of person can occasionally be discovered among illegitimate children, orphans, and unwanted children.

Thus, from the general diagnosis, I have tried to arrive at a bottom line that also pertains to drug addicts and alcoholics. I would like to prove, based on cases that I can recall, how that baseline is reflected in my material and how it opens the way to a specific diagnosis.

Speaking of drug addiction, I remember a patient who was plump as a child and had difficulty moving. If someone wished for some peace and quiet, it was only necessary to put the child on his back, even when he was four years old, and he was unable to stand up. He suffered early on from fear, as when left alone, and it was impossible to get him to go to school. He came from a well to do home with parents who had much influence in the community. It was, therefore, possible for the parents, prior to the final examination for entrance into the university, to have the examiner come to their home with the explanation that the boy was beset by fears. After he married, he never had a good relationship with his wife whom he constantly jealously pursued until she divorced him. He was an intelligent, shrewd person. He was able to attain a senior position in the government because of his connections. According to some, his work was excellent; according to others he achieved nothing substantial. He told me that before he accepted his position he became very agitated. It was the test of his ability to function and for some time he was unable to decide whether to take the position. He had an acquaintance who told him that in such situations he took a shot of morphine to get over his difficulties. This was the beginning of his morphine addiction. Every time while in this senior position, for which he was really not qualified or trained, he took morphine when faced by difficulties. He continued doing this for some time and finally required morphine on a continuous basis. His problems in this position grew increasingly and he was demoted to a lower rank. This led to his taking increasing dosages of morphine. He was beset with feelings of degradation and excessive ambitions since he thought himself the most competent among the officials in his office but with whom he was constantly in conflict. He married a second time. His wife, who did not know how to deal with a morphine addict, became very tired of him, although he did not lose his potency. This caused him to increase his morphine intake which probably also was out of anger with his wife for whom the increased dosage was meant to be a hostile act. The wife tried repeatedly to persuade her husband to abstain from his habit. After she had called a number of outstanding physicians, her husband declared that he could not leave his bed, that he could not move his limbs, and that he suffered from heart attacks. I came to know him under those circumstances and sought to free him of his morphine habit, which I was successful in doing. However, by that time he was unable to get over the fact that his wife had rejected him. Since the wife was determined to seek a divorce from him as her right, the husband reached for another means to attack her: he threatened suicide and was successful in carrying out his threat. I learned about that later. This then was the course of his life, which ran as an unbroken, and clearly apparent unity, beginning with his childhood to his end.

We can easily observe pampering and early neurosis in the case above. In another case, the patient was the second child born in his family, and immensely ambitious and active. He was short in stature, an excellent student, ambitious, and hyper sensitive, which made it difficult for him to make friends easily. One day, while in his office, he had a shattering experience when he overheard his supervisor asking: “Where is the little dwarf?” He left that job immediately and could not get out of his mind the humiliation he experienced at the hands of his boss. So as not to bear the problem of degrading criticisms, he began to take morphine. This is the only case among many in which I was able to cure an addict from his morphine habit freely, without any external compulsion. I must confess that this is probably a unique case, and that I would not trust myself to undertake such a case again without any kind of medical supervision. I also tried with physicians, supported by their insights, to withdraw them from morphine without confinement but was never successful.

Another patient came to me only after he had undergone six withdrawal treatments. This person was the only boy among five girls, therefore, extremely pampered. This patient also was very egocentric and ambitious. He was successful and had attained a senior position, but the worm was in the apple. In order to resolve his romantic problems, which put him under great tension, he married a very ugly girl. Such cases generally demonstrate that a person has little self-confidence, that he seeks to improve his situation as if he constantly expects that this ugly girl would admire him out of gratefulness. People don't know that this is always a mistake. They don't know that such a situation is unbearable.

Therefore, they hope that when they marry below their station it would bring them relief. We can see here again how this patient sought relief. During the war, he was wounded and received several injections of morphine. When he returned from the war, he settled down and again took up his married life. He then realized that his wife was extremely willful, and that she also tended to be unfaithful. The husband was extremely shocked by this and could not understand that he, a successful persons, indulged by everyone and highly esteemed, was now shaken in his self-confidence by his wife. He remembered the relief he found while wounded and reached for morphine, eventually becoming a morphine addict. The wife soon became aware of her husbands habit and saw it as an act of revenge: to show his partner what she had made of him. We find the same phenomenon with alcoholics. They display misery in order to blame another and to punish that person. When the wife saw that her husband could not be deterred from his habit, she also reached for the morphine syringe as a form of counterattack. As I mentioned earlier, she was a very ugly child who was under constant pressure during her childhood from a tyrannical father. She is probably of a type that I mentioned earlier - a hated, neglected child. Her unattractiveness was very apparent. She was sensitive, impatient, and tended to become emotional so that a cure could be attained only when both she and her husband were healed. Healing came when I explained to both their mistakes, and the errors that they had made in their original style of life, their lack of interest in others, and their fears of not being able to succeed if they did to think of themselves first.

Another case is of a single child from an affluent family who we can assume was pampered. The father, a choleric person who tended to have emotional outbursts, intervened in everything his child did. One day, the father forcefully broke up a romantic relationship of the boy which led him to become depressed. He entered a clinic where he was given morphine injections that turned him into a morphine addict. He underwent six or seven withdrawal treatments until, after his last treatment, he came to me. During his time with me I uncovered the various parts of his lifestyle. He had a strong craving for sweets, was sensitive, impatient, contrary, and tended to become emotional. He lived under constant pressure from his father who nagged his son incessantly, even at the age of 35. This patient also was cured when he was able to become independent of his father and escaped the unnecessary pressures to which he was subjected, and which consisted only as long as the patient took his father seriously. When the insignificance of that relationship was made clear to him, it was also possible to avoid a relapse. He has been free of morphine for eight years.

Another situation is that of an only son of a millionaire family who was very pampered, impatient, and intent on getting at his family's money. When they did not give him enough, he caused a great deal of trouble whereby he attained what he wanted. When his father died, his mother came into difficult financial straits so that she was unable to give her son as much money. When he noted that his unruly behavior no longer had the desired effect on his mother, he fell into the hands of a drug dealer who induced him to become a morphine and cocaine addict. The patient was committed to an institution.

I recall another case in which the patient was the youngest son of several successful sons. With regard to the youngest children in a family, we can say as a general diagnosis that they are exceedingly ambitious and are always striving to get ahead of their siblings. This is analogous to the Biblical story of Joseph who was a dreamer and fantasized that he was better than all the others, etc. The boy of whom I speak was constantly pampered by his mother and suppressed by his brothers. He was the most successful among them and became enormously wealthy. During the inflation, a large part of his wealth disappeared. Since his strength was rooted in his belief that he was better than his brothers, he lost that support. In this state of self-pity and feeling of abandonment, he met a women who was a morphine addict and who professed her love for him, moved him to marry her and made him into a morphine addict to carry him over his sorrows. That is how he became an addict. He later divorced his wife and underwent several withdrawal treatments. During one phase when he was free of the habit, he married again, but again became addicted when his business was not doing well. He then entered a phase that can be seen as indicative of a morphine addict. His wife, who constantly struggled to have him abstain from the drug was unsuccessful. In order to demonstrate to him the harm he had done, probably also in the belief that she could overcome her sorrows, the wife also began to take morphine. She also was pampered as a child who never could stand not having her way. In a general as well as in specific ways she was the type that I have described as neurotic.

On the subject of alcoholism, on which I also can offer no extensive material, I should like to present several cases that I have studied intensively. One is a case of a man who came to me after having undergone a number of treatments for drinking so heavily from time to time that he became unconscious. It turned out that he was severely pampered as a child and that he was unable to endure life and its responsibilities. As the only son, his mother and one older sister pampered him. The father cared little for him so that a tensed relationship developed between father and son; he could expect to get anything from his mother. Interesting is a minor event from his childhood. When his parents went on a trip, he came under the care of his grandmother who did not pamper him. One day, at age four, he strapped his book bag on his back and marched out of the house, declaring that he did not like where he lived and that he would not come back. We can see from this that a person moves from one situation which seems unbearable to another, easier situation, to save himself. Another recollection was of his mother and sister dressing him up as a doll and carrying him around, a clear indication of pampering. When he entered school, his mother spoke with his teacher and asked that her son be given gentle and friendly treatment. He lived in the United States where prohibition laws were strictly enforced, which made little impression on anyone, and where people drank more than before with only the quality of the alcohol being poorer. His father drank heavily with only little visible effect while his mother remonstrated strongly and became very upset with his habit. In America, young people often begin with a show of manhood that manifests itself in drinking. He also began to drink to compensate for his feelings of having been spoilt and for being easily embarrassed, and to show himself as strong and grown up. This trait betrays a person with little self-confidence who looks for an easy way to make himself important. He joined a drinking club and drank. His mother pleaded with him to stop and never to drink, which he promised to do; a promise that he kept for only a short time. In order to take a job he moved to another town where he had to depend on himself, which proved too hard for him. He stayed home a great deal of the time, read a lot, and as a good musician played music. He could not avoid being invited on occasion, which depressed him and which brought him under great stress. Not infrequently, prior to such an engagement, he would become drunk and could not make the visit. He was handsome, intelligent, and promising, which on occasion attracted girls to him. This also caused stress, which he relieved by becoming drunk. He had no luck in his job and often changed employment. When he had appointments with a customer he reached for the bottle for courage and then would wander around in a daze for two to three days. He drank most frequently when money from his mother for his upkeep did not arrive on time. Telegrams flew back and forth and he was never able to bring order into his financial affairs. When his mother failed to send him money quickly, he again began to drink. It became clear that he used this situation to tie his mother closer to him. That is the condition in which I found him. After some time it was possible for me to bring him to where he gave up alcohol and devote himself to his work. I met him again three years later fully recovered. I was successful in my effort because I convinced him that he was toyed by his pampered lifestyle.

I also should like to relate a case about an alcoholic whom I had never seen. This report probably is totally inadequate and probably also not in accord with the principles of Individual Psychology:

“He is the only son of his parents.” We again meet the same situation that we had encountered earlier. “He is physically delicate, small, intelligent.” This is possibly the result of an endocrinal deficiency. “His father was a drunkard but was able to hold his job as a white collar worker. He died early so that his mother became responsible for the upbringing of his only son.” That is the frequently inadequate situation where the mother is the only person close to her child. When we now learn that the mother kept uninterrupted watch over her son we cannot help but feel that the mother indeed was the only person close to him. “In school, he was excused from participating in playing or in sports. The mother sent excuses often against her better judgment.” We expect that the mother would not let him out of her sight. His archetype has no other contact than to his compassionate mother. “He decided to become a teacher a field in which he had many protectors. Despite his mother's efforts to protect him from alcoholism, the son, feeling that he was left on his own, began to drink beer.” Here again we see a test of the ability to function. In the absence of his mother nothing went right, particularly when he had access to large sums of money. This again shows a craving. In this situation, which is a strain on him, he cannot hold himself back, and causes him to look for delectable foods, quietude, and for some intoxicant to take him over the difficult situation of being left alone with his work. This also means that: “my mother should be here; I am too weak to be left alone; I cannot exist on my own.” Here we have the expression of an inferiority complex. “The mother lied for him whenever he encountered trouble. He succeeded in passing all his tests and in obtaining employment. When he had his own money he succumbed to alcohol, especially on pay day, when he often spent all of his money on liquor.”

At this point, I should like to make a remark that has to be verified. It concerns what we call a “dipsomaniac.” It has often been stated that there are no reasons for that, therefore, endogenous causes. As far as I know, there are always reasons. We must not forget that this man receives his money every payday. He is, therefore, no dipsomaniac, but acts in a given situation because of the insecurity from which he suffers.

“He remained unmarried.” Here again we have an indication: unable to solve a problem that requires an interest in another. I am convinced that his sexuality is expressed in ways that show his lack of a social interest. He probably expresses his sexuality like a loner through masturbation, or he is impotent, again, determined by the totality of his lifestyle, not the other way around. - “In the end, his mother was unable to bear his vice and revealed them to his supervisor. When his mother reproached him, he treated her roughly.” We find this in pampered children very often. They become tyrants in their own home early on; at first defiant and later aggressive and dangerous. “He joined a group of abstainers. He succumbed again to alcohol. He escaped from one institute because, by his testimony, he had to do physical work. He returned to his work but became drunk at the end of each month for shorter or longer periods of time, despite warnings from his mother. He missed work and was in a daze for hours during which he had no idea what he was doing.”

We can see from this report also that this is a type of person who is not prepared for life, particularly to live alone, and who wants to have his mother or a substitute. His dipsomania may also have been a way of attacking his mother, whose rebukes now offend his morbid ambitions.

In summary, I should like to state that in looking back to the prototype, to the psychological constitution that was acquired during the first years, we could establish what we have found to be germane in many cases. This aggressive searching for relief is already discernable in childhood in failures, in problem children, and in neurotic and delinquent children. One of the most frequently followed paths, one of the easiest, is daydreaming. Time and again we find the start of daydreaming in a child who does not feel strong, suffers from inferiority feelings, and feels demeaned. As if transformed, the child will flee into fantasy where he has big plans and images that help him to forget his actual situation, or help relieve him from psychic suffering. It is the seeking relief from suffering.

This is how we can characterize drug addiction and alcoholism as the daydreams of adults.

We are all in agreement with regard to the question whether psychotherapy by itself can be applied for treatment. As long as the person is under the influence of drugs or alcohol we are unable to speak with him or work with him. Therefore, withdrawal is necessary. The cause for withdrawal symptoms appears to lie in “water poisoning” which can probably be eliminated by euphyllin. Dr. Alexandra Adler provided withdrawal treatments at the psychiatric clinic of Professor Pötzl in Vienna and cured morphine addicts in a waking state in three to eight days, in most cases without hearing any significant complaints.

We shall provide only one more case history of an addict that was submitted to us by Herr Dr. Meyer, Berlin. I shall select from this extensive report only a few passages that are important for our approach and only briefly summarize the rest of the report.

The general treatment for those addicted to intoxicants rests mainly on withdrawal treatment, which has been made much easier by appropriate facilities and the development of new methods. Whether these methods by themselves ensure lasting success is more than questionable. There also are questions regarding the nature of the intoxicants themselves. Clear is only that under the influence of an intoxicant, psychological and physical inhibitions dissipate, which, of course, is very important to the patient who is severely inhibited. For that reason morphine and cocaine addicts occasionally point to a strong pleasure feeling that they not infrequently translate into sexuality. Since the sexual drive can manifest itself under all kinds of possible combinations, it should not surprise us, and we certainly need not conclude from that, that the intake of morphine has a particular connection with sexual feelings.

The question can be raised whether everyone today is looking for relaxation. This means that we need not assume that it takes particular conditions that call for a need to relax. When we know that there are morphine addicts who can withdraw on their own and, on the other hand, that withdrawal treatments for others are unsuccessful, then it says to us that the possibility for a cure depends more on the general conditions of the personality rather than on a particular situation.

We, whose starting point is Individual Psychology and the unity of the personality, must question also in cases of drug addicts to what extent their condition is the result of their style of life. We, therefore, must ask in every case: To what extent is the patient suited to deal actively with the tasks of life? We have found in all cases of drug addicts that they were more heavily burdened by their life than appeared possible for them to bear.

Before we come to the next presentation of our point of view we must examine another possibility. Is it possible to explain this phenomenon on the basis of heredity? Even those who represent that point of view can apply their theory with reference to drug addicts only very vaguely namely that “psychopaths” are more likely to become drug addicts. We can see that this would apply only to a fraction of the cases and would not explain the totality of the problem.

Opposed to that viewpoint, Individual Psychology maintains that drug addiction is one of the many attempts to evade responsibility for coping with the problems of life.

Obviously, the proof for that contention must be established in every case without the use of platitudes or formulas. We must examine exactly each individual condition by establishing all the nuances of his style of life, and by recognizing clearly any variations. We can then come to a definite conclusion and establish proof of our contention. In doing so, certain common trends will be useful to orient ourselves. They will serve to illuminate our work.

In all cases of morphine addiction I have found the portrait of a person who generally does not fit in, who from childhood lacked in a feeling of belonging, and who failed in his duties. We, therefore, have to examine in all cases the extent to which the sense of belonging was lacking prior to succumbing to drug addiction.

Another aspect should be mentioned at the outset. One must consider that when a patient appears for treatment that there are no assurances that he will not experience a relapse. However, he must be treated most kindly and with consideration so as not to raise resistance on his part that might provoke a relapse. We must consider ourselves in this as in other cases as a rescue organization and seek to avoid a protest on the part of the patient.

If we arrive at a contextual examination we must then ask ourselves into what category of failures we must place the drug addict. We can always observe along the indistinct boundaries of neuroses that every neurotic attempts to establish a barrier between himself and performance, a possibility to delay, an excuse. It then becomes clear to us that a drug addict places his addiction, as in ever other case of neurotic symptoms, between himself and his duties. We only need to ask a patient: “What would you do if you were not a drug addict?” We would then hear of all that he would achieve, but is prevented from accomplishing by his inherent nature and lack of preparation. We shall find in him what is so characteristic for neurotics: “Yes, but...”

We can read in the following report that the patient in 1925 already suffered from a nervous disorder that made him uneasy. It manifested itself in the form of a hyper sensitive hearing, mild heart trouble, etc. At that time he suffered from diarrhea for which his physician frequently prescribed opium.

There are patients who respond to the slightest excitement with diarrhea attacks. In this case also the cause for his condition could have been psychological, and we ask ourselves: To what problems does the patient respond with those symptoms? “In 1926, he married a girl with whom he had an affair, and who became pregnant after their first sexual contact. After she became pregnant he decided to marry her, although he had doubts whether he made her pregnant.” We can see that we are dealing with a suspicious person who ascribed the worst to his “partner.”

“On looking back, he did not describe the marriage as filled with love. It should be noted that he said he had made a decision to get married because neither the girl nor the parents forced him into marriage.” What kind of person is that? We can find certain analogies in people who prefer to marry a cripple or an inferior person. These are people who always count on gratitude and seek to be the dominant partner in their marriage.

“He was a stubborn child.” It means that he was of a type who sought strength in opposition. He also described his wife as stubborn, and again remarked “he cannot describe his marriage as a love affair”. Obviously, he lived under great stress at that time: a marriage not based on love, doubts regarding the legitimacy of his child, and a bad relationship with his in-laws who did not approve of the marriage. Did he want this marriage in spite of that?

“He lectures his wife a lot and makes her aware of her faults, but she is stubborn.” He sees his marriage a disappointment in that his wife fails to look up to him constantly, and is thus faced by an unsolvable problem.

“She related to me in a way that until this day I don't know how much she cared for me. She is a good mother and housekeeper, but fails to satisfy me as a wife.” We can see that he values his wife only as a sex object. What does a man do in such cases? He tries revenge. The usual form of revenge is outside affairs. This always means that all other women please the man more than his own wife.

“At that time, he constantly took opium, and was always under treatment, also by quacks. The doctors did not notice his craving, nor did they know how to counter it. At that point he was irascible toward his wife and very dissatisfied with her. He also had many headaches.” He shows symptoms that require attention. His entire behavior can be explained as an act of revenge against his wife with whom he was unable to deal.

“He made it very clear that he had trouble with his oldest son, who was much like him and whom he disliked for that reason.” Common sense would never arrive at such a conclusion. How would we explain to ourselves that he would much prefer to have his son be different from him? Obviously, he would then have another weapon for use against his wife since his suspicions about his son's true father would have been justified.

He told of his early childhood “he clung closely to his father, but was very critical of his mother.” I always recognize such a situation as the second phase in the relationship of a child to the mother. The child must already have had some experience that caused him to be disappointed with his mother.

“The mother was a morphine addict and very nervous. An older sister of the patient did not mean much to him; he lived in constant quarrel with his younger sister.” We can see two women with whom he had a bad relationship. Since we know that a lifestyle is formed in the first five year, we will not be surprised to learn that this man could not relate well to women.

“He had sexual relations since he was 17 years old, rarely satisfactory. He usually left every woman after the initial contact and in time had relations with 30 women. When he would truly fall in love with a girl he was unable to have sex with her. When married he cared little for his children and when they had to be punished he left that task to his wife.” This is the kind of person who wants to dominate but does not trust himself to have the strength to carry it out.

“He chided his wife that her voice was low and that she is noisy.” Other neurotics complain that the wife speaks in too high a voice. When someone seeks to reprimand another he will always find a reason.

When we summarize our findings up to this point, we recognize that our patient adjusts poorly to social requirements. In his behavior we find the tendency to demean others. This is a characteristic that would also apply to someone who is cruel to animals. Torture is also a way to depreciate someone. Significant is the fact that he had two teachers in school who not only beat their students without mercy, but apparently took pleasure in all forms of abuse. This could not have failed to have an influence on him. He described these events in a way to indicate his disapproval of them. Basically, however, his behavior shows the same tendencies.

We should not forget that he had learned in early childhood through his mother, the morphine addict, how in seeking this form of relief through self-abuse, cruelty can be done to others. He also experienced that with his attitude toward marriage and his desire to take revenge on his wife, such cruelty becomes desirable. In this person, who already demonstrated asocial tendencies in early childhood, greater social demands could well lead to stronger forms of cruelty. This makes his craving for intoxicants understandable to us. In the final analysis, it represents a failure that replaced a lack of social preparedness, and while it provided relief to him, it also excused his failures in life, and served as a way to accuse and punish his wife.

With regard to alcoholism, it seems to me that another cause is a particular liking for the taste of alcohol. This appears often to be the case, and taste plays a role in the choice of that symptom. Aside from my own observations concerning this, I find no other evidence in the literature. Of course, as noted above, in the struggle to cure an alcohol addict the matter of liking the taste of alcohol becomes superfluous; it might even create it. However, if one recalls that children suffering from rickets have a liking for cod liver oil, which is not the case with most children, and that many people like sour foods and seemingly unappetizing dishes, then, with regards to choosing symptoms, alcoholism should also be examined from the perspective of liking the taste of alcohol.

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