Essays and reflections on medicine, psychoanalysis, addiction treatment, and related questions of the mind, suffering, and the human experience.
These essays grow out of clinical work in addiction medicine, but they range beyond it. They deal with addiction, withdrawal, pain, and psychotherapy, and also with the phenomenological and psychoanalytic questions that clinical work brings into view — how people regulate their inner lives, how suffering takes form, what treatment can and cannot do. Presented here, they move from the more general and widely applicable to the more narrow and specific.
Essay List
What Addiction Actually Is
A starting point for how addiction is being understood on this site.
The Structure of Addiction
On the simultaneous psychological and biological organization that addiction imposes on a person’s inner life.
The Function of Addiction
On what addiction does for a person, and why that question is essential to understanding why it persists.
The Idealized Substance
How people become powerfully attached to certain substances, and why those attachments can be so hard to loosen.
The Psychology of Relapse
On relapse as the return of a previously necessary solution under sufficient pressure.
What Recovery Actually Is
On what actually changes in a person for whom addiction has genuinely become less necessary.
Why Addiction Treatment Often Fails
On what treatment leaves untouched when it addresses only part of the problem.
Psychotherapy in Addiction Treatment
On what psychotherapy in this context actually involves, and what it asks of both patient and clinician.
The Neurobiology of Withdrawal
On withdrawal as a real and often prolonged state of nervous system dysregulation.
Chronic Pain and Addiction
On the shared psychological and biological conditions that make chronic pain and addiction so likely to become entangled.
Treating Benzodiazepine Dependence
On the clinical demands of treating benzodiazepine dependence: pharmacological, diagnostic, and psychological.
Benzodiazepine Withdrawal
On what benzodiazepine dependence actually does to the nervous system and the psychological organization that depends on it.
Alcohol and Shame
On alcohol’s specific relation to shame, self-consciousness, and the wish to escape the experience of being oneself under scrutiny.
Opioids and Emotional Pain
On opioids as emotional anesthesia, and on what it means to organize a life around the avoidance of pain through dense numbness.
Cannabis and Dissociation
On cannabis, modified contact, and the person for whom the ordinary traffic between self and world has become chronically overwhelming.
Stimulants and the Craving for Aliveness
Why stimulants don't just simply make people feel good — they make people feel real, and why that distinction is the center of everything.
Compulsive Overeating and the Body
An exploration of compulsive overeating as a search for something food can approximate but never fully provide — and what that means for how the condition should be understood and treated.
Compulsive Gambling and the Organizing Moment
On gambling as the generation of an organizing state — a structurally guaranteed displacement of an interior that cannot otherwise be borne.
Nicotine
On nicotine as emotional regulator, daily structure, portable solitude, and reliable companion — and what it means to give all of that up.
GLP-1 Medications and Craving
On the emerging role of GLP-1 receptor agonists in addiction medicine, and what they may and may not be able to do.