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Lewis, M. (2015). The biology of desire: Why addiction is not a disease. PublicAffairs.

Brecher, E. M. (1972). Licit and illicit drugs: The Consumers Union report on narcotics, stimulants, depressants, inhalants, hallucinogens, and marijuana — including caffeine, nicotine, and alcohol. Little, Brown and Company.

Courtwright, D. T. (1982). Dark paradise: Opiate addiction in America before 1940. Harvard University Press.

Berridge, V. (1996). “Stamping out addiction”: The work of the Rolleston Committee, 1924–1926. In G. E. Berrios & H. Freeman (Eds.), 150 years of British psychiatry, 1841–1991 (Vol. 2, pp. 44–60). Athlone Press.

Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., Ney, J. P., & van der Goes, D. N. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain, 156(4), 569–576. https://doi.org/10.1097/01.j.pain.0000460357.01998.f1

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Chauvet, C., Lardeux, V., Goldberg, S. R., Jaber, M., & Solinas, M. (2009). Environmental enrichment reduces cocaine seeking and reinstatement induced by cues and stress but not by cocaine. Neuropsychopharmacology, 34(13), 2767–2778. https://doi.org/10.1038/npp.2009.127

Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: A systematic review. Psychotherapy and Psychosomatics, 84(2), 72–81. https://doi.org/10.1159/000370338

Tiffany, S. T. (1990). A cognitive model of drug urges and drug-use behavior: Role of automatic and nonautomatic processes. Psychological Review, 97(2), 147–168. https://doi.org/10.1037/0033-295X.97.2.147

Wertz, J. M., & Sayette, M. A. (2001). A review of the effects of perceived drug use opportunity on self-reported urge. Experimental and Clinical Psychopharmacology, 9(1), 3–13. https://doi.org/10.1037/1064-1297.9.1.3

Sayette, M. A. (2016). The role of craving in substance use disorders: Theoretical and methodological issues. Annual Review of Clinical Psychology, 12, 407–433. https://doi.org/10.1146/annurev-clinpsy-021815-093351

Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.

Yau, Y. H. C., & Potenza, M. N. (2015). Gambling disorder and other behavioral addictions: Recognition and treatment. Harvard Review of Psychiatry, 23(2), 134–146. https://doi.org/10.1097/HRP.0000000000000051

Dong, G., Wang, L., Du, X., & Potenza, M. N. (2017). Gaming increases craving to gaming-related stimuli in individuals with Internet gaming disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 2(5), 404–412. https://doi.org/10.1016/j.bpsc.2017.01.002

Grant, J. E., Potenza, M. N., Weinstein, A., & Gorelick, D. A. (2010). Introduction to behavioral addictions. The American Journal of Drug and Alcohol Abuse, 36(5), 233–241. https://doi.org/10.3109/00952990.2010.491884

Fisher, H. E., Brown, L. L., Aron, A., Strong, G., & Mashek, D. (2010). Reward, addiction, and emotion regulation systems associated with rejection in love. Journal of Neurophysiology, 104(1), 51–60. https://doi.org/10.1152/jn.00784.2009

Chapter 3. Withdrawal Syndrome

Withdrawal syndrome is the set of physical and psychological symptoms that arise when a behavior is discontinued or when the dose of a substance (or activity) to which tolerance and dependence have developed is sharply reduced. It reflects the body's adaptation to a stable source of regulation — and the imbalance that follows when that source is removed.

Withdrawal is characteristic of all forms of addiction. The symptoms differ, but the underlying mechanism is the same.

Neuroimaging studies show that the same neural networks activated in opioid or cocaine addiction are also involved in gambling and internet addiction — particularly systems related to reward, expectation, and impulse control (Dong, Wang, Du, & Potenza, 2017; Grant, Potenza, Weinstein, & Gorelick, 2010).

The destructive effects of psychoactive substances on personality are well known: increased antisocial behavior, criminalization, deterioration of social relationships. But such consequences are not unique to drugs. In the classic report Licit and Illicit Drugs, Edward Brecher showed that heroin and nicotine dependence share similar structural patterns. He described postwar Germany, where deprivation of tobacco led to theft, begging, prostitution, and the sale of personal belongings — behaviors scarcely distinguishable from those associated with heroin addiction (Brecher, 1972).

This universality is further emphasized in Love and Addiction by Stanton Peele and Archie Brodsky. The authors describe addiction as a general psychological mechanism rather than the effect of a particular substance. Addictive relationships, they argue, can erode personality as deeply as chemical dependencies (Peele & Brodsky, 1975).

"People can become addicted to other people in the same way they become addicted to drugs. We use the term 'addiction' not metaphorically, but literally."

In romantic addiction, the sustaining force is not the pursuit of intimacy but fear of loss — above all, fear of loneliness. The individual does not consciously choose destructive relationships; they are already embedded in them and act under an irrational terror of losing a psychological source of stability.

Modern neurobiological findings support this parallel. Social rejection and the breakup of close relationships activate neural systems involved in physical pain and substance withdrawal. The loss of a significant partner can produce a state neurobiologically comparable to withdrawal syndrome (Fisher, Brown, Aron, Strong, & Mashek, 2010).

Fear of Loss as the Driving Force

From this follows a key assumption: addiction is governed not by the pursuit of acquisition but by the fear of deprivation. Habituation must come first — without it, withdrawal cannot exist. Through prolonged use or long-term attachment, the substance or partner stops being experienced as something acquired and begins to feel like something that was always there. The threat of loss triggers anxiety and compels the person to restore equilibrium at any cost.

In neurobiology, this shift from seeking pleasure to avoiding suffering is described as an allostatic process. With chronic use, the baseline of the reward system shifts downward: the new "normal" falls below the pre-addiction state. The substance is no longer needed to produce pleasure but to return the person to a minimally tolerable condition. Addiction is maintained not by reward but by attempts to prevent an escalating deficit (Koob, 2013).

There is always a reason for using. It may seem trivial, but it is never absent.

Alcohol for relaxation and anxiety reduction. Food for alleviating boredom or unpleasant emotions. Caffeine for an energy boost. Nicotine for short-term stress regulation. Over time, the substance or behavior becomes integrated into the system of self-regulation. Its loss understandably provokes panic.

Importantly, fear of loss does not arise immediately. It emerges only when the object begins functioning as a regulator of difficult internal states rather than as episodic pleasure. This is why moderate users do not experience withdrawal: you cannot fear losing what has not yet become psychologically necessary.

Addiction as Preservation of a Familiar Order

Addictive behavior, in this sense, is not a pursuit of pleasure but an attempt to preserve an established psychological order. This is why withdrawal occurs not only when drugs are discontinued. Almost any stable behavior integrated into psychological homeostasis produces a similar reaction when disrupted.

Phones, social media, music, exercise, news consumption — abandoning any of them often leads to irritability, anxiety, and a persistent urge to "restore things as they were." This is not weakness of will. It is a regulatory system deprived of a key stabilizing element.

A particularly illustrative example is the cessation of long-term anabolic steroid use. What is lost is not merely a chemical effect but an identity. The person confronts the experience: "I am losing part of who I was." Research shows that abandoning behaviors tied to self-identity evokes not only discomfort but strong resistance, because it threatens the basic sense of self (Oyserman, 2009).

Discontinuation of meaningful behavior is experienced not simply as stopping an action but as losing a part of one's identity.

Two Modes of Withdrawal

Withdrawal arises both when homeostasis is disrupted involuntarily and when it is disrupted voluntarily.

A revealing contrast illuminates the nature of withdrawal. Imagine forced abstinence: the substance is confiscated, and the person makes no effort to stop wanting it. There is no ambivalence — only deprivation. What does this person actually experience? Not the classic withdrawal syndrome. They experience mobilization: anger, agitation, a focused drive to get what was taken. They scheme, demand, negotiate, beg. The energy moves outward — toward action, toward the object. This is frustrated desire, and it looks nothing like withdrawal.

Now consider the opposite: voluntary abstinence. The substance is still available — no one has taken it away. The person wants to use and is simultaneously preventing themselves from using. What do they experience? Something entirely different. The classic withdrawal pattern: muscular tension, restlessness that leads nowhere, diffuse suffering without a clear target. The energy is not directed outward — it is turned against itself. The person is not mobilized; they are immobilized. They are not fighting to obtain something; they are fighting themselves.

This contrast is diagnostic. If withdrawal were simply caused by the absence of a substance — a chemical deficit — then forced and voluntary abstinence should produce identical symptoms. The chemical state, after all, is the same. But the experiences are nothing alike. Forced abstinence produces mobilization. Voluntary abstinence produces suffering.

This mechanism was described by Fritz Perls, who argued that so-called psychogenic pain arises from inhibited impulses. Suppressed tears become muscular tension and headache — not because of physiological defect, but because of internal conflict.

In Gestalt Therapy, written with Paul Goodman and Ralph Hefferline, Perls explained the mechanism as follows:

"If you slightly open a faucet and try to hold the water back with your finger, you will feel how increasingly difficult this becomes. This is a direct analogy to what happens in internal conflict… If you clench your fists tightly, you will soon develop a cramp. A 'psychogenic' or 'functional' headache is a phenomenon of the same kind. You are about to cry, but you restrain the impulse, as if squeezing your head so as not to appear weak or to avoid giving others the satisfaction of seeing you cry." (Perls, Hefferline, & Goodman, 1951)

A firm decision to "quit" works the same way. It simultaneously generates an impulse and attempts to oppose it. The result is not energized action but painful self-restraint. Withdrawal suffering cannot be explained solely by chemical deficit; it emerges from the conflict between the need to restore equilibrium and the prohibition against acting.

Pain as a Consequence of Suppression

One might assume that pain itself activates the person. Experience suggests the opposite: physical and emotional pain tend to paralyze rather than mobilize. During withdrawal, people often do not act — they lie immobilized by suffering, unable even to move. This is not a fight response but a state of arrested action.

Contemporary research supports this. Models of emotion regulation show that chronic suppression of emotional experience increases physiological arousal and subjective distress rather than reducing them. Attempts to control feelings produce a paradoxical effect: the stronger the suppression, the greater the distress (Gross, 2015).

Consider the pre-relapse state. A person in severe withdrawal — immobilized, trembling, unable to think clearly — makes the decision to use. That decision alone produces relief before the substance is consumed. The person mobilizes, plans, acts with purpose and efficiency. No pharmacological event has occurred; no molecule has been ingested; no half-life has shifted. The only variable that changed is the decision to stop suppressing. If withdrawal were a chemical deficit, a decision could not resolve it — just as a decision to see a doctor does not relieve nerve pain, and a decision to eat does not halt food poisoning. Real detoxification proceeds on the body's timeline regardless of the individual's intentions. Withdrawal, by contrast, resolves — at least in its psychological core — the instant the decision changes.

The problem is not insufficient desire or weak willpower. The decision to stop does not break the cycle. Suffering is not chosen deliberately; it emerges as a consequence of suppression. From within this state, only two options appear to exist: relapse or endure the fight. And as long as the fight continues, it brings pain with it.

References

Dong, G., Wang, L., Du, X., & Potenza, M. N. (2017). Gaming increases craving to gaming-related stimuli in individuals with Internet gaming disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 2(5), 404–412. https://doi.org/10.1016/j.bpsc.2017.01.002

Grant, J. E., Potenza, M. N., Weinstein, A., & Gorelick, D. A. (2010). Introduction to behavioral addictions. The American Journal of Drug and Alcohol Abuse, 36(5), 233–241. https://doi.org/10.3109/00952990.2010.491884

Brecher, E. M. (1972). Licit and illicit drugs: The Consumers Union report on narcotics, stimulants, depressants, inhalants, hallucinogens, and marijuana—including caffeine, nicotine, and alcohol. Little, Brown and Company.

Peele, S., & Brodsky, A. (1975). Love and addiction. Taplinger Publishing Company.

Fisher, H. E., Brown, L. L., Aron, A., Strong, G., & Mashek, D. (2010). Reward, addiction, and emotion regulation systems associated with rejection in love. Journal of Neurophysiology, 104(1), 51–60. https://doi.org/10.1152/jn.00784.2009

Koob, G. F. (2013). Addiction is a reward deficit and stress surfeit disorder. Frontiers in Psychiatry, 4, 72. https://doi.org/10.3389/fpsyt.2013.00072

Oyserman, D. (2009). Identity-based motivation: Implications for action-readiness, procedural-readiness, and consumer behavior. Journal of Consumer Psychology, 19(3), 250–260. https://doi.org/10.1016/j.jcps.2009.06.001

Perls, F., Hefferline, R. F., & Goodman, P. (1951). Gestalt therapy: Excitement and growth in the human personality. Julian Press.

Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26. https://doi.org/10.1080/1047840X.2014.940781

Koob, G. F., & Volkow, N. D. (2010). Neurocircuitry of addiction. Neuropsychopharmacology, 35(1), 217–238. https://doi.org/10.1038/npp.2009.110

Chapter 4. Internal Conflict

Two central phenomena of addiction still require explanation. First: why does the compulsive, almost manic drive to restore "things as they were" disappear after a person has endured withdrawal? And second: why does this drive return after relapse — even following years of abstinence?

To approach these questions, consider a thought experiment.

Imagine yourself standing in an empty room. On the opposite side lies something of immense value — money, a car, any object you deeply desire. It is only a few steps away, yet an invisible wall stands between you and the goal.

You begin searching for a way past the obstacle. At first cautiously, then more insistently — you push, strike, try to go around. But the wall does not yield. The harder you try, the stronger your frustration grows: the desired object remains just out of reach. Gradually, active effort gives way to despair, then helplessness. Eventually you give up — not because you are exhausted, but because you stop believing the wall can be overcome.

This experience is a metaphor for withdrawal syndrome.

Perceived Availability

The drive to restore equilibrium persists for as long as the person believes the object remains attainable. While that belief holds, anxiety and panic remain active. When it collapses — when the path back comes to feel genuinely closed — the drive loses its purpose, and calm emerges.

The belief that pleasure remains within reach — its perceived availability — is the key factor distinguishing active addiction from abstinence. As long as a person believes things can be restored, tension, fear, and anxiety persist. When this belief collapses — when it becomes clear that the path back is closed — the person stops expending energy on futile attempts, and the pain subsides.

Experimental data support this mechanism. Reviews of studies on perceived opportunity to use show that subjective craving increases when individuals believe use is possible and decreases when they believe it is impossible (Wertz & Sayette, 2001). Craving is not a mechanical signal from the body but a response mediated by expectations.

To endure withdrawal, then, is to persist until the mind accepts that return is impossible. At that point, the drive to act loses its purpose, and the system settles into a new equilibrium.

Abstinence and Its Fragility

The period of abstinence is marked by a paradoxical shift: uncontrolled desire disappears, replaced by indifference. This does not mean the substance becomes aversive — rather, belief in its availability vanishes.

But abstinence is inherently fragile. A single breach of internal separation — a seemingly minor step backward — signals to the mind that the object is available again. Hope returns, and with it fear, anxiety, and pain. A new cycle begins.

Even a single episode of use after a long period of abstinence cannot meaningfully poison the body, yet it instantly restores confidence in the attainability of pleasure. That alone is enough to return a person to active addiction. The problem is not that the body remembers the substance, but that the mind remembers the possibility.

Marlatt and Gordon described this as the abstinence violation effect: a lapse produces not merely a physiological response but a cognitive shift — loss of perceived control, guilt, and the feeling that "everything is ruined," dramatically increasing the likelihood of continued use (Marlatt & Gordon, 1985). Within the model proposed here, this effect has a more precise explanation: relapse restores perceived availability, and with it the entire internal conflict.

To re-enter abstinence, the person must pass through psychological withdrawal again — until the mind once more accepts that access to the addictive object is closed.

The Drama of Addiction

It is relapse that makes addiction so destructive. Every addicted person eventually reaches a "bottom" — a state of fear, pain, and despair that motivates the decision to endure withdrawal. Yet even after achieving abstinence, vulnerability remains. A single misstep can undo years of sobriety, and the guilt and helplessness that follow can plunge a person into depression and despair.

If recovery depends on belief in the availability of the substance, an inevitable question arises: who persuades — and who is being persuaded? To enter abstinence, a person must convince themselves that the object is no longer accessible. During relapse, the same person convinces themselves that use is again possible.

Before every relapse, an internal dialogue unfolds: one part of the self persuades, promises, and rationalizes; another resists, doubts, and fears. This raises a deeper question: who makes the promise "it will never happen again," and who is the one to whom that promise is given?

To understand how this belief collapses and is restored, we must abandon the notion of the mind as a single, unified agent. Viewing addiction solely as a person suppressing panic — or solely as a person overwhelmed by panic before an obstacle — remains incomplete.

These two figures are parts of a single whole, interacting within one psyche.

It becomes reasonable, then, to assume that addiction is not merely a disorder of will or emotion but a stable conflict between two parts of personality: one striving for liberation, the other fearing permanent loss of the possibility of use. Between them unfolds the drama of addiction — dialogue, promises, self-deception, and relapse. Only by recognizing this internal division can we understand why addiction persists for years, even when craving appears long gone.

But if two incompatible positions truly coexist within a single psyche, how is this possible at all? How can one person simultaneously know that use is destroying their life and yet act as though it does not matter?

Answering this question requires turning to the mechanism that makes such coexistence possible — dissociation.

References

Wertz, J. M., & Sayette, M. A. (2001). A review of the effects of perceived drug use opportunity on self-reported urge. Experimental and Clinical Psychopharmacology, 9(1), 3–13. https://doi.org/10.1037/1064-1297.9.1.3

Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.

Chapter 5. Dissociation

How can two contradictory positions coexist within a single mind? How can a person simultaneously understand that a fear is unfounded and yet continue acting as though the danger were real?

To answer this, we must abandon the intuitive notion of the mind as a completely unified and continuous subject. The conflict observed in addiction is not merely metaphorical. It rests on a real psychological mechanism — dissociation, in which control, responsibility, and access to information become functionally divided among different parts of the self.

The Hidden Observer

Among the first systematic investigations of such division were the hypnosis experiments of American psychologist Ernest Hilgard. These studies showed that in trance states, individuals could cease consciously perceiving certain stimuli — sound, pain, or touch — while still responding to them indirectly (Hilgard, 1977).