Dopamine and Depth Psychology: The Long Cycle of Addiction Hiding in Plain Sight

A Reflection on My Career as A Trauma Therapist in Austin, TX

My career in counseling began in the addiction treatment field in Austin, TX and shifted along the way to becoming a trauma-focused psychotherapist. As a person in recovery myself, addiction recovery will always be close to my heart, so you may wonder why it appears I went in another direction. The short answer is I didn’t. I simply broadened my scope to serve all adults with traumatic histories, not just those who use substances as their primary means of nervous system and brain chemistry regulation. Let me explain.

I’ve always been an observant person with an inquisitive mind who can’t accept the status quo when the status quo appears to be missing the mark. My key observation over my 10 years of watching people move through levels of addiction care was the progression of relapse, and how it often wasn’t a straight line back to substance use. It typically took a detour first into something Freud called “repetition compulsion.” Those without clinical mental health training would typically write off a relapse as, “they stopped working their program.” Knowing the histories of most clients I observed over time; I couldn’t accept that. There was a clear pattern.

The Long and Short of It

I’d like to first differentiate between two important things. There is a short cycle of addiction, when a person continues to experience an unpleasant mood, preoccupation and craving for the substance, can’t imagine life without it, and holds their breath as long as they can until they come up for air and use again. This is primarily neurobiological. Then there is a long cycle, when someone experiences longer term relief from withdrawal and craving, can see a future in recovery, wants to be sober, but something systematically causes them to drift over time back to substance use. That “something” is often repetition compulsion, and I will speak to this type of the long cycle for the remainder of this article. This is more in the realm of depth psychology but stress certainly comes into play leading back to neurobiology.

Repetition Compulsion: Definition and History

Repetition compulsion is also known as trauma reenactment. It’s an unconscious process where people put themselves in, or end up in, familiar situations and scenarios where they are likely to experience a similar injury or stressor from their past in an attempt to gain mastery over it. Examples include going back to work in the same environment where you were betrayed, treated unfairly, or burned out, getting into a relationship with someone who exhibits all the red flags of an abuser or someone who betrayed you in the past, seeking the validation and affection of a parent who was never there, chasing a dream that ended in failure and humiliation, or becoming obsessed with a pursuit that was supposed to protect you from feeling inferior and cover up shame, but it never really worked.

Sigmund Freud originally coined the term repetition compulsion in 1914, writing, “the patient does not remember anything of what he has forgotten and repressed, he acts it out, without, of course, knowing that he is repeating it” (Malcolm, 1981, p. 28). He noticed people with trauma histories having recurring nightmares and dreams, children repetitively doing things that cause negative emotion as if to try to master the feeling, people repeating a scenario in the present in therapy rather than recalling it as a past memory, and people with what he called, “destiny neurosis,” similar to a character trait that seems to guarantee expression of the same experiences (Freud, 1920). This was a significant observation for Freud because it defied his “pleasure principle,” that people are primarily motivated by the desire for instant gratification of needs, wants, and urges.

Later psychoanalysts and psychologists echoed Freud’s observations, adding to and developing the concept into modern theory. These included Otto Fenichel (1945) who noted two forms: “repetitions of traumatic events for the purpose of achieving belated mastery” and “repetitions due the tendency of the repressed to find an outlet” (p. 542) Erik Erikson (1973), who stated, “the individual unconsciously arranges for variations of an original theme which he has not learned either to overcome or live with” (p. 209). And the many contributors from the early 1900’s to the mid-20th century who shaped what came to be know as Object Relations Theory, emphasizing that the unresolved conflicts in how a child engages with the objects in their life will be repeated in present time, most of which do not work, but eventually one might (Casement, 1990).

My Observations Over the Years

Coming back to my experience in addiction treatment, it appeared that being sober served to bolster repetition compulsion because people seemed to think, “now that I’m sober and feeling bulletproof surely I will be able to go into the same dark dungeon and defeat the dragon this time.” This is not entirely conscious of course but can be inferred by a person’s actions.

I would watch people have brief windows of insight in treatment only to fall back asleep and lock into their own personal repetition compulsion pathway. Substance use was typically the furthest thing from their mind as they began to set the lights, cameras, and stage for a dramatic crescendo leading them right back to the same scenario where substance use came to the rescue the last time.

I experienced my own forms of repetition compulsion in early recovery, drifting into career paths, relationships, and mindsets that felt eerily similar in a creepy and uncanny way to the history that devastated me earlier in life. It made me wonder what (or who) was pulling the strings in my mind to do this so slowly and subtly that I hardly noticed until it was glaring. It was my studies in psychology and counseling that alerted me to what was happening in time to change course. I was able to gain insight and get off the tracks that lead to the same old jam.  

This is the complexity of trauma and addiction. People with traumatic histories who don’t struggle with substance use often fall into patterns of repetition compulsion, but when the end of the cycle involves ingesting a powerful dopaminergic reward, it becomes reinforced even stronger. This is the intersection of Freud’s pleasure principle and his observation of repetition compulsion as a force of its own, they become fused into a kind of binary star system with a common center of mass. It’s almost as if addiction knows to lay dormant and allow a person to set the stage for its dramatic return. I’m convinced that a well-developed addiction has a certain degree of agency much the way a dissociative part of a personality does. The old treatment center adage, “your addiction is doing pushups in the parking lot,” may sound cliché and trite, but there’s a little truth in every cliché.

My Professional Evolution

In my quest to become a more competent and effective therapist in the addiction field I began to focus on childhood trauma, attachment injuries, PTSD, and dissociation. As soon as I began assessing my clients through this lens and asking more questions it became overwhelmingly apparent that most of my clients had significant trauma histories, but they were never addressed because acting out behaviorally and getting into trouble due to substance use stole the show. Everyone just wanted them to stop using drugs, and most people around them had stopped listening to them or believing them a long time ago. While it is vital that a person at risk of overdose or incarceration get their addiction under control first, this is only the baseline from which to work on healing and waking up to the dominant themes and patterns underneath an addiction.

I became more focused on being a long cycle interrupter. My years of working with people in the throws of simply acknowledging they have a problem had drained me and the depth of trauma work led me to powerful and meaningful experiences with my clients. It was revitalizing to have a new front to work on in the battle to bring people back from the edge.

My training in Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Ego State Therapy, Internal Family Systems Therapy, and complex trauma and dissociation in general led me to discover how pervasive adverse childhood experiences are in the general population. As I opened the doors to my private practice outside the addiction field, I met so many clients without any addiction history who had been struggling with the same patterns of repetition compulsion, using their own creative ways to manage symptoms and do the best they can to adapt. It hardly feels as if I’ve made a transition. Trauma is trauma regardless of how a person tries to deal with it.

Conclusion

My hope with this article wasn’t to provide a “hot take” that creates controversy or calls for radical change. Addiction recovery by nature must focus first on substance use primarily. Addiction is one of those things where everyone seems to have an opinion regardless of how inexperienced or unqualified they are, as if it’s a simple problem and their flippant judgments offer anything in the way of a solution. I’m experienced and qualified enough to know that I will not solve addiction with my opinions in this blog article. What I wanted to offer is the observations of a seasoned clinician who has been in the trenches vs the kind of dry clinical information you can look up on Google, or the same old self-medication hypothesis that has been repeated ad nauseum. To me it feels like much of the academic research and policy debates about addiction, trauma, and recovery are dominated by those who are out of touch with real people suffering from these issues and therefore lack depth. They speak in diagnoses and symptoms, I wanted to share clinical experience with individuals whose life stories don’t fit into diagnostic categories. If my thoughts and reflections resonated with you or perhaps helped you to understand someone else in your life, my goal here was achieved.

Alex Penrod, MS, LPC, LCDC

Owner | Clinical Director | Therapist

Neuro Nuance Therapy and EMDR, PLLC

Schedule a Free 15-Minute Consultation

References

Casement, P. (1990). Further learning from the patient: The analytic space and process. Routledge.

Erikson, E. (1973). Childhood and society (p. 209). Pelican Books.

Fenichel, O. (1945). The psychoanalytic theory of neurosis (p. 542). New York: W. W. Norton & Company

Freud, S. (1920). Beyond the pleasure principle: Group psychology and other works. The Hogarth Press.

Malcolm, J. (1981). Psychoanalysis: The impossible profession (p. 28). Rowman & Littlefield Publishers.