In this contribution the author examines the specificity of a psychoanalytic orientation in clinical work with addicts. A psychoanalytic approach focuses on the subject and his discontent, rather than on the object, the consumed substance, and does not limit itself to the trivia of the substance use but searches for that for which the drug or alcohol use is a solution. A psychoanalytic focus on addiction aims at what lies beyond the supposedly simple stimulus-response cycle of need and its satisfaction and situates need within the dynamics of desire, related to the Other and mediated by speech. Drug use circumvents those dynamics, which has consequences for the transference. The author contrasts a psychoanalytic treatment, aimed at the symbolic working-through of desire and the letting go of imaginary identifications, with an imaginary treatment, aimed at installing an identification with “the addict” or “the former drug user” with accompanying terminology and prescribed behaviour. Arguments are illustrated throughout with clinical case material.