Summary: This paper aims to discuss substance use and abuse as falling beyond the pleasure principal and the deficiencies of CBT in the treatment of substance use disorders. As we continue to ponder the beginning and ending of a pandemic, lurking close behind, is the epidemic of overdoses and substance abuse. This epidemic occurred prior to the COVID-19 pandemic, only to be exacerbated by it. Rather than viewing substance use as mere mechanical activity of our bodies in functions, what we can aim to understand better is how our repetitions and behavior express some sort of desire, wish, or fantasy. In the movie Another Round (2020), it is presented that according to Norwegian psychiatrist, Finn Skårderud, human beings are born with a blood alcohol content that is 0.05% too low. This concept would add further nuance to the terms ‘substance use,’ ‘misuse,’ and ‘abuse.’ In the Critique of Practical Reason, Kant explains the thought experiment of the Gallows Man (1998, 5:30), to convey his understanding of people’s prioritization of life over lust. He also explains that a cost-benefit analysis is not enough to prioritize life. Yet, other therapeutic modalities for substance treatment encourage the use of decisional balance worksheets and cost/benefit analyses. A psychoanalytic understanding of substance use and abuse would help unveil the desire and meaning of this activity. It is not just about controlling our brain’s biochemistry or ‘self-medicating,’ but rather, an exploration of what the substance and its use really provides for the individual. In other words, substance use, misuse, or abuse, and the language used to describe the patterns and rituals of the individual are not simply cognitive and behavioral, but more so, fantastical, emotional, and dream-like.
Where do we find the link between the Freudian death drive and the Lacanian Real? In this theoretical enquiry we trace the relationship between the growing pains of the death drive and the Real in the writings of Freud and Lacan. With Freud we examine the place of the death drive in a theoretical framework. This search inevitably leads to the constitution of the pleasure experience which is very hard to understand in relation to the death drive. We run into the trauma, which is the pleasurable encounter with the Real. Next we concentrate on the Lacanian elaboration of the death drive in the coming into being of the subject. Through this, we stumble upon the Real as that enigmatic category which escapes any elaboration. This Real is then examined in combination with the death drive in an attempt to formulate their relationship. The Borromean Knot of the Real-Symbolic-Imaginary in masochism concludes this paper.