Alcohol, Cocaine, and Loveless Sex: The Way to “The Dark”

Alcohol, Cocaine, and Loveless Sex: The Way to “The Dark”

By Judy Levitz PhD 03/17/16

Psychotherapy illuminates the meanings behind a constellation of addictive behaviors.

Alcohol and Cocaine: The Way to “The Dark”

An outwardly successful young man spends his off hours navigating a "dark world" of alcohol, cocaine, cigarettes, sex clubs and escorts. Are those behaviors a random collection of self-destructive distractions, or do they represent “layers of faulty defenses” that can be called in as reinforcements to shore up a fragile self? And to the extent that some of his behavior serves a defensive function or represents a substitution for healthier relationships, what type of therapeutic work is required as the behaviors are relinquished? Clinician, author and teacher Judy Levitz sheds light on a complicated scenario…Richard Juman, PsyD. 

Some years ago, “Michael” began treatment with me in a place we came to call “the dark.” By day, the 26-year-old risk management investor worked for a global hedge fund company, supervising a team of junior investors and analysts. By night, fueled by six shots of Absolut consumed throughout happy hour with a colleague or client, Michael hit the gentlemen’s clubs, which he would leave not recalling if he left with a woman or if he had been thrown out for behaving badly. On holiday weekends, he entertained higher-end escorts in an upscale hotel and snorted cocaine until his nose was bloody. It seemed a miracle he was alive, let alone employed.

For Michael, the entire world of sexuality, fused with aggression and self-destructiveness, was completely cordoned off from the world of love and affection. He was not and could not be a sexual person. He feared rejection and believed his flaws were all a woman would see. But when he went to his dark place, he was potent and fearless. In a version of the Madonna-whore complex, he could not maintain sexual arousal or interest within a committed loving relationship, but could have sex with a prostitute whom he needed and unconsciously debased. However, the fact of his primary, underlying sexual addiction was hidden in plain sight, obscured by the more obvious use of other substances. 

In our earliest sessions, Michael was quiet, suffering great torment to talk. He reeked of cigarette smoke but was otherwise an attractive, bright man. His reason for seeking treatment was the fact that he knew he had an uncontrollable cycle of acting out, which put him in danger. To him this danger was twofold, first, was the fear that he’d contracted AIDS. He went for retesting at least every six months and when he received a clean report, he’d act out again and not be able to recall whether or not he’d used protection. Second, was an obsessional fear that he’d gotten into a fight at a bar, hit someone and would be tracked down and sued. Despite these real and imagined dangers, he was not very interested in changing. He just wanted the terrible anxiety to go away.

Michael was the only child of an alcoholic, blue-collar father and a paranoid mother (who did not sound alcoholic but did seem to medicate herself with alcohol). He drove himself hard in academics and sports but his good grades brought none of the positive feedback he longed for from his parents.  

Two memories that seemed most relevant to Michael’ story included the time his father, after lingering outside the door to his bedroom one night, barged in to find his son masturbating. At the dinner table later on, Michael endured what felt to him to be a profound sense of humiliation as his parents exchanged silent but “knowing and mocking” glances at each other. 

The second memory took place during an afternoon barbecue at his house. His friends, all seniors on the high school baseball team, came to hang out after a game, and he saw his mother behaving inappropriately with his best friend. The inconsolable outrage and betrayal led him to accept a sports scholarship at the college farthest from home, and he never went back. It was years before he spoke to his parents again.  

Michael began drinking and smoking immediately in college, but was not sexual until his junior year. He recalls being thoroughly intoxicated during his first and subsequent sexual encounters. Cocaine didn’t enter the picture until after he landed his current job, having been turned on to it by people he worked with. Though popular as the leader of his work team, and seemingly the life of the party after hours, Michael had no real friends that he talked to or spent time with. 

A few months into treatment, he began to gradually talk about something other than the concrete features of his anxiety attacks. He expressed dissatisfaction with his job (feeling no pleasure, only pressure and lack of recognition and praise from his superiors); he reported that “Colleen,” his girlfriend of several years, had broken up with him because he was never home and was “not ready” to move in with her; and just generally likened his life to being on a “hamster wheel.” He eventually shared (with some reticence and much minimizing) that he lost hours at a time when engaged in compulsive masturbation wandering the streets and trolling the Internet. As he described more details about his behaviors, we could move towards a deepening exploration of what made Michael tick. I could also consider more formulations about what would help him change. 

For example, I had one hypothesis, informed by drive and ego psychology, that the fear of contracting AIDS and being sued for assault by his victim in a bar brawl, were manifestations of his punitive superego, relating back to feeling “caught” and punished for his masturbatory behavior at home. Another postulation, informed by a self-psychological perspective, was that Michael was driven to find a relationship that gave him what he needed. In other words, Michael didn’t only want be punished for his “taboo” sexual impulses, he also wanted to be forgiven and exonerated. This was supported by the content of some of his ruminations, which took the form of replaying conversations with various bartenders he knew, reassuring himself that they would have said something to him if he’d gotten out of hand. On one occasion I encouraged Michael to return during the day to a club he’d been to so he could ask the bartender directly what happened the night before. He had ruminated about doing that many times before. Rather than viewing this as neurotic or indulgent, I saw it as an opportunity for him to embrace a proactive role of breaking the silence and addressing the innuendo of the historical family dining room scene where he was paralyzed by shame. 

As we discussed other meanings of his multiple addictions of alcohol, cocaine, sex, tobacco, caffeine and gum chewing—not as interpretations, but from the vantage point of the functions they served to help him feel whole—Michael gained enough strength to make his own hierarchy of troublesome behaviors he should eliminate. His list went as follows: first, he should control his drinking, then smoking, then give up gum, and finally he would quit drinking coffee. That sexual encounters per se were not on his list—only the unsafe ones that he blamed on the drinking—was a clue to me that his self esteem and affect regulation was most inextricably linked to his sexual behavior. But I was happy to start with getting the blackouts and hookups with strangers behind him; we could deal with the rest later. 

Michael’s layers of substance use were like layers of faulty defenses: when one failed to achieve its purpose, another one was employed to fortify his psychic garrison. Each substance served some of the same and some different functions for Michael. Alcohol was the key to loosening his tyrannical inhibitions and quiet an overly harsh superego. When he doubled down on his addiction with cocaine, he could further experience a sense of power. He could then enjoy a grandiose high that temporarily counteracted a deep underlying depression. Cocaine drove him to the “high” life, while heavy drinking alone drove him to the streets.

Using the lens of drive theory, I could understand how alcohol, cigarettes, and even the Internet dependency helped him discharge anxiety and gratified versions of oral and early sexual needs. An object relations lens expanded this view of substances to one where I could see how Michael actually related to the substance as an object that he could control. He could pick up or put down the “relationship” at any time of his choosing. He could pick when and how much gratification he wanted to provide himself. He could self-soothe, act out aggression, become enlivened. He could make love to the drink. He could stub out the cigarette. In fact, Michael’s endless enactment of good-self/bad-self, good-object/bad–object, dull-self/dull-object, exciting–self/exciting-object, and persecuted self/persecuting object were seen repeatedly in his relationships with drugs, the prostitutes, the bar buddies, and the bartenders. 

Despite the great harm substances do to one’s body and mind, they also provide the lubricant that provides an opportunity for a symbolic “do-over”: The humiliated, inhibited man can be outgoing, assertive, sexually dominant, etc. The slights of the mocking mother/female can bounce off more harmlessly. The non-validating actions of the father/male can be aggressively confronted. Both parents can be controlled or punished, and at the same time there is a repetitive, unconscious attempt to change all imbedded role expectations and dynamics. No wonder deep mourning is a significant component of sobriety: the enormity of the loss suffered when substances are relinquished makes sense when we understand that they represent relationships themselves.

Modern analytic theory teaches us that the patient learns to turn anger against the self rather than express it directly as a way to protect our parents. When Michael compulsively masturbated, he was not just soothing his anxiety to an extreme, with an unfortunate by-product of physical abuse. He was hurting himself, symbolically punishing his parents, and basically rebelling against both parents’ dictate for him to not be sexual.  

When he was ready to share his fantasies with me, it was clear that masturbating and Internet trolling almost always involved the wish to either dominate a woman (who symbolically was sometimes his mother and sometimes his father), or liberate her from her sexual inhibitions. In the latter fantasy, he was unconsciously identified with the woman, but consciously he became the man he wanted to be, that his father never was. His Internet relationship also provided him with all his self-object needs: to be mirrored, idealized, and accepted for all of his libidinal and aggressive impulses—these could be much more easily met in a virtual space. If he found the right image of the right female, she would be the safe conduit for his fantasies. Online, he could occupy his own desired self-states without the fear of actually being destroyed or being destructive. 

However, the strength of his guilt, shame, humiliation, and resentment associated with all things sexual forced him to bury all these feelings and desires. Where repression failed, alcohol succeeded. Where alcohol was insufficient, and sexual or aggressive feelings broke through, every other substance he could utilize was brought into the service of managing his anxieties.

With time, the safety of the therapeutic space, and a diverse range of ways to accept and understand himself, Michael can now talk about his needs, not just his behaviors. His conflicts about his sense of himself in general and his sexual self esteem in particular are topics he can reflect on. He has succeeded in achieving abstinence from most substances: he no longer drinks, does not use drugs or smoke cigarettes. He occasionally drinks coffee, but has substituted this addiction with a passion for Smartwater. His anxiety level is minimal, and while Internet activity remains, it does so in a much narrower form as we continue to move between harm-reduction and mindfully abstinent approaches. He is sustaining a new monogamous relationship, and not engaging in any sex with prostitutes or escorts. His sexuality has come into the light.

Judy Levitz, Ph.D., NCPsyA is the founder of the Psychoanalytic Psychotherapy Study Center, a Caron Foundation Award Winner for Educational Excellence. It offers multi-orientational training programs in psychoanalytic psychotherapy, psychoanalysis and addictions training. Dr. Levitz maintains a private practice in Manhattan where she also teaches and runs supervision groups.

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Judy Levitz, Ph.D., NCPsyA is the founder of the Psychoanalytic Psychotherapy Study Center, a Caron Foundation Award Winner for Educational Excellence. It offers multi-orientational training programs in psychoanalytic psychotherapy, psychoanalysis and addictions training. Dr. Levitz maintains a private practice in Manhattan where she also teaches and runs supervision groups.

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