Addiction Resources | Expert Help for Addiction & Recovery by Dr. Brian Johnson

Substance use disorders span a wide variety of problems, and cover 11 different criteria:

The 11 criteria outlined in the DSM-5-TR^* can be grouped into four primary categories:
Physical Dependence, Risky Use, Social Problems, and Impaired Control.

1. Taking the substance in larger amounts or for longer than you're meant to
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not managing to do what you should at work, home, or school because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational, or recreational activities because of substance use
8. Using substances again and again, even when it puts you in danger
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance

*DSM-5-TR is the standard classification of mental disorders used by mental health professionals in the United States

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Dr. Brian Johnson Scientific Papers

Throughout his career, Dr. Johnson has published 52 articles in prestigious journals,
including The American Journal on Addictions, Frontiers in Human Neuroscience, and the Journal of the American Psychoanalytic Association. Here are a few of them.

His work has been widely recognized, and he has received royalties from
Psychoanalytic Electronic Publishing as one of their most downloaded authors.

Outpatient Detoxification Completion and One-Month Outcomes for Opioid Dependence: A Preliminary Study of a Neuropsychoanalytic Treatment in Pain Patients and Addicted Patients
‍This paper presents a preliminary study on a neuropsychoanalytic approach to treating opioid dependence in pain and addicted patients. The study investigates the effectiveness of outpatient detoxification without long-term opioid maintenance, utilizing a combination of neuropsychoanalytic therapy, low-dose naltrexone, and other adjunctive medications. The results suggest that this approach may be a viable alternative to traditional opioid maintenance, with a high rate of detoxification completion and one-month abstinence, particularly in patients whose opioid dependence is primarily due to withdrawal and tolerance. The study calls for further research to compare this method with other treatments.
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The Psychoanalysis of a Man with Heroin Dependence: Implications for Neurobiological Theories of Attachment and Drug Craving
This paper describes the psychoanalytic treatment of a man with a long history of heroin dependence. The case study explores the two phases of treatment, focusing on the patient's realization of the negative consequences of heroin use and the subsequent struggle with annihilation anxiety. The treatment emphasizes the relationship between opioid use, attachment issues, and the activation of the brain's craving systems. The study highlights the complex interplay between psychological and neurobiological factors in addiction, suggesting that psychoanalytic methods can provide valuable insights and potential pathways for treatment.
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A “Neuropsychoanalytic” Treatment of a Patient with Cocaine Dependence
This paper explores a "neuropsychoanalytic" approach to treating a patient with cocaine dependence. The study focuses on how neuroscience can be integrated into psychoanalytic therapy, demonstrating the impact of neurobiological factors on the patient's associations and treatment. Through a detailed case study, the paper illustrates how the knowledge of brain function, specifically related to addiction, can inform psychoanalytic interpretations and interventions, ultimately aiming to improve treatment outcomes for individuals struggling with addiction.
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Three Perspectives on Addiction
This paper reviews three distinct yet overlapping perspectives on addiction that emerged during the 1990s, along with earlier contributions to understanding addictive illness. It suggests that these perspectives—addiction as a biologically mediated disease, as a response to an inability to tolerate affect, and as an object or transitional object equivalent—form a hierarchy that can guide treatment based on individual patient needs. The paper discusses how these perspectives can be applied in psychoanalytic therapy, offering case examples to illustrate their practical use in understanding and treating addiction.
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A proposal for an alcohol purchase license
This paper proposes the implementation of an alcohol purchase license linked to a state-managed database, referred to as a Banned Drinker Register (BDR). The concept is aimed at reducing alcohol-related harm by restricting high-risk individuals' ability to purchase alcohol. The BDR would track individuals who have demonstrated dangerous behavior while under the influence, and those listed would be barred from purchasing alcohol. The proposal outlines the potential public health benefits, cost savings, and enforcement strategies for such a system, drawing on examples from similar programs implemented in other countries.
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The Effects of Low Dose Naltrexone on Opioid Induced Hyperalgesia and Fibromyalgia
This paper examines the effects of low-dose naltrexone (LDN) on patients suffering from opioid-induced hyperalgesia (OIH) and fibromyalgia (FM). The study found that LDN significantly improved pain tolerance in both OIH and FM patients, suggesting that LDN may help restore the endogenous opioid system disrupted by chronic opioid use. The research highlights the potential of LDN as an alternative treatment for chronic pain conditions, although it acknowledges the limitations of the study, including the lack of a randomized control group.
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Waiting for Rescue: An Attorney Who Will Not Advocate for Himself
This paper discusses the treatment of a patient with multiple psychological issues, including cannabis dependence, using a neuropsychoanalytic approach. The case study highlights the patient's use of marijuana as a coping mechanism for various psychological and emotional challenges, such as low self-esteem, shame, and a sense of helplessness. The paper emphasizes the need to understand how addiction alters brain function and how this understanding can inform psychoanalytic treatment, aiming to improve the patient's overall functioning and address the underlying psychological issues contributing to their addiction.
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Fibromyalgia, Autism, and Opioid Addiction as Natural and Induced Disorders of the Endogenous Opioid Hormonal System
This paper explores the hypothesis that fibromyalgia, autism, and opioid addiction are disorders of the endogenous opioid hormonal system. It suggests that these conditions are related to either low or high opioid tone in the body, with fibromyalgia representing a state of low opioid tone, autism a state of high opioid tone, and opioid addiction a disruption caused by external opioid use. The study presents evidence that low-dose naltrexone (LDN) can help restore normal opioid tone in patients with fibromyalgia conditions and high dose naltrexone for autism, leading to improved pain tolerance and social relatedness. The paper also speculates on the potential link between the increase in autism rates and the rise in opioid use during childbirth, proposing that this might disrupt the natural opioid balance in newborns, contributing to autism development.
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Psychoanalytic treatment of psychological addiction to alcohol (alcohol abuse)
This paper presents a psychoanalytic case study of a patient with psychological addiction to alcohol (alcohol abuse). It challenges the DSM-V's elimination of the distinction between Alcohol Abuse and Alcohol Dependence, arguing that Alcohol Abuse is a purely psychological condition without the brain changes seen in dependence. The case study demonstrates how transference interpretation within psychoanalysis was key to the patient's recovery, highlighting the importance of understanding the underlying psychological factors contributing to addiction rather than solely focusing on behavioral symptoms. The paper advocates for maintaining the distinction between abuse and dependence for more accurate diagnosis and treatment.
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Ameliorative Response to Detoxification, Psychotherapy,and Medical Management in Patients Maintained on Opioids for Pain
‍This paper reports on the ameliorative effects of detoxification, psychotherapy, and medical management in patients maintained on opioids for chronic pain. The study investigates the prevalence of opioid-induced hyperalgesia (OIH) among these patients and finds that a significant portion of them experienced improved pain tolerance after detoxification. The findings suggest that chronic opioid treatment may often worsen pain rather than alleviate it. The paper highlights the potential of using non-opioid pain management strategies, including low-dose naltrexone (LDN), to restore normal pain sensitivity and improve patient outcomes. The study underscores the need for further research to better understand and treat OIH.
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Clinical Utility of the Cold Pressor Test
This paper discusses the clinical utility of the Cold Pressor Test (CPT) in evaluating pain sensitivity and the effectiveness of treatments for opioid-induced hyperalgesia (OIH) and fibromyalgia. The study reviews data from patients treated with opioids for pain and those with fibromyalgia, comparing their pain tolerance to non-addicted controls. The results indicate that CPT provides an objective measure of pain tolerance and can help identify OIH. The paper also highlights the role of low-dose naltrexone (LDN) in improving pain tolerance and suggests that CPT, combined with subjective pain scales, can effectively guide treatment strategies for OIH and fibromyalgia.
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Engineering Neurobiological Systems: Addiction
This paper explores the integration of neurobiology and psychoanalysis to develop engineering models for understanding and treating addiction. It highlights how addictive drugs alter the brain's SEEKING system, leading to compulsive drug use despite the awareness of harm. The paper discusses the role of the addictive drug industry, the impact of childhood trauma, and the psychological mechanisms underlying addiction. By combining neurobiological insights with psychoanalytic principles, the paper proposes a comprehensive approach to treating addiction that goes beyond conventional methods, aiming to address both the psychological and biological aspects of the disorder.
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Depression in Fibromyalgia Patients May Require Low-Dose Naltrexone to Respond: A Case Report
‍This paper presents a case report discussing the potential benefits of low-dose naltrexone (LDN) in treating depression in fibromyalgia patients. The report describes a 60-year-old male with chronic pain and refractory depression, who achieved remission of both conditions after 10 weeks of LDN treatment combined with psychotherapy and adjustments to his medication regimen. The paper suggests that treating fibromyalgia with LDN may be crucial for the successful remission of comorbid depression, emphasizing the importance of addressing both conditions simultaneously. The report also highlights the use of the Cold Pressor Test (CPT) as a measure of treatment effectiveness in this context.
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Using New Technology and Concepts on the Oldest Addiction on Earth, Alcoholism
This paper proposes the implementation of an alcohol purchase license (APL) as a modern solution to the public health issues associated with alcoholism. It discusses the extensive harm caused by alcohol, both to individuals and society, and reviews existing strategies that have had limited success in curbing alcohol-related problems. The proposed APL system would require individuals to obtain a license to purchase alcohol, which could be revoked in cases of harmful behavior, such as repeat offenses or alcohol-related medical issues. The paper outlines how this system could reduce alcohol-related harm by targeting high-risk individuals while allowing responsible drinkers to continue their alcohol use without undue burden. The proposal also includes considerations for implementation, potential pitfalls, and the broader application of this concept to other areas of public health.
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The Neuropsychoanalytic Approach: Using Neuroscience as the Basic Science of Psychoanalysis
‍This paper explores the integration of neuroscience with psychoanalysis, arguing that neuroscience should be considered the basic science underlying psychoanalytic theory and practice. It discusses how modern neuroscience tools can enhance the understanding of key psychoanalytic concepts such as drive, the unconscious, and relatedness, while also improving clinical applications. The paper emphasizes that combining neurobiological insights with psychoanalytic techniques can lead to a more comprehensive understanding of the mind, offering potential advancements in both fields.
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Opioid Addiction/Pregnancy and Neonatal Abstinence Syndrome (NAS): A Preliminary Open-Label Study of Buprenorphine Maintenance and Drug Use Targeted Psychotherapy (DUST) on Cessation of Addictive Drug Use
‍This paper explores the impact of neonatal abstinence syndrome (NAS) in opioid-addicted pregnant women and their infants. It presents a preliminary open-label study examining the effectiveness of buprenorphine maintenance combined with Drug Use Targeted Psychotherapy (DUST) in reducing the use of addictive substances, including tobacco, during pregnancy. The study reports high cessation rates for addictive drugs and suggests that addressing tobacco use may significantly decrease the severity of NAS in newborns. The paper highlights the need for further research and offers insights into the potential benefits of integrating psychotherapy with medication-assisted treatment for pregnant women with opioid addiction.
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Is fibromyalgia an endocrine/endorphin deficit disorder? Is low dose naltrexone a new treatment option?
This paper discusses the potential of low-dose naltrexone (LDN) as a treatment option for fibromyalgia, hypothesizing that fibromyalgia may be an endocrine disorder related to low endorphin levels. The authors present a case study where LDN significantly improved pain tolerance and quality of life in a patient with fibromyalgia. The paper suggests that LDN could help by boosting the body's natural endorphin production, offering a new, cost-effective treatment option for this chronic pain condition.
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Psychological Addiction, Physical Addiction, Addictive Character, and Addictive Personality Disorder: A Nosology of Addictive Disorder
This paper explores the distinctions and overlaps between various forms of addiction. It examines the neurobiology of withdrawal and craving, reviews psychoanalytic literature on addiction, and proposes a refined nosology for understanding addiction. The paper argues that psychological and physical addictions have different underlying mechanisms, though they share some behavioral similarities. It also discusses treatment implications based on this nosology, emphasizing the importance of understanding the roots of addiction for effective intervention.
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Recovery from opioid use on a neuropsychoanalytic service
‍This paper reports on the outcomes of a neuropsychoanalytic approach to treating opioid use disorder (OUD) and chronic opioid therapy (COT) over a 10-year period. The study found that 20% of patients achieved at least one year of sobriety, with 91% of them being drug-free.
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The Mechanism of Codependence in the Prescription of Benzodiazepines to Patients With Addiction
This paper discusses the codependence in physicians who prescribe addictive drugs for three unconscious reasons: (a - the distress of the patient infuses the physician. The physician issues a benzo prescription to disengage, insuring that the patient will return for another benzodiazepines prescription. b) - the physician addresses their own fear of abandonment, issuing a benzo prescription to insure that the patient will not leave them. c) - there is a lack of boundaries. Who is in distress?

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