Addiction poses a complex challenge in spite of all the progress made toward understanding and treating it. A multidisciplinary approach is needed and this paper attempts to integrate relevant neurobiological, behavioral, and subjective data under a common denominator described as a latent type of depression. It is called latent because it remains a silent syndrome due to two main reasons. The first one relates to the natural use of defenses against a predominant effect of chronic subjective pain, which arises from an ambivalent type of separation distress that compromises opioid regulation (PANIC system). Furthermore, it provokes a neurochemical cascade that impacts several neuromodulatory systems. The second reason is that such chronic subjective pain usually exhausts the natural defensive system, frequently leading the person to look for other resources such as the neurochemical manipulation of psychic pain. Thus, both the use of defenses and of psychotoxic drugs make the underlying depression hard to assess, even for the very person suffering from it. The causes, course and treatment of this type of affective configuration are discussed in this paper as an attempt to explain some of the difficulties so far encountered and to contribute to potential alternative lines of treatment.

Neuroscience was the basic science behind Freud's psychoanalytic theory and technique. He worked as a neurologist for 20 years before being aware that a new approach to understand complex diseases, namely the hysterias, was needed. Solms coined the term neuropsychoanalysis to affirm that neuroscience still belongs in psychoanalysis. The neuropsychoanalytic field has continued Freud's original ideas as stated in 1895. Developments in psychoanalysis that have been created or revised by the neuropsychoanalysis movement include pain/relatedness/opioids, drive, structural model, dreams, cathexis, and dynamic unconscious. Neuroscience has contributed to the development of new psychoanalytic theory, such as Bazan's (2011) description of anxiety driven by unconscious intentions or “phantoms.” Results of adopting the “dual aspect monism” approach of idiographic psychoanalytic clinical observation combined with nomothetic investigation of related human phenomena include clarification and revision of theory, restoration of the scientific base of psychoanalysis, and improvement of clinical treatments. By imbricating psychoanalytic thinking with neuroscience, psychoanalysts are also positioned to make contributions to neuroscience research. Freud's original Project for a Scientific Psychology/Psychology for Neurologists can be carried forward in a way that moves psychoanalysis into the twenty-first century as a core contemporary science (Kandel, 1999). Neuroscience as the basic science of psychoanalysis both improves the field, and enhances its scientific and cultural status.

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Neuropsychoanalysis has been established as a field based on the dialog between psychoanalysis and the neurosciences. Freud was a neurologist for 20 years and used the neuroscientific knowledge of his time as the foundation of his metapsychology. Psychoanalysis has predominantly relied on its own method to develop techniques for the different psychoanalytic treatments. It rarely uses contributions from fields outside psychoanalysis that could enrich its understanding of the mind. Neuropsychoanalysis has informed and revised several topics in psychoanalysis, for example consciousness and the unconscious, dreams, and affect amongst many others. Clear clinical applications of neuropsychoanalysis can be appreciated in the work with neurological patients. However, a constant question from clinicians is whether neuropsychoanalytic findings can contribute to psychoanalytic treatments with non-neurological patients. This paper explores clinical applications of neuropsychoanalysis mainly based on affective neuroscience to propose an analysis of emotions that may contribute to the gradual development of a neuropsychoanalytically informed psychotherapy. The task of integrating neuroscientific knowledge into psychoanalytic technique is still considered a challenge of accentuated complexity, but it is at the same time a necessary and promising endeavor that aims at improving the quality of the treatments available for human suffering and psychopathology.