In contrast to early psychodymamic formulations of addictions which stressed pleasure seeking or self-destruction, a modern psychodynamic perspective places greater emphasis on understanding addicts' disturbances in regulating their internal emotional life and adjustment to external reality. Effective treatment rests on providing interventions and responses that appropriately respond to addicts deficits in regulating affects and behavior. Treatment modalities must keep needs for comfort, control, and safety as the highest priorities, especially initially, in considering the choice of treatment or combination of treatments which are adopted or prescribed. The concept of a primary care therapist is advanced in which a single clinician takes responsibility for holding patients to other interventions and for monitoring which elements or combinations are most helpful. Benefits, pitfalls, limitations, and risks are considered for individual psychotherapy, self-help groups (i.e., AA and NA), and group psychotherapy. The role of psychopharmacologic approaches are considered as they pertain to psychotherapy.