The most critical unresolved issue associated with psychoanalysis is whether its core precepts belong in today's substance use armamentarium. Psychoanalytic theories have resisted the criterion of falsifiability, putting them at odds with the current paradigm for treating addiction. However, Freud's earliest pronouncement on the subject, "making the patient a collaborator in his own treatment" (i.e., therapeutic alliance) not only holds up to scientific scrutiny, but is a robust determinant in improving treatment outcomes. Psychoanalytic constructs today appear as conjectures, but recognition of the primacy of the collaborative therapeutic relationship is one example of how psychoanalytic observations have influenced current research.