In simple terms, dissociation is a feeling of disconnection between you and your thoughts, memories, surroundings, actions, and identity. Dissociation is a troubling psychological symptom, and people who experience elevated levels of dissociation are more likely to struggle with addiction at some point in their lives.
But what is the connection between dissociation and addiction, and how can people work past dissociative episodes to thrive in sobriety?
What Is Dissociation?
In psychology, dissociation is a term that describes a broad range of mental health symptoms. Mild dissociation may resemble a form of emotional detachment, such as not feeling sad when you think you ought to or not experiencing joy.
In severe cases, dissociation can lead to a complete detachment from reality. Unlike psychosis, where people lose touch with what is real and what isn’t, people who dissociate instead feel separated from reality as if the world is passing them by. Some people describe a dissociative episode as feeling out of their body like they’re watching themselves in a movie.
Dissociation is a common symptom in people who have experienced significant trauma, and it’s one of the key diagnostic criteria for post-traumatic stress disorder. Detaching from reality protects the brain from future psychological harm – it’s a coping mechanism.
The Problem With Dissociation
While disconnecting from reality may provide some protection during traumatic events, the long-term consequences of dissociation can be harmful. People who experience dissociation may also experience problems such as:
- Low self-esteem
- Memory issues
- Chronic pain
- Poor social adjustment
Many people can continue to feel emotionally detached in everyday life, even well after they’ve survived a traumatic event. Like any coping mechanism, dissociation can become destructive. Luckily, trauma treatment and therapy can help.
PTSD, Dissociation, and Addiction
When considering the relationship between dissociation and addiction, we must also consider the symptoms of post-traumatic stress disorder (PTSD). PTSD affects millions of Americans each year, and dissociative symptoms are one of the key diagnostic criteria in determining whether a person suffers from this disorder. In addition to dissociation alone, many people with PTSD experience:
- Intrusive thoughts or memories
- Avoidance of particular environments or situations
- A constant state of hyperarousal
- Significant changes in mood and demeanor
- Sleep disruptions
Furthermore, several decades of research have found that people with PTSD have particularly elevated addiction rates.
Many people experiencing symptoms of dissociation may also be living with undiagnosed PTSD. Due to the nature of trauma, stress, and dissociation, they may not have a clear memory or even any awareness of the traumatic event that led them to struggle with this disorder.
What’s the Link Between Dissociation and Addiction?
Research shows that people who experience symptoms of dissociation are more likely to have problems with substance use, but the exact link between these two phenomena isn’t so clear. Scientists examining the relationship between dissociation and addiction have formed several hypotheses about the connection.
While we might not know precisely why these two conditions are related, we do have a good idea of possible mechanisms that influence addiction and dissociation.
The Chemical Dissociation Hypothesis
One of the first explanations for the connection between dissociation and addiction is known as the “chemical dissociation” hypothesis.
This hypothesis suggests that people who have experienced severe abuse or trauma strongly desire to dissociate from their emotions and environment. If they cannot detach from these events on their own, they may turn to substances.
Some drugs have dissociative properties, which is why they are labeled as “dissociatives.” These drugs can lead to sudden and intense feelings of detachment from the world.
Researchers formulated the chemical dissociation hypothesis in the early 90s after conducting interviews with adult survivors of childhood sexual abuse. While this hypothesis initially served as the primary explanation for the relationship between dissociation and addiction, further studies found certain aspects of this hypothesis lacking.
For instance, later research found that people who experience higher levels of dissociation engage in more frequent substance use than people with lower levels of dissociation, even if both groups experienced similar levels of trauma.
If a lowered ability to dissociate from negative emotions and environments results in people later dissociating chemically, this hypothesis would assume that the inverse relationship is also true.
The self-medication hypothesis provides a broader potential explanation of the relationship between dissociation and addiction. This hypothesis doesn’t look at dissociation directly – instead, it focuses on how some people who struggle with mental health symptoms turn to substance use.
As stated above, people with high levels of dissociation often experience several other mental health difficulties. They have higher anxiety levels and lower social functioning levels, and they are more likely to engage in self-harm or experience chronic pain. The self-medication hypothesis supposes that people who experience these symptoms will often turn to substance use for relief.
Self-medicating mental health symptoms with drugs or alcohol can quickly turn into an addiction; a person who feels anxious, for instance, may discover that drinking alcohol temporarily relieves their anxiety. Yet over time, alcohol produces less and less of a soothing effect, and anxiety can worsen after a person sobers up.
To compensate, they may drink even more to produce a more potent effect, only to fall into a destructive spiral of increasing alcohol use and worsening anxiety.
Connecting the Dots
Whether dissociation or addiction comes first, one thing is obvious: most people struggling to cope with trauma will try to find ways to cope, consciously or subconsciously.
Our brains work to protect us and will do what they can to relieve pain. Addiction and dissociation are not signs of weakness – they are evidence of severe trauma and attempted resilience.
People who experience dissociation and addiction are not broken. They need professional intervention and a support network to feel safe enough to heal.
Dissociation and Recovery
Left untreated, high levels of dissociation can interfere with recovery from active addiction. Research has shown that many people who experience high levels of dissociation lack healthy coping mechanisms.
Instead of facing their problems head-on and working to overcome them, they may disconnect from their problems. This isn’t a conscious choice – many people have no idea that they’re dissociating. While this defense mechanism might provide some short-term benefits, it doesn’t help individuals work through and overcome mental and emotional challenges.
Fortunately, treatment for dissociation and its associated consequences can be incredibly effective. Psychotherapy, also known as talk therapy, is the primary treatment method for people experiencing dissociation, dissociative disorders, and PTSD. Some therapy styles are often more adept at treating these problems than others. The most beneficial therapy styles for dissociation include:
- Prolonged exposure therapy (PET)
- Cognitive-behavioral therapy (CBT)
- Eye movement desensitization and reprocessing (EMDR)
- Dialectical behavior therapy (DBT)
If you’re struggling with dissociation symptoms, it’s essential to inform your therapist ahead of time to ensure you receive the appropriate style of care. CBT, for instance, can be incredibly effective for people experiencing dissociation unrelated to trauma but may not be as effective for people with PTSD as EMDR or PET.
Finding Support for Dissociation and Addiction
At All Points North, we take great care in treating the whole person when they come to us for addiction treatment. We employ a dual-diagnosis approach so that you can get to the root issue and find the support you need to address dissociation and addiction simultaneously.
If you’d like to learn more about how we incorporate various therapeutic modalities to address dissociation in our in-person treatment programs and telehealth offerings, reach out to our team. Call us at 855.235.9792 or use the live chat function or contact form to start a conversation with one of our mental health experts today.
- Najavits, Lisa M, and Marybeth Walsh. “Dissociation, PTSD, and substance abuse: an empirical study.” Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD) vol. 13,1 (2012): 115-26. doi:10.1080/15299732.2011.608781
- Roesler, T A, and C E Dafler. “Chemical dissociation in adults sexually victimized as children: alcohol and drug use in adult survivors.” Journal of substance abuse treatment vol. 10,6 (1993): 537-43. doi:10.1016/0740-5472(93)90057-9