Key Takeaways
- Dissociative disorders involve disruptions in consciousness, memory, identity, or perception that develop as protective responses to overwhelming trauma.
- Research suggests that approximately 40 to 55 percent of individuals with dissociative disorders also meet criteria for a substance use disorder, reflecting their shared origins in traumatic experience.
- Substances may be used both to intensify dissociative states for escape and to manage the frightening symptoms of dissociation, creating complex patterns that require specialized treatment.
- Treatment must proceed cautiously, as aggressive trauma processing in the presence of active dissociation can destabilize rather than heal.
- Trust SoCal in Orange County provides the specialized expertise needed to safely and effectively treat co-occurring dissociative disorders and addiction.
What Are Dissociative Disorders?
Dissociative disorders are a group of psychiatric conditions characterized by disruptions or discontinuities in normally integrated functions of consciousness, memory, identity, emotion, perception, behavior, and sense of self. These disruptions range from common experiences like highway hypnosis to severe conditions such as dissociative identity disorder, previously known as multiple personality disorder.
Dissociation develops as a psychological defense mechanism in response to overwhelming trauma, particularly trauma that occurs in childhood when the developing mind lacks the capacity to process extreme experiences. When a child cannot physically escape abuse or overwhelming stress, the mind protects itself by psychologically disconnecting from the experience. This protective mechanism, initially adaptive, can become a chronic pattern that persists long after the original trauma has ended.
The major dissociative disorders include depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder. Each involves different manifestations of the fundamental dissociative process but shares the common feature of involuntary disconnection from aspects of normal experience that most people take for granted.
The Complex Relationship Between Dissociation and Substance Use
The relationship between dissociative disorders and substance use is more complex than simple self-medication. Substances interact with dissociation in multiple directions, and understanding these interactions is essential for effective treatment planning at programs like Trust SoCal.
Substances to Enhance Dissociation
Some individuals use substances to deepen and extend dissociative states that provide relief from emotional pain. Alcohol, benzodiazepines, and opioids can intensify the emotional numbing and detachment of dissociation, creating a chemical amplification of the brain's own protective disconnection. For individuals whose dissociative capacity alone is insufficient to manage their distress, substances provide additional layers of separation from unbearable reality.
Ketamine, PCP, and other dissociative drugs are sometimes specifically sought for their ability to produce powerful dissociative experiences. These substances directly replicate the neurochemical states of dissociation, providing a guaranteed pathway to the disconnected state that the individual associates with safety and relief.
Substances to Combat Dissociation
Paradoxically, other individuals use substances to counteract dissociative symptoms that they experience as distressing rather than protective. The feeling of unreality, emotional flatness, identity confusion, and disconnection from one's own body can be profoundly unsettling. Stimulants may be used to feel more present and engaged. Alcohol may be used to feel something when emotional numbness dominates. Self-harm and substance use may serve overlapping functions of generating sensation in a body that feels disconnected.
This dual relationship, where substances may be used either to enhance or to combat dissociation, creates particular complexity in treatment. The function of substance use must be carefully assessed for each individual to develop appropriate interventions.
Challenges in Treatment
Dissociative disorders present unique challenges in addiction treatment that require specialized clinical expertise. Standard addiction treatment approaches may be ineffective or even harmful when dissociation is not recognized and accommodated in the treatment plan.
Group therapy, a cornerstone of addiction treatment, can be triggering for individuals with dissociative disorders. Hearing detailed trauma narratives from other group members may trigger dissociative episodes that undermine therapeutic engagement. The individual may appear present but be dissociatively disconnected, missing the content of sessions without anyone recognizing what is occurring.
Memory gaps associated with dissociative disorders can complicate the history-taking, treatment planning, and skill-building processes that treatment depends on. Information shared in one session may not be accessible in the next if the individual was in a different dissociative state. Treatment providers at Trust SoCal are trained to recognize and work with these memory and identity discontinuities.
- Dissociative episodes during therapy sessions that mimic treatment disengagement or noncompliance
- Memory gaps that prevent consistent application of skills learned in treatment
- Triggering of dissociation by trauma-related content in group therapy settings
- Difficulty establishing a consistent therapeutic relationship when identity states shift
- Risk of destabilization through premature trauma processing
- Misdiagnosis of dissociative symptoms as treatment resistance or manipulation
Specialized Treatment Approaches
Treatment for co-occurring dissociative disorders and addiction follows a careful, phased approach that prioritizes safety and stabilization above all else. The International Society for the Study of Trauma and Dissociation recommends a three-phase model that Trust SoCal integrates with our addiction treatment programming.
Phase one focuses on safety, stabilization, and skill development. This includes establishing sobriety, developing grounding techniques that can interrupt dissociative episodes, building internal communication between dissociative parts when relevant, and creating a sense of safety in the treatment environment. This phase may constitute the entirety of initial residential treatment for individuals with severe dissociation.
Subsequent phases involving trauma processing and identity integration are typically conducted in longer-term outpatient therapy, as they require sustained stability and a strong therapeutic relationship. Trust SoCal develops comprehensive aftercare plans that connect clients with therapists specializing in dissociative disorders for this longer-term work.
Grounding Techniques for Recovery
Grounding techniques are essential tools for managing dissociative episodes in recovery. These sensory-based strategies help reconnect the individual with the present moment and their physical environment when dissociation threatens to pull them away from reality.
Trust SoCal teaches multiple grounding techniques so that clients have options available in different situations. The five senses technique involves identifying five things you can see, four you can hear, three you can touch, two you can smell, and one you can taste. Cold water on the face or hands provides strong sensory input that interrupts dissociation. Naming objects in the room, describing your physical surroundings out loud, and feeling your feet firmly on the ground all serve as anchors to present reality.
These grounding techniques serve dual purposes in recovery: they interrupt dissociative episodes that might otherwise lead to substance use, and they provide an alternative to substances for managing the distressing symptoms of dissociation. Contact Trust SoCal at (949) 280-8360 to learn more about our specialized dual diagnosis treatment.
Practice grounding techniques when you are not dissociating so they become automatic responses available when dissociation occurs. Like any skill, grounding is most effective when it has been rehearsed in calm moments.
Rachel Handa, Clinical Director
Clinical Director & Therapist
