Awareness of trauma and its impact on the mind, body, and brain is becoming more and more widespread. (Read my article here) Additionally, the understanding of trauma as a gateway to addiction is becoming more and more understood. However, dissociation, which is a natural response to trauma, still remains a mystery to many, even those in the clinical field. Even worse, all too many have a misunderstood Hollywood concept of it. In this article, I aim to demystify dissociation and how addiction can become a close ally.
The longer I worked in the addiction field the more I saw the overwhelming prevalence of trauma. A study by the National Institute of Health (2012) found PTSD had three times the prevalence in the substance abuse population than in the general public; and those numbers are only for those that fully met criteria for PTSD and doesn’t include a large population who have trauma and trauma symptoms but may not meet the criteria for PTSD. The more I started exploring trauma, and our mind and body’s response to it, the more I saw just how common dissociation was. Yet, I was never educated about it in any of my addiction, undergrad, or graduate programs. It took extensive research and field work for me to understand this specific response to danger.
The human body’s capacity to fight for survival is truly a marvelous thing; and dissociation is simply part of this drive. Dissociation is one of our oldest primitive responses to surviving danger, driven by our nervous system. Within all of us is a nerve called the Vagus nerve. This nerve runs from our brain and connects to our face, ears, and all our organs and it is what turns on or off our nervous system based on information it is receiving via our five senses. If we perceive safety then we can rest in what’s referred to as our “social engagement zone.” This is where we can feel calm, alert, engaged, aroused, and playful. However, if we sense danger (legitimate or perceived) then this nerve activates our Sympathetic nervous system and mobilizes us to Fight the danger or Flee it. Most people are quite familiar with this Fight/ Flight response. There is however another response to danger that we share with reptiles; the Freeze response.
In moments of extreme danger, life threat, and/ or situations we can’t escape this nerve activates our Parasympathetic system and shuts us down. This is about “survival no matter what.” Our mind has perceived escape is not possible, and if we can’t physically escape then we will emotionally escape. During this response people will literally freeze, faint, submit to the danger/ go along with it, collapse in the face of it, and/ or dissociate. The goal is not to avoid pain but simply survive it. These are the moments where many survivors feel their body has betrayed them because in the face of danger their body froze. This is however, quite a common and inherent reaction we are all capable of.
There are different types of dissociation but I think it is important to conceptualize it as a spectrum; some is mild and some is more intense. Some people experience just one and others might experience them all. The younger we were when the trauma happened, i.e. the more helpless, the more likely we are to dissociate. One type of dissociation is called Derealization. This is where our reality gets skewed. The world might appear foggy, two dimensional, tunnel vision, or like a video game/ movie. Another type of dissociation is Depersonalization. This is where our perception of self gets skewed. We might have a hard time with hand-eye coordination, feel like a robot, or even feel out of our body. Some it might just be the sense standing just outside their body and others it might be like observing themselves from across the room. The third most common response is Amnesic Dissociation. This is where we basically black out, compartmentalize the experience, and tuck it away in the recesses of our mind. These memories are not dead, as in an alcohol induced blackout, but deeply repressed. This can result in lost chunks of time, possibly even years.
When we hit a dissociated state our body is flooded with opiates (our body’s natural morphine), pulls blood from our limbs to our core, and slows our heart rate down very slowly. This might sound counter-intuitive to survival but this response helps us appear dead/ unappealing so our prey stops attacking. The opiates numb any physical injuries sustained and acts as a temporary mood stabilizer while the retracted blood flow prevents us from possibly bleeding out. Essentially we are shutting down and checking out. Studies have shown we can dissociate as young as infancy. This could be from overt trauma where a caregiver harms us or possibly covert trauma such as a parent that is unable to soothe our distress; so we learn to dissociate from it. In fact, studies have found adult dissociation is more common and can be predicted in those with childhood trauma. Our early formative years are where we learn we can be soothed and how to soothe ourselves. If during these early years dissociation was our primary coping mechanism, as adults our body will fall back on our default way of managing stress. Like Donald Hebb famously said; “neurons that fire together wire together.”
While it has immediate survival benefits, dissociation can be harmful when experienced chronically over a period of time. One way I see this is the danger to be re-traumatized. If we get better and better at dissociating then we start to lose danger cues and the Fight/ Flight response; this is often referred to as learned helplessness. Additionally, dissociation leads to a loss of integration. In a dissociated state we don’t integrate thoughts, memories, emotions, or sensations. This lack of integration is going to create a great deal of dysregulation internally. When we can’t shake the trauma off our body continues to act as if it is still there. This will in turn trigger our natural response to seek relief. This is where the interplay between addiction and dissociation begin to come together. While effective at times, dissociation is not a response to coping we want to use on a regular basis. But if faced with feeling the extent of our pain versus numbing out; it is much easier to numb out.
For many clients I work with who experienced childhood trauma they typically block the memory out as a child, it can begin to surface as a teen or young adult, and in turn they start turning to substances, eating disorder, self-harm, etc…to numb themselves from the thoughts, emotions, and sensations. Active addiction is in itself a type of dissociation; a momentary altering of self and reality. In fact, at the peak of intoxication all chemicals release Opiates, the same chemical that’s released when we dissociate. Some drugs like heroin, alcohol, and meth release this in even larger doses; so it’s no surprise that we tend to see an even higher prevalence of trauma in users of these substances. Throw in the mix that many addicts re-traumatize themselves through compromising behaviors to achieve intoxication and dissociation just gets more and more reinforced.
In my opinion, many behaviors that are labeled as “resistance” in the substance abuse and mental health field are in fact subtle forms of dissociation and defense responses. Sure resistance exists, but I think of resistance as conscious while dissociation is sub-conscious. For people who have barely any tolerance for emotional stress, or those who are Alexithymic and can’t even identify emotions and sensations, when placed in group or individual settings that force them to confront their feelings or open up in front of others (like counseling or 12-step) it triggers this old response to freeze up and check out. This might come across as zoning out, spacing off, or frequent “I don’t know” responses. The reality is they very well may not know and they may be staring off because their nervous system has detected a threat (real or not) and has already launched into action.
If you work with this population, experience dissociation yourself, or a loved one is in this population, it is important to know how to see the signs and understand the triggers of dissociation. It is more prevalent than you would think. It is also important to note that this response can be balanced through therapy. Those who have a tendency to dissociate to stress that doesn’t require dissociation generally means there is some unresolved trauma that is still getting activated so the body is responding to the past and the present. Specific trauma modalities such as The Comprehensive Resource Model, EMDR, Brainspotting, and other Somatic modalities help calm this trauma response; which reduces the frequency of dissociation. I have worked with clients who spent more time dissociated than not who now almost never dissociate. I think if we want to strive for a healthier community it starts with our own internal work. While our trauma might not be our fault, healing it is our responsibility.
Curtis Buzanski, LMFT, LAADC
Thank you Curtis for this very informative article, as an MFT myself and trained EMDR therapist, I am always looking for information to help my clients with dual diagnoses. Very clear and to the point.