Addiction as Trauma-Related Dissociation Model: A Theoretical Framework for Healing

Introduction: A Call for a Paradigm Shift

Prevailing frameworks within mainstream psychiatry and psychology often approach addiction, trauma, and dissociation as distinct, compartmentalized phenomena. This siloed, symptom-focused model, rooted in a quantitative and industrial paradigm, frequently fails to capture the profound, systemic nature of these interconnected experiences. It overlooks the transdiagnostic status of addiction, its deep ties to unresolved trauma, and the crucial role of dissociation as a survival mechanism. The “Addiction as Trauma-Related Dissociation” model emerges as a necessary paradigm shift, challenging these established paradigms by offering a more integrated, humane, and qualitatively-grounded understanding. This document outlines this new theoretical framework, providing a cohesive map for researchers and practitioners seeking to move beyond reductionist approaches and embrace the complexity of human suffering and healing.

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1. Philosophical and Epistemological Foundations

Establishing clear philosophical foundations is a strategic and essential first step in proposing any new psychological model. Before deconstructing clinical concepts, a framework must first define its core assumptions about reality, knowledge, and the human body. This provides a coherent and defensible architecture that directly challenges the conventional, reductionist paradigms that have historically dominated Western medicine and psychology, paving the way for a more holistic and embodied understanding of healing.

1.1. The Epistemological Divide: Qualitative Wisdom vs. Quantitative Reductionism

The model is grounded in a fundamental distinction between two primary scientific paradigms.

• The quantitative model, which underpins much of mainstream research and practice, is characterized as an industrial, “left-brain dominant” approach. When divorced from lived experience, this paradigm can become “qualitatively cold, desperate, and psychopathically applied,” reducing complex human suffering to measurable data points while missing the essence of the experience itself.
• The qualitative paradigm, in contrast, is grounded in lived experience, “right-brain holistic logic,” and the innate human ability to perceive emergent truths. It honors the subjective reality of individuals and recognizes that a complete understanding requires embracing complexity and interconnectedness.

This epistemological divide is captured in the metaphor that “one plus one can correctly equal two and three.” In this view, linear, quantitative logic correctly identifies the sum of the parts—the “two.” However, it inherently misses the emergent, synergistic reality created by their interaction—the “three.” This “three” represents the relationship itself, the shared unconscious dynamic, or the new whole that is greater than the sum of its parts. Qualitative reasoning is uniquely capable of perceiving this holistic truth, a reality that reductionist methodologies are designed to overlook, ignore, and deny.

1.2. The Body as the Psychological Unconscious

A foundational tenet of this framework is the assertion that “the physical body is the psychological unconscious.” This principle radically reorients the understanding of mental health by positing that trauma, memories, and unresolved psychological material are not abstract constructs but are physically stored as enduring imprints in the body’s somatic pathways, musculature, and hormonal systems.

This perspective directly challenges the traditional mind-body dualism prevalent in Western thought, which treats psychological and physical health as separate domains. By identifying the body as the seat of the unconscious, the model demands a fundamental shift toward body-centered, somatic approaches to healing. It argues that true resolution of psychological distress is impossible without directly engaging the physical sensations and embodied memories where trauma is held.

1.3. Core Philosophical Concepts: Ultimate Reality and Mutual Arising

The model’s philosophical bedrock is built upon two core concepts derived from Eastern philosophy, which allow for an objective, non-pathologizing view of addiction.

• Ultimate Reality: This principle posits that reality as-it-is is fundamentally neutral and empty. It is the observer who assigns value, meaning, and judgment to phenomena. By adopting this stance, we can view addiction not as an inherent moral failing or disease, but as a neutral process that has been assigned a negative value by a society that misunderstands its function.
• Mutual Arising: This concept holds that all phenomena are interdependent and cannot exist without their opposites. Just as pain and healing require each other for their existence, addiction and recovery are seen as two sides of a single, interconnected process. One cannot be fully understood without the other.

Together, these concepts create a framework that can objectively observe addiction as an interconnected part of a larger, systemic process involving trauma and dissociation, freeing it from the stigma and judgment that so often impede healing. This philosophical grounding allows for a redefinition of the model’s core constructs, moving from pathology to process.

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2. Deconstructing the Core Constructs: Trauma, Dissociation, and Addiction

The coherence of the Addiction as Trauma-Related Dissociation model depends on moving beyond the incomplete, symptom-based definitions found in frameworks like the DSM. It is necessary to redefine trauma, dissociation, and addiction not by their superficial manifestations, but by their underlying processes and profound interrelationships. This deconstruction allows for a more accurate and integrated understanding of how these phenomena co-create the addictive state.

2.1. Trauma: The Unresolved Root

Within this model, trauma is not merely an “abnormal event” but is understood as the unresolved root of the entire addictive process. The clinical view has evolved to recognize that trauma responses are not pathological but are, in fact, normal human reactions to overwhelming experiences.

Unresolved trauma creates a chronic state of fearful stress, leaving the body’s alarm system persistently activated. This has a cascading effect on memory, attention, mood, and sleep. To manage this overwhelming internal chaos, individuals develop adaptive coping behaviors that fall into two broad categories:

• Numbing Behaviors: These are attempts to dampen the internal alarm, and can include substance use, overeating, anorexia, or addiction to work or exercise.
• Sensation-Seeking Behaviors: These are attempts to overpower the internal feelings of trauma through intense external stimuli, such as risky sexual encounters, gambling, or extreme sports.

2.2. Dissociation: The Primary Mechanism of Survival

Dissociation is the central psychological mechanism through which the mind and body manage trauma. It exists on a spectrum, from everyday experiences like being absorbed in a book to severe pathological states. When this natural survival mechanism becomes a rigid, primary way of functioning, it creates a prison that severs the connection to the present moment, to oneself, and to reality.

The key manifestations of pathological dissociation include:

• Memory Gaps: Dissociative amnesia, where significant periods of time or specific events cannot be recalled.
• Detachment: Depersonalization (a feeling of being detached from one’s own body or self) and derealization (a feeling that the world is unreal or dreamlike).
• Perceptual Distortions: Alterations in sensory experience, such as objects changing in shape, size, or color.
• Fragmented Memory Retrieval: Traumatic memories are often retrieved not as coherent narratives but as disconnected sensory and affective imprints—sights, sounds, smells, and emotions—making it difficult to form a cohesive understanding of the past.

2.3. Addiction: A Transdiagnostic Process of Reenactment

Moving beyond the “disease” or “choice” debate, this framework provides a formal working definition of addiction based on its underlying process:

Addiction is the relationship created between unresolved trauma and the continued and unchecked progression of dissociative responses.

From this perspective, addiction is a transdiagnostic phenomenon. It shares core underlying processes—such as emotion dysregulation, cognitive biases, and avoidance behaviors—with a range of other conditions, including PTSD and OCD. It is not limited to substances but is a universal process of reenactment.

Furthermore, addiction can be conceptualized as a “learning disorder.” The neurochemical dopamine, which normally helps the brain learn by signaling when old rules no longer apply, is artificially boosted by addictive substances or behaviors. This leads to an overvaluation of drug-related cues and creates a perpetual state of “wanting” that is disproportionate to any actual pleasure. This powerful conditioning makes it profoundly difficult for the individual to learn from self-destructive behaviors, trapping them in a cycle of repetition. These redefined constructs now provide the essential components for a synthesized, holistic model.

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3. The Addiction as Dissociation Model (ADM) Synthesized

This section synthesizes the redefined constructs of trauma, dissociation, and addiction into the cohesive, cyclical framework of the Addiction as Dissociation Model (ADM). By illustrating the interdependent relationships between these elements, the model explains the formation, maintenance, and expression of addictive states not as a linear problem, but as a self-perpetuating loop of survival-gone-wrong.

3.1. The Cyclical Nature of Trauma and Addiction

The three core constructs of the ADM exist in a cyclical and mutually reinforcing relationship. This cycle represents a form of unconscious reenactment, where the individual is trapped in a loop of repeating past traumatic dynamics in the present.

1. Unresolved trauma creates a persistent state of internal dysregulation and a profound need to survive. This activates dissociation as a primary coping mechanism to manage the overwhelming internal state.
2. Addictive behavior is adopted as a conditioned bond to this dissociative state. The substance or behavior provides a reliable, albeit temporary, means of managing the internal chaos and achieving a sense of regulation or numbness.
3. The addictive behavior itself is often traumatic to the body and psyche. This creates new unprocessed memories, deepens feelings of shame, and further dysregulates the nervous system, which reinforces the original need for dissociation and perpetuates the cycle.

3.2. The Expanded Spectrum of Addictive Behaviors

The ADM expands the definition of addiction beyond traditionally recognized destructive behaviors to include compulsions that are often socially sanctioned or viewed as positive.

Traditional Addictions	“Positive” Addictions
Destructive behaviors like alcoholism or gambling, characterized by negative consequences. Standard of dependence, not just to a drug or behavior.	Seemingly positive compulsions like perfectionism, altruism, and ambition. Also, food, money, drama, trauma, emotional dependence, and power and control offer more evidence.

These “positive” addictions become maladaptive and harmful when they are no longer flexible choices but rigid compulsions driven by unmet core needs for survival, belonging, or power. When an individual pursues ambition or perfectionism not from a place of values but from a desperate need to feel safe or worthy, these behaviors can lead to the violation of their own core values. This violation produces intense feelings of guilt and shame, which in turn fuels the addictive cycle as the individual returns to the compulsive behavior to regain a temporary sense of control over these painful feelings.

This dynamic explains the phenomenon of transfer addiction, where ceasing one addictive behavior (e.g., drinking) without healing the underlying trauma simply causes the brain’s rewired reward system to seek a new dependency, such as workaholism or compulsive altruism.

3.3. The Body’s Role: Endogenous Healing and Numbing Systems

The body’s own neurochemical systems play a central role in mediating the dissociative and addictive experience, containing both the mechanisms for survival and the blueprint for healing.

• The endogenous opiate system is critically involved in the numbing and dissociative response to trauma. It produces the body’s natural pain-relieving substances, which can create a physiological basis for becoming “addicted to trauma” itself. The body’s natural pain-relieving response to traumatic stress creates a physiological dependency on its own stress-induced opioids, establishing a neurobiological foundation for the compulsive repetition of traumatic patterns.
• The endocannabinoid system, a more recently understood system, is instrumental to the body’s innate healing processes, involved in regulating mood, memory, and homeostasis.

Understanding these innate systems provides a neurobiological basis for the ADM and points toward therapeutic interventions that can leverage the body’s natural capacity to heal, which is the focus of the clinical application of this model.

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4. The Path to Healing: Clinical and Therapeutic Implications

The Addiction as Dissociation Model (ADM) provides a clear rationale for a new approach to recovery, shifting the focus from symptom management to the resolution of trauma at its somatic root. This section outlines the core neurological mechanism of healing that underpins the model, as well as the therapeutic modalities that align with its principles. The goal is not merely abstinence but the integration of the fragmented self and the restoration of an individual’s connection to their body and the present moment.

4.1. Memory Reconsolidation: The Core Mechanism of Healing

Memory Reconsolidation (MR) is the natural, neurological process through which the brain heals from trauma. It is the core mechanism that all effective therapies ultimately facilitate. When a traumatic memory is reactivated, it becomes temporarily malleable, creating a window of opportunity for it to be updated with new, conflicting information before being re-stored without its original emotional charge.

Effective therapies are those that successfully create the conditions for the three essential steps of MR to occur:

1. Activation: The original traumatic memory is accessed and brought into awareness.
2. Contrast/Conflict: A new, contradictory experience is introduced simultaneously, creating a “prediction error” in the brain that signals the old memory is inaccurate.
3. New Acquired Knowledge/Integration: The memory is updated with the new information and re-stored in a modified, non-distressing form.

Many activities, including but not limited to formal therapy, can function as a Mechanism of Action (MoA) to create the state of dual attention—holding the past and present in awareness simultaneously—that is necessary for MR to take place.

4.2. The Role of Psychedelic Care

Within this framework, psychedelics are not viewed as “drugs” in the industrialized sense, but as powerful catalysts or “superfoods” that can facilitate the body’s innate healing processes.

Their primary mechanism of action involves their structural similarity to serotonin and their activation of 5-HT2A receptors, which enhances neuroplasticity and creates ideal conditions for memory reconsolidation. During a psychedelic experience, the brain’s Default Mode Network (DMN)—the part of the brain associated with ego and rigid thought patterns—quiets down. This allows for a profound reinterpretation of “hallucinations,” which are seen not as random distortions but as the emergence of deeply held “memories” and symbolic language from the unconscious body.

This perspective stands in stark contrast to industrialized approaches (e.g., sending ketamine home with a patient) that ignore the critical importance of “set, setting, and the healing relationship”—the intentional preparation, supportive environment, and therapeutic guidance essential for safe and effective healing.

4.3. Integrated Therapeutic Strategies

The ADM supports an integrated toolkit of therapeutic strategies that are trauma-informed and prioritize the mind-body connection.

• Trauma-Informed Therapies: Modalities such as Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting (BSP), and Dialectical Behavior Reorienting (DBR) are highly effective because they are designed to directly access and process traumatic memories, reduce dissociative symptoms, and build emotional regulation skills.
• Body-Based Therapies: Because trauma is physically stored in the body, practices like trauma-sensitive yoga are vital. They help individuals reconnect with their somatic sensations in a safe way, fostering a sense of presence and embodiment that is often severed by trauma and dissociation.
• Mindfulness and Grounding Techniques: These practices are essential for reducing the detachment central to dissociation. By encouraging a non-judgmental focus on the present moment, mindfulness improves emotional awareness, while grounding exercises help anchor individuals back to reality during dissociative episodes.

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5. The Archetype of the Wounded Healer

In this new paradigm of healing, the role and identity of the practitioner are as critical as the therapeutic modality itself. The “Wounded Healer” emerges as the archetypal ideal for the professional, standing in stark contrast to the conventionally licensed therapist operating within the constraints of industrialized, rule-based systems. This archetype reframes expertise, authority, and the very nature of the therapeutic relationship.

5.1. Defining the Healer: Lived Experience as Moral Authority

A “Healer” is defined as a member of a “class of moral professionals” whose authority stems not from institutional credentials but from their own lived experience. They have navigated their own “near-death wounds” and have returned with an innate understanding of the terrain of suffering and recovery. This embodied wisdom grants them a unique capacity to guide others.

Licensed Therapist	Healer
“has to do what they were trained to do, even when it goes against their morals, laws, science, and ethics”	“morally knows when to act morally and when not to”

This distinction is rooted in the concept of “Moral-Ethics,” which is presented as a higher principle of emotional and spiritual maturity. It supersedes the rigid, rule-based “Legal-Ethics” that govern conventional systems, which can compel practitioners to act in ways that are technically compliant but morally and therapeutically compromised.

5.2. The Therapeutic Dyad and Archetypal Activation

The therapeutic relationship is not merely a dyad but a triadic system, operating within a field that constellates a “third quantity” for both practitioner and patient: the Archetypal Image of the Wounded Healer. A genuine healer remains “forever a patient as well as a healer,” recognizing how a patient’s difficulties constellate their own unresolved wounds. This authentic acknowledgment of personal woundedness is the very mechanism that makes the archetype accessible.

The healing process, therefore, is not simply a product of the healer’s empathy or technique. Rather, the healer’s vulnerability and embodied wisdom constellate the archetype, allowing the patient to make direct, unconscious contact with it. This engagement is what “rouses the powers of healing in him [the patient].” The resulting process is a “trans-subjective union,” a shared, archetypal experience that transcends the individual participants and mere technique. It is rooted in a profound, mutual recognition of human suffering and the potential for recovery, which in turn activates the patient’s own inner healer and facilitates deep, lasting change. This shift in professional identity is the final, crucial element in building a new, more humane framework for healing.

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6. Conclusion: Toward an Integrated and Humane Future

This theoretical framework presents a fundamental re-conceptualization of addiction, arguing that it is not a primary disease or a moral failing, but a profound, transdiagnostic survival response to unresolved trauma, mediated by the mechanism of dissociation. It posits that healing requires a definitive paradigm shift away from reductionist, symptom-based models toward integrated, somatic, and morally-courageous practices that honor the body’s innate wisdom. The Addiction as Trauma-Related Dissociation model provides a comprehensive map that connects the philosophical underpinnings of our reality, the neurobiology of our bodies, and the psychological processes that drive behavior.

By redefining trauma as the root, dissociation as the mechanism, and addiction as the reenactment, this framework offers a more complete and compassionate understanding of human suffering. The path to recovery is illuminated through mechanisms like memory reconsolidation and is embodied by the archetype of the Wounded Healer, whose authority rests on lived experience and a commitment to a higher moral-ethic. This model offers a coherent and powerful path toward resolving the cycle of reenactment, challenging the industrialized systems that perpetuate harm, and fostering a more authentic and holistic future for both individual and collective recovery.

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References

O’Brien, A. (2023a). Addiction as Trauma-Related Dissociation: A Phenomenological Investigation of the Addictive State. International University of Graduate Studies. (Dissertation). Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023b). Memory Reconsolidation in Psychedelics Therapy. In Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023c). Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024a). Healer and Healing: The re-education of the healer and healing professions as an advocation. Re-educational and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024e). Path of the Wounded Healers for Thrivers: Perfectionism, Altruism, and Ambition Addictions; Re-education and training manual for Abusers, Activists, Batterers, Bullies, Enablers, Killers, Narcissists, Offenders, Parents, Perpetrators, and Warriors. Re-Education and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025). American Made Addiction Recovery: a healer’s journey through professional recovery. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025a). American Made Addiction Recovery: a healer’s journey through professional recovery. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025b). Applied Recovery: Post-War on Drugs, Post-COVID, and What Recovery Culture and Citizens Require Moving Forward. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025c). Recovering Recovery: How Psychedelic Science Is Ending the War on Drugs. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

*This is for informational and educational purposes only. For medical advice or diagnosis, consult a professional.