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Addiction Reimagined: The Addiction as Dissociation Model (ADM)

ByAdam O’Brien PhD

We’ve seen how psychedelics can profoundly influence our memory systems and consciousness, leading to a reinterpretation of “hallucinations” as manifestations of deeply held unresolved dissociative memories and somatically held intergenerational expressions of stress and trauma. Now, let’s connect these insights to a revolutionary framework for understanding addiction: the Addiction as Dissociation Model (ADM). This model, rooted in Adam O’Brien’s (PhD) phenomenological doctoral study (O’Brien, 2023a), posits that the dissociative state, often misunderstood, is not merely pathological but is, in fact, also necessary for healing and repair.

The ADM offers a comprehensive lens for understanding how psychedelics can facilitate profound therapeutic change by addressing the intricate interplay of trauma, dissociation, and addiction. Here are its key tenets:

  • Drug Use Memory: A single drug use event can generate an unprocessed addiction or drug use memory, functioning akin to a traumatic memory. If left unaddressed, this can lead to dissociative manifestations, mirroring symptoms seen in PTSD, such as intrusions, reenactments, and compulsive behaviors.
  • Definition of Addiction: ADM redefines addiction as the complex relationship formed between unresolved trauma and the continuous, unchecked progression of dissociative responses. This shifts the focus from addiction as a standalone pathology to a consequence of deeper, unresolved psychological processes.
  • Spectrum of Dissociation: Trauma, dissociation, and addiction are posited to exist on a spectrum, ranging from normal and reasonable altered states of consciousness (ASC) to extreme circumstances that can produce pathological states, termed “dissociation-in-trauma”. This spectrum is cyclical, with overlapping symptomology and underlying processes.
  • Survival-Oriented System: The model highlights the role of the ventral tegmental area (VTA) and nucleus accumbens (NA), which form a survival-oriented system. This system, governed by unconscious regulation and dissociative mechanisms, fuels the “wants and needs”—both pain and reward—associated with addiction and drug use.
  • Trauma vs. Dissociation: A critical distinction is made: trauma is defined as the initial event, while anything occurring post-event is considered dissociation. The symptoms of PTSD are thus interpreted as defining dissociation, representing the body’s dissociative/stress response attempting to return to homeostasis after a traumatic event.
  • Cortisol, Opiates, and Cannabinoids in PTSD: In individuals experiencing active PTSD, cortisol (a stress hormone) levels are paradoxically lower, while endogenous opiate and endocannabinoid levels are elevated. This suggests that individuals with active PTSD are essentially living in a dissociated state, utilizing these internal systems for self-regulation.
  • Dissociation as Essential: Dissociation is presented as a natural, unavoidable, and fundamental process for both survival and thriving. Addiction, in this context, is understood as being “trauma-bonded to the dissociative process that trauma caused”.
  • Addiction as Conditioning: Individuals can become addicted to dissociation itself, developing habitual or procedural memory dependence through intrusive means that generate associative learning and classical/operant conditioning.
  • Stress and Dissociation: Both pain-based and euphoria-based stressors are seen to stress the body and induce dissociation, sharing common dissociative mechanisms. They are described as “the same coin, different sides”.
  • Hallucinations and Delusions: Dissociative processes are implicated in the production of hallucinations, delusions, and “shadow” material, which are understood to be based on unresolved memories of unmet needs, often stemming from trauma.
  • Endogenous Systems in Pain-Based Responses: Pain-based dissociative responses specifically involve the endogenous opiate system, which is instrumental in numbing , and the endocannabinoid system.
  • Naltrexone and Stress Response: The universal application of Naltrexone, an opioid antagonist, is cited as evidence for how the stress response of dissociation underlies all mental health disorders, including addictions.
  • Endocannabinoid System in Healing: The endocannabinoid system is highlighted as instrumental to the body’s healing processes.
  • “Choice” in Addiction: The “choice” to engage in addictive behavior is reframed as an unconscious survival choice. The “disease” of addiction is understood as pathological dissociation, stemming from “dissociation-in-trauma”, which in turn creates a cyclical relationship of “addiction-in-dissociation” and “dissociation-in-addiction”.
  • Trauma is Addicting: Trauma itself can be addicting due to the involvement of the endogenous opiate system in dissociation.
  • Addiction to Anything: The model suggests that an individual can become addicted to virtually anything, as the core issue lies in the pathological relationship to the addictive/dissociative behavior, rather than solely the substance or activity itself.
  • Implicit Memory System: The implicit memory system is considered highly involved in early childhood development and is crucial for overall health, well-being, and healing. It is believed to play a role in the body’s inherent healing process, where one must “get sick in order to get well”.

The ADM’s definition of addiction as a “trauma-bond to the dissociative process that trauma caused” and its connection to the body’s innate healing systems fundamentally redefines addiction not as a moral failing or simple disease, but as a deeply ingrained survival strategy. This strategy attempts to achieve homeostasis through dissociative means. Since dissociation is a natural survival and healing mechanism, and addiction is a “trauma-bond” to this process, then addictive behaviors are, at their core, unconscious attempts to regulate overwhelming internal states (whether pain or euphoria) by leveraging the body’s own dissociative and endogenous self-medicating systems that would include the newly emerging psychedelic system in the body and it relationship to the innate process of memory reconsolidation (otherwise known as psychological healing). This recontextualizes addiction as a self-regulatory effort that is conditioned long before the drug is able to take hold. It shifts the therapeutic focus from breaking a “bad habit” or treating a “disease” to understanding and resolving the underlying trauma and dissociative patterns that drive the addictive behavior. This has profound implications for treatment, emphasizing compassion, trauma resolution, and working with the body’s innate wisdom rather than against it.

In our next post, we’ll synthesize all these concepts, exploring how a psychedelic therapy session unfolds in practice and the broader implications for mental healthcare.

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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/

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