Key Tenets of Addiction as Dissociation Model (ADM) by Dr. Adam O’Brien

The Addiction as Dissociation Model (ADM) represents a significant theoretical contribution, rooted in the author’s phenomenological study exploring the intricate interplay of trauma, dissociation, and addiction, particularly focusing on the concept of “drug use memory”. The core argument of ADM is that the dissociative state, though often misunderstood and poorly defined in medical literature, is not merely a pathological response but is, in fact, necessary for healing. This model seeks to provide a comprehensive framework for understanding how psychedelics can facilitate profound therapeutic change by addressing these interconnected phenomena.  

The key tenets of the Addiction as Dissociation Model are as follows :  

• Drug Use Memory: A single drug use event can generate an unprocessed addiction or drug use memory, which functions 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 perspective 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.  
• Addictive States: These are characterized as all-consuming dissociative states of being that frequently lead to further traumatic experiences.
• “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.
• Addiction as Informed Regulatory Choice: Addictive behaviors are viewed as informed regulatory choices made at an unconscious level.
• 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”.  
• Parts of Self: The intrusive nature of dissociative systems points to a universal system of “parts of self” that require consideration in any treatment approach, as they involve the implicit memory system.
• Addiction as Transdiagnostic: Providing evidence that addiction underlies all mental health disorders offers the field of psychology a fuller, realistic, and more complete picture of what mental health is and what it isn’t.
• Lost Addictions: ADM presents information on perfectionism, altruism, and ambition as process addictions.
• The Physical Body is the Psychological Unconscious: Presenting that emotions are not irrational and that the unconsciousness has consciousness, this work settles religious, legal, and philosophical arguments about the nature of the psyche.

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, albeit maladaptive, survival strategy. This strategy attempts to achieve homeostasis through dissociative means. If 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 self-medicating systems. This re-contextualizes addiction as a desperate, often unconscious, self-regulatory effort. 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.

Table 2: Key Tenets of the Addiction as Dissociation Model (ADM)

Key Concept/Tenet	Detailed Explanation/Definition
Addiction Definition	The relationship created between unresolved trauma and the continued and unchecked progression of dissociative responses.
Drug Use Memory	A drug use can produce an unprocessed addiction/drug use memory (akin to traumatic memory) and can produce dissociative manifestations (e.g., PTSD symptoms) if left untreated.
Trauma vs. Dissociation	Trauma is an event; anything that occurs post-event is dissociation, representing a bodily dissociative/stress response attempting to return to homeostasis.
Spectrum of Dissociation	Trauma, dissociation, and addiction exist on a normed range from normal/reasonable altered states of consciousness (ASC) to pathological states (dissociation-in-trauma). The spectrum is cyclical with overlapping symptomology.
Role of Endogenous Systems	Pain-based dissociative responses involve the endogenous opiate system (numbing) and the endocannabinoid system (healing). In active PTSD, cortisol is lower, while endogenous opiates and endocannabinoids are higher.
“Choice” in Addiction	An unconscious survival choice; the “disease” of addiction is pathological dissociation, stemming from dissociation-in-trauma, creating a cycle of addiction-in-dissociation and dissociation-in-addiction.
Addiction as Conditioning	One can become addicted (habitual/procedural memory dependent) to dissociation through intrusive means producing associative learning and classical/operant conditioning.
Implicit Memory System	Highly involved in early childhood development and essential for health, well-being, and healing; involved in the body’s healing process (“get sick to get well”).
Trauma is Addicting	Due to the involvement of the endogenous opiate system in dissociation, trauma itself can be addicting.

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. (2024b). 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/