Understanding the Roots of Addiction: A Citizen’s Guide to Three Key Theories
Introduction: Why Addiction Isn’t Just About Willpower
Addiction is one of the most misunderstood aspects of the human experience. It’s often viewed as a simple matter of poor choices or a lack of willpower, a perspective that can lead to stigma and ineffective solutions. However, for many individuals, the roots of addiction run much deeper, entwined with painful experiences from their past. For them, addiction isn’t a choice; it’s a survival strategy.
This guide is designed to make sense of this complex reality. We will explore and compare three influential psychological theories that connect trauma and addiction, making these powerful ideas accessible to everyone. By understanding the “why” behind the behavior, we can move from judgment to compassion and from simply managing symptoms to fostering true, lasting healing.
We will explore these key perspectives:
• The Self-Medication Hypothesis
• Repetition Compulsion
• The Addiction as Dissociation Model
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1. The Self-Medication Hypothesis: An Attempt to Numb the Pain
The Self-Medication Hypothesis suggests that people use substances or compulsive behaviors as a rational, albeit destructive, attempt to find relief from overwhelming emotional pain and trauma. When the internal distress becomes too much to bear, an individual might turn to an external source—be it a substance or a behavior—to “escape or numb out” from feelings they cannot otherwise manage.
Key Aspects of the Theory
• The Role of Trauma: Trauma is the original wound. It is the source of the deep-seated emotional pain, intrusive memories, and psychological distress that the individual is desperately trying to soothe or escape.
• The Mechanism of Behavior: The addictive behavior is an attempt to find relief. A critical insight of this model is that if one addictive behavior stops without healing the underlying trauma, the brain will simply seek a new dependency—a phenomenon known as “transfer addiction”—to continue medicating the pain.
• The Goal of the Behavior: The primary, conscious goal is not to cause harm, but to achieve temporary relief from distressing thoughts, feelings, and memories. The addiction becomes a coping mechanism to endure an otherwise unbearable internal reality.
This theory helps us view addiction not as a moral failing, but as an understandable, though ultimately harmful, attempt to cope with deep-seated suffering.
Now, let’s explore a theory that explains why, instead of just numbing the pain, some individuals seem unconsciously driven to relive it.
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2. Repetition Compulsion: Stuck in a Traumatic Loop
Repetition Compulsion is an unconscious and paradoxical drive to reenact or relive past traumatic events, relationships, or feelings. Rather than moving on from a painful past, the mind and body become “stuck in a loop,” compelled to repeat the very patterns that caused the original suffering.
Key Aspects of the Theory
• The Role of Trauma: Trauma creates a powerful, unresolved memory that remains “stuck” in the body’s survival system. This fragmented memory lacks a coherent story, leaving the mind and body compelled to repeat the experience in an attempt to make sense of it.
• The Mechanism of Repetition: This cycle is rooted in our neurobiology. A “trauma reminder” in the present can trigger the brain’s emotional alarm center (the amygdala) without the brain’s context and narrative center (the hippocampus) providing a coherent story. The result is that the person ends up “re-living the event without understanding why.”
• The Goal of the Behavior: The unconscious goal is, paradoxically, to heal. By repeating the traumatic dynamic, the mind is attempting to gain control over a past situation where it was powerless or to finally “complete a narrative that the mind has lost.”
This theory sheds light on why individuals might repeatedly find themselves in similar destructive patterns or relationships, revealing a deep, unconscious effort to resolve the past.
This brings us to a modern model that integrates the ideas of both numbing and reliving trauma, reframing the ultimate purpose of addictive behavior.
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3. The Addiction as Dissociation Model (ADM): A Misguided Attempt to Heal
The Addiction as Dissociation Model (ADM) is a modern, integrated theory that provides a profound new lens for understanding addiction. It defines addiction as a “trauma-related dissociative state.” Dissociation is a survival mechanism where a person mentally disconnects from an overwhelming or terrifying reality. According to ADM, the addiction itself becomes the primary way a person performs this act of disconnection.
Key Aspects of the Model
• The Role of Trauma: In this model, trauma is the root event that creates the need for dissociation—the mind’s need to “check out” to survive. Addiction is the behavioral expression of this ongoing dissociative process.
• The Mechanism of Repetition: The addictive behavior is more than just an escape; it is a compulsive reenactment driven by the “unmet desire to heal.” This repetition is a subconscious attempt to perform “memory reconsolidation”—the brain’s natural process for updating and resolving old, painful memories.
• The Goal of the Behavior: The ultimate, unconscious goal is not just temporary relief but healing. The addictive process is a profound, misguided attempt by the body’s innate survival intelligence to repair the original wound.
This model reframes addiction as a powerful, though paradoxical, signal from the unconscious that something is ready to be healed, shifting the focus from “what’s wrong with you?” to “what happened to you?”.
Now that we’ve explored each theory, let’s place them side-by-side for a direct comparison.
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4. At a Glance: Comparing the Three Theories
This table offers a clear, side-by-side comparison of the core ideas behind each theory, helping to summarize their unique perspectives on the trauma-addiction link.
| Theory | Primary Role of Trauma | Mechanism of Repetition | Unconscious Goal of the Behavior |
| Self-Medication Hypothesis | Creates the emotional pain that needs to be numbed or escaped. | A conscious attempt to find relief; if one addiction stops, the brain seeks another. | Temporary Relief from pain, memories, and overwhelming feelings. |
| Repetition Compulsion | Creates a powerful, unresolved memory that the body is compelled to repeat. | An unconscious neurobiological loop where emotional memory is triggered without context. | Mastery & Completion; an attempt to gain control or finish an unresolved narrative. |
| Addiction as Dissociation Model | Trauma creates the need for dissociation (mentally checking out) as a survival mechanism. | A compulsive reenactment to heal driven by the body’s innate desire to perform memory reconsolidation. | Healing; as a guided attempt by the body’s survival system to repair the original wound. |
These models show that addiction is far more than just a chemical dependency; it can be a deeply rooted behavioral pattern. This raises an important question: what else can we be addicted to?
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5. Beyond Substances: Are We “Addicted to Trauma”?
Building on these ideas, researcher Bessel van der Kolk observed that people can become “addicted to trauma” itself. This concept radically expands our understanding of addiction, suggesting that the compulsive, repetitive cycle is not limited to substances or activities like gambling.
This connects directly to the Addiction as Dissociation Model’s concept of “positive addictions” or “universal addictions.” These are seemingly positive or socially acceptable behaviors that can become rigid, compulsive patterns used to avoid underlying emotional pain. Examples include:
• Perfectionism: A relentless, anxiety-driven pursuit of flawlessness to feel in control and avoid feelings of inadequacy.
• Altruism: A compulsive need to help others, often at the expense of one’s own well-being, to gain a sense of worth.
• Ambition: An obsessive drive for success and achievement, used to escape feelings of emptiness or powerlessness.
This expanded view helps us recognize that addictive processes can hide in plain sight, disguised as socially acceptable behaviors. It reminds us that the core issue is the compulsive pattern used to avoid pain, not just the specific substance or activity.
Understanding addiction in this deeper way naturally leads to a profound shift in how we approach recovery and healing.
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6. A Shift in Healing: From Punishing Symptoms to Healing Wounds
The evolution in our understanding of the trauma-addiction link is mirrored by a revolution in how we approach healing.
The Traditional Approach has often been reductionist and punitive. It has relied on pathologizing labels from diagnostic manuals like the DSM, which often fail to capture the interconnected nature of trauma and addiction. This perspective fueled the punitive “War on Drugs” and promoted the oversimplified “chemical imbalance” theory, which suggested that complex human suffering could be fixed with a pill. This approach focuses on managing symptoms and controlling behavior.
The Emerging Approach is a more holistic and compassionate paradigm. Instead of punishing the behavior, it seeks to heal the root cause of the trauma. This new wave of care is “dissociation-informed,” meaning it recognizes and works with the mind’s survival strategies. It honors the wisdom of the body, understanding that “the body is the unconscious”—a living repository of memory and experience. This approach utilizes new and ancient modalities, such as “Psychedelic Care,” to help individuals safely access dissociated material and facilitate deep healing through memory reconsolidation.
The fundamental mission is shifting from controlling a person’s behavior to compassionately and effectively healing the whole person by addressing the wounds that drive their suffering.
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7. Conclusion: A More Compassionate Path Forward
Viewing addiction through the lens of trauma provides a more compassionate, comprehensive, and ultimately more hopeful understanding of a person’s struggle. It moves us away from blame and shame, and toward curiosity and empathy.
The three theories we’ve explored—the Self-Medication Hypothesis, Repetition Compulsion, and the Addiction as Dissociation Model—are not mutually exclusive. Instead, they offer different but complementary perspectives on the same fundamental human effort: the struggle to cope with, make sense of, and ultimately heal from overwhelming pain.
This deeper understanding does more than just change our perspective; it illuminates a more effective path to recovery. It shows us that the goal is not simply to manage a “disease” or stop a behavior, but to embark on a profound journey of healing the underlying wounds that have fueled the addiction all along.
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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.
