When Addiction becomes Living Dissociated: Addiction as Dissociation Model
The central problem addressed by O’Brien (2023a) is the incomplete nature of current clinical definitions of addiction. These definitions, including those found in the Diagnostic Statistical Manual for Mental Health Disorders (DSM-5), lack crucial components related to trauma and dissociation, which significantly impedes the development and implementation of effective treatment strategies. Predicated on the unresolved nature of survival memory, the main argument posits that addiction is fundamentally a manifestation of trauma-related dissociation. This perspective suggests that addictive behaviors serve as an unconscious survival and healing mechanism, a deeply ingrained response to overwhelming experiences rather than merely a behavioral choice or isolated brain dysfunction. Exploring states of dissociative consciousness, what must be defined is who is who.
Addiction as Dissociation Model’s key conclusions are philosophically and psychologically transformative. It asserts that the “disease” of addiction is, in essence, pathological dissociation, originating from experiences of overwhelming stress, whether traumatic or otherwise. This pathological dissociation is not merely a dysfunctional state but is observed to unconsciously facilitate a process of healing. It asserts that because traumas can be addicting, then addictions are not just substance and gambling only. Another critical finding is that in active addiction, the unconscious body often assumes control, implying that decisions to continue substance use, despite adverse consequences, are unconscious survival choices rooted in the reptilian brain. Concluding that the physical body, with all its lived experience, is the psychological unconscious. The research further establishes the transferability of patterns and processes observed in trauma and dissociation to the understanding of addiction, highlighting its universal systemic nature, and adaptive value in physiological and psychological healing. Clinically, this necessitates a dual-faceted treatment approach: addressing both the conditioning (habit formation) and the resolution of traumatic or addiction-related memories. Failure to resolve these underlying memories allows the addictive dissociative network to perpetuate reenactments and the transfer of addictive behaviors. Yet again, psychology has to confidentially be able to psychologically and legally name who is who and what the Addiction as Dissociation research helped define is how dissociative one must be living to not know it.
The broader implications of this research are substantial and universal, suggesting substancial implications in micro and macro aspects of society and Western culture. It advocates for a paradigm shift in diagnostic categories, suggesting that addiction could be reclassified as a subcategory of Dissociative Disorders, given that post-traumatic stress disorder (PTSD) is fundamentally dissociative (e.g., conditional expressions of unresolved material). This new understanding calls for clinical practice to evolve beyond trauma-informed care to include comprehensive dissociation and addiction-informed approaches. Moreover, it challenges societal perceptions of addiction, urging for integrated, compassionate, and holistic interventions that acknowledge addiction as a predictable human response to overwhelming circumstances, rather than an anomaly or moral failing.
Initial Conceptualization: Trauma, Dissociation, and Addiction as a Spectrum
This study hypothesizes that addiction does not exist in isolation but resides on the same continuum as trauma and dissociation, a perspective informed by the foundational work of researchers such as Van der Kolk (1995), Scaer (2005), and Ross (2013). Consistent with the principle of mutual arising, trauma and dissociation are considered interdependent. This means that dissociation, in its various forms, cannot occur without an antecedent of trauma or significant stress, and conversely, traumatic experiences cannot fully manifest without the involvement of dissociative processes. Consequently, addiction, conceptualized as a direct manifestation of dissociation, is inherently linked to the trauma that initiated the dissociative response. This reciprocal relationship implies that trauma cannot occur without dissociative and, by extension, addictive processes being involved, as all these experiences are profoundly interdependent.
This initial conceptualization aims to bridge the historical silos that have traditionally separated these fields of study. It suggests that addictive processes are not isolated pathologies but play a key, often overlooked, role in a wide array of other mental health presentations. The positioning of addiction on the trauma/dissociation spectrum immediately elevates its status from a mere behavioral problem or a purely brain-based condition to a fundamental state shift and human response to overwhelming experience. This understanding implies that addiction is not an anomaly or a moral failing, but rather a predictable, albeit frequently maladaptive, outcome of the body’s inherent survival and regulatory mechanisms. If addiction is understood to exist on the same spectrum as trauma and dissociation, it inherently shares common underlying mechanisms and etiological pathways. This reframes addiction from an isolated pathology to a deeply integrated, biologically and psychologically driven response. This profound connection is crucial for comprehending its universality and for developing more effective, integrated treatments that address the root causes of suffering rather than solely focusing on the symptomatic expressions.
Progression of Understanding: Stages of Change Analogy
To illuminate the historical trajectory of clinical understanding across traumatology, dissociation, and addictionology, this study employs Prochaska and DiClemente’s Stages of Change model (1983) as an illustrative framework. This model, comprising stages such as pre-contemplative, contemplative, preparation, action, maintenance, and relapse or termination, provides a valuable meta-perspective on where the collective clinical knowledge base stands for each phenomenon. This analogy highlights the journey of understanding within each field, from initial recognition of a problem to the eventual development and widespread implementation of actionable interventions.
The deliberate use of the Stages of Change model as a meta-framework carries a significant implication: it suggests that the entire field of addictionology, and to a notable extent dissociation, is currently in a state of “contemplation” regarding its own understanding. This represents a critical self-reflection within the academic and clinical community, indicating that the prevailing scientific consensus might be entrenched in an earlier developmental stage. This necessitates a fundamental re-evaluation of current paradigms. If the field itself is recognized as being in a “contemplative” stage, it signals a acknowledged need for change in understanding but a persistent lack of clear, unified action or widespread consensus. This observation provides a compelling justification for the dissertation’s exploratory nature, as it aims to provide the foundational insights necessary to propel the field into an “action” stage by offering a new, integrated definition and comprehensive framework for addiction.
Traumatology’s Evolution: From “Abnormal” to “Normal” Response
The recognition of trauma symptoms has a long history, dating back to ancient Greek historians like Thucydides and observations of “shell shock” in World War I and II. However, a formal diagnosis of Posttraumatic Stress Disorder (PTSD) only emerged in 1980 with the third edition of the DSM (DSM-III), initially characterizing its symptoms as an “abnormal response to an abnormal event”. A significant evolution occurred by 1994, influenced by Judith Herman’s seminal work, Trauma and Recovery, which reframed trauma responses as normal human reactions.
This shift was further propelled by the Adverse Childhood Experiences Study (ACES) in 1996, which powerfully demonstrated the epidemic proportions of trauma, establishing its widespread occurrence as a normal, albeit distressing, part of human experience. The development of trauma resolution therapies, such as Eye Movement Desensitization and Reprocessing (EMDR), which effectively resolve traumatic memory through processes like memory reconsolidation, further moved the field of traumatology out of the contemplative stage and firmly into an “action stage”. This historical progression illustrates a crucial shift from pathologizing a response to understanding it as an adaptive, albeit distressing, human reaction to overwhelming events. The development of effective trauma resolution therapies further solidified this shift in clinical approach.
The monumental shift in traumatology from labeling responses as “abnormal” to “normal” sets a crucial precedent for this dissertation’s argument regarding addiction. It demonstrates that phenomena once stigmatized and pathologized can be re-contextualized as adaptive, albeit difficult, human responses. This re-contextualization opens the door for a similar destigmatization and re-conceptualization of addiction. If trauma responses are now recognized as normal, then the physiological and psychological sequelae that often follow—including dissociation and, as this dissertation argues, addiction—can also be understood as normal, albeit often maladaptive, responses to abnormal or overwhelming circumstances. This reframing is essential for reducing stigma, fostering empathy, and developing more compassionate and effective interventions for individuals struggling with these conditions.
Dissociation’s Elusive Nature and Emerging Understanding
Since the earliest days of psychology, the study of dissociation has been intimately coupled with traumatology. Despite this long-standing connection, dissociation has remained an elusive topic due to the inherent complexity of its symptoms, pervasive societal stigma, and fluctuating clinical trends. For example, while schizophrenia has long been understood to have a genetic component, current thought increasingly views dissociation as primary to schizophrenic presentations.
Similarly, dissociation appears to have been largely overlooked as a significant component in the etiology of many psychological presentations until the last three decades. Recent advances in traumatology and neuroscience have significantly increased awareness, providing a more robust framework for understanding how dissociation functions within the body. Brain imaging techniques are now being employed in emerging research to quantitatively measure dissociation severity, adding crucial empirical support for dissociative presentations. However, despite these advancements, dissociation has not yet achieved the same level of “action” in the Stages of Change model as traumatology, with some professionals still questioning its validity and clinical diagnoses.
The persistent “elusiveness” of dissociation and the continued questioning of its validity, even in the face of growing neuroscientific evidence, points to a collective discomfort or cognitive blind spot within the mental health field. This difficulty in fully embracing complex, non-linear psychological phenomena, which often defy easy categorization, mirrors the historical resistance encountered in fully understanding and destigmatizing addiction. This societal and clinical resistance becomes a significant barrier to developing truly integrated and effective mental health care systems, as it prevents a comprehensive understanding of how the mind and body respond to overwhelming experiences.
Addictionology: Living Dissociated in Contemplation and Debate
In stark contrast to the advancements seen in traumatology, addictionology is described as being “stuck in the contemplative stage”. This stagnation is a direct result of ongoing and unresolved debates, primarily centered on whether addiction should be conceptualized as a “disease” or as a “choice”. While more recent definitions of addiction have leaned towards defining it as a medical condition or a brain condition/disease, these definitions, while identifying where the dysfunction originates, still fail to adequately answer the fundamental questions of what is occurring, how it occurs, and why it occurs.
This significant knowledge gap is critical. For the addiction field to progress beyond the contemplative stage and into an “action stage,” a clear, operational clinical definition, one that addresses the underlying processes, is paramount. The compelling observation is that the answer to what, how, and why addictions form and progress may fundamentally lie within the dissociative processes that unresolved traumatic events produce, and that unresolved dissociation symptomology inevitably perpetuates. If addiction’s “what, how, and why” remain unanswered, then current treatments are likely to be symptomatic rather than curative, leading to persistent challenges such as high relapse rates and ongoing suffering. By proposing trauma-related dissociation as the underlying process, this study offers a clear pathway out of this contemplative stasis, suggesting that a deeper understanding of etiology is the key to unlocking more comprehensive and effective interventions. The “stuckness” of addictionology is therefore not just an academic or clinical problem but a profound societal one, perpetuating ineffective interventions, fostering blame, and maintaining the pervasive stigma associated with addiction. Addiction and dependence not just being drug and gambling related, suggests that the transdiagnostic status of addiction and dissociation deserves a more thorough investigation; however, recovery communities no longer have to standalone because their solutions are just as valid as any others.
The Medical Model’s Limitations and Drug Use as Trauma
Applying the medical model to addiction reveals a significant logical conflict unless the body’s stress system or emotional landscape is fully considered. The medical model typically identifies a dysfunction in an organ that produces symptoms, which are then diagnosed to apply the most effective treatment. However, in the context of addiction, this model defines a “dysfunction in the brain” without adequately explaining what created that dysfunction or where it precisely resides. For instance, providing insulin for diabetes addresses symptoms but does not explain why the pancreas fails to produce enough insulin. Similarly, in addiction, observing symptoms or diagnosing the illness does not explain the underlying cause or mechanism.
A crucial observation often overlooked is that ingesting a poison or toxin, even if it leads to an overwhelming, albeit pleasurable, experience, could still meet Criteria A of PTSD. This is because such an experience is potentially life-threatening, particularly for the physical body, which is inherently programmed to detect, reject, dispose of, and remember such substances or experiences for future recall. Existing literature supports this perspective, suggesting that drug use can create an “addiction memory” akin to traumatic memory, potentially producing similar traumatic symptomology, including “euphoric symptomology” that mimics or mirrors traumatic responses. This is especially true for dissociative responses and pathology due to the intense and overwhelming emotional experiences that drug use can induce. Current definitions of addiction primarily identify symptomatic presentations. However, this approach fails to explain where these underlying experiences occur, what is occurring, how they are produced, or why they are happening. Consequently, without capturing the how and why, a direct and effective way of treating the “dysfunctional” organ (the brain) is not readily achieved.
The radical reframing of drug use itself as a traumatic event (even if initially pleasurable or sought for relief) represents a profound shift in understanding. This perspective moves the narrative beyond an individual’s “bad choices” or an inherent “brain disease” to emphasize the inherent biological and psychological impact of the substance on a survival-oriented system. This creates a more compassionate and accurate etiological understanding, fundamentally moving beyond moral judgment. If drug use is inherently traumatic, then the body’s natural response is to engage survival mechanisms, including dissociation. This creates a feedback loop where the initial “solution” (drug use for relief or pleasure) paradoxically becomes a new “trauma,” perpetuating the cycle of dependence and suffering. This understanding is foundational for the dissertation’s working definition of addiction, as it explains the deep, often unconscious, drive behind continued use despite negative consequences. From the dissociative survival perspective, all consequences are negative.
With the drug use is the trauma, the benevolent body keeps and holds the score in the form of memory. Unresolved trauma expressing or reenacting attachment and developmental traumas, financial abuse, immature parenting, and memories that qualify for a diagnosis of PTSD are all subjective to not only the minds measurements, but evolutionarily to the psychological unconscious body. This has a profound implications on the nature of consciousness and philosophical conclusions.
Addiction as Dissociation Model’s Working Definition of Addiction
For the purpose of this research, the working definition of addiction is explicitly articulated as: “the [dependent] relationship created between unresolved trauma and the continued and unchecked progression of dissociative responses (e.g., living dissociated)”. This definition is designed to capture the underlying process of addiction, integrating the critical roles of both trauma and dissociation. It directly addresses the significant knowledge gap identified in current clinical definitions, which often fail to connect the observable symptoms of addiction to their deeper psychological and physiological roots. This definition implies that the perpetuation of addiction symptoms is driven by the intrusive nature of unresolved trauma and the subsequent unchecked progression of dissociative symptomology. This conceptualization links back to the inherent meaning of “surrender” implied in the etymology of the word “addiction”.
The process of surrendering, in this context, may result from the profound impact of trauma and/or through a process of classical and operant conditioning between internal and external cues. This explicit working definition serves as the core thesis of the dissertation, directly linking trauma, dissociation, and addiction in a causal and progressive relationship. It posits that addiction is primarily a response to unresolved trauma, mediated and perpetuated by dissociative processes, rather than an isolated behavioral or biological phenomenon. This redefines the problem itself and, consequently, illuminates new pathways to its resolution. This definition serves as the guiding hypothesis for the entire study, providing a clear conceptual lens through which to analyze the lived experiences of participants and critique existing theories. By defining addiction as a relationship—specifically, a conditioned bond—to unresolved trauma and dissociation, it moves beyond simplistic cause-and-effect models to a more dynamic, systemic understanding of the unconscious condition of the body and our shared history.
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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/
