The dissociative symptoms of depersonalization-derealization disorder mimic many effects of substance use but without the temporary improvements to a mood that drugs can cause. They make people feel separated from their own experience in ways that are disturbing and that can lead to the development of co-occurring disorders like anxiety and depression. By receiving treatment for both depersonalization disorder and substance use, people can start to feel their emotions more fully again.
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Drug Abuse as a Hindrance to Depersonalization-Derealization Disorder Treatment
Therapy for depersonalization-derealization disorder helps people reconnect with feelings that have been blocked off behind a wall of dissociation. By developing insight into the causes of their dissociative symptoms, which often include childhood messages that their feelings or thoughts were not acceptable, people with depersonalization disorder start to heal. They realize their feelings, selves, and the world are real and symptoms of depersonalization and derealization have served a protective function that they no longer require.
Substance use disrupts this process. Naturally arising emotions are blunted or changed by the effects of drugs. People lose clarity as the effects of substances distort their thinking. In many ways, the effects of substance use and the symptoms of depersonalization disorder are similar: the edges of emotional experience are blurred. Because of this, active substance use makes it hard, if not impossible, to experience the benefits of therapy that is meant to reconnect people with their full emotional range.
Effects of Substance Abuse on Depersonalization-Derealization Disorder Symptoms
Symptoms of depersonalization and derealization are frequently triggered by substance use and abuse. For people with the underlying depersonalization-derealization disorder, the effects of drugs prolong and intensify their symptoms. They can also make it harder for them to maintain insight that their perceptions of unreality are part of their condition instead of an accurate conclusion about the world.
The dreamlike feeling of derealization can become acute after prolonged substance use. People may start to accept it as a permanent state, which can be profoundly discouraging. When they feel disconnected from their accomplishments, people have a hard time maintaining the effort to preserve them. Even basic self-care can start to seem pointless. This persistent dissociative state can also trigger comorbid depression and lead to problems at work and at home.
Drug Abuse as a Cause of Depersonalization-Derealization Disorder
Not only can substance use cause symptoms of depersonalization and derealization, but it can also trigger the onset of the full disorder. Research by Nicholas Medford and his colleagues has shown that substance-induced depersonalization disorder is almost clinically identical to the same disorder when it is not drug-induced.
Unlike symptoms of other psychiatric conditions, depersonalization and derealization do not depend on genetic or neurochemical factors. They arise from a certain way of experiencing and seeing the world — one that can emerge from drug-induced states. While the disorder includes effects on sensory processing, it can present as more of a philosophical or existential problem, making it tricky to detect as a clinical syndrome and to properly treat. The prolonged induction of dissociative experiences through substance use can lead to a lasting change in perception.
A 2015 study by Sirvent and Fernandez found that changes in brain chemistry from substance use were not the only cause of a substance-induced depersonalization-derealization disorder. For people in recovery, these symptoms can reflect a sort of adjustment disorder as they learn to cope with emotional pain and stress without using substances. They can even arise from the experience of entering the disorienting new reality of recovery.
Depersonalization-Derealization Disorder and Marijuana
Marijuana is known for its capacity to induce dissociative symptoms including derealization and depersonalization. It is linked to more cases of substance-induced depersonalization disorder than any other drug.
Usually, depersonalization and derealization symptoms arise while the drug is active and fade after its effects wear off, but some people may experience persistent symptoms for weeks, months, or even years after quitting. Risk factors for cannabis-induced depersonalization and derealization symptoms include the following:
- Having a previous or co-occurring anxiety disorder
- Using marijuana after exposure to trauma
- Using marijuana during periods of acute stress
- Ceasing marijuana use after a long period of regular use
Many people who use marijuana develop depersonalization symptoms during recovery. In some ways, this can be understood as a sign of active changes in the brain as it adjusts to the absence of the drug. Sustained treatment for depersonalization usually resolves these symptoms, especially if they are addressed directly as part of an integrated treatment system.
Depersonalization-Derealization Disorder and Alcohol
Alcohol is not as strongly linked with a substance-induced depersonalization-derealization disorder as marijuana and hallucinogens are, but it can still cause the disorder. In high volumes, alcohol can trigger dissociative symptoms and even periods of dissociative amnesia. For people with the underlying depersonalization-derealization disorder, the effects of alcohol can induce or intensify their symptoms during active use or during the withdrawal phase.
People who abuse alcohol may actually experience higher rates of onset of depersonalization-derealization disorder during recovery than people recovering from other substance use disorders. This could be due to changes in the brains of people in recovery from alcohol use disorders or may reflect the profound difference in how they experience the world without the effects of alcohol.
Depersonalization-Derealization Disorder and Stimulants
Stimulants have not been studied as a particular cause of substance-induced depersonalization and derealization. However, they are known to cause panic attacks and transient psychotic or delusional states, as well as depression and anxiety during the withdrawal phase. Panic attacks and other manifestations of extreme anxiety can cause dissociative symptoms, and the kind of prolonged dysphoria associated with stimulant withdrawal can lead to derealization, especially in people with other risk factors or who already have depersonalization-derealization disorder.
If symptoms of depersonalization and derealization arise after stimulant use, the most important factor in determining whether they reflect a transient response or the onset of a chronic dissociative disorder is time. If symptoms last longer than two weeks, specific therapy for depersonalization-derealization treatment may be necessary.
Statistics on Depersonalization-Derealization Disorder and Drug Abuse
- Up to 25 percent of people in recovery from substance use disorders suffer from severe depersonalization disorder.
- Almost 44 percent of people in treatment develop mild depersonalization disorder at some point in the course of their recovery.
- Less than 20 percent of people who have depersonalization-derealization disorder experience onset of the disorder after the age of 20.
Epidemiological studies show that up to 2 percent of people in the general population have depersonalization-derealization disorder. These same studies show it is underdiagnosed with an annual prevalence of diagnosis of only 0.007 percent.
Treating Depersonalization-Derealization Disorder and Co-Occurring Substance Use Disorders
The primary intervention for depersonalization-derealization disorder is therapy. Cognitive behavioral therapy helps people with the disorder explore the underlying beliefs linked to their symptoms and correct the cognitive distortions that drive their thoughts that the world or the self-are unreal. Psychodynamic psychotherapy facilitates insight into early experiences that caused people to start dissociating and allows them to reconnect to emotions they previously couldn’t allow themselves to feel or express.
Interventions developed for specific trauma-related disorders, such as borderline personality disorder and post-traumatic stress disorder, are also effective for dissociative disorders. Eye movement desensitization and reprocessing and dialectical behavioral therapy help people who have depersonalization-derealization disorder process trauma, recover once-repressed thoughts and emotions and learn how to accept a wide range of inner states.
The gold standard for treatment of co-occurring substance use and mental health disorders is integrated treatment. Integrated treatment allows clinicians to more quickly address the symptoms of derealization and depersonalization that can arise in the early phases of recovery. As a result, people with co-occurring dissociative and substance use disorders have better outcomes in their recovery from both conditions. The Recovery Village uses an integrated approach to treat substance use disorders and co-occurring mental health conditions.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.