Dissociative Disorders and Substance Abuse
People with dissociative disorders feel disconnected from their own experience in profound ways. Their thoughts, feelings, sensations, and memories do not feel like their own. The way people dissociate varies widely. There are three main types of dissociative disorders:
- People with Dissociative Identity Disorder (DID) develop a fragmented identity in which different selves, or “alters,” show up under different conditions.
- People with Depersonalization-Derealization Disorder experience their inner states or their external circumstances as unreal.
- People with Dissociative Amnesia cannot remember important personal information or events.
Dissociative symptoms and conditions typically develop in response to trauma. When people have no physical escape from chaotic and extremely stressful environments, especially ones in which they are abused or feel like their lives are constantly under threat, they are flooded with overwhelming levels of stress and painful emotions. As a result, they learn how to inwardly escape by distancing themselves from these inner states.
It is not uncommon for people with dissociative disorders to develop co-occurring substance use disorders. They may use substances to facilitate more powerful dissociation from painful emotions or memories or alternately to find relief from the discomfort caused by dissociative symptoms. Some people with dissociative disorders abuse substances to temporarily break through their dissociation and feel again, if only for a short while.
Drug Abuse as a Hindrance to Dissociative Disorder Treatment
Active substance abuse makes it difficult to treat any mental health condition. The effects of substances can mask or distort psychiatric symptoms and impede the ability to formulate an accurate diagnosis and treatment plan.
Even when a clinician can give an accurate psychiatric diagnosis to someone actively abusing substances, the effects of illicit drugs often render mental health treatments ineffective. Drugs interfere with the action of psychiatric medications and with the emotional responses needed to effectively progress in therapy.
Drug abuse has an especially complicating effect on trauma-related conditions like dissociative disorders. Treating these conditions often requires a multi-step process in which a person must integrate successive phases of treatment and maintain an equilibrium easily interrupted by substance abuse. Substance abuse makes it especially difficult to achieve the first milestone in trauma-related therapy: establishing safety and stability.
Effects of Substance Abuse on Dissociative Disorder Symptoms
Substance abuse typically intensifies the symptoms of mental health disorders. Because of the way substance abuse affects the brain, people often experience “boomerang effects” in which the mental states that they use substances to avoid come back even stronger after the effects of the substance wear off. People with dissociative disorders usually find that drug abuse makes them feel even more disconnected from their experiences. Substance abuse can also make the “see-saw” between intrusive emotions and dissociative states even more pronounced.
Dissociative symptoms typically develop as a way to avoid unpleasant memories and emotions linked with past trauma. Drug abuse can increase the frequency with which these aversive states break through typical dissociative defenses. This leads to a vicious cycle in which dissociative symptoms worsen and people ramp up substance abuse to cope.
In fact, studies show that people with higher levels of dissociation report greater expectations that substances will be able to manage their psychiatric symptoms. Substance abuse also triggers more experiences of depersonalization and derealization.
Dissociative Disorder and Alcohol
Studies show that trauma, dissociation, and alexithymia, or the inability to identify emotions, are all predictors of alcohol dependence. Alcohol is relatively easy to access and has effects that make it attractive to people with dissociative disorders, causing many people to become reliant on it as a way to experience relief from their symptoms.
Alcohol slows down cognitive processes and can provide temporary relief for people with overactive minds. However, it ultimately exacerbates dissociative symptoms. Not only does alcohol blunt sensations, it can induce dissociative amnesia through blackouts. Under the disinhibiting influence of alcohol, people are also more likely to act out on self-destructive impulses triggered by intrusive traumatic emotions or memories.
Dissociative Disorder and Marijuana
Marijuana’s growing acceptance as a recreational drug poses a risk to people with conditions exacerbated by its use. Marijuana is especially dangerous for people with dissociative disorders. Not only has it been shown to produce acute dissociative symptoms, but it can also even cause people to develop Cannabis-Induced Depersonalization-Derealization Disorder.
To people without histories of trauma who do not already experience dissociative symptoms, the transient dissociative states induced by marijuana can be pleasant. However, for people who already experience unpleasant dissociative symptoms, marijuana use can increase their discomfort. Feelings of unreality and paranoia can worsen and in turn heighten anxiety. Marijuana use can also interfere with attempts to treat dissociative disorders.
Dissociative Disorder and Stimulants
In addition to marijuana, stimulants including MDMA and cocaine have been shown to trigger acute symptoms of dissociation. Cocaine, methamphetamines, and other stimulants can also induce paranoid delusional states and psychosis. As people develop cocaine or amphetamine dependence, they experience worsening anxiety, dysphoria, and anhedonia during withdrawal periods. All of these effects exacerbate dissociative symptoms. Paranoid ideation can worsen depersonalization and derealization and withdrawals can trigger defensive dissociation.
Stimulants associated with dissociative disorders and symptoms include:
- Prescription stimulant drugs like Adderall
- Synthetic stimulant drugs like “bath salts“
In high doses, these stimulants can trigger paranoia and panic attacks, which in turn exacerbate dissociative symptoms.
Statistics on Dissociative Disorder and Drug Abuse
Research has revealed these statistics about the connection between dissociative disorders and drug abuse:
- Ten percent of adults in the United States have a substance use disorder.
- One to three percent of people in the general population has a dissociative disorder.
- Ten to twenty percent of people in mental health programs have a dissociative disorder.
- About twenty percent of people enrolled in inpatient substance abuse programs have a comorbid dissociative disorder.
- About two-thirds of people with comorbid substance use and dissociative disorders started having dissociative symptoms before they started abusing substances.
These statistics show that people who abuse substances experience dissociative disorders at a higher rate than the general population.
Studies show that focused treatment of dissociative disorders improves general mental health treatment outcomes, lowering the cost of both inpatient and outpatient mental health services. Given the significant overlap between people with dissociative disorders and people with substance use disorders, treating dissociative disorders is likely to improve substance abuse treatment outcomes as well.
Drug Abuse as a Cause of Dissociative Disorder
Marijuana is not the only substance that can induce dissociative disorders. A variety of drugs including alcohol, hallucinogenic drugs, and prescription drugs can cause a wide range of dissociative symptoms and disorders, including depersonalization and dissociative fugues.
Alcohol and benzodiazepines are well known for causing people to experience states in which they are not aware of their actions and do not remember them later. Repeated induction of these states can cause people to develop a condition very similar to Dissociative Amnesia.
Hallucinogenic drugs can induce lingering symptoms of derealization and depersonalization, and like marijuana, can trigger the development of Depersonalization-Derealization Disorder. For people with trauma histories, dissociative effects can be intensified and make underlying trauma-related issues harder to detect and to treat.
Treatment for Dissociative Disorder with Co-Occurring Substance Use Disorder
Research shows that integrated treatment models for dual diagnosis patients are the best approach. In integrated treatment approaches, the same teams of clinicians provide mental health and substance abuse treatment. This is more effective than parallel treatment models in which substance abuse and mental health treatment are provided by two different teams of clinicians. Regardless, these models utilize a series of interconnected treatments that address all components of the dually diagnosed disorders.
For people with the most severe psychiatric and substance use disorders, inpatient treatment is recommended as a first step. Inpatient programs provide a safe and structured environment in which an initial period of abstinence from substance use can be established. Most inpatient programs provide a range of interventions and tailor treatment programs to each patient’s individual needs. These treatments may include group and individual therapy, medication management, and complementary therapies like yoga and art therapy.
Intensive Outpatient Treatment
Intensive outpatient programs provide structure for people in recovery as well as freedom and are usually more affordable and accessible than inpatient programs. They offer a similar range of interventions as inpatient programs, including group and individual therapy and supportive therapeutic activities. Many utilize random drug screenings and other means to hold patients accountable for maintaining abstinence from substance use.
Pharmacotherapy, or medication treatment, can be provided as part of inpatient and outpatient programs, as well as by individual physicians. While there are no medications that are specifically used to treat dissociative disorders, medications that treat related symptoms or comorbid conditions like depression and anxiety can help. A combination of selective serotonin reuptake inhibitors (SSRIs) and lamotrigine, an anticonvulsant and mood stabilizer, has been shown to be an effective treatment for dissociative disorders.
The most common intervention for dissociative disorders is psychotherapy, or “talk therapy.” Trauma-related psychotherapies like dialectical behavioral therapy (DBT) and eye movement desensitization and reprocessing (EMDR) are particularly effective for dissociative disorders. Cognitive behavioral therapy (CBT) has not only been shown to successfully treat dissociative disorders but has also proven to be a good intervention for people with dual diagnoses.
Peer Support Groups
Twelve-step groups and other self-help and peer support groups are associated with improved substance abuse treatment outcomes. They do not replace the need for treatment provided by professional clinicians but offer unique benefits: community, mentorship, and accountability.
These groups combat social isolation, provide safe spaces for people vulnerable to a setback, and help people learn from others who have established long-term recovery. They are a great place to start for people looking for relief from dually diagnosed disorders.
If you or someone you love is struggling with a substance use and co-occurring disorder like dissociative disorder, treatment is available. At The Recovery Village, a team of professionals provides a number of treatment programs for substance use and co-occurring disorders. Call and speak with a representative today to learn more about which program could work for you.