Dissociative Disorders & Substance Abuse
Those who have dissociative disorders are more likely to also struggle with substance abuse.
The treatment of a dissociative disorder is most often going to consist of intensive psychotherapy, and addiction treatment requires the use of medications and psychotherapy. When a person has a substance abuse problem and a dissociative disorder, both disorders need to be treated at the same time in order for the person to recover.
What Are Dissociative Disorders?
Dissociative disorders are mental health disorders that occur when there is a lack of continuity between a person’s thinking, memory, actions, or identity. These people often attempt to escape their situation in a manner that is unhealthy and dysfunctional.
These disorders typically develop in people as a reaction to a traumatic event. They are often used to keep threatening information out of one’s consciousness.
Dissociative disorders are ultimately dysfunctional ways for people to cope with reality. They are:
- The person is not feigning or deliberately attempting to forget or conceal some unsettling experience.
- The person’s attempt to cope with the situation results in significant impairment in their functioning and/or significant distress for them.
- The attempt to cope with the stress is itself stressful.
What Are the Symptoms?
The specific symptoms of a dissociative disorder depend on the type of disorder one has. Some generalized symptoms associated with all dissociative disorders include:
- Problems with memory, including memory loss.
- Problems with one’s sense of identity.
- Being detached from one’s emotions or feelings.
- A sense that things or people are not real, or they are significantly distorted.
- Significant issues coping with emotions.
Types of Dissociative Disorders
While there are specific types of dissociative disorders, dissociation is also a common manifestation that occurs in other disorders, such as PTSD and schizophrenia.
The American Psychiatric Association (APA) recognizes three major dissociative disorders.
- Dissociative amnesia occurs when a person cannot recall important personal information. This amnesia typically occurs after a stressful event. In rare cases, it may result in a complete loss of one’s identity; the person may develop a new identity.
- Depersonalization-derealization disorder involves the feeling of an ongoing sense of detachment from oneself or others, or feeling as if one is outside oneself and observing one’s actions and feelings from a distance (almost as if one is watching themselves in a movie). Experiences often take on a dreamlike or foggy presentation.
- Dissociative identity disorder occurs when a person develops multiple alternate identities (personalities), often in an effort to cope with some traumatic event. This is formally known as multiple personality disorder. Each personality may take on its own identity and lifestyle.
Dissociative disorders are typically very rare, although they are often popularized by the media and may seem commonplace. There’s also some controversy associated with these disorders.
Some clinicians have stated that dissociative disorders are not real mental health disorders, but they are manifestations of coping. Other clinicians disagree with this analysis and validate the existence of these disorders.
People who suffer from dissociative disorders are at risk for some serious complications that can include:
- Suicidal thoughts or suicide attempts.
- Other types of self-harm or self-mutilation.
- Co-occurring issues with anxiety or anxiety disorders.
- Co-occurring issues with depression.
- Co-occurring post-traumatic stress disorder.
- Co-occurring eating disorders.
- Co-occurring personality disorders. Some clinicians believe that the dissociation in the dissociative disorders is simply a manifestation of certain personality disorders.
- Problems with sleep.
- Major issues with personal relationships.
- Major issues with one’s occupation or career.
- The development of substance use disorders.
Dissociative Disorders & Substance Abuse
The research regarding the prevalence of substance use disorders in people who have dissociative disorders is not well developed.
Dissociation (a loss of the connection between one’s sense of self and experiences) is a feature that can occur in several different types of mental health disorders, particularly trauma- and stress-related disorders like PTSD or psychotic disorders like schizophrenia. These disorders are known to have high comorbidities (co-occurrences) with substance abuse.
Some older research studies suggest that one of the common comorbid conditions that occurs in people who have any type of dissociative disorder is some type of addiction. However, dissociative disorders are relatively rare, and the actual prevalence rates of these disorders and comorbid substance abuse is not well-defined.
Because dissociative disorders often occur in conjunction with some form of trauma and stress, it would be expected that the development of any type of substance abuse issue would be a common co-occurring condition in someone with a dissociative disorder. Simply having a dissociative disorder increases the likelihood that one will also abuse substances.
The first step in treatment is to diagnose the dissociative disorder. Because it is very difficult to recognize and diagnose someone with a dissociative disorder, such as dissociative amnesia or dissociative identity disorder, it may be quite some time before clinicians understand the nature of the person’s issues. Oftentimes, a diagnosis might come after a person has been in therapy for a few months.
There are no medications that are specifically approved are designed to treat any of the major dissociative disorders. Psychotropic medications like antidepressants or anti-anxiety medications may address certain symptoms (depression or anxiety) when they occur in someone who has a dissociative disorder. They will not, however, address the issues associated with the person’s disorder.
Instead, long-term individual psychotherapy is the approach that is most commonly used to address a dissociative disorder.
Cognitive Behavioral Therapy
Typically, cognitive-behavioral approaches are used in the treatment of dissociation and dissociative disorders. Cognitive behavioral therapies represent a family of different types of therapies that operate on the same general principles.
- Your actions and your emotions are based on certain types of thoughts or belief systems you have.
- Many times, people have irrational beliefs that lead to irrational types of behaviors.
- The therapist needs to understand the person’s belief system in order to understand how they feel and how they act.
- When the therapist understands the person’s belief system, the therapist can help that person restructure any irrational beliefs and change their behavior or feelings.
Again, cognitive behavioral therapy (CBT) is a group of different types of therapies that all hold the same general assumptions. The approach of many of these types of CBT may be slightly different, but they all follow the same general blueprint.
For instance, dialectic behavior therapy is a form of cognitive behavioral therapy that is designed to address people who are traditionally hard to treat. These include people who are suicidal, who have severe personality disorders, or who have other severe mental health conditions.
Other Types of Therapy That May Be Useful
In treating dissociative disorders, it is very important to understand the nature of a person’s early experiences (traumatic experiences). Types of psychodynamic therapies that attempt to uncover the person’s defense mechanisms and reaction to early trauma can be used to address the particular dissociative disorder in question.
Eye movement desensitization reprocessing (EMDR) therapy incorporates the principles of cognitive behavioral therapy with the use of lateral eye movements (moving the eyes back and forth) or focusing one’s attention on some other physical attribute, such as lights or sounds. This type of therapy is most likely effective due to its incorporation of cognitive-behavioral techniques and not for the eye movement component.
No matter what type of therapy is used, one of the most important features in the treatment is for the therapist to develop a strong bond with the patient, known as the therapeutic alliance. This alliance is a crucial component in the effectiveness of the psychotherapy of individuals with dissociative disorders. Without it, the patient is unlikely to experience significant progress in therapy.
Treating Dissociative Disorders & Substance Abuse
The co-occurrence of substance abuse and any other form of mental health disorder is common. This condition is commonly referred to as co-occurring disorders or a dual diagnosis.
The accepted method of care is to treat both conditions at the same time. Substance abuse is typically treated with a combination of medications and therapy.
These approaches can be incorporated into the treatment of the person’s dissociative disorder. Simply addressing one of the conditions and not the other is not an effective way to treat someone who has a dual diagnosis.
A substance abuse issue would be treated by:
- Thoroughly assessing the person’s substance use and the reasons behind such use.
- Placing the person in a medical detox (withdrawal management) program if it is deemed necessary. This will vary according to the substance of abuse as well as the duration of abuse.
- Using medications to control cravings or other issues. Some medications may only be used during detox, whereas others may be used on a long-term basis.
- Incorporating addiction treatment with therapy for the dissociative disorder. Therapy for dissociative disorders is most often done in individual therapy sessions, while addiction treatment can consist of individual therapy, group therapy, or both. Both conditions will be addressed in therapy sessions.
- Getting involved in peer support groups like 12-step groups.
- Using complementary and alternative treatments, like art therapy, music therapy, psychodrama, and similar approaches as adjunctive treatments to assist the major treatments.
- Using case management services and other interventions as deemed appropriate.
The Necessity of Long-Term Treatment
There isn’t a quick fix to addiction. Recovery often requires long-term treatment and ongoing support to effectively manage the disorder. While the intensity of treatment wanes over time, most people remain in some kind of aftercare program for the rest of their lives. This may be as simple as attending monthly therapy sessions or going to 12-step meetings periodically.
Treatment of a dissociative disorder is also usually long term. Brief interventions will typically not address deeper issues that fuel the disorder, such as the person’s reaction to trauma that resulted in the development of the dissociative disorder. Most patients find that they need some type of continuing intervention to keep them stable in recovery.
Lifestyle changes are important to maintaining recovery on both fronts. These include things like a regular sleep schedule, a healthy diet and exercise regime, and other activities that support overall wellness. A good system of support is also key to maintaining mental wellness, so building this system will be part of the treatment and recovery process.
While co-occurring dissociative disorder and substance abuse can make treatment a bit more complicated, both conditions can be managed on a long-term basis. This means people with these co-occurring disorders can lead healthy, robust lives in recovery.