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Update on Treating Addictions with EMDR

Gabor Maté says that “the root cause of addiction is trauma” (Maté, 2010) but I think we need to add dissociation to that sentence because addiction is a dissociative process caused by trauma. I do not think that he would disagree considering that he wrote a book called Scattered (1999), which talks about the roots of ADD/ADHD as emotional dissociation.

You will have to reference my previous blog on this subject (HERE) to have more of the backdrop of what I am presenting here. This is intended for EMDR/trauma resolution clinicians but believe that anyone would benefit from exploring. Also, before I can give you this update, I will briefly make sense of how addiction, trauma, and dissociation interplay.

“Addiction as Dissociation Model” is what I have been working on for the past year (along with my mentor Dr. Jamie Marich) and have submitted it as a position paper and is currently under review. HERE is a recent blog that we did to highlight some of the main points (O’Brien & Marich, 2019). I believe that this model’s importance is critical to the treatment of addiction because it highlights where addictions fit into the mental health “disorder” paradigm but also because addiction symptomatology can hide in other mental health presentations.

I put “disorder” in quotations because specifically addiction, trauma, and dissociation are normed experiences, meaning that they are supposed to happen given certain conditions and for this reason they are interrelated. Addiction, trauma, and dissociation are inseparable forces of nature because like a stone into a pond (trauma) there going to be ripples (dissociation and potentially addiction). I believe that addiction and dissociation are the same process and that it is the impact of trauma that creates the extremes. Because of this, the root of addiction is untreated dissociation caused by trauma and untreated trauma. We use the definition of “dissociation in trauma” as the operational definition for dissociation (Nijenhuis & Van der Hart, 2011). For addiction, I will use our working definition of addiction as “a manifestation of untreated dissociation and trauma.”

When looking at these three experiences and how they overlay, we have to recognize 3 things.

1) Any life-threatening or adverse life experience, perceived or real, can produce the same symptomatology i.e., trauma and stress symptomatology, 2) that dissociative/addictive states create traumas, 3) and that dissociation always accompanies trauma due to the law of cause and effect.

So I ask, can you have trauma without dissociation? Can you have trauma without addiction? Can you have addiction without trauma and dissociation? Can you have dissociation without addiction?

Here are my answers and rationale for what I am suggesting.

Can you have trauma without some form of dissociation? No, i.e., a stone thrown in a pond is going to create a ripple. It was brought to my attention in a FB group, basically warning me against absolutes, that dissociation does not always happen during a traumatic event because people can consciously experience a traumatic event. I agree that people can be conscious during a traumatic event but this does not mean that a form of dissociation is not present because we can be consciously dissociated. This viewing of an experience sounds more like depersonalization, which is a form of dissociation. Furthermore, there is the concept of co-consciousness that suggests that both can be happening at the same time. Dissociation is not just about checking out momentarily; we can be consciously living dissociated, which can be considered dual attention. This is paradoxical but is essential to understanding dissociation and addiction and this is why parts work is essential to treating addictions.

Can you have trauma without addiction? Yes, you can have trauma without addiction but the trauma is most likely from a natural disaster i.e., an “act of God” as insurance companies call them but ultimately, “God” gives enough warnings before a natural disasters. Staying and not heeding the warnings is a sign of being addicted. “Addiction as Dissociation” explores when we are living dissociatively we are in a state of being addicted. All other traumas that I can think of happen as a result of someone else trying to get their needs met in excessive or maladaptive ways while under the influence of this unmet need (not just a drug).

Can you have addiction without trauma (and dissociation)? No, because addictive behaviors are traumatic/life threatening to the survival reptilian brain and this would produce dissociation as a response. Addictive Memory (Boening, 2001) is traumatic memory and so would produce the same symptoms. Addictions are on the spectrum of trauma and dissociation and what can be inferred is that since dissociation has a normal range of presentations so do addictions and trauma.

Can you have dissociation without addiction? Yes, because there is a normal range of dissociative experiences, however, outside the normal range is where pathological dissociation (Waller, Putnam, & Carlson, 1996) begins and this can be considered an addicted state. Interestingly enough, dissociation is produced by the endogenous opiate and cannabinoid systems in the brain (Lanius, 2014), which suggests that we can become addicted to the processes produced by dissociation and the traumas that cause them (Van der Kolk, 1989).

When conceptualizing “Addiction as Dissociation” we must see that the addictive behaviors are a manifestation of a previous dissociative experience that is manifesting as a re-enactment and/or creating a feedback loop. So, to explore this connection comprehensively with EMDR, by performing a floatback from the first time the client fell in love with the drug or bonded with their dissociation, will produce their dissociation history.

When doing this, what I have found is that clients floatback to early childhood experiences of excessively watching TV, playing video games or sports, eating sugar/food, studying/school, fighting, stealing, or extra-circular activities. Again, these are all done excessively suggesting that they were compensating for emotional abuse or neglect. We can conceptualize these as “small d” dissociations. Also, and more obviously, previous dissociative experiences as a result of traumas or adverse life events. These would be “big D” dissociations which would include any (real, potential, or perceived) medical procedure/illness of the individual or family member or hearing age-inappropriate stories with adult themes or death. More on this last point in the conclusion.

Here is the update… The Set-up

The dissociative response produces a felt experience of numb (the relief moment) that would emotionally be interpreted as safety, stillness, peace, and comfort. Some dissociative responses like fighting and stealing produced a high as well and if that still stays with them then it is a target. Even though it may be in the absence of conscious presence, it is still real to the person experiencing the immediate effects of relief from the subjective experience. Our survival brain would retain these experiences for future survival needs and would reproduce/reenact it as a way of communicating this need to the conscious self.

Temporally, there is a before, during, and after any given trauma. However, I contend that there are really two memories created in the “during phase” i.e., the stone and the ripple. First, is the inescapable shock moment (trauma) and then second is the dissociative response (safety/relief moment). If the dissociative response registers on the Positive Feeling State Scale (PFS) or even if it registers on the SUD scale, then it is the target. If it doesn’t register then it may have been processed naturally or is dissociated suggesting that it is unresolved. It is essential to target this because this is what is being re-enacted or caught in the feedback loop. We can target it by switching the NC and the PC as I suggested in my previous writing.

What we are doing as EMDR therapist is treating the “during” part of the memory when we are reprocessing a traumatic memory (Phases 4 and 5). Typically, when reprocessing the trauma you can get the dissociative moment (the safety/relief moment) as well - but not always. Taking a dissociative history like we do a trauma history is probably not something that most clinicians do regularly so this relief moment is often missed as a component of the client’s treatment. By doing the dissociative floatback it will provide more access to their dissociative profile, provide targets, and provide comprehensive treatment.

We can treat dissociation by targeting the dissociative moment and/or the safety that it provides. This is the memory that we need to target when treating dissociation and also addiction. In reference to my previous blog, how we set this up with our clients is by asking, “Do you remember that moment that checking out felt good or right?” This is the same question for addiction “Do you remember when you fell in love with the addictive behavior or that feeling of numb?” PC: “What does that make you believe about yourself or this situation?” (You will need a greatest hits list for this purpose. Click HERE for Dr. Marich or HERE for mine.) “What do you need to believe about this now (as the adult you)? Then get a PFS (Positive Feeling State) or SUD, feeling, and body sensation i.e., standard protocol.

Conclusion

Addictions can form as a response to trauma but often times linking the addictive behavior to the consequences or treating the trauma does not eliminate the addiction. In cases where addictions are present, we need to treat both the trauma and dissociative response from the earliest ages (even pre-verbal or inter-generationally) and for that we need the Addiction as Dissociation conceptualization. Once that is in place, then we can use trauma resolution methods to treat it. This is what Dr. Marich and I providing. Treating the cravings or triggers is really treating the symptoms of addiction. Often times this leads to the underlying mechanisms of dissociation but to securely say that we have treated an addiction therapeutically we have to resolve both the trauma and the dissociative response.

To me the dissociative response of living dissociatively (this includes re-enactments and feedback looping in the memory system) is what defines active addiction. We cannot separate from trauma from dissociation anymore then we can separate water from the wave. Someone who is addicted (to be fair I believe that bonded is a better word for addiction) to his or her dissociation is going to produce reenactments that are based on emotional logic. See my most recent blog HERE on the subject.

Often times addiction is seen an avoidance tactic. What is the difference between avoidance and keeping one safe? For me, it is our cultural stigma, which inform our negative beliefs. With “Addiction as Dissociation” conceptualization, addictions are more of a survival need for securing a feeling of safety. Clients respond better to this more humanistic approach rather than being told that they are doing something wrong.

Lastly, the power of story cannot be denied or dissociated from. Stories are often our first highs in life. A good story hooks us in and it is that hook that gets us before any addictive behaviors sets in. Our stories are what our survival brains eat for food. It gobbles up the information as facts because it might have to use this knowledge in the future in order to survive but also in order to thrive. I write this last part because you may have to address the glorifying stories that the client has heard or seen from their childhood or saw in media. For example, I have targeted characters from “Dazed and Confused” and “Hunter S. Thompson,” however, more often I have targeted familial stories. Hearing that mom or dad did this or that when s/he was younger suggests to the child listening that this is what s/he has to do in order to be a wo/man or adult. Following in the footsteps of our parents is inevitable but it does not have to be so literally. Ultimately, this is breaking the cycle of addiction, which is essential to truly treating addictions. Stories are our reference material for life, so be mindful of what and how you share.

References

Boening, J. (2001). Neurobiology of addiction memory. Journal of Neural Transmission, 108, 755-765.

Lanius, U. (2014). Dissociation and endogenous opioids: A foundational role. In U. Lanis, S. Paulsen, and F. Corrigan (Eds.), Neurobiology and treatment of traumatic dissociation: Toward an embodied self. (pp. 81-104). New York: Springer Publishing Company.

Maté, G. (1999). Scattered: How attention deficit disorder originates and what can you do about it. New York, NY: Plume.

Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. Berkeley, CA: North Atlantic Books.

Nijenhuis, E.R.S., & van der Hart, O. (2011). Dissociation in trauma: A new definition and comparison with previous formulations. Journal of Trauma and Dissociation. 12:4 (pp. 416-445). DOI: 10.1080/15299732.2011.570592

O’Brien, A., & Marich, J. (2019). Addiction as Dissociation Model by Adam O'Brien and Dr. Jamie Marich. Retrieve https://www.instituteforcreativemindfulness.com/icm-blog-redefine-therapy/addiction-as-dissociation-model-by-adam-obrien-dr-jamie-marich

Van der Kolk, B.A. (1989). The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12, 389-411.

Waller, N., Putnam, F.W., & Carlson, E.B. (1996). Types of dissociation and dissociative types: A taxmetric analysis of dissociative experience. Psychological Methods, 1(3). 300-321.

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