Addiction is a dissociative response. Sounds like common sense, right? For many years we’ve operated in our practices fueled by this assumption. As individuals in personal recovery, the link between unhealed trauma/dissociation and addiction has been blatantly obvious. Even when we share our work with people on developing this new model of Addiction as Dissociation, we are met with a great deal of, “Well yeah, obviously.”
Yet the reality is that no contention in the literature has been directly made addressing this link… until now. The connection between unhealed trauma and addiction has been well asserted, with giants in the field like Gabor Mate, Bessel van der Kolk, and many others speaking to this link. What about dissociation? Dissociation comes from the Latin word meaning to sever. When an experience or a moment becomes too overwhelming for a person’s system to handle, we have a tendency to sever from that present moment, or from our core self. Dissociation is a very normal response of the brainstem that can activate when we are met with overwhelming distress. Dissociation can be adaptive (e.g., spiritual pursuits, proper use of guided imagery, daydreaming, the Netflix binge when you need to decompress) or maladaptive. When the manifestations of dissociation are maladaptive, they are likely to cause functional impairment. The various signs and symptoms of addictive responses can be examples of this phenomenon. Moreover, maladaptive manifestations of dissociation result when traumatic experiences or stressful events have not been processed and reconsolidated.
Both of us have been working very hard in 2019 to scour the literature and create a model that we are now calling Addiction as Dissociation. Regardless of your adopted stance on addiction (e.g., a disease, a response to trauma) or whether you even like the word (i.e., you may prefer behavioral compulsivity), this model will likely be relevant to your practice. We’ve prepared a table version of the model that you can examine in this blog. You are welcome to share it and we also value your comments on what resonates and what may still need refinement. Our scholarly paper that fully supports the contentions and flow of the model is currently under review and we will keep you posted about the more formal debut of this model to the world.
When I first started to use EMDR with my clients, particularly with more complex cases, there seemed to be more that needed to get done before trauma processing. There needed to be more resourcing but also something that is able to touch a deeper trauma that is inside of our clients. Shame is usually the culprit.
Mason (2013) stated that, “shame safeguards the spirit.” When shame is our reality, we don’t feel good about ourselves. Shame is generally learned from experiences in our most vulnerable developmental years. However, since memories can be moved/restored through the process of memory reconsolidation (Ecker, Ticic, & Hulley, 2012), our reality is subjective to the meaning we give it. This teaching may question our foundation of what composes our reality. Even more to the point, it calls into question the very essence of who we are.
In the Institute for Creative Mindfulness EMDR therapy training, we explore the client’s trauma targets using a thematic approach. Addressing traumas in a thematic way allows the client to address what they believe and how they feel about themselves in order to rewrite, renew, or own their story. Because of this, anything can be targeted with EMDR, if it holds adaptive or maladaptive value and the client can emotionally access it. However, what about the experiences that are there but not recognized consciously or that started before narrative or declarative memory developed in the brain?
Let me first acknowledge the difference between what I am presenting and Paulsen and O’Shea’s (2017) “When There Are No Words” protocol. Paulsen and O’Shea’s stance is that their protocol “reset the hardwired neuro-affect circuits” and this is done in Phase 2 Preparation. What I am presenting here is an option for clinicians who are not trained to do “When There Are No Words” (or are having difficulty following the nuances of protocol they downloaded off the web). Paulsen and O’Shea’s protocol can be helpful for clients; however, I also believe that accessing implicit memories through what I am suggesting holds additional value on two levels. One, it is a good and safer place to get “buy-in” from a client, and two, if it does not go as we would hope, it can be “diagnostic.” I want to gain access to my client’s earliest wounds. What I am proposing is more of a “Phase 2.5” intervention that links Phase 2 and the reprocessing Phases 3-6 (Marich, 2019). This intervention allows clinicians to address our client's preverbal schemas with any and all thematically shame-based core belief clusters because this is actually where the cluster begins.
Shape and Color Set-up: While taking clients trauma history (Phase 1) and assessing core beliefs (Phase 3), I am looking to put their core beliefs in two categories: shame-based (i.e., I am bad, I am worthless) and fear-based (i.e., I am in danger, I am powerless) core beliefs. Before floating back on a core belief I will ask, “Do any of these shame-based beliefs just feel like they have always been there?” (I will either ask this during Phase 1, Client History or Phase 3 Assessment.) Nine times out of ten, clients will identify a shame-based negative cognition. If the clients pick a fear-based cognition like “I am in danger,” I stay away from it because it is most likely linked directly to an event that can be directly recalled and I am not trying to have them start reprocessing a direct memory. If this happens, I will guide them towards a shame-based core belief.
After resourcing in Preparation (Phase 2), assessing targets (Phase 3), and establishing some kind of stop signal, I then have the client create a target of the core belief felt-sense by asking, “What shape and color would represent this ‘has always been there’ belief?” Once the client has the image (and negative cognition) then it is standard protocol time (i.e., Phases 4-7 and Phase 8 in the next session). Future template can be done but I feel that because I am priming the pump and that there are declarative memories still to go, I wait until I see how the client responses to the process and do future templates with memories that are able to be recalled.
Rationale: I am trying to see what is going on under the hood and also preparing their memory system for reprocessing shifts. My reference to the shape and color or image comes from Mark Grant’s work on pain management (1995). Paulsen and O’Shea also use this strategy; they do not, however, want you to activate the client. My position is that if we are addressing the client’s schema, that they are feeling all the time, they are already activated. Again, I suggest doing this on shame-based themes and not fear-based ones because I believe it is safer and the client is less likely to activate actual memories. However, activating shame-based memories does happen. In this case, I will guide them back to target or go back to resourcing. If the client has too much shame then the standard practices of creating some distance between the client and image, having the client pendulate, or taking only doing a fragment is advised. To further support my position, if the theme carries a high SUDs, which it normally does, Shapiro (2018) suggests doing a more intense early memory first because if they can do this, then they can handle whatever else is to come. Lastly, and for obvious reasons, this is actually the start of the cluster.
Buy In: Starting with a shape and a color allows the client to test-drive reprocessing. When clients open up to reprocessing they are opening themselves to their own healing. When that positive shift happens, they have experienced something that is effective and they will have more buy-in into their treatment. When, as the clinician, we express that it is a more indirect way of reprocessing EMDR, it implies that we are starting someplace safer. Clients appreciate this. Also, since their core beliefs are something that they already feel and live with on a daily basis they are familiar with it and okay talking about this more than their traumas. Once they have seen a shift in this, then now know and have direct experience that EMDR therapy works for them.
Diagnostic: Doing this is also a good test run to see if the person is able to do the deeper work and can be diagnostic in the sense that you get a feel for the clients protective/dissociative system and their level of preparedness on an unconscious level. Ideally, this is assessed in Phases 1-3 of EMDR but it is not always apparent on an unconscious level. Obviously, we need to have rapport, do assessments like the DES (at a bare minimum), and use our clinical judgment but it is not always obvious how someone’s unconscious will respond. If the client picks a shape and a color that goes from dark to something light and has freed something in them or they feel lighter, then chances are they are ready to do the deeper work that they are coming to us for. Additionally, they now have direct experience with feeling a shift in their emotional body, particularly with something that feels like it has always been there, again, we get a lot of buy-in.
As clinicians, we also get a lot of information regarding diagnostics if the client cannot remember their early childhood and/or by seeing if the client can do calm/safe place or container. If they cannot do this effectively then there is more going on in their dissociative process that is worth discussing with them (Paulsen, 2009). I started doing the Color and Shape Set-up before having the Dissociative Table (Paulsen, 2009) as a tool in my EMDR toolbox. I now will start with the dissociative table, O’Shea and Paulsen’s “When There Are No Words,” and then this Color and Shape Set-up, when appropriate.
Observations: The shame color/shape/image is usually dark. When reprocessing goes well, people get to a bright and lively color and/or translucent image. Sometimes, it just disappears. When it does not go “right” the image usually stays the same and clients will say, “it does not feel like it is going to move.” This is clinically telling and potentially diagnostic so more psycho-education and resourcing may be needed. Yes, some clients will have the wherewithal to identify that “it has always been there” or “I just feel it.” This insight may indicate where they are at in their readiness to do deeper reprocessing. This suggests to me that they are highly attuned to their body and are already primed to do EMDR or trauma reprocessing.
Generalization: Generalization is when the client starts to reprocess all of the thematic memories in a cluster (Ecker, Ticic, & Hulley, 2012). This happens because once a core belief is resolved in an earlier memory the lesson learned is applied to other similar situations. Since the brain works through making associations, any association can connect to the neuro-network that rides this theme is going to be impacted, hence has the opportunity to be reprocessed. If the client is consciously and unconsciously open to healing then they are going to do a great deal of work starting in this way.
Populations: I particularly love doing this with people are addressing their addictions because they are usually living in their right-brain processes. This also goes for people who are creative and children between the ages of 2-12 respectfully. Highly motivated adolescents respond well but other adolescents find it weird. Similarly, I like doing this with personality disorders as well because it gives them the opportunity to allow shifts to happen, and/or challenges them if it does not. It provides experiential material to work on. For more left-brained people, it can be a challenge but it gives them the opportunity to connect to their more emotional side.
Healing Light: Also, consider that this can be done in combination with healing light. I will have clients get their SUDS down to a like 2-3 and then I will perform the healing light or Light Stream on the remainder. I have witnessed some very spiritual and religious experiences by doing this.
Target Order: When I do a floatback and get the earliest memory if it is not between the ages of 2-5, I have my client’s try and float further back. Because of what I am purposing, with regard to schemas and shame-based beliefs, it is implied that the earliest recall memories are going to be represented around the chronological ages of 2 to 5. Our expertise that tells us that the schemas started before the age of 2.
Clients are coming to us for our expertise on the therapeutic process and trauma etiology, which can conflict with letting the client lead or decide what memory to do first. If I have a client who wants to address something more recent or only one specific memory then I will have them try the Color and Shape Set-up first as a test run. Similarly, if there is no discrete memory (Greenwald, 2007) or test run memory to do, I also do this. There are times when having the client lead or pick a memory that they want to work on can be effective. Allowing the client to lead the selection of targets without any guidance, however, can be what creates more work later. So, we have to have a good case conceptualization in order to maximize the outcomes of healing and our conceptualization has to be based on trauma-informed care, which means to me, safety first. What this writing ultimately comes down to is that traumas are compounded in the memory network because our neuro-networks are associative and by previous traumas so starting off at the earliest is the safest and will be more likely going to produce better outcomes (Greenwald, 2007).
Feel free to contact me for individual consultation or attend my weekly group on Friday’s 12-2pm EST.
Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.
Grant, M. (1995). From https://emdrtherapyvolusia.com/wp-content/uploads/2016/12/Mark_Grants_Pain_Protocol.pdf Retrieved on 2/8/19
Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. Binghamton, NY: Haworth Press, Inc.
Marich, J. (2019). EMDR Therapy Phase 2.5: Honoring a Wider Context for Cnhanced Preparation. [Blog Post] Retrieved from https://www.instituteforcreativemindfulness.com/icm-blog-redefine-therapy/emdr-therapy-phase-25-honoring-a-wider-context-for-enhanced-preparation-by-jamie-marich-phd-lpcc-s-licdc-cs-reat-ryt-200
Mason, M. (2013). Women and shame: Kin and Culture. In. Claudia Bepko (Ed.), Feminism and addiction (pp. 175-194). New York, NY: Routledge
Paulsen, S. (2009). Looking through the eyes of trauma and dissociation: An illustrated guide for EMDR therapists and clients. Bainbridge Island, WA: A Bainbridge Institute for Integrative Psychology Publication.
Paulsen, S., & O’Shea, K. (2017). When there are no words: Repairing early trauma and neglect from the attachment period with EMDR Therapy. Bainbridge Island, WA: A Bainbridge Institute for Integrative Psychology Publication.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures (3rd ed). New York, NY: Guilford Press.
As a trauma and addiction clinician and a person in long-term recovery from my addictions, I recognize my, and the clients I serve, need to answer the question “what is addiction?” I find that most people struggle with making sense of addiction initially because it is often paradoxical but when I share my perspective on addiction, people readily and agreeably understand. So, this led me to the question of “Can Addiction be Made Simple?” In my quest to answer this rather large question for myself, (before heeding Dr. Jamie Marich’s warning in her chapter “The Addiction Imperative” from Trauma Made Simple (2014) that she has seen many people go down as a result of chasing this answer), I found that simplifying addiction through philosophical understandings and reframing the psychological symptoms of addiction through a trauma-informed perspective offered the answer that addiction is a series of stuck memories i.e., trauma. As a result of this finding, it is clear to me that addiction and trauma are inseparable because they are a part of the same process.
As I began to better understand trauma and how the memory systems work in the brain and mind, I saw addiction present itself in a way that was relatable. I believe the journey I took to answer this question and the conclusions I have drawn will help others define addiction for themselves but also provide insight into how we conceptualize, categorize, and diagnose mental health disorders.
From a philosophical point of view, the question of “what is addiction?” revisits the age-old question, “Is the essence of human nature good or bad?” In the ever-telling pursuit of truth, the answer lies in the journey as the philosopher sits patiently and waits to have you quantify two extremes. “Who is asking the question?” the philosopher asks while waiting to observe a spark of enlightenment. Any two extremes exist in contrast to one another; hence they are a part of the same process. For example, night and day are relative to the observer and the truth of the answer lies in timing of the question. Pain and pleasure, an obvious example of opposites, are understood by reference to one another. This is illustrated in the Taoist concept of Mutual Arising and the Buddhist concept of Dependent Origination (Watts, 1975). Both of these concepts imply that you cannot have one without the other - if one ceases to exist, so does the other i.e., existence and non-existence must co-exist.
Here we enter into the paradox of addiction. What feels good is actually bad. The addicted person’s “choice” to pursue a course of action that is ultimately harmful isn’t logical! The person who is addicted and the outside observer understand addiction from different perspectives. Both understandings are right since the context of each perspective is important for shaping the ways in which we come to define, know, and treat addiction: The person who is in an addicted state is much more feeling or emotionally oriented, while the outside observer is more focused on the illogical nature of the outcomes. These are often the result of short-term vs. long-term thinking, hence adding to the dualistic nature of opposites.
Addiction’s Paradox in the Brain
These two perspectives come from different sides of the brain. The left side of the brain houses logical processes that use verbal language and the right brain houses emotional processes that use non-verbal communication (Siegel & Bryson, 2011). The different sides of the brain speak two different languages and represent the argument of “choice or disease.” The choice argument, associated with the logical or left side of the brain, is correct in saying that there is a choice in any behavior. But I had to ask myself, where does the brain get the information to make those choices? The answer lies in memory systems, which include our unconscious reptilian brain. The reptilian brain has one mode and primary function: survive by any means necessary and is only interested in short-term outcomes. Survival needs include staying alive in dangerous situations (pain) as well as ensuring that procreation happens (pleasure). The fact that pleasure is a survival need means that pleasure is a main motivator for addictive behaviors.
Survival mode fluctuates due to environmental stresses and stimuli, but also it is not alone in processing information. There are higher levels of brain functioning like decision-making processes that take place in the neo-cortex and mid-brain and with which the survival brain must communicate. However, when the survival brain is activated, it dominates the higher levels of functioning by controlling the information through regulation of the blood flow in preparation for fight, flight, freeze, or appease when a perceived danger or opportunity for pleasure is present. So, the innate drive to survive is what informs our decision-making process or “choice”, particularly when confronted with danger or our need to satiate with pleasure to ensure procreation.
So what are the physical and psychological symptoms of addiction (pleasure)? Intrusive reminders, dreams about the experience, mood irregularities based on whether or not the pleasurable experience is going to happen, strong emotions related to everything, and distorted beliefs about anything and everything… “Wait a moment, trauma, is that you? It is like I am looking in the mirror and it is me but not me.” “Yes. It is me, trauma. I have been hiding in addictive behaviors.” So, trauma and addiction are a part of the same process and that is why I say that addiction is trauma (in its positive form and relative to the observer). Conversely, I can also say that trauma is addiction but will have to save that twist until the end.
In order to see how addiction is traumatic, we have to see beyond the idea that addiction is a choice (which ultimately implies fault and produces the stigma of addiction) and the disease argument. These are not the only options. If we attempt to observe addictive behavior without the “addiction is a choice or disease” framework, what is happening? The body is being injected with poison, smoke is in the lungs, neurological systems are being physically stressed by being overloaded and flooded with neurotransmitters, or one is drowning oneself with something flammable – the survival of the organism is being threatened and it likes it. The body remembers experiences like chicken pox or environmental toxins because it might have to defend itself again, just like it remembers the addictive behavior and the effects of the behavior as means of survival. In this sense the body is practical and functional in performing this neutral action and as Deb Dana (2018) points out, the autonomic nervous system does not calculate “good or bad” it just performs its obligation to survival. With respect to understanding addiction as a disease, we must see how addiction behaviors produce trauma in the organism and create traumatic memory. At a symptoms level, active addiction is more reflective of Acute Stress Disorder (ASD) or Post-Traumatic Stress (PTSD), which boils down to unresolved traumatic memories (Shapiro; 2001, ver der Kolk, 2014; Ecker, Ticic, & Hulley, 2012).
Body and mind meet when memory is formed or accessed. Both the body and the mind access memories to guide their decision-making process and when these experiences are referenced; this is what informs the decision-making process. There are different types of memory and they perform different tasks with different responsibilities to help us get through the day. What in our understanding is not based on memory? Genetics, language, and the entire universe are all series of events, remembrances, and links in a chain connecting the present moment to the past. Both trauma and addiction create stress in the body and mind. Positive stress is still stress. Biological symptoms of addiction speak to withdrawal, cravings, and triggers but these can be understood as physical manifestations of PTSD symptoms because bodily operations and responses are a form of memory. Yet if there is a disconnect between the higher and lower functioning’s of the brain or the lateral exchange of logical and emotional content then there is going to be dysfunction. So, fundamentally addiction should be understood as a manifestation of PTSD. Moreover, Addiction and trauma can be understood as two poles on the spectrum of dissociation
Dissociation is the Relationship Between Addiction and Trauma
Van der Hart, Nijenhuis, and Steele (2006) cite Pierre Janet’s early observations from 1887 that dissociation is a “division of the personality or of consciousness” and that these include “systems of ideas and functions that constitute personality (2006).” In essence, dissociation is the process of disconnecting from the conscious or present moment due to a stress and acts as a defense mechanism for the “personality.” Both addictive behaviors and occurrences of trauma induce dissociation due to the impact on the state of consciousness that occurs during the response or act. The types of events and frequency ranges from a single incident to way too many to count, so they can be seen as on a spectrum as well. Ross (2013) sees PTSD as on a dissociation spectrum but does not identify addiction as on the spectrum of trauma-related dissociation. Yet Ross and others miss the point that the body is neutral when a toxin, which creates a trauma, invades the body, mind, and memory system. To include addiction on this spectrum, even if it is induced-dissociation (which I think that there is more to it then just that), means that we have a fuller picture of our pathology and of human behaviors like self-harm, sexualized behaviors, all forms of abuse, dependent issues, obsessive-compulsion, suicidal ideation, eating disorders, perfectionism, entitlement, abuses of power, and personality disorders.
I propose, as Ross suggests (2013), that trauma is really on a dissociative spectrum but I would also like to include addiction-induced dissociation because the impact is similar on the psyche i.e., Dr. Jekyll and Mr. Hyde as different aspects or parts of the personality emerge when under the influence. All addictive behaviors mimic existing states in the body and mind (Inaba & Cohen, 2007) and so dissociative states are going to be produced in addictive behaviors. This is why I believe that we should be focusing on trauma and dissociation when understanding, treating, or making addiction simple enough to understand.
Traumatology has provided a roadmap for categorizing mental health disorders. I feel that a better understanding addiction would lead to a similar understanding, i.e. would create more space for trans-diagnostic treatments. Over the past two decades, Traumatology and Trauma-Informed Care has greatly increased our understanding of trauma but has not identified one core ingredient as its cause. We still must ask, under what conditions do most traumas occur? I would suggest that our addictions (being in a state of trying to satiate unmet survival needs via harmful behaviors) are an answer to that question. Here we can see the intimate relationship between trauma and addiction, wherein addiction is a function of trauma, and the core ingredient of trauma can be understood in terms of addiction. This is why our human drama unfolds the way it does. We become addicted to our stories and our stories become addicting and create the traumas from which we can heal. At its core, our addictions are wants labeled as needs. The results of trying to get our mislabeled needs met, we creates trauma. Our addictions are traumatizing to society and culture and represent a major disconnection between our logical and our emotional world.
To make addiction simple, we simply need to look at it as if it were a trauma because they are a part of the same process. To redefine addiction in this light we see that it is the relationship between trauma and addiction that needs to be defined and determined whether or not it is healthy for ourselves. When we define addiction accurately and categorize it appropriately we find that it is traumatic and produce ASD/PTSD symptoms and dissociation. Luckily we have effective treatments for addressing both, we just need more clinicians experienced in treating all three.
Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. New York, NY: W.W. Norton & Company.
Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.
Inaba, D., & Cohen, W. (2007). Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Sixth Edition, Medford, OR: CNS Publications, Inc.
Lanius, U., Paulsen, S., & Corrigan, F. (2014). Neurobiology and treatment of traumatic dissociation: Toward an embodied self. New York, NY: Springer Publishing Company.
Marich, J. (2014). Trauma made simple: Competencies in assessment, treatment and working with survivors. Eau Claire, WI: Pesi Publishing & Media.
Ross, C. (2013). Structural dissociation: A proposed modification of the theory. Richardson, TX: Manitou Communications, Inc.
Siegel, D., & Bryson, T. P. (2011). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. New York, NY: Bantam Books Trade Paperbacks.
Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. New York, NY: Guilford Press.
Watts, A. (1975). Tao: The watercourse way. New York, NY: Pantheon Book.
Adam O'Brien LMHC, CASAC (EMDRIA Approved Consultant through ICM) - is a Licensed Mental Health Counselor and Credentialed Alcohol and Substance Abuse Counselor in New York State. He is in the certification process to become a Certified Expressive Arts Therapist with Dr. Jamie Marich. Located in Chatham (Albany/Hudson area) where he maintains a private practice. In his writings, he is actively seeking to destroy the stigma of addiction.
Institute for creative mindfulness
Our work and our mission is to redefine therapy and our conversations are about the art and practice of healing. Blog launched in May 2018 by Dr. Jamie Marich, affiliates, and friends.