What’s New in Psychology?
Dissociation and Substance Use
Jim Windell
One way to cope with a traumatic event is to detach emotionally from it. This psychological defense is known as dissociation.
In effect, dissociation is a psychological escape hatch people tend to use to try to escape from threatening situations. Not only is it a common symptom of PTSD, but it is also utilized by people who have experienced particularly harmful early-life trauma.
Some previous research has linked dissociation with alcohol and substance use. That is, a significant number of people suffering from PTSD also have a substance use disorder. This implies that using alcohol or drugs is a form of self-medication among traumatized people. But what is not so well understood is the relevant pathway or mechanism that is used by those who have PTSD and turn to alcohol and drugs. Understanding more about the pathway from trauma to substance abuse could potentially inform and expand treatment options as well as increase the effectiveness of substance abuse treatment.
A new study, published in Alcoholism: Clinical & Experimental Research, examines dissociation as a potentially influential link between PTSD severity and alcohol-related problems.
For the study, Canadian researchers worked with 334 adults at an Ontario in-patient program for PTSD treatment. The sample was evenly split between women and men, who had an average age of 44. The participants filled out questionnaires on their mental health, alcohol use, demographics, along with self-report checklists assessing PTSD (including four symptom clusters), dissociative symptoms, alcohol-related problems, emotional dysregulation, and childhood adversity. The researchers then used statistical analysis to explore the influence of dissociative symptoms on the relationship between PTSD and alcohol-related problems. They were particularly interested in looking at this relationship in the context of specific PTSD symptom clusters.
The analysis by the researchers revealed that more severe PTSD was associated with heightened dissociative symptoms, and dissociation in turn was linked to greater alcohol-related problems. Looking at a contrasting model, the researchers found that greater dissociative symptoms were associated with more severe PTSD. However, more severe PTSD was not associated with alcohol-related problems. When they put the two findings together, it appeared that dissociative symptoms become a key influence, or mediator, in the relationship between PTSD severity and alcohol-related problems.
As the researchers analyzed specific PTSD symptom clusters, this provided supporting evidence. For instance, alterations in arousal (i.e., hypervigilance, sleep disturbance, etc.), intrusive thoughts and memories, and negative shifts in cognition and mood were associated with dissociative symptoms, which in turn were linked to alcohol-related problems.
This study may be the first study that reveals the unique role of dissociative symptoms in raising the risk for alcohol-related problems among some people with PTSD. It suggests that people with PTSD who experience heightened symptoms of dissociation are at increased risk of self-medicating with alcohol and other substances and may experience more severe alcohol-related problems than people whose PTSD does not involve dissociation.
The implication is that targeting patients’ dissociative symptoms may be a helpful approach in treating PTSD and problematic drinking. The researchers recommend further examination of dissociation’s role over time, including comparing its influence during and in the aftermath of trauma.
To read the original study, find it with this reference:
Patel, H., O’Connor, C., Andrews, K., Amlung, M., Lanius, R. & McKinnon, M.C. (2022). Dissociative symptomatology mediates the relation between posttraumatic stress disorder severity and alcohol-related problems. Alcoholism: Clinical & Experimental Research, 46(20), 289-299.
