Trauma, Dissociation, and Opiate Use Disorder
- 43 Downloads
Purpose of Review
The objective of this article is to identify the role of opioid use among survivors of trauma and to characterize the dissociative functions associated with this class of substances. More precisely, this paper will evaluate if the biochemical impact of opioid substances, such as heroin, has particular psychological effects on traumatized users, pertinent to their emotional needs.
Reviewed studies demonstrated not only that the vast majority of opioid use disorder (OUD) patients reported a history of childhood trauma but that dissociation played an important role in both the experience of opioid use and abstinence.
Traumatized individuals were more likely to report dissociative experiences during their opioid use (chemical dissociation) and were more likely to report dissociative experiences during abstinence. The small body of literature on the inter-relationship between opioid use disorder (OUD) and dissociation suggests that heroin produces powerful sensations that mimic psychogenic dissociation. It might therefore be employed when posttraumatic distress can no longer be regulated by psychogenic mechanisms and when it is available. Future research should explore if OUD treatment can be more efficient following effective resolution of trauma-related dissociation and underlying posttraumatic psychopathology.
KeywordsDissociation Dissociative disorders Opioid use disorder Substance use disorder Trauma
Compliance with Ethical Standards
Conflict of Interest
The author declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 4.Ross CA, Heber S, Norton GR, Anderson G, Anderson D, Barchet P. The dissociative disorders interview schedule: a structured interview. Dissociation. 1989;2(3):169–89.Google Scholar
- 8.Schäfer I, Langeland W, Hissbach J, Luedecke C, Ohlmeier MD, Chodzinski C, et al. Childhood trauma, dissociation and posttraumatic stress disorder in patients with alcohol dependence, drug dependence or both – a multi-center study. Drug Alcohol Depend. 2010;109:84–9. https://doi.org/10.1016/j.drugalcdep.2009.12.012.CrossRefGoogle Scholar
- 9.Schäfer I, Reininghaus U, Langeland W, Voss A, Zieger N, Haasen C, et al. Dissociative symptoms in alcohol dependent patients: associations with childhood trauma and substance abuse characteristics. Compr Psychiatry. 2007;48:539–45. https://doi.org/10.1016/j.comppsych.2007.05.013.CrossRefGoogle Scholar
- 10.Merlin MD. Archaeological evidence for the tradition of psychoactive plant use in the old world. Econ Bot. 2013;57:295–323. https://doi.org/10.1663/0013-0001(2003)057%5B0295:AEFTTO%5D2.0.CO;2.CrossRefGoogle Scholar
- 13.Fisher GL, Harrison TC. Substance abuse. Needham Heights: Allyn & Bacon; 1977.Google Scholar
- 14.National Institute on Drug abuse (2018). Heroin. Retrieved from https://www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use. Accessed 20 Oct 2018.
- 18.Robins LN, Davis DH, Goodwin DW. Drug use by army enlisted men in Vietnam: a follow-up on their return home. Am J Epidemiol. 1974;99:235–49. https://doi.org/10.1093/oxfordjournals.aje.a121608. CrossRefGoogle Scholar
- 21.Kessler RC, Cram RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-UI-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997;54:313–32. https://doi.org/10.1001/archpsyc.1997.01830160031005.CrossRefGoogle Scholar
- 23.• Horton GH, Diaz N, Peluso PR, Mullaney D, Weiner M, McIlveen JW. Heroin use among individuals who abuse substances in residential treatment. J Addict Offender Couns. 2009;29:81–95. https://doi.org/10.1002/j.2161-1874.2009.tb00047.x This study showed that dissociative symptoms were related to lifetime heroin use. CrossRefGoogle Scholar
- 24.•• Somer E. Opioid use disorder and dissociation. In: Dell PF, O’Neil JA, editors. Dissociation and the dissociative disorders: DSM-V and beyond. New York: Routledge/Taylor & Francis Group; 2009. p. 511–8. This chapter explores the various connections between OUD and dissociation and provides qualitative evidence that people with OUD seek dissociative experiences in drug use. Google Scholar
- 25.Somer E, Abu Raya H. & Nsairy Slimaan. Maladaptive daydreaming among recovering substance use disorder patients: prevalence and mediation of the relationship between childhood trauma and dissociation. Int J Ment Heal Addict. (in press).Google Scholar
- 27.Peles E, Adelson M, Seligman Z, Bloch M, Potik D, Schreiber S. Psychiatric comorbidity differences between women with history of childhood sexual abuse who are methadone-maintained former opiate addicts and non-addicts. Psychiatry Res. 2014;219:191–7. https://doi.org/10.1016/j.psychres.2014.05.003.CrossRefGoogle Scholar
- 29.Somer E, Ross C, Kirshberg A, Shawahdy R, Ismail S. Dissociative disorders and possession experiences in Israel: a comparison of opiate use disorder patients battered Arab women and a non-clinical group. Transcult Psychiatry. 2015;52(1):58–73. https://doi.org/10.1177/1363461514552584.CrossRefGoogle Scholar
- 32.•• Somer E, Altus L, Ginzburg K. Dissociative pasychopathology among opioid use disorder patients: exploring the “chemical dissociation” hypothesis. Compr Psychiatry. 2010;51:419–25. https://doi.org/10.1016/j.comppsych.2009.09.007 The findings of this support the chemical dissociation hypothesis of OUD by showing that detoxified OUD patients had higher levels of dissociation than outpatients on methadone maintenance therapy who still benefit from chemical dissociation. CrossRefGoogle Scholar
- 37.Kianpoor M, Bahredar MJ, Ommizade SJ. Comparing the level of dissociative experience in prisoners with and without opioid dependence disorder in shiraz and its relationship with other psychiatric disorders. Iran J Psychiatry Behav Sci. 2010;4(1):18–22.Google Scholar
- 38.• Kianpoor M, Bahredar MJ, Ommizade SJ. Comparing the level of dissociative experience in prisoners with and without opioid dependence disorder in shiraz and its relationship with other psychiatric disorders. Iran J Psychiatry Behav Sci. 2010;4(1):18–22 This study showed a relationship between dissociative symptoms and heroin use. Google Scholar
- 39.Carlson EB, Putnam FW. An update on the dissociative experiences scale. Dissociation. 1993;6(1):16–27.Google Scholar
- 40.Ghafarinezhad A, Rajabizadeh G, Shahriari V. Relationships between dissociative disorders and personality traits in opium addicts on methadone treatment. Addict Health. 2013;5(1–2):21–6.Google Scholar
- 41.Kianpoor M, Ghanizadeh A, Badiei H. The relationship between dissociative experiences and the success of treatment through abstinence from opioid-use disorders. Zahedan J Res Med Sci (ZJRMS). 2012;14(10):56–60.Google Scholar
- 43.Benishek D, Wichowski HC. Dissociation in adults with a diagnosis of substance abuse. Nurs Times. 2003;99(20):34–6.Google Scholar