Opioids, Dissociation, and PTSD – The Shocking Connections

Post-traumatic stress disorder can make a person feel disconnected from the world. When I was diagnosed with PTSD, I finally had something that helped explain why I didn’t understand myself and why I had an overwhelming urge to alter my perception with drugs. Right before I got sober, my journals filled up with entries that could probably be used in a psychology class to teach future therapists what their patients might be thinking.

I wanted no one to care about me, but I also wanted to feel a connection. I didn’t know if I wanted to rebel and be wild or if I wanted to exist in a vacuum of solitude. I didn’t know why I made certain choices, why I had certain thoughts, it seemed like I kept making outrageous choices contrary to how I consciously thought. I knew I shouldn’t drink and I knew I should be honest, but I couldn’t seem to reconcile all the pieces of myself. My substance use and abuse provided me with an excuse for my disconnected feelings. I still am struggling to understand my post-trauma identity.

Post-traumatic stress disorder puts people at risk of developing addictions. Opioids play a critical role in the biology of PTSD. Endogenous opioids naturally occurring in the human body are different in people with trauma disorders. Opioids, such as morphine, have been found to produce the same effects as spontaneous dissociation. In Judith Herman’s book Trauma and Recovery: The Aftermath of Violence she says endogenous opioid regulation is altered significantly by trauma and that “traumatized people who cannot spontaneously dissociate may attempt to produce similar numbing effects by using alcohol or narcotics.”

Dissociation is a natural protective measure that the brain develops to cope with distressing events. Childhood trauma is common among those with dissociative disorders, although it isn’t only childhood victims who suffer from dissociation. Most of my significant trauma occurred in my mid-20s. Dissociation is not due to a separate medical condition or brain injuries. It works as intended during the actual trauma, but when it occurs in other situations it can be a disruptive and debilitating maladaptation.

Dissociation is an experience akin to suspended reality. Many people describe it as feeling disconnected from their body and the rest of the world. Someone who is dissociating may be unable to move or speak. Other symptoms include amnesia, confusion about your own personality, taking on different identities, feeling as if life is being lived around you and you are just a spectator outside of your own body. I recently had a flashback followed by dissociation, during which I couldn’t speak and felt like I wasn’t in my own body even though I was also stuck inside my head.

In the 19th century, the psychologist Ernest Hilgard was interested in hypnosis. In his research, he discovered that consciousness levels shift during hypnosis and that cognitive functions are split while one part of the mind goes solo to carry out functions independently. Hilgard called this psychological state “divided consciousness.” Hypnotic responses in the brain are comparable to dissociative reactions and Hilgard theorized that hypnosis was a highly-controlled form of dissociation.

Brain imaging and neurobiological research explains that distinct areas of a posttraumatic person’s brain, such as the locus ceruleus, activate with triggering stimuli. The locus ceruleus is in the brainstem and is involved in the body’s response to stress. In this area, there is a high density of opioid receptors. When the brain senses danger, natural opioids are released en masse and normal opioid receptor binding is affected. In people with PTSD, this continues long after the end of the stressful event. What this does is reduce sensitivity to physical and emotional pain. It’s what happens in the brain during dissociation.

Opioids create a dissociative state where emotional responses are altered and pain is numbed. When scientists tested stress responses in already-stressed animals, they discovered that the animals became desensitized to stressors because endogenous opioid production automatically kicked into high gear. Scientists successfully reversed the numbing effect with the use of naloxone. Animals that are put under constant duress seem as if they are on an opioid like heroin. Scientists also observed animals reacting like addicts in withdrawal when an opioid blocker was used to disrupt the flow of natural endogenous opioids.

EMDR, or Eye Movement Desensitization and Reprocessing, is a therapeutic technique to help people who have experienced prolonged and severe trauma. The eye movement is theorized to work similarly to REM sleep, reshuffling and correctly organizing memories so they become less intrusive. Like hypnosis, EMDR is connected to endogenous opioid production. Patients who undergo the therapy EMDR are sometimes monitored for natural opioid production and have even been put on opioid blockers to reduce the numbing effect of the opioids and allow the reprocessing of memories.

I am undergoing EMDR therapy as part of my treatment program. I didn’t begin EMDR until I had over two years of therapy where I learned critical coping skills. My therapist will sit opposite of me and move her hand from side to side as I follow it with my eyes going left to right. It sounds like a gimmicky carnival act but it works. We go through series of these movements, each one beginning with me focusing on an upsetting memory. As I move my eyes I am supposed to allow the thoughts to pass by, then we discuss what I experienced. Sometimes I experience dissociation during EMDR sessions, where I feel as if my body is physically manifesting memories before storing the stress in a more comfortable location. I am part of a recovery group for my alcoholism and I see both a psychologist and a psychiatrist regularly to work on my PTSD. I know that one disorder could not be treated without also addressing the other.

Co-occurring disorders have long been recognized as needing multiple treatment methods. When only one of the disorders is targeted in treatment, people are more likely to relapse. However, recovery communities don’t always disseminate information on the interconnectedness of substance use disorders and PTSD. If someone with this comorbidity is lucky enough to get a bed at a rehab covered by insurance, they are mainly going to be treated for their addiction and not their PTSD. Connecting the dots of opioid dependence and trauma could shed light on how to help those who suffer from both trauma and substance use disorders.

Originally published on The Fix