Trauma, dissociation, and addiction - Essential facts for public policy and effective treatment

By: Tom Cloyd

(Published: 2026-07-12:2343; reviewed: 2026-07-12:2343 Pacific Time (USA))

addiction and despair

Photo by Art Institute of Chicago on Unsplash

 

Addictions are a group of disorders much afflicted by misperceptions, inappropriate social and governmental responses, factual distortions, and outright lies.

As an example of the widespread confusion we must deal with, in the Preface to the DSM5-TR, it is noted that "'Dependence' has been easily confused with the term 'addiction' when, in fact, the tolerance and withdrawal that previously defined dependence are actually very normal responses to prescribed medications that affect the central nervous system and do not necessarily indicate the presence of an addiction."1

If we are to act with compassion for those struggling with addictions, It is critical to know and respond to the fact that trauma, dissociation, and addiction are often found in close association.

Some important facts:

  • In the U.S. general population, about ~9.35% of individuals in any 12-month period have a substance use disorder (SUD).2
  • Among people with PTSD, comorbid SUD is present in roughly 20–35% of the clinical population — several-fold higher than the general-population SUD rate3.
  • In SUD treatment settings specifically, 30–60% of patients have comorbid PTSD.3
  • A 2024–2025 systematic review of dissociative experiences and SUD after childhood trauma found dissociation mediates the pathway from childhood adversity to adult substance use across multiple recent studies (2016–2022), supporting the self-medication/structural dissociation model clinically.4
  • A reanalysis of the National Comorbidity Survey Replication examined pathological dissociation and found it associated with substantially elevated rates of comorbid psychiatric and substance use conditions relative to non-dissociative respondents, reinforcing the fact that dissociation itself (not just full-syndrome DID) has distinct associations with addiction risk5.

(NOTE: This brief article is a work in progress and will be further developed.)

Notes ^

  1. American Psychiatric Association (Ed.). (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (Fifth edition, text revision). American Psychiatric Association Publishing. /Library. https://ia800804.us.archive.org/6/items/dsm-5-tr_202412/DSM-5-TR.pdf. p. xx1v. ↩

  2. Grant, B. F., et al. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders. Archives of General Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527250/ ↩

  3. Gender-Based Analysis of PTSD in Addiction. (2025). medRxiv. https://www.medrxiv.org/content/10.1101/2025.09.25.25336653.full.pdf ↩↩

  4. Dissociative Experiences and Substance Use Disorder in Adulthood After Childhood Trauma: A Systematic Review of the Literature. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12923189/ ↩

  5. Simeon, D., & Putnam, F. (2022). Pathological dissociation in the National Comorbidity Survey Replication (NCS-R): Prevalence, morbidity, comorbidity, and childhood maltreatment. Journal of Trauma & Dissociation, 23(5), 490–503. https://doi.org/10.1080/15299732.2022.2064580 ↩

 

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