dissociation as the goal of being a junkie

In keeping with recent “discoveries” that cannabis and psychedelics can be good for you, it makes sense to ask what opiate users have to say about opiates. “Opioid Use Disorder and Dissociation” is a cool paper by Somer along those lines, included as a chapter in the Big Book O’Dissociation. It argues that, for addicts, the psychological benefit of opiates is that they induce a state that’s a lot like the “normal” depersonalization associated with trauma.

First, they cite a series of studies to claim that PTSD increases the risk for addiction, but not vice verse. Also, childhood trauma is more common among addicts.

Where are the opioid receptors?

Opioid Receptor Distribution
Lutz & Kieffer (2013). Opioid receptors: distinct roles in mood disorders. Trends in Neurosciences 36(3):195–206

Somer lists the locus coeruleus, hippocampus, amygdala, and anterior thalamus in particular. Stress is associated with norepinephrine release, and clonidine treats opiate withdrawal symptoms. Endogenous or exogenous opioids reduce norepinephrine release. Stress-induced analgesia is a well-documented, opioid-mediated phenomenon, and it makes sense that the same opioid release would explain trauma-related emotional numbing.

They talked to addicts about their drug use and identified 4 themes, all of which are consistent with the distribution of mu opioid (“endorphin”) receptors:

1. Amnesia.

Heroin helps me forget the pain in my life. Soon after the injection I feel I can stop thinking about the troubles…the horrible memories…without heroin I couldn’t leave home. I was simply too overwhelmed.

…my daily problems with bills and my family become so small I could hardly care about them. They just fade away.

2. Suppression of posttraumatic arousal symptoms.

After I shoot up, the anger doesn’t bother me anymore. It’s like I disconnect it. I turn it off. Maybe it is still there, but I am elsewhere, unbothered by it.

I am constantly on edge. On guard. As soon as I get high I, umm…nothing bothers me anymore. I can calm down and it’s like I am able to deal with many of those fears much better…sometimes I also get the feeling that nothing scares me anymore. It’s such a relief to be able to unwind from all my stresses and get a real break from my tensions…it sure beats sleep.

3. Numbing, depersonalization, derealization.

I hate my sexuality, my sex drive makes me sick…When I’m high I am not in touch with my real sexual drive. I prefer it that way.

I can disregard my emotions when I am on the drug. I couldn’t care less about myself because I hardly felt myself. It is pretty awful to be myself you know…I’d rather not feel the stuff that makes me feel so bad, the sadness and the emptiness, those endless internal quarrels. This white stuff helps me not to feel my depression, I can ignore all the threats and the dangers in this fucking world they don’t even seem real anymore, I couldn’t give a shit about nothing. This world is full of all sorts of creeps who always want to fuck you or hurt you. When I was on the drug, they could take my body and do what they fucking pleased with it. I wasn’t home.

4. Soothing, gratifying pleasure. [obvious]

This is a depressing quote even for the type of things that I read:

Moreover, a few survivors that were recovering from their addiction assigned benevolent nurturing human qualities to the drug. This was a sad testimonial to the emotional emaciation of these individuals.

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