Dissociative identity disorder, or DID, was once called multiple personality disorder. While the condition involves several symptoms like amnesia and additional mental health problems, the most diagnosable symptom is the presence of at least one other personality, referred to as an alter. The alternate personality or personalities appear when the primary individual is under stress, and it takes over to manage the situation. DID is believed to develop as a response to intense psychological stress during childhood, often from violence or sexual trauma.
Substance abuse is more likely to develop in people who struggle with mental illnesses, including mood disorders, borderline personality disorder, obsessive-compulsive disorder, schizophrenia, and dissociative identity disorder. Depression, insomnia, nightmares, anxiety, suicidal thoughts, panic attacks, eating disorders, and mood swings are all symptoms of DID, even though they are also mental illnesses in themselves. A person with DID may suffer from these conditions and also develop a substance use disorder to self-medicate mood problems. Additionally, an alter may have a substance use disorder while the primary personality does not.
When It’s More Than Substance Abuse
We Address & Treat Underlying Co-Occurring Issues
Treating dissociative identity disorder requires consistent therapy in order to reintegrate the personalities and reduce the risk of relapse. When dissociative identity disorder co-occurs with addiction, treatment must address both conditions, as substance abuse can make some symptoms of DID, like dissociative amnesia and stress response, worse.
Treating Dissociative Identity Disorder and Substance Abuse
To treat dissociative identity disorder and substance abuse, certain steps are generally taken.
Step 1: Diagnose both conditions.
Before beginning treatment for dissociative identity disorder, a psychotherapist must appropriately diagnose the individual, based on symptoms. Some of these symptoms include:
- Difficulty maintaining work or relationships
- Dissociative amnesia (wandering or traveling on purpose while unable to remember personal information)
- Other periods of amnesia, typically when an alter takes over
- Episodes of memory loss that are unrelated to other mental health conditions or substance abuse
People who struggle with DID and addiction typically develop DID first, as it is a long-term response to traumatic events in childhood. Substance abuse is likely to develop later in life, as a response to stress caused by DID.
Step 2: Undergo detox.
Ending an addiction to an intoxicating substance requires detox, supervised by a medical professional. The supervising doctor can ease withdrawal symptoms with mood medications, maintenance drugs like buprenorphine or bupropion, or over-the-counter medications to treat physical pain or nausea. The doctor or therapist will also ensure the client remains sober and does not relapse or overdose during the withdrawal process.
Step 3: Participate in Cognitive Behavioral Therapy.
Once a person has received a diagnosis of dissociative identity disorder and successfully detoxed from the substance of abuse, the next step is therapy. There are several types of therapy used to treat both addiction and DID, but Cognitive Behavioral Therapy (CBT) is among the most successful for both conditions. CBT helps the person recognize negative thoughts and destructive patterns of behavior, and address the cause of that behavior based on past experiences. For people who have intense trauma in their past, working toward acknowledging this trauma can take a long time.
People with dissociative identity disorder must also work on integrating their alters into the primary personality. Personality integration and dealing with childhood trauma can take years. During that time, therapy should consistently focus on avoiding relapse into substance abuse.
Step 4: Participate in family and group therapy.
CBT can be part of individual therapy, which is important for people struggling with dissociative identity disorder; however, this style of therapy can also apply to family and group therapy. Both mental illness and addiction damage relationships, so family therapy helps to mend relationships with family and friends.
Group therapy involves peers working together, guided by a therapist or counselor. Group therapy provides social support for people in similar difficult situations. The group helps everyone involved maintain to sobriety, get support they need, and stay on a path of healing trauma.
Step 5: Take medications as prescribed.
There are currently no medications that directly address dissociative identity disorder; however, because mood disorders can occur along with DID due to trauma from the condition and past trauma, antidepressants, anti-anxiety medications, and other mood stabilizers can be helpful to manage stress, which could otherwise trigger a switch to an alternate personality.
Recovery from addictions to opioids, alcohol, and tobacco may involve the use of maintenance medications to help people end their addiction to these drugs and avoid relapse. Alcohol is one of the most commonly abused substances, and withdrawal symptoms can be physically dangerous. If appropriate, clients will receive a prescription for maintenance drugs to stabilize the body while they undergo therapy in rehabilitation. Maintenance and psychiatric medications should never be taken without supervision from medical professionals.