Beyond Craving: Cue-Induced Dissociative State Switches in Substance Use Disorders

Abstract

Participants in studies of cue-induced drug craving have reacted to cues not only by craving drugs, but also by vividly reexperiencing drug-using sensations and perceptions, for example, tasting cocaine in the back of the throat or feeling euphoric. This study investigated whether such cue-triggered reliving (C-T-R) states are common, what subjective qualities characterize them, their relationship to craving, and their relationship to trauma. Questionnaires and a PTSD screening tool were administered to 77 participants recruited from substance use disorder treatment and self-help fellowships, and a comparison group of college students enrolled in human services programs. Questionnaires inquired about the frequency and quality of C-T-R experiences and history of trauma. C-T-R experiences were reported to be very common among persons with substance use disorders (83%) and significantly more common among them than among the normative sample of students (28%). C-T-R experiences tended to consist of clusters of several different state variables, one of which was often but not always craving. No relationship was found with past trauma. C-T-R experiences were often dissociative in nature (e.g., reliving physical sensations, feeling outside oneself watching, feeling as if in a trance). Implications of the findings are discussed.

Keywords: Addiction; craving; dissociation; flashbacks; substance use disorders.