Self-medication, traumatic reenactments, and dissociation: a psychoanalytic perspective on the relationship between childhood trauma and substance abuse

This article explores the relationship between developmental trauma, dissociation, and substance abuse within the framework of the self-medication hypothesis. By means of presenting a clinical vignette, the article illustrates how substance abuse can serve as a maladaptive coping strategy for managing overwhelming emotions that stem from traumatic experiences in attachment relationships during childhood. Individuals who have undergone developmental trauma may dissociate negative attachment memories and their related emotions, which consequently leads to compartmentalization of their internal states and hinders their self-regulation abilities. In such scenario, substances can act as external regulators of distressing emotions, distancing these individuals from their traumatic memories and facilitating the adoption of an omnipotent and self-reliant attitude. Hence, it is of utmost importance for clinicians to accurately identify and address the self-medication needs of these individuals. This is fundamental in facilitating these clients' capacity to acknowledge, explore, and integrate their distressing memories as intrinsic elements of their identity, thereby fostering the development of a unified and cohesive self-concept.