Attachment and Substance Use Disorders—Theoretical Models, Empirical Evidence, and Implications for Treatment

Abstract

introduction: The article reviews attachment-oriented research in individuals with substance use disorders (SUDs). Based on attachment theory, substance abuse can be understood as "self-medication," as an attempt to compensate for lacking attachment strategies. Attachment theory suggests a developmental pathway from insecure attachment to SUD and, on the other hand, a negative impact of substance abuse on attachment security. Earlier reviews have indicated a general link but have been inconclusive with regard to other aspects. In the light of a growing body of research, this review is looking for evidence for the general link, for its direction, for differences due to different patterns of attachment, different substances and severities, comorbid psychiatric disorders, and age groups.Methods: Using medical and psychological databases, 34 cross-sectional studies, three longitudinal studies, and a systematic meta-analysis were identified. Methodological problems such as poor assessment of SUD and the use of different measures of attachment limit comparability. Results:All cross-sectional studies in the review confirm a link between insecure attachment and SUD. Results of longitudinal studies show insecure attachment to be a risk factor for SUD, while continued substance abuse impairs the ability to form close relationships. With regard to specific patterns of attachment, results mainly point toward very insecure patterns. They indicate different patterns of attachment in different groups of substance abusers, suggesting different developmental pathways. Fearful-avoidant attachment was frequent in heroin addicts, while alcohol abusers displayed more heterogeneous patterns. Comorbid mental disorders and severity of SUD seem to be important factors, but data are still inconclusive. The link between insecure attachment and SUD seems to be stronger in adolescence compared to adulthood.Discussion: The last decades have seen a substantial growth in studies on attachment and SUDs. Despite methodological problems, the general link between insecure attachment and SUD today is well established. Attachment theory might contribute to

Attachment-Based Family Therapy for Adolescent Substance Use: A Move to the Level of Systems

“…At the point of referral, the typical situation is one of breakdown in the major attachment relationships across the family. This is consistent with the empirical findings of a bidirectional relationship between attachment insecurity as both an antecedent predictor of substance use disorder, but also that substance use induces further deterioration in the quality and functioning of close relationships (54). In some cases, there is strong intergenerational transmission and one is dealing with the adolescent offspring of parents with a history of substance abuse (64).…”

“…These include findings of a strong association between preoccupied-enmeshed and substance use in a sample of orphans (57). The other adolescent studies of this type have found associations between avoidant-dismissing and unresolved-disorganized representations in a variety of different substance using groups (54). Adult studies of substance abuse have found associations with Lyons Ruth's hostile-helpless pattern and also with the Main coding of unresolved/disorganized (58).…”

“…The psychological and developmental literature already contains several excellent reviews that have examined the empirical findings showing the relationship between a variety of measures of attachment and different kinds of addiction (53,54). While it is well accepted that addiction results in the deterioration of the quality of close relationships, Fairbairn's review showed that longitudinal studies have established that attachment insecurity prospectively predicts the development of later substance problems irrespective of the type of measure used.…”

Substance Abuse and Public Health: A Multilevel Perspective and Multiple Responses

“…The abuse of different types and forms of substances may generate different levels of addiction and harm [2,51], which in turn may trigger distinct social maladjustment and craving behaviors [12,52]. Therefore, future research should discern and clarify the effects of different types and forms of substances on the progress, abstinence and relapse of addicts; this would lead to a better comprehension of the nature and impact of substance abuse.…”

Jugend und Alkohol

“…Der häufige Aufenthalt in kontrollfreier Umgebung, mangelnder Rückhalt in der Familie und leichter Zugang zu Alkohol gelten als weitere Risikofaktoren [25]. An Persönlichkeitsmerkmalen stellt ein spezifisch ausgeprägtes Neugierverhalten ("novelty seeking" oder "sensation seeking") einen prognostischen Faktor für den frühen den Konsum psychotroper Substanzen dar [26], auch unsichere Bindungsmuster sind klar als Risikofaktoren für Suchterkrankungen im allgemeinen und Alkoholabhängigkeit im speziellen erhöhen [27]. Häufig findet sich ausgeprägter juveniler Alkoholkonsum weiters co-morbid bei Jugendlichen mit Aufmerksamkeitsdefizit-Hyperaktivitäts-Syndrom, Angststörungen und depressiven Syndromen sowie bei Jugendlichen, welche in ihrer Geschichte frühe Traumatisierungen aufweisen [28].…”