New Directions in Treatment, Education, and Outreach for Mental Health and Addiction by Thalia MacMillan & Amanda Sisselman-Borgia

Author:Thalia MacMillan & Amanda Sisselman-Borgia
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Attachment and Substance Misuse: A Theoretical Perspective

Attachment theory was initially developed by John Bowlby (1958), who became interested in the subject while working with children. Attachment behavior, according to Bowlby (1951, 1958), is an instinctive penchant to seek safety in proximity with a specific individual, the attachment figure (typically mother or primary caregiver), who is perceived to be protective. Bowlby (1951) posits that interactions of genetic, neurobiological, and developmental factors contribute to the regulation of stress resilience, anxiety sensitivity, and personality development. In addition, the primary caregiver’s ability to tune into (attunement) and reflect (mirroring) the emotional states of the infant are essential to the development of emotional capacity and competence (Bretherton, 1992). It is through these processes that the infant comes to understand the self as a separate entity with distinct feeling states and ultimately develops understanding of and empathy for the feelings of others. This is the groundwork for emotional self-regulation and identity. Incongruent mirroring leads to mistrust of one’s own emotional responses and the need to search the social environment for cues about how to think, feel, and act (Padykula & Conklin, 2010).

Substance use disorders can evolve from the attempt to regulate one’s attachment system in an effort to adapt (Padykula & Conklin, 2010). Individuals with substance use disorders suffer because they cannot or do not regulate their emotions, self-esteem, relationships, and behavior (Khantzian, 2012,). Self-regulation difficulties increase vulnerability to substance misuse. These individuals have great difficulty recognizing and tolerating feelings. This is due, in part, to fragile self-esteem and the absence of self-efficacy and competence (Graber, Turner, & Madill, 2016). Therefore, relationships with oneself and others are undeveloped or impaired by the lack of insight and skill necessary to sustain them. Substances become a means of avoidance and distraction. Or, they might provide a false sense of confidence often portrayed as bravado that further undermines relationships. Taking Khantzian’s thinking forward, it can be suggested that the substance of abuse becomes the substitute for relationship to oneself and others (Khantzian, 2012). Höfler and Kooyman (1996) argued that an individual might choose a substance as an attachment alternative to relationships. They linked this use of substances-as-relationships to attachment ruptures in childhood, manifesting during the life-transition stage in adolescence. “Because these individuals have an inability to recognize and regulate their own feelings and sense of self, they act as though they do not need close interpersonal relationships” (Khantzian, 2012, p. 112).

Flores (2006) suggests that individuals who struggle with developing intimacy and closeness with others may seek a method in which to self-soothe in times of distress. The relationship with substances can arguably become an attachment, which acts as both an obstacle to and a substitute for interpersonal relationships (Fletcher et al., 2015). A drug can create the feeling of having a secure base, and, within this framework, “addictive behaviors can be understood as misguided attempts at self-repair ” (Flores, 2006, p. 112). Substance abuse then becomes the solution, and the consequence of an individual’s impaired ability to develop and

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