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A great many people who struggle with addiction suffer also from attachment disorders. Attachment and addiction are correlated, which can be treated simultaneously. This has important considerations for our understanding of addiction and our approaches to treatment. Twelve-step Programmes are uniquely suited to help people in this respect.
The Prevalence of Attachment Disorders
They say a difficult childhood makes you unhappy, untrusting, and insecure – the clinical term for all that is likely to be ‘attachment disorder’. These days it is by no means uncommon in the population, especially among addicted people. At 12-step meetings, they often talk about feeling different, and the ‘hole in the soul ’is a familiar term that many at the meetings will recognise. Such people may in fact be struggling with attachment issues. At CATCH Recovery we see many patients showing symptoms of this condition.
What Is an Attachment Disorder?
Attachment disorder was first recognized in the 1950s by British psychologist John Bowlby and later investigated by American Mary Ainsworth in her ground-breaking Strange Situation Studies. An attachment disorder is an emotional condition that very young children acquire as the result of actual or perceived failures in the protective parenting role by their closest caregivers (normally this would be a parent).
Such failures might range from withholding love or neglect to some kind of traumatic event, including abuse. The young child consequently struggles to form healthy, trusting relationships. The condition usually continues into adulthood and may be lifelong, unless addressed carefully, thoroughly, and appropriately.
The Link Between Attachment Disorders and Addiction
There is no definitive study on the link between insecure attachments developed in childhood and subsequent addiction but all major research such as that by Andreas Schindler of the University of Hamburg in 2019 agree that the link exists.
Variations of diagnosis, methodology, and the complexity of addiction itself make precise figures difficult. At our residential rehab, Castle Craig Hospital, well over fifty percent of patients present with attachment disorders of at least one of the three recognized problem categories: anxious-insecure, avoidant-insecure, and disorganized-insecure.
Types of Attachment Disorder
Ainsworth and later researchers defined four states of attachment – one healthy and the others not:
- Secure attachment is a healthy attachment when parents or other caregivers meet the child’s needs for security by being available, understanding, interactive, and accepting. Such children are usually trusting and self-respecting. As adults, they are competent, handle emotions well and establish good relationships. A 2004 Canadian Study identified only 55% of those assessed as in this category.
- Anxious-insecure attachment happens when care and protection are not given consistently and the child cannot trust parents enough to feel secure, becoming demanding and ‘clingy’ and over-needy in seeking an acceptable parental response.
- Avoidant-insecure attachment is when the child becomes self-reliant because the parental response has been rejection or minimization of their needs. The child also learns that suppression of emotions is the best course of action.
- Disorganized-insecure attachment results from aberrant and often abusive behaviour by parental figures (who may have mental health issues themselves). By rejecting, frightening, and ridiculing the child in their care they produce extreme and haphazard responses of rejection, aggression, and self-reliance in the child they should be nurturing. This is the most serious form of the disorder, being not learned behaviour but a series of disorganized responses, usually brought about by fear of the caregiver.
The first three categories represent a learned behaviour response by the child whereas the fourth represents a more unplanned reaction. Actual diagnosis (see below) appears to take this differentiation into account.
Diagnosis of Attachment Disorders
The fifth edition of the US Diagnostic and Statistical Manual (DSM – V) categorizes two distinct forms of attachment disorder. Reactive Attachment Disorder (RAD) is the inability to attach, through avoidance, to a caregiver of choice and lack of emotional control, whereas the second – Disinhibited Social Engagement Disorder (DSED) relates to social disinhibition, and lack of selective attachment – the child may be excessively social with strangers.
Adult Relationships and Attachment Disorders
Behaviour learned in the crucial early years of life affects the way people feel and behave in adult relationships. Any childhood experiences, especially those around attachment issues, are highly likely to influence a personality in later life. The child is the father to the man, as the old saying goes and adults often carry a damaged ‘inner child’ within them for their whole lives.
Attachment Disorders and the Disease Concept of Addiction
Attachment theory does not go against the concept of addiction as a physical, mental, and spiritual disease. Indeed, it reinforces the idea. People suffering from attachment disorders do not choose to become addicted, in fact, almost no one does.
They may learn addictive behaviours that begin as coping strategies and they may be genetically pre-disposed towards addiction, but people become addicted for a whole variety of reasons. Attachment disorders diagnosed as RAD’s or DSED’s often coexist with, for example, diagnosed substance abuse disorders (SUDs). Indeed a 2020 study of comorbid symptoms in adolescents in Norway concluded that:
“Most adolescents with RAD or DSED disorders or symptoms have additional psychiatric disorders and psychosocial problems of an emotional and/or behavioural nature”. The additional psychiatric disorders referred to included SUD’s.
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How Attachment Disorders Lead to Addiction
People who have difficulty establishing close attachments will be more inclined to turn to maladaptive coping strategies – substance abuse especially – as self-medication for their relationship inadequacies. In their struggle to relate to others, especially at an intimate level, they may consider addictive behaviours either as a way to release their inhibitions or as a substitute for the intimacy they cannot find. In effect, they form a relationship with their addiction of choice instead of with a person.
The Familiar Downward Spiral
The downward spiral into addiction follows a familiar pattern: a seemingly helpful coping strategy first becomes a habit and then turns into a dependence – physical, and psychological. What started as a help to social interaction becomes a self-destructive nightmare. Addiction is once again paradoxically both the destroyer and the object of desire.
Coping Strategies and Addictive Habits Can Be Unlearned
Attachment disorders present as behaviour, usually maladaptive, that has been learned or else is a direct response to stressful situations in childhood around failures of love and caregiving by parent figures. Recovery involves replacing this behaviour with more healthy and effective techniques. This can be done, but the process is not an academic exercise – it requires guidance, positive action, and much practice.
Recovery Is Re-Attachment
The first time an addicted person walks into a 12 Step meeting, or a recovery group in rehab, and declares themselves an alcoholic, addict, or whatever, they will feel relief to be accepted simply for who they are, with no criticism. This experience – of feeling they belong, at last, maybe the most meaningful attachment experience of their lives to date. As a consequence, many people who do this remain in sobriety for the rest of their lives.
The Unique Help of The Twelve-Step Programme
The Twelve Step movement was established long before the idea of attachment disorder was formulated, but the underlying idea of recovery from addiction that it promotes is that of re-attachment or re-connection with society. As co-founder of AA Bill W put it:
“Life takes on new meaning in AA. To watch people recover, to see them help others, to watch loneliness vanish, to see a fellowship grow up about you, to have a host of friends – this is an experience not to be missed.”
(Alcoholics Anonymous, p 89).
Everything about the AA programme leads the newcomer gently but surely on a course of re-connection – meetings, sponsors, service, the Twelve Steps themselves and the Twelve Traditions, and just the way that members mix and interact before and after meetings – they all have the effect of bringing a person out of the isolation that their addiction has imposed.
The Twelve Steps Can Be Seen as Four Stages of Re-Attachment
The Twelve Steps are often summarised as a progression: giving up, cleaning up, making up, and keeping up. Although the Steps were not conceived with relationship issues specifically in mind, each of these stages is an aspect of re-attachment – a re-forming of relationships. Thus:
- Steps 1 – 3 ‘Giving up’ – this is to do with our relationship with our Higher Power. The act of asking for help and giving up the illusion of self-reliance is a profoundly important first step towards re-connecting with one’s fellow humans too.
- Steps 4 – 7 ‘Cleaning up’ – this is about our relationship with ourselves. Admitting our defects and showing ourselves honestly, perhaps for the first time, means that at last, we can start relationships based on the reality of our true selves.
- Steps 8 – 9 ‘ Making up’ – this is about our relationship with those we have hurt – family, friends, and colleagues. Making amends can be hard, but the results will speak for themselves because when we reach out to others honestly, they will respond in kind.
- Steps 10 – 12 ‘Keeping up’ – this is about maintenance and making new relationships. A Twelve Step Fellowship meeting is the perfect place to acquire like-minded contacts who will soon become friends. Emotionally damaged newcomers learn social skills in a safe and non-judgmental environment. Not only that, by doing service and giving of themselves, they acquire self-esteem and the respect of others.
One of the best-known AA slogans is ‘You are never alone’. It speaks the truth.
Residential Treatment Programmes
Residential rehab, among many other benefits, provides a safe and supportive training ground for those struggling with attachment issues as well as addiction. Her newly sober people with attachment disorders can find support and guidance and they can practice social skills with their peers, many of whom will be doing the same.
Additionally, special therapy will be available to address sensitive relationship issues and the damaged ‘inner child’ that many adults carry within them from their earliest years, the product of childhoods upended by parental neglect or abuse.
Such is the complexity of addiction and its effect on individuals, there is no standard treatment response – each person must be assessed according to their needs. There is much learning to be done because managing re-attachment – the ability to make and keep meaningful and satisfying relationships, is one of the hardest aspects of recovery. It takes time and a lot of practice.
Family involvement in treatment is an essential part of recovery. The process of re-attachment must be taken slowly, carefully, and appropriately. The old therapy advice to those in early recovery who are seeking a deep relationship rings surprisingly true: start with a pot plant – if it survives six months, get a pet. If that survives six months, get a real person.
At CATCH Recovery, we have successfully helped many addicted people with attachment disorders to recover and lead happy lives, free of addiction. If you would like to discuss any of the issues in this article or any other aspects of addiction treatment, we are always available to talk. Give us a call on 0203 468 6602.