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Clinicians rely on a standard set of protocols to define addiction and gain insight into patients’ behavior patterns in order to determine the appropriate course of treatment. Often these include the disease model of addiction, relapse prevention, development of coping skills, therapy sessions and behavioral strategies to assist in developing a successful sobriety.

Over the last 40-plus years, origins of attachment theory has emerged to shed light on many areas addressed by psychology. Attachment theory research has provided a consistent link to connect addiction and recovery protocols and hopefully unite the various processes of treatment cohesively.

The Origins of Attachment Theory

Attachment theory was first proposed by John Bowlby. Bowlby’s work with children in stressful environments, such as hospitals and long days in nurseries, and his work studying the behaviors of animals with their young led to the creation of his theory. As his protégés, Mary Ainsworth and Mary Main, furthered his theory, it gave way to a growing wealth of research that splintered to focus on various areas of human functioning. These areas include romantic relationships, emotional regulation, grief, trauma, perception, cognition, physiological responses, neurological development and more.

Attachment Styles

Attachment styles are developed via caregiver and child interactions within the first three years of life. During this attachment phase, infants learn to regulate their emotions and develop cognitive maps to define and understand their emotions and, ultimately, act on them. One’s attachment style is activated by anything perceived as a threat—which is very subjective—and the primary goal of an activated attachment style is to obtain security—also very subjective.

During these early years, infants will learn about threats, how to manage them and who will assist with this—hopefully, the mother or a primary caregiver. During this process, safety or the lack thereof becomes internalized in what Bowlby called an “internalized working model.” If a healthy and consistent enough form of safety is experienced, a secure attachment style develops. If this safety is not healthy, is inconsistent or withheld, these too will be internalized as a model for coping with distress called an insecure attachment style.

Attachment researchers have shown that one’s attachment style will stay fairly consistent throughout life unless someone or something comes along to impact it in a healing way. The silver lining here is that attachment styles are not permanent, but can be changed—or healed, as we would say in the attachment field.

Attachment Theory and Addiction

At this point, one might ask, “What does this have to do with addiction and recovery?” As this will be a series, I promise to explain this in future blogs.

For now, I’ll provide you with a cursory review of attachment styles. Bowlby, Ainsworth and Main discovered four attachment styles: secure, anxious/ambivalent, avoidant and disorganized. Later, researchers elaborated on the avoidant style to create five: secure, anxious/ambivalent, dismissive avoidant, fearful avoidant and disorganized. There are also various names applied to these—preoccupied instead of anxious/ambivalent, or anxious avoidant instead of avoidant—yet they remain the same in essence.

When the attachment style is activated, it floods the brain and body with neurochemicals to communicate distress. Our systems don’t like to exist in distress, and a solution is required. Our attachment styles bring up those cognitive maps to interpret and react to regain safety. When these strategies fail, distress remains. Distress assaults the system psychologically and physically. With insecure attachment styles, there tends to be a lack of healthy coping strategies.

As a result, those with insecure attachment styles continue to seek out forms of safety that rarely work long-term; it affects everything the individual seeks and everyone they engage with. This is where substances play their role in the individual’s seeking. In the next part of this series, I will move on from the origins of attachment to explain how substances create “positive attachment experiences.”
Until then…

Dr. Mark Smith