Influence of Attachment on Addiction

1. Influence of Attachment on Addiction Addition and Psychiatry Seminars UCLA Donna Markus, Ph.D.

2. Attachment Theory • Framework for understanding how an individual’s early attachment experiences may influence his or her personality development and current functioning. • The protective functions of attachment extend beyond biological need for security to an emotion-based sense of security which is fundamental to healthy psychological functioning. (Bowlby, 1980; Bischoff, 1975; Bretherton, 1985; Sroufe & Waters, 1977). • Attachment organization contributes to healthy or pathological patterns of personality development.

3. Ainsworth “Strange Situation” • Securely attached child welcomed mother upon reunion and, if distressed, was readily comforted. Caregiver used as base of security to regulate feelings of distress and anxiety provoked by Strange Situation. • Insecurely attached unable to be comforted during reunion with heightened ambivalent expressions of attachment and anger or avoidance and detachment. • Ambivalent: inconsistent, conflicted and indecisive attempts to elicit comfort or support. • Avoidant: did not actively seek support nor utilize caregiver to regulate and dissipate negative affect

4. Working Models • Main, Kaplan and Cassidy (1985) suggested that individual differences in attachment styles can be viewed as “differences in the mental representation of the self in relation to attachment [and] the secure versus various types of insecure attachment organizations can best be understood as terms referring to particular types of internal working models of relationships, models that direct not only feelings and behavior but also attention, memory, and cognition”

5. Working models: based on the child’s affective experiences with primary caregiver, attachment becomes structuralized as an internal working model representing the self, attachment figure(s) and the external world. These working models, or internal representations of self and others, help children predict what to expect in terms of caregiver responsiveness and availability, and how to adjust their behavior accordingly. • Thus, children’s early attachment relationships impact their emerging self-concept (e.g., whether one is worthy of care and attention) and developing view of the social world (e.g., caring, responsive). These internal representations are carried forward into new relationships where they guide expectations, perception and behavior.

6. Attachment patterns are not immutable. Development “turns at each and every stage of the journey on an interaction between the organism as it has developed up to that moment and the environment in which it then finds itself” (Bowlby, 1973 p. 364). • As Sroufe, Carlson, Levy and Egeland (1999) note, “Child and context are mutually transforming…The individual is the product of all of his or her experiences, not early experiences alone” (p.2)

7. Internalized model determines individual’s style of social interactions and emotional regulation. Future experiences are interpreted so that continuity in one’s sense of self is maintained. All current and future relationships will be weighed against the cumulative representation of one’s experiences, particularly when the individual is distressed. Similarly, behavior will be based on expectations engendered by those comparisons.

8. Consequences of disturbed attachment become more apparent during late childhood and early adolescence . Individuals who are insecurely attached are less flexible in dealing with stressors accompanying these developmental periods; working models (internal representations of self and others) and strategies for regulating distress often result in maladaptive responses.

9. Attachment styles • Secure attachment associated with a positive self-concept, self-efficacy, healthy interpersonal relations and a sense of well being (Arend, Gove, & Sroufe, 1979; Collins & Read, 1990; Cummings & Cicchetti, 1990; Hazan & Shaver, 1987; Matas, Arend, & Sroufe, 1978; Simpson, 1990; Sroufe, 2000; Sroufe, Carlson, Levy, & Egeland, 1999).

10. Attachment styles (cont’d) • Insecure attachment styles: difficulty with affect management, exhibit maladaptive coping strategies when confronted with stressful situations (Kobak & Sceery, 1988; Main, 1990; Main, Kaplan, & Cassidy, 1985; Mikulincer, Florian, & Tolmacz, 1990) • Related to an array of psychological difficulties including anxiety, depression, substance abuse (e.g., Allen et al, 1996; Bowlby, 1978; Burge et all., 1997; Cole-Detke & Kobak, 1996; Rosenstein & Horowitz, 1996).

11. Attachment Styles and Affect Regulation • Working models appear to influence an individual’s affective responses to emotionally distressing situations as well as the methods or strategies individuals use for coping with such distress (Kobak & Sceery, 1988; Mikulincer et al., 1990; Sroufe & Waters, 1977). • Cognitive schemata related to attachment experiences and style influence one’s level of awareness of negative feelings. • If attachment figure has been responsive and available to child’s distress signals, distress can be regulated with strategies that involve active seeking of support and comfort – able to acknowledge distress, turn to others for support, and able to modulate negative affect in a constructive manner.

12. Attachment styles and affect regulation (cont’d) • Insecurely attached individuals display a propensity to either: • exaggerate negative emotions in an attempt to elicit a response figure, or • Inhibit negative emotions to reduce the anxiety induced by an unresponsive attachment figure.

13. Attachment styles and affect regulation (cont’d) • Avoidant attachment style Modulate negative feelings by restricting acknowledgement of distress and being “compulsively self-reliant” rather than exhibiting behaviors aimed at seeking comfort and support. This strategy entails a dismissal of the importance of attachment relations, an inhibition of the display of negative emotions, and an emphasis on autonomy • Ambivalent attachment style Negative feelings intensified because they direct attention toward distress in a hypervigilant manner that functions to inhibit the development of autonomy and self-confidence.

14. SOCIAL SUPPORT • Since attachment theory is concerned with effects of early attachment relationships on one’s emerging view of self, expectations of others, and capacity for close relationships, it’s not surprising that a link between attachment style or organization and social support has been established.

15. Social Support (cont’d) • Relationship between social support and positive outcomes for recovering addicts has been supported by research (e.g., Gordon & Zrull, 1991; Humphrey, Moos & Cohen, 1997; Miller, Ninonuevo, Klamen, Hoffman & Smith, 1997). • Difficulties in establishing supportive relationships with which to recover are based on a history of unsuccessful interpersonal experiences. Histories of addicts as well as histories of children raised in substance abusing households reveal impoverished social support resources as well as a limited capacity for these children to utilize such resources (Bays, 1990; Black, 1985, 1988; Black, Bucky, & Wilder-Padilla, 1986; deCubas & Field, 1993).

16. Social Support (cont’d) • Research supports theoretical assumptions regarding the differences in how securely attached, avoidantly attached and ambivalently attached individuals view themselves in relationship with significant others. • Likewise, the divergent cognitive schemata associated with these attachment styles extend to differences in these individual’s perception and use of social support system (Florian, Mikulincer & Bucholtz, 1995; Kobak & Sceery, 1988; Simpson, Rholes, & Nelligan, 1992)

17. Social Support (cont’d) • Support perceived to be available is more consistently related to outcome measures than support actually received (Sarason, Shearin, Pierce, and Sarason, 1987). As such, social support provides a protective function. Furthermore, as a result of this belief, individuals feel assured that they can overcome challenges and pursue goals through their own effort or with assistance from significant others.

18. Demographics (N=206) • Gender Male 91 44.2% Female 115 55.8% • Ethnicity Asian 2 1.0% African-American 25 12.1% Caucasian 128 62.1% Hispanic 32 15.5% Native American 3 4.5% Multi- or Bi-Racial 15 7.3% Other 1 .5% • Age Mean 45.5 SD 10.26

20. Drug of Choice

22. Drug Use History

23. Comparison of Addicts and General Population on Prevalence of Insecure Attachment

24. Comparison on prevalence of insecure attachment

25. Comparison of Family History Positive (FH+) Addicts vs Family History Negative (FH ) Addicts on Insecure Attachment History (Hypothesis 2A)

26. Comparison of Family HistoryPositive Addicts (FH+) vs Family History Negative (FH ) Addicts on Current Attachment Style (Hypothesis 2B)

27. Current Attachment Style by Length of Time Abstinent for All Participants

28. Current Attachment Style by Length of Time Abstinent for Family History Positive Participants

29. Family History Status (FH+ vs FH-) and Age of Onset N Mean SD Std Error t df Sig. Mean (2-tailed) ____________________________________________________ Age of Onset FH+ 119 11.63 3.15 .29 FH- 87 13.68 4.16 .45 -4.03 204 .000

30. Regression for Age of Onset of Use Step R-Square Change F Change p_ Family History 1 .074 16.23 .000 Security of Attachment 2 .046 10.65 .001

31. Comparison of Secure and Insecure Attachment Styles on Age Alcohol or Other Drug Use was Identified as a Problem

32. Comparisons of Participants with Secure and Insecure Attachment Styles on Perceived Social Support