A Disease of Loneliness: Addiction Through an Attachment Theory Lens

Session Description: The question of why some individuals that drink alcohol and use substances, and not others, develop a severe substance use disorder (SUD) is difficult to answer. While there is no consensus in the field, most agree it includes varying degrees of biological, psychological, and sociological factors. One area that touches upon all three is found in attachment theory, where there is a growing body of research linking SUDs to being insecurely attached. In this talk, we will look at basic theories of how SUDs emerge and are maintained, including evidence that difficulty coping with negative experiences, regulating affect, and expressing attachment needs in close relationships is a risk factor. We will then review why connecting to others is a primary human motivation, the impact deprivation of relationships has on physical and emotional health, and the neurobiological evidence explaining the similarities between the strong responses individuals with an SUD have to substances and people, in general, have to intimate relationships. In addition, we will explore the interplay between different styles of insecure attachment, co-morbidities, and SUDs. We will conclude with a discussion on clinical implications, including how attachment theory may contribute to SUD prevention and improve treatment outcomes, the utility of assessment and a focus on common factors in therapy, and the current the state of attachment-based therapies.