Ian is a therapist and program director at Marietta-based Fresh Start Recovery, a program that specializes in treating opiate addiction. Ian has been treating addiction and co-occurring mental illness since 2008; he received a Master’s of Science degree in addiction counseling from Prescott College.
One of the confounding issues related to addiction is understanding why someone would continue using substances in light of the very serious negative consequences they experience. Why, for example, would a person who is facing legal problems, losing their family, facing unemployment, and suffering from health complications continue substance use? Or worse, relapse and return to active use after receiving treatment and being sober for some period of time? Often we hear answers like, “they’re not ready to be sober” or “they haven’t hit bottom yet”. These are easy, convenient answers that imply an addicted individual is making a rational decision to prioritize substances over their loved ones or their freedom. It is understandably difficult to feel much empathy for such a person. But one way to make sense of the more complex factors involved with this behavior is by understanding Attachment Theory, and how it relates to addiction and recovery.
Attachment Theory suggests that human beings are designed to connect with one another in meaningful relationships. Some key factors in developing healthy attachment are trust and consistency, where this trust and consistency is learned through experience. As children grow and their brains develop, this desire to attach to others becomes a fundamental and primary motivation throughout their lives. This seems simple enough, but what happens if a person does not find healthy attachment to their caregivers or other important people in their lives? Whether through abuse, neglect, trauma, or inherent emotional issues or disorders, some people struggle to achieve healthy attachments.
Attachment is sometimes achieved in an unhealthy way through substance use and abuse. From nicotine to alcohol, cocaine to opiates, using these substances results in the brain producing tremendous amounts of the chemical dopamine. Designed to reinforce positive behaviors, our brains produce dopamine when we engage in enjoyable activities such as eating and sex; this chemical is produced when we interact with people in meaningful relationships, like in the case of a mother and her newborn. If, for whatever reason, attachment is disrupted a person may actually feel attached to substances.
Consider the nature of a substance like alcohol. Not only does it make you feel good, but a person learns through experience that they can trust that alcohol will always be available (just go to your local bar or liquor store). Additionally, alcohol is very consistent in the sense that people learn precisely what amount will make them feel a certain way. Repeat this process and over time, a person can feel “attached” to alcohol in the same way people feel attached in important relationships. For the addicted individual, substances may be the most trusting, consistent relationship they have ever experienced. Sure, this is a lonely and unsatisfying relationship - but from the brain’s perspective, it does not matter. To that end, one might begin to understand how difficult it is for an addicted individual to “let go” of the substance upon which they’ve come to depend; asking them to stop using substances is akin to asking them to never again speak to the person with whom they are the closest to. It is for this reason that many find it extremely difficult to consistently abstain from using.
Shameless Plug for Treatment and 12-Step Recovery
Treatment for addicted individuals is essential. In stopping substance use, treatment-professionals are asking individuals to give up what is psychologically the most important relationship in their life. If treatment professionals cannot help remove the barriers to connecting with people and facilitate developing relationships in a deep and meaningful way, the addicted person will likely return to their most effective relationship in substances.
There are many types of support groups that help those seeking recovery, and one of the most successful is a 12-Step program. These programs support healthy attachment through sharing common experiences with the group, connecting in a meaningful way with a sponsor, and finding the ultimate connection through a Higher Power. This is just one reason why 12-Step recovery is so effective and is often recommended as an adjunct to treatment.
Addiction takes a horrible toll on family members and other important relationships in a person’s life. But this situation is exacerbated by the belief that an addicted-individual is making a rational decision when they choose substances over their loved-ones. By viewing addictive behavior through the lens of Attachment Theory, we gain some understanding for why ending substance use is such a difficult task, and it is through this understanding that we have a better opportunity to support the healing of those struggling with addiction.
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