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Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00727

Attachment and substance use disorders – theoretical models, empirical evidence and implications for treatment

  • 1University Medical Center Hamburg-Eppendorf, Germany

Introduction
The article reviews attachment oriented research in individuals with substance use disorders (SUD). Based on attachment theory substance abuse can be understood as “self-medication”, as an attempt to compensate for lacking attachment strategies. Attachment theory suggests a developmental pathway from insecure attachment to SUD, and on the other hand a negative impact of substance abuse on attachment security. Additionally, differences due to different patterns of attachment, different substances, comorbid psychiatric disorders, and age groups are reflected.
Methods
Using medical and psychological databases 33 cross-sectional studies, three longitudinal studies, one systematic meta-analysis and six reviews were identified. Methodological problems such as poor assessment of SUD and the use of different measures of attachment limit comparability.
Results
Results of longitudinal studies clearly show insecure attachment to be a risk factor for SUD, while continued substance abuse impairs the ability to form close relationships. With regard to specific patterns of attachment results mainly point towards fearful and dismissing avoidance, while some studies report preoccupied and unresolved patterns. Results indicate different patterns of attachment in different groups of substance abusers. Fearful-avoidant attachment was frequent in heroin addicts while alcohol abusers had more heterogeneous patterns. The link between insecure attachment and SUD seems to be stronger in adolescence compared to adulthood.
Discussion
The last decades have seen a substantial growth in studies on attachment and SUDs. Today, the general link between SUD and insecure attachment is well established. However, connections between different patterns of attachment with different pathways towards SUD were also found, but data are still inconclusive. Evidence suggests that fostering attachment security and mentalization might improve the outcome of state-of-the-art treatment approaches in the field of SUD.

Keywords: Attachment, Attachment theory, Patterns of attachment, Substance use disorders (SUD), substance abuse, Addiction

Received: 30 Apr 2019; Accepted: 10 Sep 2019.

Copyright: © 2019 Schindler. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Andreas Schindler, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, a.schindler@uke.de