Written by: Travis Thompson, LMFT, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
Over the decades, theories and treatment of substance and alcohol abuse have shifted. Early on, addiction was seen as a moral issue. If a person could simply invoke resolve and repent for their issues, then they can deal with their choice to drink or use. This was emphasized by programs such as Mother Against Drunk Driving, hoping to shame alcoholics into sobriety. Ultimately, the failure of programs like this led to a cultural look of disgust toward the alcoholic and addict. After this came the medical model, hoping to treat addiction like any other disease. This approach was born out of a further push from the medical community, seeing some similarities between the treatment of conditions like diabetes and other behavioral and mental health issues like schizophrenia and bipolar disorder. While it has been beneficial to see individuals within a context of medical treatment and advocate for continual work to remain healthy and sober, the minimization of systemic and holistic needs can lead to a loss of understanding and an inability to make lasting change. Other ideologies have been paired with the medical model to boost its effectiveness, such as a behavioral and neurological framework.
Respectively, changing reactions to symptoms allows for a stream of direct feedback through behavioral shifts. Just as well, recognition of neurological factors involved in addiction, such as the variance in dopamine intake, gives greater insight into the daily experience involved in addiction and recovery. Another significant benefactor to the recovery world is that of anonymous groups, spearheaded by Alcoholics Anonymous. This group is self-contained and unable to be truly researched due to internal traditions of distance from outside entities. Even with this restriction, it can be hard to deny the innumerable testimonies of miraculous change from people around the world.
Considering this plethora of information, descriptions of the nearly unbearable nature of the daily life of the addict, and the struggle of how to shift daily living skills, still the question remains: How did they get there?
What’s Wrong with Now?
Any of the previously mentioned models have shown benefit in helping those suffering from addiction. Understanding the biological and medical factors involved in addiction has allowed for significant insight into the ways that the body responds to substances and alcohol. Without these incredible efforts towards the unveiling of addiction, lifesaving drugs such as Narcan, a drug that can save someone from an opioid overdose, would not exist. Furthermore, understanding the effects that dopamine loss and serotonin imbalance have on therapy and treatment has revolutionized medications to give people a fighting chance in regulating their emotions and sense of pleasure from progressing in treatment. Even behavioral models can allow individuals to see some modicum of progress in their lives, motivating them for future change and possible hope for recovery. Anonymous recovery groups also contribute services for anyone who will walk through the door, often providing the only intervention some may be able to access and accept.
One thing that is lacking from these groups is a consistent and supported etiology. The previously mentioned models of addiction treatment lack an origin story to explain the development of and retainment of addiction. Previous theorists pose that problematic patterns, genes, or troublesome modeling from parents could cause addiction to occur. Still, others do not make any attempt to find the beginning of addiction, only describe the current effects of it. Unfortunately, none of these theories allow for meaningful emotional understanding and actionable differences in changing the perspectives of the past or making a concerted effort to prevent a cycle of addiction to continue in children.
What is Attachment?
Attachment Theory originates from researchers Bowlby and Ainsworth and their observations of children and caregivers in the 1970s. While some information was known about the connection between caregivers and their children, little was understood about how these connections and reactions developed over time. To delve into this phenomenon, Bowlby and Ainsworth devoted their research efforts to sets of studies to explore how needs and connections are made. Their most popular study named the “Strange Situation” noted the various ways that children handled separation from their caregivers and the subsequent reunion. From these repeated studies, some common themes emerged.
The first concept that came from these studies was the three types of attachments that children showed with their caregivers. Attachment styles varied in frequency among groups but were consistent enough to show helpful information. These groups were labeled as Secure, Anxious, and Avoidant. Children that showed Secure attachment to their caregivers were upset when they left the room, were unable to be consoled by a stranger, and were able to be soothed and resume calm interaction when their caregiver returned. Anxious children were upset when their caregiver left, did not show significant comfort from a stranger, and showed mixed responses to the caregiver when they returned. Some children that were labeled as anxious were somewhat able to be consoled and some were “punished” or were not easily consoled. Anxious children also did not show a sense of comfort and safety after they calmed down and appeared unsure about how to handle being in the room, even with their caregiver present. The last group, Avoidant, appeared indifferent to the caregiver for most of the study. This was true whether the caregiver was in the room and when they returned after a time away.
The second concept that is gained from Attachment Theory is that of the four basic needs of connection that children gain as they grow in an environment with caregivers. These needs are a Secure Base, Save Haven, Proximity Maintenance, and Separation Distress. In order, a Secure Base is where a child can call home. This place helps shape their view of the world, how people interact, as well as what to expect from others. Whatever a secure base is for a child is often considered the launching pad or frame of reference that they see the rest of the world from, such as a parent who teaches life lessons or a belief system that guides behavior. Safe Havens are where children would run when danger is present, or they feel unsure about a situation. These places represent a sense of serenity and protection from the outside world like a mother’s arms when a child has been crying. Proximity Maintenance relates to how a child will deal with distance between themselves and their caregivers. This is easily seen as children will often check to see if a parent is present and watching in a new situation, such as playing on a playground or in a new environment. Separation Distress is defined as the way that a child would handle knowing that distance and disconnection have occurred. This is not abandonment, but when a caregiver is not immediately reachable, as when a baby is dropped off at daycare.
A Missing Hug from a Sharp Needle
Children, parents, and researchers in the 70s, what does this have to do with heroin addiction? What connection could be made from a child feeling disconnected from their mother to an adult doing anything they can to get their next drink? As adults, we find ourselves too sophisticated with intricate detail and embossed with nuance. However, with some slight shifts in detail, styles of attachment and basic attachment needs fall into place.
Of the attachment styles, Secure, Insecure, and Anxious, one stands out as the most harmful for the psyche over time. A Secure and Avoidant attached child both have consistent expectations of what to expect from their caregiver. Each of them understands the dynamic in play with their relationship. This predictability allows for the adaptation of belief and interaction. The Anxious child does not share this experience. Interactions with the caregiver of an Anxious child are variable, the child is not sure whether or not their caregiver will respond positively, negatively, or even at all. Due to this uncertainty in expectation, a child may begin to enact behaviors such as hyperawareness or intensity. Hyperawareness allows for a more significant perception and intensity allows for the enforcement of interactions. The child may come to believe that if they can see what is going to happen, then they can prevent or encourage it or if they can become intense, they can ensure a reaction. For the addict, relationships are tenuous, often becoming volatile when expectations are not met. Substances and alcohol can fill that role. The addict knows exactly how cocaine will make them feel and exactly how much they need to get it. It is consistent in its relationship with no judgment or expectation.
The four basic needs also connect to the need for substance and alcohol addiction. With a Secure Base of a relationship with alcohol, the rest of the world is seen as risky and a threat. The addiction starts to interpret everything around the addict’s world. A gram of heroin can easily be the emotional place to run to when the reality of the world hits, or consequences come knocking at the door, the inevitable Safe Haven. That warm embrace that they are missing is found in a sharp, numbing point. When someone is in the deepest measures of addiction, the world starts to revolve around the last two needs, Proximity Maintenance and Separation Distress. The day, even the hour is dictated by how far away the next dose is and how the frenzy could be dealt with.
Hugging the Hurting
All of this theory and connection come to a head in one way. What do we do now? As someone either personally or interpersonally affected by addiction, Attachment Theory tells us that you or someone you love has lost themselves. The world has become so unpredictable and distant that the next use is what makes the most sense. It is not simply about getting high or drunk again, it is about feeling safe again. A need for connection has warped its way into a corrupted sense of not feeling exposed and exploited. Addicts are lost in a sea of isolation, hoping that the next use could help them feel whole again. Whether it is from a lack of value or some distorted sense of justice in the world, addiction stands as the ultimate shrine of ever-distant safety, daring the addict to take a risk somewhere and suffer the consequences. All the while, true intimacy, and connection are becoming more obscure and unobtainable.
Compassion and concern come next. No treatment programming could hope to delve into the intricacies of every addict’s past hurt and how they have led them to seek support in something that could kill them in the very next moment. However, understanding that there is more to it than a theorized alcoholic gene that has not been found or a set of behavioral guidelines that can trick the brain into forgetting trauma is a monumental step. Take a moment and empathize that the person you are or the person you love has lost the part of themselves that finds connection and safety. Boundaries and interventions are necessary for lasting change, but a connection with deeper issues opens a door to a relationship that can speak the truth and implore change without manipulation. Addiction is not some far-off issue that cannot be understood. It is a small child who wonders if mom is ever coming home or if dad even loves them. When we can see a broken and scared child rather than a spiteful adult, the next steps can become more clear, and true healing can come.
Travis Thompson, LMFT, Executive Contributor Brainz Magazine
Travis Thompson, is a researcher, teacher, and therapist focused on healing the lives of those in addiction. With a drive to see effective, long-term change in his community, he has dedicated himself, his practice, and his doctoral work on both research, education, and implementation of recovery. He strives to further the mental health field towards a holistic and advanced understanding of what addiction truly is, where it comes from, and how we all can help.
