addiction

Is addiction an Attachment Disorder?

Harvard-Science-of-Neglect-Video-screenshot-300x224

Here we cite and use excerpts from an interesting article (1) that suggests addiction is the consequence of insecure attachment to our caregivers in early childhood and that as the result addicts often learn to consume substances, or behave in certain “rewarding” ways such as gambling, hypersexual activity etc to cope with emotional distress. An emotional distress borne out of not being able to regulate our own emotions effectively, a distress borne out of not having the the neural machinery to regulate out emotional states. This impaired neural machinery has not developed as the vital emotional connection between person and primary care giver has been lacking, or the person has had a number of adverse childhood experiences.

It is saying that environment, the most basic environmental stimulus, that of our primary caregiver is actually fundamental to  wiring our emotional brains. What we experience externally is in fact reflected in the internal architecture of our brains like a negative neural plasticity.

The hope for some one who have suffered in this way is a “learned attachment”  via group therapy or 12 step affiliation as we are exposed to a surrogate attachment via 12 step groups which allows us to return from the steppes of our isolation and gain an emotional attachment with our peers.

This appears to be fundamental to recovery, this acceptance of ourselves by others, this filling of the “hole in the soul” by the love of others and eventually by ourselves.  Love is the drug we have all been loving for!

I do not disagree with this idea but later in the conclusion I suggest that although this environmental factor of attachment seems hugely important to many addicted individuals it is not relevant to all. Some addicted people have had secure attachment. Thus they must have inherited a vulnerability to later addiction which is fairly independent of environment. In fact this inherited vulnerability may have certain overlaps with what is the consequence of insecure attachment, namely difficulties in recognising, processing and regulating emotion.

Obviously insecure attachment would perhaps make these deficits more severe and perhaps also contribute to a more chronic addictive disorder?

Here we quote Kathy Brous (1) extensively.

“Addiction or Survival Mechanism?

The Adverse Childhood Experiences (ACE) Study, research on 17,421 people who were simply asked if they’d had bad childhood experiences, physical or emotional. The study compared their childhoods, to whether they later developed life-threatening physical medical conditions and/or addictions.

Based on the ACE Study statistics, Dr. Felitti said, “The risk factors which can be  attributed to Adverse Childhood Experiences include… about 2/3 of all alcoholism, about half of all drug abuse, and about 3/4s of intravenous drug use (in the U.S.).

“And,” Dr. Felitti continued, “the things that we call ‘risk factors’ are in fact, effecting coping devises.  This is an important idea.

“Many of these things termed ‘public health problems’ are in fact, personal solutions.

“This is what psychoanalysts have been saying for a hundred years; but they’ve been saying it based on two cases or four – and we’re saying it based on 18,000 cases.  One way of describing it would be: you have this large base of individuals with Adverse Childhood Experiences, and most of them are going to be impaired as a result in some way, maybe socially, maybe emotionally, maybe cognitively…

Felitti ACE DVD 3-min Preview screenshot“By the time they become adolescents and have some freedom, they ordinarily will try to do something to feel better, and hence initiate what we call health-risk behaviors, but which might be called more properly ‘self-help behaviors.’  Those, over time, will produced disease and disability in many of them, and a significant portion of them will die early” .

“Swiss psychoanalyst Alice Miller says: ‘The truth about our childhood is stored up in our bodies, and lives in the depths of our souls’,” Dr. Felitti ended.  ” ‘Our intellect can be deceived, our feelings can be numbed and manipulated, our perceptions can be shamed and confused, our bodies tricked with medication. But our soul never forgets. And because we are one whole soul in one body, some day our body will present its bill.’

What if the human organism, when subjected to the childhood traumas reported in the ACE Study, reacts with these addictions as a form of sheer biological and physiological necessity?  What if these behaviors turn out to be necessary for the raw survival of each separate traumatized individual being turned loose to fend for his or her self ?

Brousblog1a Perry brains X-secIn 2011 Kathy heard about “Adult Attachment Disorder” at a church meeting (sic), and decided that was me.  “Science has only recently demonstrated that unless kids are given deep emotional connection (‘attachment’) from birth by parents or other humans, infant neurological systems don’t develop well. They can now do brain scans showing that chunks of neurons in some brain regions don’t fire; it’s dark in there,” she wrote.  It’s called “in-secure attachment” or attachment disorder.

March 2013, she was at a conference where Dr. Bruce Perry, MD of the Child Trauma Academy in Houston, showed these brain scans. The scan at above right is of a normal 3-year old; the scan above of a 3-year old with attachment disorder. Parts of it are dark.

Kathy went to attachment and brain science conferences, and bought every book  she could get by Judith Herman, Ruth Lanius, Daniel Siegel, Allan Schore, Bruce Perry, Bessel van der Kolk, Peter Levine, and so on.

Humans, from the instant of birth, require a constant stream of “emotional, spiritual, psychological, and physical inputs” from another loving human, says Dr. Mary Jo Barrett of the University of Chicago —  just as we require air, food, and liquid. “Complex or developmental trauma is about traumatic interruptions [of that stream],” she notes. “I from birth…have a series of relationships where I am emotionally, spiritually, physically vulnerable… If my spirit, my emotional stability is endangered, my physical being, is endangered, if I am repeatedly interrupted in the context of these relationships, these repetitions create a person who spends their life in fight, flight or shut down.

A child left without this input stream learns that its own hard-wired biological needs are terrifying.  “I learn that what I experienced internally and expressed externally with a cry, was met by a response that didn’t make any sense to what I needed,” says Dr. Daniel Siegel, MD of UCLA. “The organization of that child’s brain will be quite different, as neurons which fire together, wire together.

“I will have learned: it doesn’t matter what I’m feeling, because people don’t get me what I need. So I’ll learn to live without calling out to other people, and studies show, as I have those experiences over and over again, I will actually have a different way of being in the world.  Ultimately, I’ll become quite disconnected, not only from other people, but even from my own internal bodily self and my emotional experience. ”

The emotional pain and terror are so intense, the child will do anything to distract itself from those screaming needs. “In this distress I can only comfort myself in ways that are often maladaptive – I may bite myself, I may rock myself perpetually, trying to distract myself from my needs,” Dr. Siegel states. Such children “have all sorts of self-regulatory processes that are not interpersonal. They are very isolated.”

Do so many Americans use alcohol, tobacco, marijuana, meth, IV drugs, food, sex, violence, workaholism,  sports, internet porn, etc. for sheer survival Kathy asks?  Are they compelled to medicate with these to escape an intense fear, anxiety, depression, or anger which if they had to feel it, might literally kill them.

She suggests this is what Attachment Theory and brain science say about attachment and substance abuse like alcohol.

Harvard Science of Neglect Video screenshot“At birth we are biologically waiting for input from adults around us to ‘serve and return,’ a back and forth interaction that literally shapes the architecture of the infant brain,” report Dr. Jack Shonkoff, M.D., Director of Harvard’s Center on the Developing Child and his colleagues in a 2012 video “The Science of Neglect.”  “It begins when a child looks at something, observers something, that’s the serve. The return is when the parent responds to the child. When serve and return is broken, you literally are pulling away the essential ingredients for the development of human brain architecture… When a baby is not attended to, that is a sign of danger to the baby’s biological systems, so its stress systems are activated. In a brain that is constantly bathed in stress hormones, key synapses, the connections between nerves, fail to form in critical regions of the brain.

And the flood of stress chemicals doesn’t just stop. It can go on for years and decades, biology gone haywire.  Bruce Perry explains it in terms of how the three regions of the brain react. His slide below shows the highest thinking “cortex” level of the brain in blue, the next higher emotional-attachment-relational “limbic’ brain in green, and the lowest survival brain, aka reptilian brain, made up of the cerebellum and the brain stem, the foundation of the entire brain, in yellow and red.

So why do people drink Kathy asks?

“We can’t persuade people with developmental trauma with a cognitive argument (cortex brain), or compel them with an emotional affect (limbic brain), if their brain stem (survival brain) is dysregulated,” Perry warns.  “We can’t talk people in this kind of alarm state into doing the right thing, because their thinking brain’s been turned off by the alarm state.  And we  can’t reach their emotional-attachment-relational (limbic) brain if they feel so threatened they get into an alarm state, because they can’t feel reward from relations with people.

“If their brain stem, the foundation of their entire brain as a whole, is completely dysregulated, the only way they can feel reward is from sweet/salty/fatty foods, alcohol, drugs, sex, and so on. They know in their head that it’s wrong to steal from Grandma, and they may love Grandma in their heart – but at that moment, cognitive beliefs, or even human relational consequences, can’t relieve their anxiety.  They are in such distress in the lowest parts of their survival brain that it (survival brain) needs the reward of the drugs too badly.

“In fact, they can get to the point where they can’t feel any reward at all –  reward can’t even reach the lower part of the brain, if they’re so ramped up and anxious. At that point, the ONLY thing they want is to relieve the distress, and the only thing that can do it is to drink.  Alcohol will reduce the anxiety. It also makes us more vulnerable to other unhealthy forms of rewards.”

“Addiction as an Attachment Disorder”

Attachment disorder is surely a major component of many Adverse Childhood Experiences.

Flores, Addiction as Attachment DisorderAs to ACEs and substance abuse, note Dr. Philip J. Flores’ 2004 book entitled “Addiction as an Attachment Disorder.”

Dr. Flores reports that the human need for social interaction is a physiological one, linked to the well-being of the nervous system, as we’ve already seen. When someone becomes addicted, he says, mechanisms for healthy attachment are “hijacked,” resulting in dependence on addictive substances or behaviors. Flores believes that addicts, even before their addiction kicks in, struggle with knowing how to form emotional bonds to connect to other people.

While it’s commonly understood that early childhood attachments to parents and family are necessary for healthy development, Flores says, emotional attachments remain necessary throughout adulthood. It’s not enough, he says, to “just stop drinking. ” To achieve long-term well-being, addicts need opportunities to forge healthy emotional attachments.

Flores reports that this is the reason for the phenomenal success rate of Alcoholics Anonymous over more than 50 years.  When people walk into an A.A. meeting, the whole point is to admit openly that they are an alcoholic and yet to feel fully accepted for exactly who they are, with no condemnation.  What a relief! This experience of, in essence, pure attachment, may be the best attachment experience in their lives – and most people who walk in and experience this, miraculously, stay sober for decades or a lifetime.

Healing the Adult-Child

It took deep emotional attachment to heal the “adult me” in Kathy over the last years. It required a broad safety net: an empathic, painstaking therapist skilled in Adult Attachment Theory; support groups modeled on the A.A. principle of total acceptance and emotional attachment for the wounded; and close friends who were serious about staying attached to her because they wanted to heal, too.

As Dr. Felitti told her “After we talked to the very first round of ACE Study participants about their childhood experiences in the results of their ACE questionnaires, we saw a staggering 20% or higher reduction in the number of medical complaints, office visits, and other indicators of physical ailments in the next year alone.  Over and over, people thanked us for simply listening to them and their stories.”

That’s human emotional attachment: being seen, being known, just as we are, warts and all, by another human being – and then being fully accepted, and finally feeling that we belong.”

This is a very interesting article but for us it shows the compounding impact of insecure attachment on addiction vulnerability, i.e. it may not solely cause it. I, like my eldest sibling, became an alcoholic. My two middle sisters  did not although we all experienced similar adverse childhood experiences.

Why did my eldest sister become alcoholic when she remembers only happy experiences of childhood compared to me who has memories of many abuses? And what of alcoholics who report a loving upbringing?

Equally my middle sisters have grown up with emotional difficulties but no alcoholism or addiction.  They appear to have a neural machinery sophisticated enough to cope with these negative emotional states, to process them and re-appraise them, without being overwhelmed by them.

Thus for me it is genetic vulnerability which marks us our for later addiction and alcoholism. Insecure attachment however does appear to compound the problem. It appears to create more severe addiction difficulties and may even be more difficult to treat. It may have made my alcoholism more chronic? But I am not sure it created it?

Up to 60% of alcoholics, for example, have genetic inheritance, they got the alcoholic vulnerability from either parents or grandparents, perhaps regardless of environmental influence. Which begs the question what is inherited in this genetic endowment?

For us it may be emotional recognition, regulation and processing deficits, regardless of upbringing.

Obviously attachment disorder is linked to emotional processing deficits such as alexithymia which worsens these emotional processing deficits considerably.

Also the actions of chronic stress, the result of the addiction cycle, can also worsen the addict’s emotional processing, recognition and regulation deficits and appear as a severe form of alexithymia.

To conclude, alcoholics in particular may be born with a sense of separation (perhaps borne out of genetic impairment which results in neurotransmitter deficits,  for example in serotonin which is linked to well being, dopamine linked to negative emotions, GABA linked to inhibition, the “brakes” of the brain and excess stress chemicals all of which could contribute in a “cocktail” of emotions which manifest as feeling separate from others, not belonging)   and emotional problems exacerbated by insecure attachment, adverse childhoods and the neuro-toxic effects of alcohol and drugs on stress and emotional regulation to the point where drugs and alcohol, and other addictive behaviours are consumed or used to “regulate” these troublesome, distressing negative emotions.

What decreases in the addiction cycle is the ability to regulate our emotional selves.

Regardless, the treatment of this emotional disorders appears to be as suggested in this article.

Having some one listen to you without prejudice or censor is a first for many of us, having the confidence to verbalise one’s emotions is in itself a therapeutic tour do force as it helps us identify (recognise), label, process and regulate our emotions and in time allows us to offer the same courtesy to others. In the fullness of time, we become adapt at reading and responding to our and other’s emotional language.

I knew nothing of emotions a decade ago, now I am fascinated by them, research them and use them to converse with others and use them read the world around me. All as the result of going to 12 step meetings where other people allowed me to be myself.

Did this fill the hole in my Soul?  It certainly helped so there must be something to attachment disorder theories too.

Reference

http://www.mentalhealthexcellence.org/substance-abuse-survival/

and

http://attachmentdisorderhealing.com/blogs/

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11 replies »

  1. Dear Paul,
    Thanks for quoting me by name above, from my 3 blogs “How Your Brain Works 101,” “ACE: The Greatest Study Never Told,” and “Substance Abuse or Survival. ” Be sure to check out the blogs on the “Hole In Me” (‘cos it hurts!). They’re on my blog page http://attachmentdisorderhealing.com/blogs/ , under the subhead: “What is Addiction”:
    …Dr. Vincent Felitti: Origins of Addiction
    …Philip Seymour Hoffman: The Hole in Me
    …The Hole in Half of Us: More from Dr. Vincent Felitti
    …Substance Abuse or Survival Mechanism
    Let me know what else I can to do to help your important efforts to let people know the latest in brain science. Science now shows that we who have been put through trauma have nothing to be ashamed of!
    Warm wishes,
    Kathy Brous
    http://www.AttachmentDisorderHealing.com

  2. Hi Kathy, and thank you for the excellent work you have contributed to helping others understand attachment and it’s possible effects on addictive behaviors and psycho pathology in general. I agree we carry the real effects of trauma in our heads and brains and strangely help recover from them through our hearts and our connectedness with like minded people and a Higher Power. By learning to love. We can build in later life what was absent, traumatizing or dysfunctional in childhood.
    Thank you again for letting me quote widely from your work.
    Thank you too for your interest in my modest work and I am sure we can work together some time soon and look forward to it.
    Best wishes, Paul

  3. The whole of human race should be aware of these findings. Parents, children..we would all profit!
    Addiction is a terrible illness. We must try to help with education, maturity and love.

  4. Whilst this article makes some excellent points, let’s not forget society’s contribution to the source of the problem. There are many addicts in this world who were raised in well adjusted families. Society plays the role neglectful parent then typically seeks to blame the byproduct whilst coming up with it’s own chemical solutions.

    • I agree – some alcoholics/addicts have the “hole in the soul” without adverse childhoods. Emotion processing difficulties can be genetically inherited. We do not advocate chemical solutions to these issues however. “Secure” attachment can be learnt via recovery groups, therapists and treatments such as EMDR can help deal with developmental trauma. The brain generally has an amazing capacity to heal itself.

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