Attachment relationships among alcohol dependent persons

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This article (1)  presents the results of a study on alcohol dependent patients attachment style and its various dimensions.

This study demonstrated that that people with alcohol dependence significantly differ from non-alcoholics in terms of attachment style and its dimensions. They also receive significantly lower scores on secure attachment style and higher scores on insecure attachment style – anxious-ambivalent and avoidant style, and higher scores on attachment dimensions – anxiety and avoidance.

There were no differences in attachment styles and their dimensions for patients with alcohol dependent and non-dependent parents.

This study concluded that “Alcohol dependent persons rarely present secure connection to others and more often manifest mistrust in interpersonal relationships and avoid closeness and intimacy.”

“…Growing interest in issues of attachment, socio-cultural, psychological, and above all clinical perspectives, is also reflected in the emergence of research on the relationship of attachment styles in patients addicted to different psychoactive substances…

Attachment theory described by Bowlby refers to people’s biologically rooted tendencies to create strong emotional bonds with attachment figures (caregivers) in their first years of life [1, 2]. Empirical studies clearly confirm that the history of the attachment relationships significantly affects the shape and quality of interpersonal relationships formed in adulthood, shaping personality and developing a sense of identity, emotional functioning, coping with stress, the presence (or not) of psychopathological symptoms and even health conditions (see examples 1, 3., 4., 5., 6. and 7.).

Early interactions with caregivers become a source of knowledge, comprising among others, beliefs, expectations, emotions concerning relations to oneself, others and the world of human relationships. Such knowledge gets expressed in internal operating models throughout the course of one’s life [4]. Internal models that guide the perception and experience of oneself and others in interpersonal relationships are attachment patterns which are defined as strategies of “being with another person”. Research pioneered by Ainsworth involving children has shown that there are qualitatively different ways of functioning in close relationships. Ainsworth et al described three main patterns of attachment: secure, ambivalent and avoidant [8].

Each pattern contains a different representation of one’s own internal “me” and the other person, and only the secure attachment style is based on a positive experience of themselves and others. Subsequent researchers have created similar or slightly modified, but still consistent typologies: Main and Solomon continuing research on children added a disorganised pattern; Hazan and Shaver examining the specifics of romantic relationships of adults distinguished three adult attachment styles: secure, anxious-ambivalent, and avoidant [9]; Bartholomew created a typology of attachment styles with four different categories: secure, preoccupied, dismissive, fearful[2, 4, 8, 10].

Other researchers used several questionnaires that measure various aspects of adult attachment and examined over a thousand people and discovered two distinct dimensions with regards to bonds: anxiety – corresponding to fear of rejection, and avoidance – referring to avoidance of intimacy (closeness).

The anxiety dimension is associated with evaluating events in the context of the goals pertaining to attachment, such as physical and psychological proximity to the attachment object, or its achievability. The behavioural system keeps track of signs of possible dangers to one’s sense of security in interpersonal relationships or rejection signals. The avoidance dimension, in turn, regulates behaviour associated with search for contact and support for their object of attachment in the event of attachment anxiety or withdrawal and coping alone [4]

Empirical studies confirm that patients addicted to alcohol and other psychoactive substances are very likely to have insecure attachment styles and to display severe anxiety and avoidance in attachment dimensions 21., 22., 23. and 24., as well as showing that in the group of alcoholics displaying insecure attachment styles there is a higher level of anxiety as a trait, depression, schizoid traits and alexithymia [23, 25, 26]

The aim of this study was to determine patterns of attachment in Polish alcohol-dependent patients, taking into account gender, as well as addiction in the family (having an addicted parent), which seems to be of importance taking into consideration attachment theory as a theoretical framework…


The results of this study confirm our hypothesis that alcohol dependent persons are significantly more likely to exhibit insecure attachment styles (anxious-ambivalent and avoidant styles) than non-alcoholics, and significantly less likely to display secure attachment style. As indicated by the results obtained, alcohol dependent persons also differ from non-alcoholics in terms of anxiety and avoidance attachment as they received higher scores on these dimensions.

These results are consistent with the results of other studies in which the percentage distribution of the occurrence of the secure style in people addicted to alcohol varies from 5.4 to 40%, while insecure attachment styles vary from 66 to 94.6% [21, 23, 24, 35].

Studies have also shown that among addicts variables such as the avoidance of closeness and fear of intimacy assume much higher values than in patients without addiction [22]. It seems therefore, that the occurrence of insecure attachment styles and dimensions of such intensity (that indicates feelings of mistrust in interpersonal relationships) is prevalent in patients with alcohol dependence.

In addition, there are also a number of studies conducted in non-clinical groups, especially among adolescents and students, which show that the presence of insecure attachment styles and high levels of anxiety and avoidance attachment dimensions is associated with alcohol abuse and experiencing serious consequences of drinking [29, 36, 37].

Taking into account the results obtained in this study the practical implications seem important, especially in the therapeutic relationship and the therapeutic allianceestablished with alcohol addicted persons. The present study shows that among alcohol dependent patients there will be some that initially experience distrust, fear and insecurity in the therapeutic relationship, not necessarily due to unstable motivation for treatment. These patients may unconsciously recreate old relationships in their interaction with a therapist which probably lacked a sense of security, support and hope driven by internal operating models and styles of attachment. This sheds new light on the issue of termination of psychotherapy by patients or relapse in the treatment of addiction, and – in the opinion of the authors of the article – on the aims of in-depth psychotherapy for alcohol dependent patients.”


  1. Wyrzykowska, E., Głogowska, K., & Mickiewicz, K. (2014). Attachment relationships among alcohol dependent persons. Alcoholism and Drug Addiction, 27(2), 145-161.

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