Adult attachment security and college student substance use

Dissociation and Temporality in Substance Abuse: A Clinical Phenomenological Overview

The term "dissociation" encompasses a wide array of symptoms and phenomena, all sharing the common characteristic of involving altered states of consciousness where an individual temporarily loses the sense of continuity of their own identity. In the context of addiction pathology, however, the dissociative paradigm remains a topic of ongoing debate. It fluctuates between the description of individual dissociative symptoms and the notion of post-traumatic dissociation as a structural process. This process involves fragmentation that extends beyond the confines of perception and experience within a singular moment, instead ensuring a persistent discontinuity of the self throughout one's existence. Pathological addiction stresses the question of the donation of sense in this deep and dramatic experience; it situates individuals within a compressed and constricted realm of vital space, alongside a frozen perception of time. Within this context, every emotion, sensation, and comprehension becomes impaired. Consequently, we have embarked on a journey starting with a historical analysis: the aim was to construct an elucidative framework for the dissociative paradigm in the context of addiction. This involves an in-depth exploration of the fundamental constructs of trauma and temporality, examined through the lens of phenomenological perspective.

Insecure Attachment Styles and Phubbing: The Mediating Role of Problematic Smartphone Use

Lately, increasing concern has focused on the incessant and intrusive use of smartphones across a wide range of interpersonal and relational contexts. Of concern is that many people appear to snub someone during face-to-face interactions by focusing more on their smartphone than on their relational partner, namely, phubbing. Individuals with insecure attachment styles may phub their intimate others more often. However, such relationships have not been examined. This study used a cross-sectional design to examine key relationships between insecure attachment styles on phubbing. An online survey was conducted to examine the relationships between the variables of this study ( $N=444$ , 72% female: mean age 20). The analyses revealed both anxious-preoccupied and dismissive-avoidant attachment styles to be positively associated with phubbing. Moreover, both insecure attachment styles indirectly predicted phubbing through problematic smartphone use (PSU). Insecure attachment styles appear to impact how often people phub others within intimate relationships, and further, PSU may function as a mechanism linking these insecure attachment styles with phubbing.

Relations between attachment, identity and borderline personality disorder symptom severity in male inpatients with alcohol use disorder

Insecure attachment style and borderline personality disorder (BPD) symptoms are related to the severity of alcohol use disorder (AUD) and can also complicate its course and treatment. We propose a theoretical model of relationships between adult attachment style and BPD and AUD symptom severity in which the sense of identity is a mediator. The aim of our study was to test this model in a sample of male inpatients with AUD. Male inpatients with AUD (N = 114) aged 22-72 years (M = 43.05; SD = 9.84) completed the Experiences in Close Relationships-Revised, the Multidimensional Identity Questionnaire, the Alcohol Use Disorders Identification Test and the Borderline Symptom List 23. Results showed that the sense of identity fully mediated the positive relationship between attachment anxiety and BPD symptom severity. There was also a positive indirect effect of attachment avoidance on BPD symptoms via weaker sense of identity. Contrary to hypothesis, AUD symptom severity was not related to attachment, identity or BPD symptoms in our sample. Sense of identity could be a possible target for interventions for insecurely attached men with AUD to reduce BPD symptoms.

Associations of Childhood Maltreatment and Attachment Styles with Romantic Breakup Grief Severity: The Role of Emotional Suppression

Childhood maltreatment (CM) and insecure attachment styles may partly explain grief severity following romantic breakup. Empirical studies examining the factors that could possibly explain this association, however, remain sparse. The present study tested whether the relations among CM, attachment styles, and romantic breakup grief severity could be explained by emotional suppression in Iranian college students. In a cross-sectional study, 239 Iranian college students (ages 18-45; M = 24.11, SD = 15.29; 50.6% women) with a recent romantic breakup experience were recruited from University of Tabriz. Participants completed a diagnostic interview and self-report battery, including the Persian version of the Child Abuse Self-Reported Scale, Revised Adult Attachment Scale, Romantic Breakup Grief Inventory, and Weinberger Adjustment Inventory. Structural equation modeling was used to empirically explore the relations among variables. Results indicated that those who reported higher levels of CM also reported higher levels of romantic breakup grief. Attachment closeness showed a significant negative and direct effect on romantic breakup grief severity. However, attachment anxiety was positively associated with greater levels of romantic breakup grief. Bootstrapping results showed that CM might affect romantic breakup grief severity via emotional suppression. Furthermore, attachment closeness and attachment anxiety exerted indirect effects on romantic breakup grief severity through emotional suppression. Clinical and empirical implications are discussed.

Parental Acceptance/Rejection Perceptions and Attachment Styles of Men With Online Gambling Disorder

Online gambling disorder has recently emerged as a significant public health issue. Family dynamics play an important role in the development of online gambling disorder. In this research, the aimed to compare the parental acceptance/rejection and attachment styles of individuals with online gambling disorder with a healthy control group. Also, the relationship between parental acceptance/rejection and attachment styles was examined in individuals with online gambling disorder. The study group consisted of 53 male patients with online gambling disorder and 57 healthy controls. The individuals with online gambling disorder perceived more rejection from mothers but especially from fathers than the individuals in the control group. Paternal hostility/aggression and indifference/neglect are determinants of online gambling behavior. The individuals with online gambling disorder had lower levels of secure attachment and higher levels of dismissive and fearful attachment than the individuals in the control group. Both secure attachment style and dismissive attachment style are thought to be determinants of gambling behavior. Mother-father rejection and insecure attachment are important in terms of creating risk for online gambling. Assessment of the effects of maternal and especially paternal rejection in online gambling disorder will be beneficial within the scope of preventive mental health.

Early parent-child interactions and substance use disorder: An attachment perspective on a biopsychosocial entanglement

This review aims to elucidate environmental and genetic factors, as well as their epigenetic and neuroendocrine moderators, that may underlie the association between early childhood experiences and Substance Use Disorders (SUD), through the lens of parental attachment. Here we review those attachment-related studies that examined the monoaminergic systems, the hypothalamic pituitary adrenal stress response system, the oxytoninergic system, and the endogenous opioid system from a genetic, epigenetic, and neuroendocrine perspective. Overall, the selected studies point to a moderating effect of insecure attachment between genetic vulnerability and SUD, reasonably through epigenetic modifications. Preliminary evidence suggests that vulnerability to SUDs is related with hypo-methylation (e.g. hyper-expression) of high-risk polymorphisms on the monoaminergic and hypothalamic pituitary adrenal system and hyper-methylation (e.g. hypo-expressions) of protective polymorphisms on the opioid and oxytocin system. These epigenetic modifications may induce a cascade of neuroendocrine changes contributing to the subclinical and behavioural manifestations that precede the clinical onset of SUD. Protective and supportive parenting could hence represent a key therapeutic target to prevent addiction and moderate insecure attachment.

A Comprehensive Model of Tobacco Cigarette Smoking in Adolescence: The Role of Attachment Style and Personality

Several previous studies have investigated the association between smoking, attachment style and personality, but they were either focused on personality or on attachment style and considered these variables separately. Starting from such findings, the study aims to investigate both factors, as they might not be independent, in order to clarify their role in the onset of smoking behavior in adolescence. This study was conducted on a convenience sample of 338 adolescents [male: 55% (186) - female: 45% (152)] (aged 16.63 ± 1.63). All participants completed a set of standardized questionnaires that assessed attachment style, personality and smoking behavior (starting age, daily cigarettes, nicotine dependence). Results showed that the dismissing attachment style, novelty seeking, and older age were associated with a higher likelihood of having a cigarette smoking experience; while self-directedness and gender (being female) were associated with a lower likelihood of having a cigarette smoking experience (p < .001). The secure and avoidant attachment styles were associated with a late smoking onset, whereas dismissing attachment and reward dependence were associated with an earlier smoking onset (p < .009). These findings highlight the possibility of developing a psycho-cognitive profile of adolescent smokers, and help to describe a smoking trajectory that may aid in designing tailored interventions and treatments to discourage smoking.

Distinct paths to alcohol problems: Impacts of childhood maltreatment, attachment insecurity, and interpersonal problems

Childhood maltreatment is a strong risk factor for increased alcohol use and alcohol-related problems. One possible explanation for these associations is the influence of dysfunctional attachment styles and interpersonal problems in adulthood. Individuals who have experienced childhood maltreatment are likely to develop maladaptive interpersonal styles due to insecure attachment. Maladaptive interpersonal styles may increase emotional distress, which in turn, can make these individuals vulnerable to alcohol use and alcohol-related problems. Using data from 508 undergraduate students, this study examined the associations between three types of childhood maltreatment (i.e., sexual abuse, punishment that included physical abuse, and a negative home atmosphere that included neglect), alcohol use, and alcohol-related problems via insecure attachment and interpersonal problems. The results showed that punishment predicted alcohol problems via avoidant attachment and selfish interpersonal style. Sexual abuse and negative home atmosphere predicted alcohol consumption through anxious attachment and selfless interpersonal style. In addition, sexual abuse directly predicted alcohol problems. These findings provide new insights for the field of childhood maltreatment and addiction literature.

Mental disorders and substance abuse among Rwandan university students: the moderating effects of interpersonal violence

Background: There is an abundance of evidence suggesting that interpersonal violence commonly co-occurs with mental disorders and substance abuse. Interpersonal violence is one of the most well-documented and salient factors of mental disorders and substance abuse; however, there are no studies investigating the moderating role of interpersonal violence in post-conflict Rwanda. Objective: The aim of the present study was to explore the relationship between mental disorders and substance abuse among Rwandan university students, and whether the role of interpersonal violence is a moderating factor. Method: A purposive sample of 143 undergraduate university students (mean age = 22.4 years, SD = 2.6) from University of Rwanda-Remera Campus were selected for participation in this cross-sectional study. We used linear regression analysis to examine the relationships between mental disorders, substance abuse and interpersonal violence. Results: Substance abuse was significantly associated with post-traumatic stress disorder (PTSD), anxiety, depression and interpersonal violence. Interpersonal violence was a significant moderator of the associations between PTSD symptoms (β = 0.43, p < 0.001), anxiety symptoms (β = 0.47, p < 0.001), depressive symptoms (β = 0.48, p < 0.001) and substance use. Conclusion: The results imply that PTSD, depression and anxiety symptoms are associated with increased risk of substance abuse, and this risk appears to become substantially more elevated when there are also current or historic reports of interpersonal violence.

Food Addiction and Tobacco Use Disorder: Common Liability and Shared Mechanisms

As food addiction is being more commonly recognized within the scientific community, parallels can be drawn between it and other addictive substance use disorders, including tobacco use disorder. Given that both unhealthy diets and smoking are leading risk factors for disability and death, a greater understanding of how food addiction and tobacco use disorder overlap with one another is necessary. This narrative review aimed to highlight literature that investigated prevalence, biology, psychology, and treatment options of food addiction and tobacco use disorder. Published studies up to August 2020 and written in English were included. Using a biopsychosocial lens, each disorder was assessed together and separately, as there is emerging evidence that the two disorders can develop concurrently or sequentially within individuals. Commonalities include but are not limited to the dopaminergic neurocircuitry, gut microbiota, childhood adversity, and attachment insecurity. In addition, the authors conducted a feasibility study with the purpose of examining the association between food addiction symptoms and tobacco use disorder among individuals seeking tobacco use disorder treatment. To inform future treatment approaches, more research is necessary to identify and understand the overlap between the two disorders.

Adult Attachment System Links With Brain Mu Opioid Receptor Availability In Vivo

BACKGROUND

Secure attachment is important in maintaining an individual's health and well-being. Attachment disturbances increase the risk for developing psychiatric disorders such as affective disorders. Yet, the neurobiological correlates of human attachment are poorly understood at the neurotransmitter level. We investigated whether adult attachment style is linked to functioning of the opioid and serotonergic systems in the human brain.

METHODS

We used positron emission tomography with radioligands [¹¹C]carfentanil and [¹¹C]MADAM to quantify mu opioid receptor (n = 39) and serotonin transporter (n = 37) availability in volunteers with no current psychiatric disorders. Attachment style was determined according to the Dynamic-Maturational Model of Attachment and Adaptation with the structured Adult Attachment Interview.

RESULTS

Secure attachment was associated with higher mu opioid receptor availability in the hippocampus, amygdala, thalamus, and prefrontal cortex when compared with insecure (i.e., avoidant or ambivalent groups combined) attachment. In contrast, attachment style was not associated with serotonin transporter availability.

CONCLUSIONS

Our results provide preliminary in vivo evidence that the opioid system may be involved in the neurocircuits associated with individual differences in adult attachment behavior. The results suggest that variation in mu opioid receptor availability may be linked with the individuals' social relationships and psychosocial well-being and thus contributes to risk for psychiatric morbidity.

A dyadic approach to attachment anxiety and avoidance, marital conflict, and drinking

In this research, we integrate attachment theory and dyadic methodology to examine how attachment anxiety and avoidance might interact with marital conflict to influence alcohol consumption, drinking motives, and alcohol-related problems in a sample of 280 married and cohabiting couples over 3 years. Both husband and wife attachment anxiety were related to higher levels of own drinking to cope and alcohol-related problems. Additionally, both husband and wife reports of marital conflict were associated with own alcohol-related problems. For wives, significant interactions between anxiety and marital conflict suggested that anxiety was more strongly associated with alcohol consumption, coping, and problems at higher levels of conflict. For husbands, significant interactions between avoidance and conflict indicated that avoidance was more strongly associated with coping and problems at lower levels of conflict. This research suggests two main patterns of attachment and alcohol use, both exacerbated by marital conflict and different for husbands and wives.

Sources of Stress and Their Associations With Mental Disorders Among College Students: Results of the World Health Organization World Mental Health Surveys International College Student Initiative

The college years are stressful for many students. Identifying the sources of stress and their relative importance in leading to clinically significant emotional problems may assist in the development of targeted stress management interventions. The current report examines the distribution and associations of perceived stress across major life areas with 12-month prevalence of common mental disorders in a cross-national sample of first-year college students. The 20,842 respondents were from 24 universities in 9 countries that participated in the World Health Organization World Mental Health International College Student Initiative. Logistic regression analysis examined associations of current perceived stress in six life areas (financial situation, health, love life, relationships with family, relationships at work/school, problems experienced by loved ones) with six types of 12-month mental disorders (major depressive disorder, bipolar disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder). Population attributable risk proportions (PARPs) were calculated to estimate the upper-bound potential effects of interventions focused on perceived stress in reducing prevalence of mental disorders. The majority of students (93.7%) reported at least some stress in at least one of the six areas. A significant dose-response association was found between extent of stress in each life area and increased odds of at least one of the six disorders. The multivariable models that included all stress measures were significant for all disorders (F = 20.6–70.6, p < 0.001). Interpretation of PARPs as representing causal effects of stresses on disorders suggests that up to 46.9–80.0% of 12-month disorder prevalence might be eliminated if stress prevention interventions were developed to block the associations of stress with these disorders.

Health Risk Behaviors and Self-Esteem Among College Students: Systematic Review of Quantitative Studies

BACKGROUND

Due to their impact on premature mortality and long-term disabilities, a better understanding of health risk behavior (HRB) determinants among college students is crucial in order to build the most appropriate prevention tools. Although self-esteem appears to be a relevant candidate, a clear picture summarizing its multiple links with HRB is lacking to guide clinicians and researchers. This study aims to provide a systematic review of the associations between health risk behavior and self-esteem among college students.

METHODS

This search was performed in several databases on 02/02/17. Study eligibility criteria were original articles in peer-reviewed journals, in English; observational quantitative studies; among college students; and investigated the association between self-esteem and HRB. The PRISMA statements were complied with.

RESULTS

One hundred fifteen articles were included: 46 on substance use, 35 on sexual behavior, 11 on nutritional habits, 27 on physical activity, and 5 on other HRB. Most studies reported an association between higher self-esteem and healthier behavior. For alcohol consumption and number of sexual partners, both negative and positive associations have been reported. Directionality was investigated in a few studies suggesting potential bidirectional effects.

CONCLUSIONS

This review points out the need for consensus for the definition of self-esteem and HRB. There was high heterogeneity in (1) the measurement of self-esteem either in the concept measured (global vs. domain) or in the way to implement validated tools; and (2) the definition of HRB. Self-esteem seems to be a relevant target to intervene on HRB, especially alcohol abuse and physical activity.

TRIAL REGISTRATION

Registration number: PROSPERO (ID = CRD42017056599).

Attachment style and addictions (alcohol, cigarette, waterpipe and internet) among Lebanese adolescents: a national study

Background

The prevalence in the Lebanese general population of cigarette and waterpipe smoking, alcohol drinking and internet use seems to be increasing lately. So far, no study was done relating the above to attachment styles in Lebanese adolescents. Consequently, the objective of our study was to assess the relationship between attachment styles (secure, preoccupied, fearful, and dismissing) and addictions (cigarettes, water pipes, alcohol, and internet) among this population.

Methods

It is a cross-sectional study that took place between January and May 2019. Two thousand questionnaires were distributed out of which 1810 (90.5%) were completed and collected back. A proportionate random sample of schools from all Lebanese Mohafazat was used as recruitment method.

Results

A secure attachment style was significantly associated with lower addiction to alcohol, cigarette, and waterpipe, whereas insecure attachment styles (preoccupied, dismissing and fearful) were significantly associated with higher addiction to cigarette, waterpipe, alcohol, and internet.

Conclusion

Lebanese adolescents with insecure attachment had higher rates of addiction to cigarette, waterpipe, alcohol, and internet. They should be closely monitored in order to reduce the risk of future substance use disorder and/or behavioral addiction development.

The effect of significant other involvement in treatment for substance use disorders: A meta-analysis

OBJECTIVE

Substantial research has accrued in support of a key role for social processes in substance use disorders (SUD). Researchers have developed a range of interventions that capitalize on these social processes to bolster treatment outcomes by involving significant others (e.g., romantic partners, family, friends) in SUD treatment. Yet dissemination of these treatments to many contexts has been slow, and information on their broad efficacy is lacking. This meta-analysis aims to quantify the effect of significant other involvement in SUD treatments above and beyond individually-based therapies.

METHOD

A total of 4,901 records were screened for randomized controlled trials examining the effect of Significant Other Involved SUD Treatments (SOIT) versus individually-based active comparator treatments. Our search yielded 77 effect sizes based on data from 2,115 individuals enrolled in 16 independent trials.

RESULTS

Findings indicated a significant effect of SOIT above and beyond individually-based active comparator treatments for reducing substance use and substance-related problems, d = 0.242, 95% CI [0.148, 0.336], I² = 10.596, Q(15) = 16.778. This effect was consistent across SOIT treatment types and endured 12-18 months after the end of treatment. Analyses of raw mean differences indicated that this effect translates to a 5.7% reduction in substance use frequency-the equivalent of approximately 3 fewer weeks a year of drinking/drug use.

CONCLUSION

Findings indicate a significant advantage for SOIT in SUD treatment, and hold interesting conceptual implications for theories of SUD maintenance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impact of the interaction between alexithymia and the adult attachment styles in participants with alcohol use disorder

The current study aims to investigate the effect of the interaction between adult attachment styles and alexithymia among participants with alcohol use disorder (AUD). This study is cross-sectional, conducted between November 2017 and March 2018, which enrolled 789 community-dwelling participants. The interaction between alexithymia and secure relationship tended to significance (p = 0.057). Higher interaction between alexithymia and a fearful relationship style (β = 0.04) were significantly associated with higher AUD. The interaction model revealed the importance of stratifying the results according to presence/absence of alexithymia. Being a female and having a secure relationship style were significantly associated with lower AUD in both groups. Being divorced was significantly associated with higher AUD in both groups. Increasing age (β = -1.48), secondary (β = -4.65), and university level of education (β = -6.46) were significantly associated with lower AUD in the non-alexithymic group. Intermediate monthly income (β = 2.69) and being widowed (β = 8.24) were significantly associated with higher AUD in the non-alexithymic group. High monthly income (β = 3.46) was significantly associated with higher AUD in the alexithymic group. The results of this study showed that the consideration of the combination between attachment styles and alexithymia is of significance in the diagnosis and therapy of alcohol use disorders.

Parenting styles and metacognitions as predictors of cannabis use

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First study to investigate metacognitions in cannabis use.

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Negative affect, parenting styles and metacognitions were correlated with cannabis use.

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Coercive authoritarian parenting style and cognitive confidence predicted cannabis use.

Metacognitions, the beliefs held about internal mental processes and the strategies aimed at controlling such processes, are known to play a significant role in the development and maintenance of addictive behaviours. Specifically, lack of cognitive confidence and beliefs about the need to control thoughts have been implicated across addictive behaviours. No research to date, though, has explored the role of metacognitions in cannabis use. Research has also shown that an authoritarian parenting style (where a parent uncompromisingly enforces their own ideas regardless of the will of the child) may be correlated with addictive behaviours. However very limited research has investigated the role of parenting styles in cannabis use. In the current study we aimed to investigate the relative contribution of parenting styles and metacognitions to cannabis use. A sample of 85 participants completed a series of online questionnaires, measuring negative affect, parenting styles, metacognitions and cannabis use. Spearman correlations indicated that cannabis use was positively correlated with each of the metacognitions and both permissive and authoritarian parenting styles. Regression analyses demonstrated that a combination of the physically coercive aspects of the authoritarian parental style and lack of cognitive confidence predicted cannabis use when controlling for negative affect. The implications of the current findings are discussed.

Attachment and Substance Use Disorders-Theoretical Models, Empirical Evidence, and Implications for Treatment

Introduction: The article reviews attachment-oriented research in individuals with substance use disorders (SUDs). 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. Earlier reviews have indicated a general link but have been inconclusive with regard to other aspects. In the light of a growing body of research, this review is looking for evidence for the general link, for its direction, for differences due to different patterns of attachment, different substances and severities, comorbid psychiatric disorders, and age groups. Methods: Using medical and psychological databases, 34 cross-sectional studies, three longitudinal studies, and a systematic meta-analysis were identified. Methodological problems such as poor assessment of SUD and the use of different measures of attachment limit comparability. Results: All cross-sectional studies in the review confirm a link between insecure attachment and SUD. Results of longitudinal studies 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 toward very insecure patterns. They indicate different patterns of attachment in different groups of substance abusers, suggesting different developmental pathways. Fearful-avoidant attachment was frequent in heroin addicts, while alcohol abusers displayed more heterogeneous patterns. Comorbid mental disorders and severity of SUD seem to be important factors, but data are still inconclusive. 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. Despite methodological problems, the general link between insecure attachment and SUD today is well established. Attachment theory might contribute to the understanding and treatment of SUDs in a significant way. But to do so, a lot of open questions have to be answered. We will need more carefully designed longitudinal studies, more studies connecting psychological data with brain processes, and more clinical trials.

Psychological factors associated with smoking and quitting: addiction map of Turkey study

BACKGROUND

Smoking is the most important modifiable factor in increased morbidity and premature mortality. This study aims to examine the psychological factors associated with smoking and quitting in a broad, nationally representative sample.

PARTICIPANTS AND METHODS

The sample included a total of 24.494 adult individuals. Participants were divided into three groups as smokers, non-smokers, and "ex-smokers" who had stopped smoking since at least last one year. For the current smokers, cigarettes per day also noted. Brief Symptom Inventory, Toronto Alexithymia Scale (TAS), Personal Well-Being Index Adult Form, Positive and Negative Affect Schedule, Experiences in Close Relationships-Revised Scales were used.

RESULTS

43.6% (n=10,672) of the participants were smokers; 5.7% (1386) were ex-smokers; 50.7% (n=12,414) were non-smokers. A higher number of daily smoked cigarettes was related to all subscales of Brief Symptom Inventory, TAS - Difficulty in Recognition of emotions, TAS - Difficulty in Expressing Emotions, Positive Affect Score, Negative Affect Score, Avoidance and Anxious Attachment scores (p<0.05). Externally oriented thinking is found to be significantly higher among ex-smokers than current smokers and non-smokers (p<0.05).

CONCLUSION

The results of the present study indicate that smokers have more psychopathological characteristics in the psychometric evaluation, whereas ex-smokers are found to have similar scores to non-smokers. The higher percentage of externally oriented-thinking style in ex-smokers may suggest that this alexithymic characteristic can help the individual to deal with psychological addiction throughout quitting. On the other hand this result could also be related that stopping smoking leads to greater externally orientated thinking and other changes in psychological characteristics.

Investigating the role of attachment styles, dysfunctional attitudes, and spirituality in predicting membership in addicted and non-addicted groups

Drug addiction as a biological, psychological, and social issue affects all dimensions of one's life. The purpose of this study was to determine the role of attachment styles, dysfunctional attitudes, and spirituality in predicting membership in addicted and non-addicted groups. This was a cross-sectional study conducted on 60 addicted people and 60 non-addicted people. The Adult Attachment Scale of Hazan and Shaver, Allport Religious Orientation Scale, and the 26-item Dysfunctional Attitude Scale (DAS-26) were used to measure the variables. Based on the results, which were analyzed by logistic regression analysis, the variables of attachment style and dysfunctional attitude can significantly predict drug addiction (p < .001). However, avoidant attachment style and spirituality cannot predict readiness for addiction. The results of this study indicate the importance of safe and ambivalent attachment styles and dysfunctional attitudes. Thus, attending to these factors in studies and interventions related to the treatment of substance abuse disorders is essential.

Childhood Adversity and Hazardous Drinking: The Mediating Role of Attachment Insecurity

BACKGROUND

Harmful alcohol use is associated with disease and mortality. Identifying new determinants of harmful drinking may aid the 16.3 million adults who have alcohol use disorders. Childhood adversity is associated with alcohol use, but is not amenable to change. Attachment insecurity (anxiety and avoidance) may be associated with alcohol use and may be a target for modification or used to personalize interventions.

OBJECTIVES

This study aims to (a) identify the association between attachment insecurity and harmful drinking, (b) determine if attachment insecurity may mediate between childhood adversity and harmful drinking, and (c) test sex as a moderator between attachment insecurity and harmful drinking in the mediation relationship.

METHODS

Adult primary care patients (N = 348, 60% women) completed a cross-sectional survey study using validated measures in 2012. Statistical analyses were performed using Hayes's PROCESS macro in SPSS.

RESULTS

Childhood adversity was reported by 61% of the cohort and 18% endorsed harmful drinking. Attachment anxiety was associated with harmful drinking (p >.001), but attachment avoidance was not (p =.11). Attachment anxiety may mediate between childhood adversity and harmful drinking (95% CI:.03-.14). Sex did not moderate the relationships between attachment anxiety and harmful drinking in the mediation relationship (women: 95% CI:.031-.179; men: 95% CI:.003.-.182). Conclusions/Importance: Attachment anxiety may mediate between childhood adversity and harmful drinking in both men and women. Attachment anxiety may be a potential therapeutic target for people with a history of childhood adversity.

Who stays in addiction treatment groups? Anxiety and avoidant attachment styles predict treatment retention and relapse

Attachment styles have been shown to be an important predictor of relationship quality and well-being. They have also been linked with ability to function well in groups. Insecure attachment styles are thought to be an underlying cause of addiction and represent a target for change in one-to-one therapy. How attachment styles themselves affect group therapy for addiction is understudied. The current study addresses this gap by examining the effects of attachment styles on relapse and treatment retention amongst a population of people attending addiction therapy groups. Fifty-eight individuals in such groups completed measures of attachment anxiety and avoidance. Participants were followed up 4 weeks later, and their continued treatment attendance and relapse status were recorded. In terms of treatment retention, high anxiety/high avoidant participants had the highest retention. In terms of relapse, low anxiety/high avoidant participants had the lowest rates. These results are discussed in terms of the potentially protective effects of avoidant attachment styles during group therapy and the role of anxiety attachment in the continued maintenance of both protective and risky personal relationships.

Depression symptoms and reasons for gambling sequentially mediate the associations between insecure attachment styles and problem gambling

One of the central pathways to problem gambling (PG) is gambling to cope with negative moods, which is a cardinal feature of depression. Insecure attachment styles are also etiologically related to depression; and, therefore, by extension, those who are insecurely attached may engage in excessive gambling behaviors to cope with depression. In this study, we aimed to evaluate this and to this end predicted that depression severity and coping motives for gambling would conjointly mediate the relations between insecure attachment styles and PG. Data came from a larger investigation of PG within mood disorders. Participants exhibited a lifetime depressive or bipolar disorder and endorsed a mood episode within the past ten years. Participants (N=275) completed self-report measures during a two-day assessment. Path analysis supported two main indirect effects. First, anxious attachment predicted elevated depression, which in turn predicted increased coping motives for gambling, which subsequently predicted greater PG severity. Second, this double mediational pathway was also observed for avoidant attachment. Results suggest that insecure attachment relates to PG via depressive symptoms and coping-related gambling motives. Mood symptoms and associated gambling motives are malleable and are promising targets of gambling interventions for insecurely attached individuals.

A meta-analysis of longitudinal associations between substance use and interpersonal attachment security

Substance use has long been associated with close relationship distress. Although the direction of influence for this association has not been established, it has often been assumed that substance use is the causal agent and that close relationship distress is the effect. But research seeking to establish temporal precedence in this link has produced mixed findings. Further, theoretical models of substance use and close relationship processes present the plausibility of the inverse pathway-that insecure close relationships may serve as a vulnerability factor for the development of later substance problems. The current review applies an attachment-theoretical framework to the association between close social bonds and substance use and substance-related problems. Targeting longitudinal studies of attachment and substance use, we examined 665 effect sizes drawn from 34 samples (total N = 56,721) spanning time frames ranging from 1 month to 20 years (M = 3.8 years). Results revealed a significant prospective correlation between earlier attachment and later substance use (r = -.11, 95% CI [-.14, -0.08]). Further, cross-lagged coefficients were calculated which parsed auto-regressive effects, indicating that lower attachment security temporally preceded increases in substance use (r = -.05, 95% CI [-.06, -.04]). Analyses further indicated that the pathway from earlier attachment to later substance use was significantly stronger than that from earlier substance use to later attachment. Results also revealed several moderators of the attachment-substance use link. These findings suggest that insecure attachment may be a vulnerability factor for substance use, and indicate close relationship quality as a promising line of inquiry in research on substance use disorder risk. (PsycINFO Database Record

Father and son attachment styles in alcoholic and non-alcoholic families

Background

The theory of attachment is important to understand a lot of human behaviour. Styles of attachment could be important predictors in developing dependence on alcoholism. Insecure attachment patterns could be significant risk factors for future alcohol use.

Methods

Participants for this study consist of fathers with alcohol dependence syndrome (ADS) from treatment centres and fathers from the community with no dependency on alcohol, and their sons (n=200). The Michigan Alcoholism Screening Test (MAST), socioeconomic status scale were administered, and attachment styles were derived by the Attachment Style Questionnaire (ASQ). We hypothesised a prior concept reflecting theoretical predictions for the association between attachment styles and alcohol in both the generations.

Results

Statistics on SPSS-16 was used to test our hypotheses. As predicted, fathers with ADS had insecure attachments styles in comparison to the control group. Substance abuse/dependence and treatment participation were at an all-time low for the secure group.

Conclusion

The findings from this study identify attachment styles as an influential factor in understanding the divergence between alcohol dependence in treatment seekers. The findings further imply that differential treatment may need to be provided taking into account one's attachment representation to promote successful recovery. It also highlights the need to develop secure ties in children of alcoholic parents to protect them from use of substances as a coping and a learned mechanism. Limitations of the study and suggestions for further research are highlighted and implications for diagnosis and treatment are discussed.

Adult attachment and drinking context as predictors of alcohol problems and relationship satisfaction in college students

BACKGROUND

Evidence suggests that for young adults, intimate partners influence each other's drinking patterns. Therefore, exploration of variables related to intimate partner relationships (such as attachment style) could broaden the current understanding of risk factors for alcohol problems in this demographic.

OBJECTIVES

The current study examined the role of drinking context in the relationships among insecure attachment, alcohol problems, and relationship satisfaction. A path model was hypothesized where the relationship between insecure attachment and alcohol problems would be explained via two distinct drinking contexts (i.e., drinking with one's partner and drinking away from one's partner). It was also hypothesized that the relationship between insecure attachment and relationship satisfaction would be explained via these same two drinking contexts.

METHODS

Participants were 194 undergraduate students ages 18-25 who reported being in a monogamous intimate partner relationship for at least 90 days and had also consumed alcohol in the past 90 days. The sample was comprised of 76% women and 24% men.

RESULTS

The hypothesized direct relationship from anxious attachment to alcohol problems was significant; there were also significant direct paths from both anxious and avoidant attachment to relationship satisfaction. The hypotheses regarding indirect relationships were not supported.

CONCLUSION

The results of this study contribute to the existing literature, in that they suggest that drinking in the context of an intimate relationship may not directly affect relationship satisfaction in this population. However, relationship functioning still appears to be an important variable to consider in the prevention and treatment of alcohol-related problems affecting college students.

Attachment, motivation, and clinical progress in a Filipino therapeutic community: a mediation analysis

Purpose

The therapeutic community (TC) is a widely used intervention program in treating substance use disorders. Despite its documented utility, researchers and practitioners are still perplexed on how it exactly works. The purpose of this paper is to suggest the role of attachment styles and treatment motivation in the TC process.

Design/methodology/approach

Applying an explanatory correlational research, this notion was tested by examining the responses of 200 patients with substance use disorder in a TC using mediation analysis.

Findings

The results revealed that attachment styles indirectly affect client’s clinical progress by the path of treatment motivation. Although the current study cannot conclude causality, the results provide empirical evidence suggesting that attachment activates motivation in treatment within the social dynamics of the TC, thus influencing clinical progress.

Originality/value

From these findings, recommendations for the modification of TCs along with considerations for further research, and socio-political implications are discussed.

Adult Attachment, Social Adjustment, and Well-Being in Drug-Addicted Inpatients

In recent years, attachment studies have gathered overwhelming evidence for a relation between insecure attachment and drug addiction. The existing literature predominantly addresses attachment styles and little attention is given to attachment-pattern-oriented studies. The current study explored how attachment, social adjustment, and well-being interact in 40 (28 men, 12 women; ages 20-52 years, M = 32.3, SD = 9.4) inpatients with drug addiction. The Adult Attachment Projective Picture System (AAP), the Social Adjustment Scale-Self-report (SAS-SR), and the General Health Questionnaire-28 (GHQ-28) were administered. Descriptive statistics were computed as well as differences between patterns of attachment in all variables were measured. None of the inpatients showed a secure attachment pattern: 7 scored as dismissing (18%), 5 preoccupied (12%) and 28 unresolved (70%). AAP stories were mainly connected with themes of danger, lack of protection, and helplessness. Inpatients classified as unresolved reported significantly higher maladjustment on the SAS-SR and GHQ-28 than those with resolved attachment patterns. Implications for clinicians and researchers are presented.

On Mourning and Recovery: Integrating Stages of Grief and Change Toward a Neuroscience-Based Model of Attachment Adaptation in Addiction Treatment

Interpersonal attachment and drug addiction share many attributes across their behavioral and neurobiological domains. Understanding the overlapping brain circuitry of attachment formation and addiction illuminates a deeper understanding of the pathogenesis of trauma-related mental illnesses and comorbid substance use disorders, and the extent to which ending an addiction is complicated by being a sort of mourning process. Attention to the process of addiction recovery-as a form of grieving-in which Kubler-Ross's stages of grief and Prochaska's stages of change are ultimately describing complementary viewpoints on a general process of neural network and attachment remodeling, could lead to more effective and integrative psychotherapy and medication strategies.

Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions

Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.

Narcissistic Vulnerability and Addiction

The main body of research on addiction and pathological narcissism has focused on the study of their co-occurrence by applying Diagnostic and Statistical Manual of Mental Disorders ( DSM) definitions for these clinical phenomena or by assessing trait narcissism in substance-dependent populations. Clinically informed comprehensive conceptualizations of narcissism which focus on its phenomenological range from vulnerability to grandiosity have not been applied in studying the specific narcissistic disturbances that underlie the relationship between these comorbid conditions. Aiming to examine this relationship, this study compared the presence of pathological narcissism, and more specifically narcissistic grandiosity and vulnerability, in substance-dependent individuals in treatment with individuals from the general population. Comparisons indicate that substance-dependent individuals experience significant narcissistic disturbances more likely related to vulnerability than grandiosity. Shame, rage, and self-esteem contingent upon external validation comprise the intrapsychic and interpersonal vulnerability. Implications for the clinical conceptualization of pathological narcissism as well as for substance dependence treatment interventions are discussed.

Influence of mother-daughter attachment on substance use: a longitudinal study of a Latina community-based sample

OBJECTIVE

Advancing our initial, cross-sectional study, which showed that adult Latinas' mother-daughter attachment relates to their substance use, the current, longitudinal study tests whether mother and daughter attachment scores at baseline predict their substance use over time.

METHOD

We analyzed data from a convenience sample of 133 Latina adult mothers (mean age = 52 years, SD = 10) and 133 Latina adult daughters (mean age = 27, SD = 9) at baseline and at 5-year and 6-year follow-ups after baseline (attrition rate = 16%). Multilevel longitudinal modeling was used to examine the effect of mother-daughter attachment at baseline on their substance use over time.

RESULTS

Each unit of increase in the attachment score at baseline is associated with a 0.28 drink decrease in monthly alcohol use (p < .05) and a lower likelihood of being a heavy alcohol or other drug user [exp(β) = 0.97, p < .01] compared with average attachment score at baseline (M = 91.52, SD = 18.00). Time and older age at baseline are associated with decreased substance use. Being born outside the United States is associated with decreased risk of heavy alcohol or other drug use. Being a mother is associated with increased substance use.

CONCLUSIONS

The findings of this longitudinal study on adult Latinas indicate that mother-daughter attachment has long-lasting effects on substance use trajectories among adult Latinas. Future research should focus on (a) investigating social and cultural factors mediating this relationship and (b) greater substance use among Latina mothers compared with daughters.

Family Dynamics May Influence an Individual's Substance Use Abstinence Self-Efficacy

BACKGROUND

Previous work on substance use suggests the influence of family dynamics on emotion regulation.

OBJECTIVE

The present study examined the role of family in substance use recovery. It is of importance to examine whether conflict with various family members influences an individual's abstinence self-efficacy.

METHODS

We examined individual abstinence self-efficacy scores and lifetime conflict with mother, father, and siblings in a sample of 200 women who had been justice involved.

RESULTS

We found that conflict with mother was the best predictor of abstinence self-efficacy compared to conflict with father and conflict with siblings. Individuals who indicated having conflict with mother over their lifetime had lower confidence that they could abstain from use in potentially emotionally triggering situations.

CONCLUSIONS/IMPORTANCE

These findings suggest that family dynamics, specifically lifetime conflict with mother, do play a role in an individual's confidence to regulate emotions in high-risk relapse situations without turning to substances. Limitations include using abstinence self-efficacy as a proxy for emotion regulation and not directly measuring emotion regulation. Examining family relationships may be especially important in the treatment of women in recovery from substance use.

Exploring Attachment Patterns in Patients With Comorbid Borderline Personality and Substance Use Disorders

Studies exploring attachment patterns in samples of patients with borderline personality disorder (BPD) report a combination of preoccupied and fearful-avoidant patterns. This has been interpreted as reflecting the approach-avoidance dilemma of BPD. Comorbid substance use disorders (SUD) have not been considered in these studies, despite the high proportions of SUD among BPD patients and despite the more avoidant attachment in SUD samples. This cross-sectional, naturalistic study explores attachment patterns in a sample of comorbid (BPD and SUD) patients, comparing them to two samples of patients with either SUD or BPD only. Within-group comparisons replicated findings of both preoccupied and fearful-avoidant attachment in BPD and comorbid groups. But between-group comparisons showed that comorbid patients were significantly less preoccupied (p = 0.018) and more dismissing-avoidant (p = 0.030). Although both groups were similar in several psychiatric measures, attachment patterns of the comorbid group were more similar to substance abusers than to borderline patients.