addition as attachment theory?

The Power of Identification!!

Posted on by alcoholicsguide

The main reason I am alive today, sober and have recovered from a seemingly hopeless condition of alcoholism is simple!

Or rather the first step can be simple.

The first step on my recovery journey was to identify with the life stories of other recovering alcoholics.

Not necessarily with where they grew up, or the damage alcoholism had inflicted on their lives. Although many alcoholics talk themselves, or their illness talks them, out of the possibility of recovery by saying I am not as bad as that guy, or that woman.

You may not be as bad “YET!” – the “yets” are often talked about in AA – you may not have done the damage others have, yet? Keep drinking and you are bound to. You, like them, will have no choice.

Alcoholism increasingly takes away choice.

It takes over your self will.

Your self will, your self regulation, is a combination of your emotional, attentional, memory and reward/survival/motivation networks.

Alcoholism takes over these networks, progressively, over time.

Neuroscience has shown this, over the last twenty odd years.

A superb longitudinal study, “The Natural History of Alcoholism” by George Vaillant  clearly showed this progression in six hundred alcoholics over a 60 year period!

In my own research and in articles, with two highly respected Professors at a UK University, I have shown how the alcoholic brain progressively “collapses inwards” to subcortical responding.

In other words, we end up with a near constant “fight or flight” reaction to the world,  with alcoholism causing distress based compulsion at the endpoint of this addiction.

All the above neural circuits become governed by a region of the brain which deals with automatic,  compulsive behaviour. All the self regulation parts of the brain progress to an automatic compulsive behaviour called alcoholism and we are then often without mental defence against the next drink!

I identified with this one simple fact – the progression of this neurobiological, emotional, and spiritual disease state called alcoholism. I saw it in my own life, this progression over years of drinking.

The “invisible line” that is crossed, according to AA members, can be viewed on a brain image, I believe.

Can you see it in your life?

Like these recovering alcoholics I had not taken my first drink hoping to end up an alcoholic

It was something that had happened to me,  happened despite my very strong will not because my will is weak. I am as wilful a person as you would hope to me. How come I became an alcoholic then?

I did also relate to other things these people shared.

I identified with the damage caused by alcoholism  in their lives and the lives of their family.  How this illness affects everyone in the immediate and even extended family.

I had never considered the effect on others, apart from me?

I listened and identified with how they talked about a “hole in the soul”, how they never felt part of, felt different from others, detached. I related to this. That was me too.

Alcohol made me feel more me! I became attached to it and grew to love it like someone would love another person, more so perhaps? Alcohol came first, loved ones second.

Alcoholism takes away all the good things in life and then your life too.

All of this was the case with me too.

I identified with all this.

I identified too with their solution.

I identified with and wanted what these now happy people in recovery had.

I decided to take the same steps as they had towards this happiness.

There is a solution.

We do recover!

How Far Have We Come In Understanding this “Spiritual Malady” of Alcoholism?

Posted on by alcoholicsguide

In our previous blog we wondered if some commentators, who have co-occurring disorders may be puzzled at how having a “spiritual malady” could be related in any way to have a co-occurring condition?

This is a pretty valid question?

In fact this may be at the heart of the issue in many cases  of feeling the need to take medication  for so-called co-occurring conditions?

Seeing alcoholism as partly the product of a spiritual malady, instead of the affective disorder I believe it to be, may influence certain AAs to seek additional help for supposed additional conditions when the manifestation of these conditions may actually be part of the emotional disorder of alcoholism?

It is at least worth considering?

For me sometimes there is a confusion with what is perceived to be a spiritual malady?

I do not believe I have the same type of spiritual malady as my wife for example who is an normie, earthling, normal person (whatever that is?) I believe, if any thing I have a super enhanced, at times turbo-charged,  spiritual malady, often fuelled by stress/distress, as the result of my alcoholism.

I do not believe I have the same spiritual malady as other normal people such as those people who were in the Oxford Group.

That is not to say that normal people cannot be full of sin –  a cursory look around the work and it’s events will soon confirm this is the case. What I am saying is that they do not have the emotion dysregulation or fear based responding that I seem to have which often prompts “sin”.

By sin I mean negative emotions that cause distress to me and others.

For example, false pride, intolerance, impatience, arrogance, shame, lust, gluttony, greed. Yes these all create distress.

The spiritual principles of AA and the 12 steps in particular were drawn from the 4 absolutes of the Oxford group, via initially the 6 steps  and the idea of a spiritual malady is also borrowed from the Oxford group.

I have for several years wondered if the spiritual malady described in the Big Book adequate or accurate enough in describing what I suffer from.

I believe others have difficulties in reconciling the spiritual malady of the Big Book with their own alcoholism, addiction and  co-occurring conditions?

Part of the problem may lie in not being specific enough about what   alcoholism is.

It may be that research and the world have not progressed far enough to give a comprehensive account of what alcoholism is. Also the spiritual malady concept of AA has for 80 years helped millions of people recover from this most profound of conditions? So why change it if it’s not broke?

That is a good point? I am not advocating changing anything, I hope AA recovery remains as it is for 80 more years and much more years. I would not change one word in the first 164 pages of the BB.

However, many AAs ignore the spiritual malady thing completely, or do not do the steps, so, in my opinion, they often do not properly understand what they suffer from?

The magic of the the steps is that they seem to reveal  the patterns of behaviour that our actions have prompted over the course of our lives.  Maladaptive behaviours I should add. It helps us see ourselves and our condition of alcoholism and how it effects us and others.

It shows the areas of behaviour and attitudes that can be treated by working the steps. It shows us how our approach to life can possibly be transformed for the better.

For me personally it often showed a pattern of emotional responding to events that do not go my way!!?

As Bill Wilson once wrote we suffer when we cannot not get what we want or others seem to prevent us getting what we want.

My inventory of steps 4/5 showed me that my long lists of resentments were mainly the product of emotional immaturity and responding in an immature manner to not getting my way.

My inventory showed me also that I did not seem to have the facility previously to emotionally respond to the world in a mature way. As the world dominated me.

My recovery has thus since been about “growing up” a bit, however unsuccessful I am in this pursuit on occasion.

I have often written that this inherent emotional immaturity may even be linked to the possibility that the areas of my brain that regulate emotions have not matured properly  as alcoholic seem to have different connectivity, functionality and morphology (size/volume)  in this emotion regulation  circuit/network to healthy normal people.

Alcoholics seem not to be able to fully process emotional information externally, i.e reading emotion expression of faces accurately, or internally reading what emotions we are having, or even whether we are hungry or tired!

So we have issues with emotions and somatic/body feeling states. This is perhaps compounded by most of us having experienced abuse or maltreatment which can also lead to alexithymic characteristics such as not being able to label or describe, verbally, emotional states we are experiencing – although we can be good at intellectualising these emotions – which is not the same as processing them.

Alcoholics and children of alcoholics have a tendency to avoid emotions (use avoidant coping strategies) in fact and to use emotional reasoning when arguing a point.

These emotion processing deficits also appear to make us more impulsive, and to choose lesser short term gain over greater long term gain in decision making. It can lead to a distress feeling state that can make us fear based, perfectionist, have catastrophic thoughts, intolerance of uncertainty, low frustration and distress tolerance, be reactionary, moody, and immature in our emotional responding.

But how has any of this got anything to do with the so-called spiritual malady we are suppose to suffer from?

I believe the spiritual malady mixed with the ancedotal evidence throughout the BiG Book hints at these emotional difficulties as being an intrinsic part of our alcoholism, “We were having trouble with personal relationships, we couldn’t control our emotional natures, we were a prey to misery and depression, we couldn’t make a living, we had a feeling of uselessness, we were full of fear, we were unhappy…”

It was 80 years ago, so our knowledge base has moved on greatly from when the Big Book was written. Hence I believe we should appreciate that this definition of our condition has been updated by research into emotions especially in the last 20 years.

I am happy to say a spiritual malady is what we suffer from, as the steps provide a solution to my emotion disorder by treating it as a spiritual malady but  I do not think it is the straightforward spiritual malady adopted by AA from the Oxford Group, mainly because in the majority of situations I do not choose to sin, the sinning seems to happen to me. In other words it is the consequence of my fear based condition, this affective disorder.

The Oxford Group explain a general spiritual malady that all people can have. I do not think alcoholics are like all people. We are human beings, but extreme versions of human beings. I believe, even when I try my best to be virtuous and holy, I could sin at the sinning Olympics for my country. I am that naturally good at it!

I sin so naturally, effortlessly  and usually without even trying. I believe my so-called defects of character are linked to my underlying emotional disorder of alcoholism.

Sins I believe are the poisoned fruit of fear, often  helped along in alcoholics by false pride, shame and guilt. These defects are related to me being an alcoholic, they are intrinsic to my condition.

In order to illustrate how I believe my spiritual malady is the consequence of my emotional disorder, called alcoholism/addiction first let’s  go back to where this idea of spiritual malady came from.

According to a wonderful pamphlet “What is the Oxford Group”   written by The Layman With a Notebook ” Sin can kill not only the soul but mind, talents, and happiness as surely as a malignant physical disease can kill the body…

Sin is a disease with consequences we cannot foretell or judge; it is as contagious as any contagious disease our bodies may suffer from. The sin we commit within this hour may have unforeseen dire consequences even after we have long ceased to draw living breath…

…Like physical disease Sin needs antiseptics to prevent it from spreading; the soul needs cleaning as much as the body needs it…

Unhappiness to us and others, discontent, and, frequently, mental and bodily ill health are the direct results of Sin.

…Morbidity of mind must affect the physical health. If we can be absolutely truthful to ourselves we can analyse our sins for ourselves and trace their mental and physical effects. Sins can dominate us mentally and physically until we are their abject slaves. We cannot get rid of them by deciding to think no more about them; they never leave us of their own accord, and unless they are cut out by a decided surgical spiritual operation which will destroy them, roots and all, and set us free from their killing obsession, they grow in time like a deadly moss within us until we become warped in outlook not only towards others but towards ourselves….”

One can see how this concept of sin disease or in other words spiritual malady could be and was applied to early AA and incorporated into the Big Book of AA.

However, it is equally stating, I believe, that alcoholics suffer from the same spiritual malady as other people but our spiritual malady has led to chronic alcoholism, this is the manner in which sin has dominated  “mentally and physically until we are their abject slaves”.

In fact the Big book’s first chapters look more at the manifestation of this malady, problem drinking,    than the malady.  It suggests that there is more than this malady, there is also a physical reason for alcoholism- an allergy (or abnormal reaction) to alcohol. So this is a departure from the Oxford Group as it clearly states that alcoholism is more than a spiritual malady.   It is not simply the consequence of this spiritual malady although this malady may contribute.  So is this saying some of us are spiritually ill while also having an abnormal reaction to alcohol?

In the foreword The Doctor’s Opinion suggests  that “the body of the alcoholic is quite as abnormal as his mind.” and  a first mention of a disorder more than “spiritual” is suggested, “It did not satisfy us to be told that we could not control our drinking just because we were maladjusted to life, that we were in full flight from reality, or were outright mental defectives. These things were true to some extent, in fact, to a considerable extent with some of us. (my emphasis)

“The doctor’s theory that we have an allergy to alcohol interests us…as ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.”

“the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker.”

Here we have an abnormal reaction to alcohol and for some alcoholics a maladjustment to life.

For me this maladjustment to life is not exactly the same as the spiritual disease mentioned in the Oxford Group pamphlet.

All of my academic research in the last 6 years has explored the possibility that this “maladjustment to life” is more than a spiritual malady, i.e. it is not simply the consequence of Sin but the result of abnormal responding, emotionally (which has obvious consequences for sinning) to life.

This emotion dysregulation, as I name it, has consequences for how we feel about ourselves, how we interact with people, how much we feel we belong, how rewarding alcohol and drugs are, how much these substances make us feel better about ourselves (fix our feelings ) and how they turn off the internal critic of maladaptive and negative self schemas.

 

In fact our first “spiritual” wakening was probably the result of drinking as it transformed how we felt about ourselves and the world in which we lived. I know it did for me. In fact, I felt “more me” when I drank, it was like I escaped a restrictive sense of self to be a more expansive, people loving self.  I had a connection with the world I could not generate myself, when sober.

I was a “spirit awakening” if nothing else? It is interesting that a common definition of “spiritual” as it relates to AA, is a sense of connection with others.

As the BB states “Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks—”

For me this section is saying our emotion dysregulation leads to feelings of being “restless, irritable and discontented” which prompt a return to drinking.

The Doctor’s Opinion even offers some classifications of alcoholics “The classification of alcoholics seems most difficult, and in much detail is outside the scope of this book. There are, of course, the psychopaths who are emotionally unstable… the manic-depressive type, who is, perhaps, the least understood by his friends, and about whom a whole chapter could be written.”

This section would appear to be stating clearly that there alcoholics who have other (co-occurring) conditions or conditions appearing as co-occurring?

I contend that alcoholism is an emotional disorder which results in chemical dependency on the substance of alcohol. However in order to treat it we have to first contend with the symptomatic manifestation of this disorder, chronic alcohol use, as it is the most life threatening aspect of this disorder when we present our selves at AA.

What we used once to regulate negative emotions and a sense of self has eventually come to regulate our emotions to such an extent that any distress leads to the compulsive response of drinking. Alcoholics had become a compulsive disorder to relief distress not to induce pleasure.

The “spiritual malady” of the Oxford group seems enhanced in me, I believe I sin more than normal people because of my emotional immaturity and reactivity. My “loss of control” over drinking is also linked to emotion processing difficulties as it prompted  impulsive, uninhibited drinking.

This emotional immaturity is referenced throughout the Big Book I believe.

“… He begins to think life doesn’t treat him right. He decides to exert himself more. He becomes, on the next occasion, still more demanding or gracious, as the case may be. Still the play does not suit him. Admitting he may be somewhat at fault, he is sure that other people are more to blame. He becomes angry, indignant, self-pitying. ”

“Whatever our protestations, are not most of us concerned with ourselves, our resentments, or our self-pity? Selfishness—self-centeredness! That, we think, is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate. ”

“So our troubles, we think, are basically of our own making. They arise out of ourselves…”

“…Our liquor was but a symptom…”

“Resentment is the ”number one“ offender. It destroys more alcoholics than anything else. From it stem all forms of spiritual disease, for we have been not only mentally and physically ill, we have been spiritually sick.”

For me this is saying that out of my emotion dysregulation  “stem all forms of spiritual disease”.

It then talks of the fear that “was an evil and corroding thread; the fabric of our existence was shot through with it. ”

The list of emotional difficulties continues throughout the Big book’s first 164 pages.

One of the earliest studies on AA members concluded that  they were linked in commonality by two variables, emotional immaturity and grandiosity! I would contend that grandiosity is a part of emotional immaturity. I also contend that our “maladjustment to life” is based on emotional immaturity which is in itself a function of emotion regulation and processing deficits.

A book titled Matt Talbot by Morgan Costelloe has cites this reference –  “American authorities on alcoholism hold that the following psychological traits are commonly found in alcoholics:

> 1. A high level of anxiety in interpersonal relations
> 2. Emotional immaturity
> 3. Ambivalence towards authority
> 4. Low frustration tolerance
> 5. Low self-esteem
> 6. Perfectionism
> 7. Guilt
> 8. Feelings of isolation”

The list is  almost word-for-word identical with one in Howard Clinebell’s
“Understanding and Counseling the Alcoholic” p 53 of the revised edition of 1968 (the original edition appeared in 1956), the only difference being that Clinebell included grandiosity and compulsiveness.

Years after the Big Book Bill Wilson wrote about this emotion immaturity in the guise of discussing emotional sobriety, for me what he is saying that our emotional difficulties are present in long term recovery and need to be addressed – in other words there is more to alcoholism than sinning and drinking. What we are left with after the steps is ongoing and underlying difficulties with living life on life’s terms because we are emotionally immature. This I believe also preceded our drinking, for many of us anyway?

For many recovering alcoholics this may be another unpalatable truth, that they have issues with emotional responding, with being emotionally mature. If further validation is required I suggest a frank conversation with  a loved one, wife, husband, child, parent, etc.

Here is what Bill Wilson wrote ” Those adolescent urges that so many of us have for top approval, perfect security, and perfect romance—urges quite appropriate to age seventeen—prove to be an impossible way of life when we are at age forty-seven or fifty-seven.      Since AA began, I’ve taken immense wallops in all these areas because of my failure to grow up, emotionally and spiritually”. (my emphasis) 

Bill continues “Suddenly I realized what the matter was. My basic flaw had always been dependence – almost absolute dependence – on people or circumstances to supply me with prestige, security, and the like. Failing to get these things according to my perfectionist dreams and specifications, I had fought for them. And when defeat came, so did my depression.”

” Emotional and instinctual satisfactions, I saw, were really the extra dividends of having love, offering love, and expressing a love appropriate to each relation of life… I was victimized by false dependencies…       For my dependency meant demand—a demand for the possession and control of the people and the conditions surrounding me.”

For me this is emotional immaturity, regulating ones emotions and distress via external dependencies on others, demanding in an immature manner that others do one’s bidding?

I would suggest in relation to the issue of co-morbidities that one try to deal with these alcoholism related issues and then see if there are any other to deal with afterwards. For me, as someone who has been treated for anxiety and depression prior to recovery the 12 steps appear to have treated these as emotional consequences of my underlying condition of emotion dysregulation which I call alcoholism.

I think part of the issue is whether doctors, who know in my experience often know next to nothing generally about alcoholism,  can always properly diagnose depression and anxiety in someone suffering from alcoholism?

I also think the issues are complicate because alcoholism have some many similarities to GAD, MDD, OCD, and so on. They all may be similar but different.

This is why we need a satisfactory definition of what alcoholism and addition is? Rather than describing these conditions in terms of the manifest symptoms, i.e chronic substance abuse or, at times, vague “spiritual maladies”.

For example, one variable I believe is slightly different in alcoholism  to other affective disorders is distress based impulsivity which leads to maladaptive decision making, it leads to always wanting more of that…that anything.

These may be specific to addictive behaviours.

It may also be that we feel we have a co-occurring disorder because the underlying distress states prompt similar reactions in various differing disorders.

My distress feeds perfectionism, and catastrophic thinking as with other anxiety disorders like OCD, does that mean I have OCD too?

Maybe or maybe not? My tendency to not  regulate emotions has caused a distress state since childhood, it feeds into perfectionism and many other manifestations like always wanting just one more…?

It is the always wanting one more that makes my affective disorder that of addiction and not another disorder.

My affective disorder via various neural and cognitive – affective mechanisms leads to chronic substance use and dependency of these substances.

GAD, MDD, OCD have different manifestations and different mechanisms.

If we start by trying to recover from alcoholism and addiction and find we still have other issues then obviously address these with outside professional and specialist help.

I believe we can unwittingly complicate our treatment of alcoholism by believing we have (and treating) other conditions we see as distinct from alcoholism but which are in fact part of this condition called alcoholism.

I never fully knew what alcoholsim was until I did the 12 steps. Only then did it become clear what I suffered from?

I have suggested clearly in previous blogs how I think AA’s 12 recovery programme helps specifically with problems of emotion dysregulation.

How the Alcoholics Anonymous-12-step-program of recovery helps with emotional dysregulation

Maintaining Emotional Sobriety (and sanity) via the steps 10-12.

These illustrate how the 12 step programme can help with an emotion dysregulation disorder.

I end, however, with some words from a doctor who seems to be suggesting that AA works because it makes us more emotionally healthy.  For me she is saying how AA treats emotional illness.

An article by Dr. Jacqueline Chang’s paper given to the National Workshop for Health Liaison in York in 1998 and published in the Winter 1999 edition of the AA News suggests that

“The principles of the programme of Alcoholics Anonymous are scientific and closely follow all the helping therapies which lead people to emotional well-being.

AA proposes living “ One Day at a Time”. It is emotionally healthy to live in the day … in the here and now. Professional therapists teach people to live in the present.  AA encourages members to share their experience, strength and hope with other members. It is emotionally healthy to accept our past experiences, however painful, as past events and move on to a richer, more fulfilling future.

Step 1 in the AA programme is “ We admitted we were powerless over alcohol – that our lives had become unmanageable”. It is emotionally healthy to surrender and accept things over which we have no control.
“God grant us the serenity to accept the things we cannot change, courage to change the things we can and the wisdom to know the difference” is the Serenity Prayer used at every AA meeting. It is emotionally healthy to prioritise problems. The Serenity Prayer is the greatest exercise in prioritisation.

It is emotionally healthy to accept that we cannot change a particular situation but we can change the way we react to it.

It is emotionally healthy to accept yourself as you are.
It is emotionally healthy to recognise your environment and interact with it as it is, not as you wish it would be.  It is emotionally healthy to associate or be in contact with other human beings.

It is emotionally healthy to be altruistic – to help others without question or expectation.
It is emotionally healthy to anticipate – to plan for future discomfort or crises. This is the function of the AA Step programme. ”

 

AA provides many ways of becoming more emotionally well, which ultimately means more emotionally mature.

 

 

 

Insecure attachment affects emotion regulation in alcoholics?

Posted on by alcoholicsguide

I have blogged recently about how insecure attachment is linked to various addictive behaviours.

What is important is to establish a mechanism by which insecure attachment contributes to later addictive disorders. It may not be enough to say attachment and addiction are linked but that they are linked via a pathomechanism of some sort.

I have argued many times before that I believe this pathomechanism, the mechanism by which a pathological condition occurs, or the mechanism that  drives a disease state (or disorder) is emotion processing and regulation deficits.

We look here (1) at a study that demonstrates how insecure attachment correlates in alcoholics with difficulties in emotion processing and regulation difficulties. I believe this is how addiction is driven to it’s endpoint of chronic, compulsive behaviour, although this study is only a correlational study and makes no such claims about causation.

“Attachment theory has been conceptualised as an affect regulation theory, proposing that attachment is associated with the expression and recognition of emotions as well as interpersonal functioning… the objective of the present study was to investigate potential associations between attachment, Negative Mood Regulation (NMR) expectancies, fear of intimacy and self-differentiation…(with)  findings support broad attachment theory suggesting that attachment is associated with and predicts affect regulation abilities, difficulties with intimacy and intrapersonal as well as interpersonal functioning in a sample of substance use disorder inpatients.

Attachment is associated with the expression and regulation of emotion. Early attachment theory postulates that early bonding
with a significant caregiver is essential for the development of internal working models for communication, regulation of emotions and interpersonal behaviour.

These early attachment experiences are associated with adult attachment styles. Adult attachment styles are relatively stable and influence attitudes, emotions, affect regulation and behavioural strategies in relationships…Empirical evidence has indicated associations between insecure attachment, fear of intimacy and
emotion regulation difficulties  and between secure attachment
and a higher capacity for intimacy, emotional awareness and empathy.

Substance abuse has been proposed to be a consequence of emotion regulation difficulties with individuals using alcohol/drugs to avoid
intimacy or rejection, to ease pain, anger and ambivalence and possibly establish a “secure base”.

Negative mood regulation (NMR) expectancies are beliefs regarding a person’s ability to terminate or alleviate a negative mood state.

High NMR presumably reflects the ability to cope successfully with bad moods, whereas having low NMR may lead to less efficacious or maladaptive ways of coping… high NMR may be associated with secure attachment, as securely attached individuals tend to seek comfort from others when emotionally upset, and utilise constructive coping mechanisms to decrease the intensity of distress.

By contrast, low NMR may potentially be associated with anxious attachment as well as substance abuse...insecure attachment is a fearful attachment style characterised by a fear of intimacy and rejection, high emotional reactivity and a self-belief associated with being deserving of rejection. Some have argued that fear of intimacy (FIS) is associated with mental health issues and substance use problems…FIS research to date has largely reported significant associations with loneliness, lack of self-disclosure, low social interaction and low relationship quality.

Differentiation of self is defined as the degree to which an individual is able to balance emotional and intellectual functioning, intimacy and autonomy in relationships…Individuals with lower
self-differentiation experience higher levels of chronic anxiety, emotion regulation difficulties, mood disturbances and substance abuse.

In addition, previous studies have reported higher levels of mood regulation and interpersonal difficulties in substance abusers compared to controls…(As) attachment has been hypothesised to be associated with relationship functioning and mood regulation (and)  addiction has been proposed to be an attachment disorder,  potential relationships of attachment with mood regulation and interpersonal functioning in substance abusers may
potentially inform the development of future treatment approaches.

The results (of this study) indicated a significant negative association between anxious attachment and NMR…suggesting that anxious attachment may be associated with lower abilities to regulate one’s negative moods. This is in accordance with other research evidence suggesting that insecurely attached individuals tend to show poor affect regulation.

The present investigation also found that attachment was a strong predictor of FIS (and)  the present results suggest that adult
attachment is related to difficulties in intimacy and interpersonal functioning, in accordance with previous evidence that reported a significant association between insecure attachment and relationship problems as well as lower levels of trust, interdependence and commitment.

The present investigation also found that anxious attachment significantly predicted emotional reactivity (ER).

These data support the predictive power of anxious attachment in relation to being more emotionally reactive, having difficulties with emotion regulation and maladjustment in those with substance dependence…The predictive utility of attachment was also related to Emotional cut-off (EC)…This is in line with previous research suggesting a link between attachment and EC  in those with substance abuse and implies that attachment style is related to traits of emotional aloofness, anxiety, isolation from others and exaggerated independence…EC may be associated with, or a consequence of alexithymia, a personality trait associated with difficulties in identifying and describing feelings.”

The above sounds so familiar, doesn’t it? Sounds like most newcomers to recovery that I have ever come cross, including me.

Reference

1.  Thorberg, F. A., & Lyvers, M. (2009). Attachment in relation to affect regulation and interpersonal functioning among substance use disorder in patients.Addiction Research & Theory, 18(4), 464-478.

 

 

 

Is My Neediness linked to My Insecure Attachment?

Posted on by alcoholicsguide

I don’t know about you but I have previously been described on occasion, and still can be, as being a bit needy, a bit grasping of affection, a bit manipulative in attempting to coerce others into given me attention, affection and so on.

It is not a trait that I particularly like in my self. I believe it is directly linked to my insecure attachment based on an uncertain, unpredictable and sometimes conditional relationship I had with my mother, in particular.

My mother was affectionate at times, distant at others. You could never really count on her being there for you.

Her affection  seemed dependent (conditional) on how she felt. Given that she was probably experiencing some form of mental breakdown and had already started taking the Valium that would in later years become full blown dependence would explain her ambivalence to me and my emotional needs.

I have forgiven my mother for her many omissions but that does not mean that this forgiveness has resolved my attachment issues or heal the emotional pain I have been scarred with.

I still live with the consequence of these emotional scars and they still impact on my life, behaviour and recovery today. In fact, the longer I am in recovery the more I become aware of internal battles that I re-enact in my daily life with people in general life often playing the role of my primary care giver. I fight the same fights over and over again but with different people and in different scenarios.

The long term s consequences are also a lack of trust in others, an a time emotional ambivalence to others, a low self esteem, a feeling of “I’m not good enough” and whatever I do, “enough is never enough” This is why I think insecure attachment may be a good reason for the knawing feeling many of us have that we are not good enough, that we are lacking, that we are less than, that are missing something very important. That we have no secure internal base. Instead we have this “hole in the soul”.

attachment2

 

I fight injustice constantly. I fight bullies. I have real difficulties with feelings of rejection, even seeming rejection from people I do not particularly like, respect or admire. Thus it is not a cortical, conscious process, it is a pre-progammed emotional response to rejection per se.

I am constantly trying to be good enough, better than good enough, the best if possible. To measure up. Be the Number One guy, just like Bill Wilson who had similar problems with his mother to me. Internally I am constantly trying to show the world I am good enough, deserving enough of their love, respect and affection, often when I consciously have no real desire for these things, from these people.

It is a continual re-enactment of the efforts I made, often unsuccessfully with my mother. My early childhood has habitualised my behaviours and emotional reactions to the world. I must have found my mother’s behaviours unjust also hence my constant fighting of perceived injustice, although I am well aware of the 12 step plea not to fight anyone or anything.

Easier said than done, for me.

What I am trying to say, I guess, is that I have become aware that I am fighting the same psychic battles over and over again. The adult child is still in turmoil, reaching out for unconditional affection.

I have found that unconditional love in a Higher Power but in my illness I relapse back to this emotional insobriety.

I have recovered though. I am sane enough to know that I have other issues that  have partly driven my addictive behaviours. They have created emotional disturbance and dysfunction which “sharing” my experience with others has increasingly helped self soothe.

Anyway back to my sometimes evident emotional immaturity.

I have studied neuroscience for a number of years and see that it offers a great facility for challenging existing views about addiction and contributing to the greater arguments and debates about causes and consequences of addiction but I am also aware that it does not have all the answers and that it can veer towards reductionist views and reductionist solutions such as giving drugs to addicts to help with behavioural manifestations of addiction which can be bizarre at times.

Bizarre because the manifestations of addiction are more complex that observable neuro-biological processes in the brain. Attachment theory highlights this issue for me. It may impact on neuro-biology and neural plasticity of the brain but it is not necessarily the product of these. It can not be “cured” bu purely chemical means.

It seems that it can only be resolved by re-applying behaviours that were missing in the first place. In this case, earned attachment via various group therapeutic groups can help with the consequences of insecure attachment experienced in early childhood.   In other words these more adaptive behaviours can help you “manage” the maladaptive behavioural patterns ingrained in one’s brain.

We need other people not drugs or medications in other words. We tried that, it did not work. Love is what we need, we are designed, to give and receive it.

It is a fundamental force in helping develop a healthy brain.

Via neuroscience, I have never been able to get an angle on two vital aspects of my addictive personality. The “hole in the soul” what is it, where does it come from, how can it be explained? The other is why I collapse to needy behaviours?

Attachment disorders explain this for me. It also also explains the constantly fighting. Trauma also has a part to play. I grew up in a very violent, traumatising place. This can also lead to constant fighting. Constant emotional reactivty.

While in SELF, I hasten to add.

 

Equally I have found a solution to all these problems. I am generally contented, happy in my own skin. I did not used to be. Now I am. I have much love that I share with those around me. I can also receive it, mostly. I have found what I have been looking for. Love.

I have faith that all my scars will heal in time as so many already.

The results of the study we cite and take excerpts form (1) showed that there is significant difference in attachment styles and emotional maturity between opiate addicts and non-addicts. The results revealed that addicts usually have insecure attachment styles while non-addicts have secure styles. Besides, addicts enjoyed a lower level of emotional maturity compared with non-addicts.

“Addicts suffer from negative and inflexible emotions so that they are often fraught with anger, resentment and hatred. They
also suffer from loss of love, joy and intimacy. They may have not experienced hope and love for a long time. This exposes them to a serious emotional vacuum which must be dealt with in a
treatment process. A typical problem with addicts is their lack of emotional maturity and propensity to self-alienation and dependency disorder which causes a universal sense of fear and
mental insecurity.

A thirty-year old addict may perform like a ten-year old adolescent in terms of emotional functioning because most of the addicts have been forced into adulthood before they could have experienced childhood. That is because both society and family have not given them the opportunity to grow emotionally so that they have been confined within the walls of emotional crudity and feel insecure towards the outside world. Evidently, they need support to be
able to escape the confinement and interact with their environment, which requires them to be dependent on others [11].

Addicts suffer from severe feelings of disillusionment with their mothers. Mother’s disregard for the child’s emotional needs causes disruption in children’s self-regulatory processes and consequently
damages their mental structure of internal behavioral control. As a result, they will become dependent on external mediums like drugs to compensate for their emotional deficiencies.
Therefore, their harmful experiences of childhood in regard to disillusionment with their mothers may be drawn upon to account for the mechanisms which influence attachment styles.
Accordingly, mothers’ disregard for children’s emotional needs may justify the prevalence of insecure attachment styles in these children [1].

Research has shown that insecure attachment style contributes to the development of mental disorders. Developed at early childhood, insecure attachment is a risk factor for drug abuse and may also influence the treatment of drug abuse disorder. Using Hazan and Shaver adult attachment interview (AAI), Taracena et al (2006) reported that there is positive correlation between drug abuse and avoidant attachment styles. Hankin et al. (2007) conducted a study at the University of Illinois and reported that there is positive correlation between insecure attachment styles and smoking, alcohol use and marijuana use. In a follow-up research in the same
university, the results showed that there is a significant positive correlation between anxious attachment style and the prevalence of stimulant drug use, smoking and alcohol use. Haward and
Medway investigated the relationship between attachment styles, coping styles, life stresses and due responses in 75 couples. They reported that with secure styles, adults’ attachments are positively correlated with family relations but negatively correlated with negative social behavior including alcohol use, smoking and/or drug use [3].

Therefore, attachment styles can influence drug abuse disorders through the processes of familial interaction, social control, emotional regulation and self-efficacy. Marlatt et al. (2002)
investigated the factors contributing to the frequent relapse of addition and reported that encounters with negative emotions and events are most effective in addiction relapse. It seems
that insecure individuals more frequently resort to drug use as a self-treatment mechanism to relieve their negative emotions and experiences comparing with secure individuals. Shakibaie
(2000) studied 137 people and reported that 91.3% of the participants suffered from at least one mental disorder. Accordingly, 68.7% of the participants experienced decreased libido, 59.3% had
hypersomnia, 58.7% suffered from major depression and 24.7% suffered from apprehension.
Therefore, in line with previous studies, the present research aims to investigate the relationship between attachment styles and emotional maturity in both addicts and non-addicts.

Hogan and Roberts (1998) contended that immature emotional
behavior includes: impulsive behavior, fuzzy temper, impatience in facing failures, incongruence between specific visual stimuli and responses, inability to forgive others, and too much dependence on others. The present findings showed that there is significant difference in attachment styles between opiate addicts and non-addicts,  that addicts suffer from lack of emotional maturity more than do non-addicts. In
addition, the difference between addicts and non-addicts was significant in all the subscales of emotional immaturity.

Torberg and Lyvers (2005) investigated the relationship between attachment, fear of intimacy and differentiation of self in 158 volunteers including 99 individuals registered in an addiction treatment program. As expected, the patients under treatment who suffered from alcoholism, heroin dependency, amphetamines dependency, cocaine or hashish abuse reported high levels of insecure attachment, fear of intimacy and low levels of secure attachment and differentiation of self comparing with the control group.

Insecure attachment, fear of intimacy and differentiation of self may indicate vulnerability of drug abuse.

Besharat (2007) reported that there is significant difference in attachment styles between Iranian drug addicts and non-addicts. There were also significant negative and significant positive
correlations between the severity of drug dependency with secure and insecure attachment styles, respectively. Consequently, attachment styles can influence dependency on drugs through the
processes of familial interactions, social control, emotional regulation and self-efficacy.

 

 

References

1.  Mortazavi, Zeinab, Faramarz Sohrabi, and Hamid Reza Hatami. “Comparison of attachment styles and emotional maturity between opiate addicts and non-addicts.” 

 

Is the Addicts’ “Hole in the Soul” caused by Insecure Attachment?

Posted on by alcoholicsguide

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?

“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 I 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,” I wrote.  It’s called “in-secure attachment” or attachment disorder.

March 2013, I 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.

I went to attachment and brain science conferences, and bought every book I 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.”

We’ve just  detoured to the “attachment” ball park to gather a wider set of data on Dr. Felitti’s original Big Question:

Do so many Americans use alcohol, tobacco, marijuana, meth, IV drugs, food, sex, violence, workaholism,  sports, internet porn, etc. for sheer survival?  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.

So here’s 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?

“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 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 me because they wanted to heal, too.

As Dr. Felitti told me “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 vulnrability, 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 my 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/