This Fleshy Hunger

In our sister blog Inside the Alcoholic Brain –  http://insidethealcoholicbrain.com/

I had a comment posted on one of the blogs about the pain and heartache that one person had faced as the result of her partner’s addictive behaviour.

The person who posted mentioned her ex partner who is a sex addict as well as alcoholic/addict. It really moved me what the person, who posted anonymously, said in her comment.

I identified with the breaking of her trust and her heart by the unacceptable behaviour of her ex.

Addicts can leave a wake of destruction, lies and deceit, broken promises and broken hearts. In the Big Book of AA it looks at the effects of the life with an alcoholic as akin to having had a tornado wreck havoc in  your life, with the alcoholic often causing so much wreckage  without fully realising it.

This comes across strongly in this post, which I use below, as it was posted publicly and the person was also anonymous.   I use this post to help me and help others understand more fully the damage addiction, especially sex addiction can cause others.

I failed to mention something in my reply, below, which I will now add.

I know where her ex partner is coming from because I too am a sex addict.

I have never admitted that to anyone other than my wife. I have been in recovery ten years but have only realised in the last 15 months or so that I too suffer from sex addiction, in addition to alcoholism, substance addiction, chronic attachment disorder and PTSD.

sex-addiction-eye (1)

Even now I find it difficult to be honest about my sex addiction. It seems to me much more shameful than saying I am a chronic alcoholic or addict.

Maybe that is irrational but I am just trying to be honest.

If any addiction could embody and illustrate the conditional love I was reared with it is my sex addiction.

As I mention in my reply to the post below, in sex addiction somewhere in one’s personal development the brain gets fused in a manner so profound that close intimate human affection can often be just about the most terrifying experience because we don’t really know what the hell it is.

If one has not experienced unconditional love in their primary attachment relationships to a primary care giver, e.g. one’s mother, then the brain may not develop in the same way as with unconditional love – it will be a brain that has distress and a excess of stress chemicals and a deficit in oxytocin,  the “love/cuddle” chemical of human bonding.

Intimacy can be frightening in the extreme.

The human heart is born to beat a beat of love and to have an automatic approach to the love of other humans. In fact we are not singular – we are born into the world as “I and one other”, as we would die otherwise, we need to be reared as we are helpless alone.

So when the heart is naturally moved towards a love attachment which is inconsistent, ambivalent, alternatively available then dismissive and distant, then the most basic survival instinct is impaired, warped, and love of the most basic fundamental type can be mixed with fear and stress chemicals with distress.

Love is the most  fundamental “glue” in the  brain and human development so when it is not consistently given it can have profound effect on the developing infant brain.

Some would say that being conditional it is  not real love but it is as close as some got. “Love” for some often had love mixed with or outweighed by fear, or oxytocin by stress chemicals in the brain.

While a child is looking to receive their love and “cuddle” chemical, that of oxytocin but it is not always available, in that it is shrunk away in the brain by stress chemicals. This reduces oxytocin and the heightened stress chemicals reduce this oxytocin even more.

I grew up then looking for “love” – this oxytocin but unfortunately it is not straight forward. This search is for a conditional loves as it is all I knew, it is not for a fullsome healthy unconditional love but for a “love” that will alleviate our distress and increase our oxytocin. I searched for this thing, this “love” in  sexual acts.

Sex, and reproduction, are fundamental to the human species so it is another “survival instinct” that gets impaired in the addiction cycle – in fact all addictions involve the usurping of systems essential for survival – eating, sex, money, motivation etc and all addictions take over the reward/motivational region of the brain.

Sex addiction does the same – this is also why we see cross addictions as different addictions all activate this same reward/motivational part of the brain.

Back to sex addiction, I grew up through puberty to adulthood with this  now constant battle in my heart between two chemicals that interact to help us survive via our human relationships and communities. Now they interact in the way most opposite to healthy survival. The compete and fight and are conditional on the behaviour of the other.

The are two partners in a dance of destruction. Their neuro-chemical offspring is dopamine – the chemical of wanting (needing). The battle between stress and oxytocin results in a pathological wanting (needing), peaks of dopamine when distressed with dopamine increase reflect the need to take action to relive distress. .

Distress is the result of never finding relief in human relationships, in human bonding, in healthy relationships, so healthy human love and bonding is replaced by the need relieve the inherent distress in an activity which guarantees a reduction in stress. In an activity guaranteed to increase in oxytocin. Sex with another human being, a fleeting physical intimacy.

That is a role oxytocin has, to reduce stress/distress (and control dopamine)  via human contact. If that contact was never there fully it never played a role in our survival. Instead we have to find this oxytocin elsewhere, like alchemists, outside healthy human bonding.

I found it via a different  type of “love”. A so-called love making when it was really an approximate transient glimpse of intimacy, or the opposite of intimacy in fact, a refuting of intimacy, instead simply a transient increase in our love making chemical. It feels like a yearning for something always beyond one’s reach but something that feels somehow essential and has to be got.

A fleshy hunger.

But these fleeting “intimacies” didn’t work, it wasn’t enough to still our hearts and reassure us, it was a temporary harbour in a storm of distress.

When it calms, I was left with the receding tides of shame, shame and more shame. It wasn’t enough, I wasn’t enough. And the distress cycle begins again.

Every time I searched for this love I ended with less than before.

Anyway here are the comments.

“I discovered that he had been seeing a secret drinking/ sex partner the entire time, one 5 years older that his daughter who, by cultural standards, was not attractive. The phone I finally looked at showed that, in addition to worshiping him as a senior co-worker, she was a great devotee of 50 Shades and all night activity. I had noted only a lack of interest in me – which I attributed to his passing age 50. The crafty extremes he went to to hide this affair from me while cutting as close as possible the encounters he had with the two of us was completely out of character in terms of the persona he showed me. Still, I have felt stupid for the extent of my trust.

Reading this and Part 1 have offered me great comfort. He was definitely denied affection in his youth, and is definitely a late stage alcoholic, but is tested for drugs frequently by work. Sex does not show up in lab work, I guess. Thanks for this very helpful post.”

Part of my Reply –

“thank you Anonymous for your honest post – can I also suggest this post Looking for love in all the wrong places –http://insidethealcoholicbrain.com/2015/07/02/looking-for-love-in-all-the-wrong-places/ – which looks at how lack of attachment in childhood to a primary care giver has dire consequences in terms of later adult relationships – where sex is used instead of intimacy – it is also probably more common than mentioned, the cross addiction of sex and other addictive behaviours like alcoholism – anecdotally I know it to be an issue in recovery for many. There is often a migration from one addiction to another mainly because we generally use and have used external means to regulate negative emotions and negative self schema. We probably have done so one way or the other since childhood. Emotional relationships for some are terrifying, full of angst, conflict etc and have not been straightforward, unconditional love relationships like many people have experienced. In fact relationships with sex addicts often have an element of conditional love about them as this is generally how addicts have grown up to understand relationships, as being conditional, if you do this I will do that, type thinking. I give you this and you give me that etc etc Sex addiction runs very deep as it is linked to an impaired ability to form loving, healthy relationships throughout one’s life and the relationships in a sex addict sense are often abusive, often in a dominant/domineering sense. The sex addict brain can often fuse what should be affection with arousal. Often “good looks” are not that much of an issue, it is often what the person “can do” sexually that is the main consideration. What sort of “fix” that they can offer. Sex does show up in labs in the sense that sex addiction activates the same brain areas as any other addictions and similar neurotransmitters like dopamine. A fascinating thing however is that sex gives one a “shot” of oxytocin which is the “love/cuddle” brain chemical and which is there in major amounts during caring for a child and in human bonding, in attachment to another human being. In sex addicts this might actually be the so-called “hole in the soul” the “love” drug we have all been looking for. So the sex addict brain has been fused to confuse human affection with arousal as oxytocin is activated and prompts the addict to want more of what he/she does not have in great supply namely oxytocin. Sometimes addiction seems like it is a compulsion to “replenish” chemicals one is deficient in, e.g. natural opioids and heroin abuse. I hope you continue to have the compassion you seem to have through your understandable hurt and upset – it sounds like a real rollercoaster you have been through. He is a very very sick (mentally) sick person like all addicts of one hue or the other. The problem also is that we sometimes are the last to see how sick our behaviours can be. Forgiveness is maybe a long way off, but in the end this heals the pain of the past more than anything else. It helps you just as much if not more than the person who has really hurt you. Hope this comment helps you too. Paul

Childhood Maltreatment and later Alcoholism/Addiction

One old timer I know often says two things that I often take issue with – 1. there are as many alcoholisms as alcoholics and that 2. we all come to AA in different boats but end up in the same dock.

Thanks to having a wife in Al Anon I have had the benefit of her insight and from other al-anons who state how remarkably similar we alcoholics are in our behaviour, particularly in dealing/coping with distress and stress, our emotional reactivity and at times immaturity (or so-called defects of character), I disagree that we are so different in our addictive behaviours.

All addictive behaviours from alcoholism, substance addiction, eating disorders to hypersexual disorder seem to be based on an inherent problem with emotion and stress dysregulation.

I believe I have a distress based condition. It results in what appear to be distress based reactions such as perfectionism, distress intolerance and frustration intolerance, normally exemplified in my shouting at my PC when it doesn’t work quickly enough or crashes!

I also believe I have distress based impulsivity, I want that thing, whatever it is, NOW. That anything!

In fact I have noticed when I want something, anything, I end up pathological wanting it in no time at all! It seems then like I NEED it. I too think this is based on distress and heighten stress reactivity.

In fact it is through this pathological wanting that my so-called defects of character that my examples  of emotional dysregulation appear.

If I can’t get what I want, all range of negative emotions spill forth such as intolerance, impatience, arrogance, pride, shame, selfishness etc .  They only appear when I want something and you are getting in the way of me having it!!

So there is a link between my motivation (which is dysregulated due to the effects of chronic stress which turns simple wanting into something more akin to “needing”) and my subsequent emotional dysregulation.

So where does this distress come from? Is it purely the effects of chronic stress dysregulation caused by years of neuro toxic brain damage or does it go back further, into childhood?

I do not think we all have separate alcoholisms, I feel we have remarkably similar reactions to life and these centre on an inherent difficulty regulating stress and emotion.

I also believe we have come to recovery in similar boats. In fact the majority of us have come to recovery in a remarkable similar boat so much so that it would resemble a gigantic ship rather than a boat. That boat is the ship of childhood maltreatment.

Child maltreatment has been frequently identified in the life histories of adolescents and adults in treatment for substance use disorders, as well as in epidemiological studies of risk factors for substance use and abuse.

 Child Maltreatment

One study (1) suggests there is ample evidence exists for higher rates of substance abuse and dependence among maltreated individuals.

In clinical samples undergoing treatment for substance use disorders, between one third and two thirds evince child abuse and neglect histories (Dembo, Dertke, Borders, Washburn, & Schmeidler, 1988Edwall, Hoffman, & Harrison, 1989Pribor & DiWiddie, 1992Schaefer, Sobieragi, & Hollyfield, 1988).

In the US a survey of over 100,000 youth in 6th though 12th grade, Harrison, Fulkerson, and Beebe (1997) Harrison, Fulkerson, and Beebe (1997) found that those reporting either physical or sexual abuse in childhood were from 2 to 4 times more likely to be using drugs than those not reporting abuse; the rates were even higher for youth reporting multiple forms of child maltreatment. Similar findings have been reported by Rodgers et al. (2004) and Moran, Vuchinich, and Hall (2004).

Among youth with Child Protective Services documented maltreatment, Kelly, Thornberry, and Smith (1999) reported one-third higher risk for drug use among those with an abuse history. In a large epidemiological study, Fergusson, Boden, and Horwood (2008) have shown physical abuse and particularly sexual abuse to be related to illicit drug use, as well as abuse and dependence.

Another Study (2) study would suggest the figures are much higher –   data were collected on 178 patients–101 in the United States and 77 in Australia–in treatment for drug/alcohol addiction. The purpose of the study was to determine the degree to which a correlation exists between child abuse/neglect and the later onset of drug/alcohol addiction patterns in the abuse victims. The questionnaire explored such issues as family intactness, parental violence/abuse/neglect, parental drug abuse, sibling relationships and personal physical/sexual abuse histories, including incest and rape. The study determined that 84% of the sample reported a history of child abuse/neglect.

A third study (1) stated that, using the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein & Fink, 1998; Bernstein et al., 2003) to assess childhood maltreatment in a community sample of active drug users, Medrano, Hatch, Zule, and Desmond (2002) found that 53% of women and 23% of men were sexually abused, 53% of women and 43% of men were physically abused, 58% of women and 39% of men were emotionally abused, 52% of women and 50% of men were physically neglected, and 65% of women and 52% of men were emotionally neglected.

Substance abusers, in addition to having higher rates of childhood maltreatment than members of the general population, have been found to have levels of psychological distress that increase with increasing severity of all types of childhood maltreatment (Medrano et al., 2002). This association is important considering that stress increases an individual’s vulnerability to addiction and addiction relapse (Goeders, 2003; Sinha, 2001;Wills & Hirky, 1996).

There is also evidence that the way in which people cope with stress is related to substance use. For example, researchers have found that greater use of avoidance stress-coping strategies (i.e., disengaging from investing effort to cope with a problem) is related to a greater likelihood of drug use initiation, higher levels of ongoing drug use, and a greater probability of relapse, whereas greater use of active stress-coping strategies (i.e., taking steps to deal with a problem) most consistently functions to protect individuals from substance use initiation and relapse (Wagner, Myers, & McIninch, 1999; Wills & Hirky, 1996).

Childhood maltreatment may influence substance use behavior through its effect on stress and coping. There is emerging evidence that childhood maltreatment may negatively affect the maturation of self-regulatory systems that enable an individual to modulate and tolerate aversive emotional states (Cicchetti & Toth, 2005; Hein, Cohen, & Campbell, 2005). Childhood maltreatment may disrupt neurobiological development and elevate subjective stress by biologically altering the brain’s response to stress (Bugental, 2004;DeBellis, 2002; Heim & Nemeroff, 2001; Heim et al., 2000; Sinha, 2005; Wills & Hirky, 1996). Childhood maltreatment may also affect an individual’s characteristic style of coping with stress so that he or she may be more likely to rely upon maladaptive strategies, such as avoidance of problems, wishful thinking, and social withdrawal, rather than active strategies, such as seeking information and advice from others (Bal, Crombez, Van Oost, & Debourdeaudhuij, 2003; Futa, Nash, Hansen, & Garbin, 2003; Krause, Mendelson, & Lynch, 2003; Leitenberg, Gibson, & Novy, 2004; Thabet, Tischler, & Vostanis, 2004).

Elevated stress and maladaptive coping related to childhood maltreatment may translate to greater substance use behavior by making the coping motives of substance use appear more attractive (Wills & Hirky, 1996). Indeed, substance users commonly report using psychoactive substances such as alcohol, cannabis, and cocaine to cope with stress and regulate affect (Boys, Marsden, & Strang, 2001)

Most cocaine dependent inpatients reported multiple types of childhood maltreatment, and only 15% reported no maltreatment at all, (similar figures to study 2).

“Our findings suggest that the severity of overall childhood maltreatment experienced by recently abstinent cocaine dependent adults has a significant relationship with perceived stress and avoidance coping in adulthood.

Our findings suggest that having a more severe childhood maltreatment history may result in a greater sensitivity to stress…basic coping skills training may not be adequate in decreasing distress and avoidant coping in order to decrease substance use and relapse. Additional interventions that focus on stress tolerance, altering appraisals of stress, stress desensitization, and affect and emotion regulation skills may be of particular benefit to patients with childhood maltreatment histories.

The fact that childhood maltreatment is a preventable phenomenon that occurs early in life and affects psychological functioning well into adulthood makes our findings relevant to clinical practice with children as well. Early identification and treatment of maltreated children may help prevent stress sensitivity or the development of a less adaptive style of coping. Assessment of coping ability and the implementation of coping skills and stress tolerance training may also be indicated for maltreated children in an effort to increase their coping efficacy and decrease their vulnerability to stress later in life.”

I may have been in recovery for a number of years now but coping with stress/distress is still central to my recovery. Dealing with the effects of childhood maltreatment not only via negative self esteem and self schema but in the real sense of coping with every day stress/distress, mainly prompted in my interpersonal relationships (other people!) and with my PC!

 

References

1. Rogosch, F. A., Oshri, A., & Cicchetti, D. (2010). From child maltreatment to adolescent cannabis abuse and dependence: A developmental cascade model.Development and psychopathology, 22(04), 883-897.

2. Cohen, F. S., & Densen-Gerber, J. (1982). A study of the relationship between child abuse and drug addiction in 178 patients: Preliminary results. Child Abuse & Neglect, 6(4), 383-387.

3.  Hyman, S. M., Paliwal, P., & Sinha, R. (2007). Childhood maltreatment, perceived stress, and stress-related coping in recently abstinent cocaine dependent adults. Psychology of Addictive Behaviors, 21(2), 233.

Forgiving Others is the Number One Healer!?

“Resentment is the “number one” offender. It destroys more alcoholics than anything else… In dealing with resentments, we set them on paper. We listed people, institutions or principles with whom we were angry… The first thing apparent was that this world and its people were often quite wrong. To conclude that others were wrong was as far as most of us ever got. The usual outcome was that people continued to wrong us and we stayed sore. Sometimes it was remorse and then we were sore at ourselves. But the more we fought and tried to have our own way, the worse matters got…It is plain that a life which includes deep resentment leads only to futility and unhappiness…If we were to live, we had to be free of anger. The grouch and the brainstorm were not for us. They may be the dubious luxury of normal men, but for alcoholics these things are poison…We saw that these resentments must be mastered, but how?… (1)”

Later, p.77, it suggests  “a helpful and forgiving spirit.”

In the 12 Steps and 12  Traditions, p.78, in reference to step 8 it suggests “why shouldn’t we start out by forgiving them, one and all?

These truncated passages from the Big Book (1)  and the 12 and 12 (3) illustrates how resentments cause relapse and that they need to by treated with the antidote of forgiveness.

We suggest also that the myriad of resentments which swirl around our minds in early recovery are also negative emotions unprocessed and thus unregulated from the past. They continually haunt us because we have not put them “to bed” in long term memory.

We have not dealt with them, by clearly identifying, labelling, sharing via verbalising them with others and then by letting go of them via forgiveness. “Letting go” is another emotional regulatory strategy that healthy people use.

res images (42)

Instead of constantly holding on to memories and incidents from the past, endlessly ruminating on them we maturely face up to them and consign them to the past.

We were thus interested in a study which was not using 12 step recovery but which came to the same conclusion but via another route (2).

“Anger and related emotions have been identified as triggers in substance use. Forgiveness therapy (FT) targets anger, anxiety, and depression as foci of treatment. Fourteen patients with substance dependence from a local residential treatment facility were randomly assigned to and completed either 12 approximately twice-weekly sessions of individual FT or 12 approximately twice-weekly sessions of an alternative individual treatment based. Participants who completed FT had significantly more improvement in total and trait anger, depression, total and trait anxiety, self-esteem, forgiveness, and vulnerability to drug use than did the alternative treatment group. Most benefits of FT remained significant at 4-month follow-up.

The levels of anger and violence observed among alcohol and other substance abusers are far higher than the levels found in the general population.

Alcohol and other substance abusers administered the State-Trait Anger Expression Inventory typically have been shown to have higher state and trait anger, to be more likely to express anger to others, and to have less control of their anger.

Reducing levels of anger and its related emotions is now seen as an important feature of recovery programs. For example, according to the Project Match 12-step facilitation therapy manual, “Anger and resentment are pivotal emotions for most recovering alcoholics. Anger that evokes anxiety drives the alcoholic to drink in order to anesthetize it. Resentment, which comes from unexpressed (denied) anger, represents a constant threat to sobriety for the same reason” (Nowinski, Baker, & Carroll, 1999, p. 83).

Marlatt (1985) emphasized the importance of anger and frustration as triggers for relapse in both the intrapersonal and interpersonal domains. He noted that 29% of relapses are related to intrapersonal frustration and anger and that 16% are related to interpersonal conflict and associated anger and frustration.

Litt, Cooney, and Morse (2000) reported that those alcoholics who had urges to use after treatment had higher degrees of alcohol dependence, anxiety, and trait anger than those without such urges.

Forgiveness is an important way to resolve anger and restore hope (Enright & Fitzgibbons, 2000). In helping clients move toward forgiveness, it is essential to differentiate forgiving from condoning, pardoning, reconciling, or forgetting.

Forgiveness is a personal decision to give up resentment and to respond with beneficence toward the person responsible for a severe injustice that caused deep, lasting hurt. FT helps the wronged person examine the injustice, consider forgiveness as an option, make a decision to forgive or not, and learn the skills to forgive.

Findings – Our clients came to the program with trait anxiety and trait anger scores substantially above the published norms for adults; after treatment, however, FT participants exhibited scores comparable to the average.  In other words, the treatment did not lead simply to a change in anxiety and anger (particularly the reportedly more stable trait anxiety) but to a change toward normal profiles. In contrast, patients in the alternative treatment condition had anxiety scores well above average, especially in terms of trait anxiety, which showed little change at post test and only minimal improvement at follow-up.

FT did not focus on drug vulnerabilities, whereas the alternative treatment did. Urges to use substances are not necessary for relapse, they are important indicators.

FT  treatment is centered more on clients’ thoughts, feelings, and behaviors about someone other than themselves: an offender who hurt them deeply and unfairly. In FT, a potential reason for substance use is examined, that of avoiding painful memories of betrayal, violence, or abuse. When patients are allowed to heal, their motivation to abuse substances may be substantially reduced…(it) is worth considering as a way to address core issues of emotional pain.

resentment

 

This can lead to a reduction in negative emotions and increases in self-esteem and forgiveness… it moves to the heart of the matter for some clients. Deep hurts borne out of unfair treatment seem to play a part in substance use and abuse. Even when clients have many people to forgive…we find that they seem to know which person is most crucial to forgive first before moving to other offenders. Substance use, from this perspective, is a symptom of underlying resentments and related emotional disruptions.

If we fail to realize this, we may end up treating only symptoms rather than underlying causes. ”

 

This process seems practically the same as the inventory of Step 4 and the forgiveness implicit to steps 8 and 9. This study also highlights that we through forgiveness we actually tackle the underlying condition of emotional dysregulation. It is this emotion dysregulation (or spiritual disease) which appears to drive addiction so needs to be fundamentally addressed. By addressing these issues via the steps especially step 4 we begin to see how it works!

It was interesting that forgiveness led to higher self esteem, as if being tied to the past was akin to being tied to a former negative self schema, that people from our pained past did actually have the power to control us! Especially how we feel about ourselves. We change how we feel about ourselves and our past by simply forgiving, it is such a powerful tool in recovery.

Importantly by viewing studies like this (2)  we get beyond negative views of 12 step recovery to show that the recovery program’s effectiveness is clearly highlighted by the success of other psychological treatments getting the same positive results by using exactly the same strategies.

12 step groups provide a battery of the most profoundly effective psychological therapies for addiction ever contained within one treatment philosophy.

Don’t we all need to re-appraise how we see 12 step recovery?

Can’t we all benefit from stepping to one side and looking via a different angle to see why 12 step recovery is effective?

 

Reference

1. Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.

2. Lin, W. F., Mack, D., Enright, R. D., Krahn, D., & Baskin, T. W. (2004). Effects of forgiveness therapy on anger, mood, and vulnerability to substance use among inpatient substance-dependent clients. Journal of consulting and clinical psychology, 72(6), 1114.

3.   Twelve steps and twelve traditions. (1989). New York, NY: Alcoholics Anonymous World Services

Interpersonal Factors in Relapse – Part 1

“Living life on life’s terms” essentially means living with others.

The majority of relapses I have witnessed have been due to interpersonal factors, e.g. arguments at home with family and loved ones, not being able to cope with relationship breakdowns, perceived rejection by loved ones.

Research itself shows that the majority of relapses are caused by an inability to deal with distress (negative emotions) especially in the context of interpersonal relationship.

While neurobiological accounts of addiction suggest the main cause of relapse is due to responding to alcohol or drug cues, an effect heightened in the presence of stress, it does not allow for the main arena in which this stress/distress occurs i.e. with loved ones or people we are having relationships with, or thwarted relationships . Living with others can be difficult for alcoholics and addicts especially as we often found ourselves living in social isolation from others at the endpoint of our addictions.  Especially as many of us, if not the majority, have insecure attachment styles.

So why do addicts and alcoholics and others suffering from a range of addictive behaviours from sex to eating disorders have difficulties with coping with relationships with others?

This point certainly needs addressing as it appears to be a major determinant of relapse!

I do not know about you but there are certain parts of my “personality” that I do not like.

I believe these are mainly do to my insecure attachment – these include the tendency at times to be dismissive, to be needy, look at “me, me me!”, to be wary of others and their motives and to be very rejection sensitive. I have major issues with rejection from others and guard against it. I am also taking action in my personal life to deal with these issues more adaptively, more healthily.

It appears to me increasingly that part of my alcoholism is rooted not only in the genes I inherited from both my parents but in the fertile ground of insecure attachment and childhood maltreatment.

So have any researchers considered these factors? Not many it has to be said but this study (1) certainly did an it is one o the best and most comprehensive studies I have read in relation to these issues.

So in short, is there a sequelae between insecure attachment, rejection issues, low self esteem, interpersonal relationship difficulties and relapse?

“In this article, we review the literature on interpersonal stress and rejection sensitivity and examine how these factors increase the risk of relapse in individuals with alcohol or drug dependence…(to) provide insight into the role of interpersonal stress as a powerful and oftentimes destructive factor that affects individuals in recovery from substance dependence.

Relapse following treatment for alcohol or drug use disorders is a common problem. Studies indicate that 50–70% of patients are unable to remain abstinent during the first year following addiction treatment (1)…(we)  review the constructs of rejection sensitivity, insecure attachment, and low self-esteem, integrating these traits and considering how they influence relapse vulnerability…

Next (blog 2), we review the constructs of expressed emotion, perceived criticism, and marital distress, examining how these negative social contexts can contribute to unfavorable outcomes among individuals recovering from substance dependence.

We conclude with the testable hypothesis that there exists a subgroup of substance-dependent individuals with high trait rejection sensitivity that is particularly vulnerable to relapse in the context of a harsh and critical interpersonal milieu. We propose that high trait rejection sensitivity is a unique risk factor for relapse that can inform research in this area.

rejection images (40)

Intrapersonal Vulnerabilities to Addiction and Relapse

Interpersonal stressors are regarded by many as the one of the most severe forms of stress and can affect an individual’s cognition and behavior. Interpersonal stress is a well-known precipitant of maladaptive drug and alcohol use…we will review the extant literature on the related constructs of rejection sensitivity, insecure adult attachment style, and low implicit and explicit self-esteem. Although not identical, all of these constructs contribute to an individual’s compromised sense of self and an inability to interact comfortably and effectively with others. Further, they all share a propensity to increase an individual’s vulnerability to addiction.

Rejection Sensitivity

Rejection sensitivity (RS) is defined as the disposition to anxiously expect, readily perceive and react intensely to rejection. High-RS individuals interpret ambiguous social cues as indicative of rejection (22,23,24). Individuals entering into a romantic relationship with expectations of rejection attribute insensitive behavior by their partners to hurtful intent. RS also causes people to be dissatisfied in relationships and to anticipate that their partners are dissatisfied and want to end the relationship. High-RS individuals react in ways that undermine their relationships, ultimately serving as “self-fulfilling prophecies” (22,23). High-RS people have lower self-esteem and coping skills than those with low RS…and have higher levels of drug use than low-RS individuals (24).

High-RS individuals may quickly activate a defensive motivational system (DMS), which acts automatically and at a nonverbal level (22). The DMS results in rapid execution of automatic behavior aimed at self-protection, whether the threat is physical or social (22). Although the DMS is adaptive when a quick automatic defense to threat is required, it is maladaptive when a response requires higher reflective cognition (22)….

…thwarting a person’s fundamental need to belong produces cognitive dissonance, leading to a failure to self-regulate effectively, which is manifested in self-defeating behaviors (25).

Insecure Adult Attachment Style

Anxiously attached adults lack self-confidence, are extremely sensitive to interpersonal rejection and lack effective emotion regulation skills, while securely attached adults have high self-worth, perceive that other people are accepting and engage in healthy coping skills (28,29,30). The ability to regulate distressing emotional experiences is theorized to develop during infancy in the context of a responsive and available caregiver (27,28,30). A primary function of attachment, therefore, is the interpersonal regulation of distressing emotional states (27,31). Insecure attachment is marked by deficient mood regulation skills and a propensity to use maladaptive coping methods, such as drugs and alcohol, to modulate distressing affect (27,29,30,31,32).

Anxious attachment, therefore, predisposes individuals to heightened interpersonal conflicts due both to their diminished self-worth and their deficits in regulating emotion.

rejection

Insecure adult attachment is associated with addictive disorders (27,28,29,31,32). Thorberg and Lyvers (30) found that, compared with control subjects, individuals with a substance use disorder scored lower on the “attachment dimension of close” and the “attachment dimension of depend” and higher on the “anxiety dimension” of the Revised Adult Attachment Scale. These measures reflect the extent to which a person feels comfortable with closeness and intimacy, how much they feel they can depend on others, and how anxious they are of being abandoned or unloved. Those with substance use disorders were also more emotionally reactive than controls (30). Another study by these investigators (31) used the Negative Mood Regulation (NMR) expectancies scale to examine the association between anxious attachment and mood regulation. The NMR measures an individual’s ability to regulate and successfully cope with negative affective states. They found an association between anxious attachment and a diminished ability to regulate negative moods and postulated that substance use represents a “mood regulating coping mechanism” (30).

McNally et al. (27) examined the relations between alcohol-related consequences and adult attachment dimensions. They used the adult attachment style conceptualization of Bartholomew and Horowitz, which is similar to that of Hazan and Shaver except that they differentiated avoidant attachment into “dismissive” and “fearful” attachment. Two dimensions exist in this model: view of self and view of others. Securely attached individuals have a positive view of self and others; anxiously attached (renamed “preoccupied”) individuals have a positive view of others but a negative view of self; dismissive individuals have a positive view of self but a negative view of others; and fearful individuals have a negative view of both self and others. These investigators found that individuals with a negative view of self (i.e., those with preoccupied and fearful attachment styles) reported greater alcohol-related consequences, which were mediated by the individual’s desire to alleviate negative affect. The investigators noted that the “individuals’ global feelings of insecurity in relationships and interpersonal interaction, and in particular, their sense of themselves as both inadequate and undeserving (negative model of self) appear to have a direct effect on the motivated use of alcohol to cope with negative affect, and an indirect effect (mediated by coping motives) on drinking-related problems” (p. 1124).”

Negative reinforcement of social rejection is not the only mechanism increasing high-rejection-sensitivity individuals’ risk for addiction and relapse. Because rejection activates the defensive motivational system, these individuals frequently respond with automatic aggressive behaviors, sometimes assuming a passive form of “going out and getting wasted” to “punish” the person who rejected them. Social rejection also impairs self-regulation, further diminishing the high- rejection-sensitivity individual’s ability to employ the strategies and cognitions necessary to avoid relapse.

I call this a “to Hell With It!” relapse! You reject me and I will reject you back! Again this ties in with the emotional immature reactions that we blogged on before, and the direct consequence, again, of insecure attachment.

In Part 2 we will look at low self esteem and interpersonal vulnerabilities to relapse (particularly in family settings).

To be continued.

 

References

1. Leach, David, and Henry R. Kranzler. “An Interpersonal Model of Addiction Relapse.” Addictive disorders & their treatment 12.4 (2013): 183–192. PMC. Web. 30 Jan. 2015.

Abusive Childhoods Increase Risk of Later Alcoholism

Sitting in AA meetings over a number of years I have been struck by the amount of stories I have heard about fellow AAs having had abusive childhoods and have always wondered how much this sort of maltreatment in childhood contributes to later alcoholism.

In my research I have found that child maltreatment has been frequently identified in the life histories of adolescents and adults in treatment for substance use disorders, as well as in epidemiological studies of risk factors for substance use and abuse.

Ample evidence exists for higher rates of substance abuse and dependence among maltreated individuals (1) so much so that alcoholism and addiction for many represent a developmental cascade.

In clinical samples undergoing treatment for substance use disorders, between one third and two thirds evince child abuse and neglect histories (2-7).

In a survey in The USA, of over 100,000 youth in 6th though 12th grade, Harrison, Fulkerson, and Beebe (1997)  found that those reporting either physical or sexual abuse in childhood were from 2 to 4 times more likely to be using drugs than those not reporting abuse; the rates were even higher for youth reporting multiple forms of child maltreatment (8).

Similar findings (9,10) have been reported by Rodgers et al. (2004) and Moran, Vuchinich, and Hall (2004). Among youth with Child Protective Services documenting maltreatment, Kelly, Thornberry, and Smith (1999) reported one-third higher risk for drug use among those with an abuse history(11).

 

Substance-abuse-effects-families-300x169

 

In a large epidemiological study, Fergusson, Boden, and Horwood (2008) showed physical abuse and particularly sexual abuse to be related to illicit drug use, as well as abuse and dependence (12).

It also appears that  extreme economic deprivation characterizes many maltreating families who are residing in impoverished areas with substantial neighborhood disorganization and ample availability of drugs in the community(13).

Hawkins, Catalano, and Miller’s (1992) highlighted poor and inconsistent family management practices, high family conflict, and poor bonding to family as risks for adolescent substance abuse, and these factors also are characteristic of the dysfunction in maltreating families in which abuse and neglect occur.

These features are consistent with the progression of developmental failures exhibited by maltreated children (14).

Consequently, compromised adaptation in the social and academic arena contributes to association with deviant peers, who escalate the access to and modeling of substance abuse, contributing to early onset of drug use.

 

For many the propensity for later alcoholism and drug addiction are determined in part by genetic inheritance but all genetic transmission also relies on environmental conditions.

It would appear that abusive childhoods and emotional deprivation provide fertile grounds.

 

References

1.  Rogosch, F. A., Oshri, A., & Cicchetti, D. (2010). From child maltreatment to adolescent cannabis abuse and dependence: A developmental cascade model.Development and psychopathology22(04), 883-897.

2.  Bayatpour M, Wells RD, Holford S. Physical and sexual abuse as predictors of substance abuse and suicide among pregnant teenagers. Journal of Adolescent Health. 1992;13:128–132.

3. Cavaiola AA, Schiff M. Behavioral sequelae of physical and/or sexual abuse in adolescents. Child Abuse & Neglect.1988;12:181–188.

4. Dembo R, Dertke M, Borders S, Washburn M, Schmeidler J. The relationship between physical abuse, sexual abuse and tobacco, alcohol, and illicit drug use among youths in a juvenile detention center. International Journal of the Addictions.1988;23:351–378

5. Edwall GE, Hoffman NG, Harrison PA. Psychological correlates of sexual abuse in adolescent girls in chemical dependency.Journal of Adolescent Chemical Dependency. 1989;1:53–68.

6. Pribor EF, Dinwiddie SH. Psychiatric correlates of incest in childhood. American Journal of Psychiatry. 1992;149:52–56.

7. Schaefer MR, Sobieragi K, Hollyfield RL. Prevalence of child physical abuse in adult male veteran alcoholics. Child Abuse & Neglect. 1988;12:141–150.

8. Harrison PA, Fulkerson JA, Beebe TJ. Multiple substance use among adolescent physical and sexual abuse victims. Child Abuse & Neglect. 1997;21:529–539.

9. Harrison PA, Fulkerson JA, Beebe TJ. Multiple substance use among adolescent physical and sexual abuse victims. Child Abuse & Neglect. 1997;21:529–539.

10. Moran PB, Vuchinich S, Hall NK. Associations between types of maltreatment and substance use during adolescence. Child Abuse & Neglect. 2004;28:565–574.

11. Kelly BT, Thornberry TP, Smith CA. In the wake of child maltreatment. Washington, DC: Office of Juvenile Justice and Delinquency Prevention; 1997. pp. 1–15.

12.  Fergusson DM, Boden JM, Horwood LJ. Exposure to childhood sexual and physical abuse and adjustment in early adulthood.Child Abuse & Neglect. 2008;32:607–619.

13.  Hawkins JD, Catalano RF, Miller JY. Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin.1992;112:64–105.

14. Cicchetti D, Valentino K. An ecological transactional perspective on child maltreatment: Failure of the average expectable environment and its influence upon child development. In: Cicchetti D, Cohen DJ, editors. Developmental psychopathology: Vol. 3. Risk, disorder, and adaptation. 2nd ed. New York: Wiley; 2006. pp. 129–201