Love is the Drug!

Science as we have shown in many blogs has given us unprecedented insight into brain mechanisms implicated in addiction. It has shown us how various neural networks governing reward/motivation, memory, attention and emotions seem to be usurped in the addiction cycle.

Important aspects of “the self” are taken over in other words. It has shown how those vulnerable to addiction seem to have decision making deficits, suffer impulsivity, choose now over later, do not tolerate distress or negative emotions etc. Over react to life!!

It shows how addicts have difficulties in  regulating stress, and that stress systems in the brain are altered to such an extent that they rely for brain function on allostasis not homeostasis.

They show us that various neurotransmitters are also reduced in the addict’s brain such as GABA, the inhibitors or brakes of the brain. We are deficient in natural opioids, dopamine, serotonin etc. Our brains are different to “normies” to “earthlings.

Science suggests the majority of addicts have had abuse or trauma, neglect or adverse experiences while in childhood and this too contributes to addiction vulnerability via stress and emotion dysregulation and a heightened sensitivity to the stimulating effects of drink, drugs and certain behaviors such as eating, sex, gambling, gaming, internet use  etc.

Science also offers suggestions on treatment. It offers the use of chemicals or antagonists to reduce “carving” and it suggest the effectiveness of CBT, Mindfulness and DBT but it seems to know little about how or why 12 step programs work.

Science can’t quite bring itself to believe that laypeople, fellow addicts, can help solve each others’ problems. It scratches it’s head about “spiritual maladies” and “spiritual solutions”; how the 12 steps could bring about such a cathartic change in personality to change someone from a hopeless addict to a person in recovery.

It wonders how helping others and taking fearless and honest inventory can bring about the psychic change sufficient to help some with addiction recover. To be restored to sanity.

 

love-pain1

In various blogs we have suggested the spiritual malady can also be viewed as a emotional disease and that the 12 steps also allow us to process emotions and regulate feelings in a way we could not before.

It helps us process the many negative emotions of the past via steps 4-9 and sets us free by consigning these emotions to long term memory instead of having them swirl around forever in explicit memory, forever tormenting us.

For us, 12 step programs offer a workable definition of the addict. The “spiritual malady” mentioned in the Big Book does however refer to all people, not just alcoholics/addicts, and is borrowed directly from the Oxford Group.  But reading around this, there are many examples of emotional and stress dysregulation in the BB, some 70 plus examples in the first 164 pages  of  how our emotions dominated us and how we were shot through with fear.

It is the description of alcoholics in the BB that highlights we have an emotional as well as spiritual  disease. What is a spiritual disease if not manifest in negative emotional states such as resentments, false pride, anger, jealousy, and so on. The need to control, to be better than, to know best, all also signs of emotional immaturity.  The BB clearly show us alcohol(ism) has made us very emotional irresponsible. We step on the toes of our fellows and they retaliate.

We have a spiritual malady but, from descriptions of ourselves, it seem more extreme than normal people. It is not only in terms of alcohol that “the delusion that we are like other people, or presently may be, has to be smashed.”

The definition is thus workable because it allows one to act in relation to it. For example, if I am aware of the nature of my defects of character I am in effect aware of what cuts me off from the “sunlight of the spirit”, aware of what keeps me spiritually and emotionally ill, what keeps me in a state of unprocessed emotions, of emotional dysregulation, of undealt with distress. Of what keeps me in resentment in a viscous circle of unprocessed negative emotions.

It shows me how this dysregualtion effects other people and gives me the tools to correct my mistakes, to make amends for the mistakes I have made. To relieve distress. It gives me a framework, a program of action which allows me to live with others, on life’s terms, although I might not immediately agree with those terms, which is often the case!

It gives me a choice that I never had before. It says to me you can live with unregulated negative emotions and cultivate your misery or you can choose to use the program to free yourself from these negative unregulated emotions and by processing them be restored to to sanity. It can help me get out of the past/future and into the now, the present.

The solution to my spiritual and emotional malady is this simple. Identify, label, verbalise either to God or to another human being the nature of these wrongs/sins/defects/shortcoming/negative emotions – those factors that trapped me in self propelled distress – and they are quite simply removed. That is my experience. Honesty, openness, willingness, the how of getting out of self. Repeatedly during the day. When I do not do this I suffer emotionally, and others suffer too.

The steps allow me to reduce my distress and this control of distress and stress via the cultivation of serenity, balance, selflessness deactivates my illness for a while allows me to be happy, joyous and free as this appears to be the state of freedom from self, in my experience, this seems to be a state of Grace in other words. The sunlight of the spirit that Bill W mentioned.

It is the solution. I drank to get away from myself. To exhale some air and go “phew!”  I do not not have to even consider that now because I can do that via the steps, by simply taking inventory and letting go. It is our emotions that hold on to negative thoughts, that grow them in the dark shadow of our souls like fungus. Honesty is a light that extinguishes them. By letting go, by allowing my emotions to lower in intensity, to label and identify them and thus allow via, God’ loving Grace, for them to be removed (and stored away where they belong in long term memory).

But there are so many more reasons why 12 step programs work! If the majority of us have had abusive upbringings then it suggests perhaps that there are attachment issues present in many of us. For me my insecure attachment to my primary care giver, my mother, may have caused an insecure attachment which has certainly kick started my later addictions. In fact some observers have gone so far as to view addiction as an attachment disorder.

I will blog on this in the next weeks or two. I will blog on this attachment disorder as perhaps causing that “hole in the soul” that many addicts talk about in meetings.

That not belonging, being separate from. That isolation – these may all stem from insecure attachment. Insecure attachment can shape the brain in a way that makes it difficult to regulate stress and emotion and thus contribute to later addiction. It may cause the differences in emotions mentioned above. It may also point to heart of the problem and why 12 steps groups work in treating addiction.

12 step groups seem to directly treat the “Hole in the soul” by instantly giving an addict a sense of belonging which is particularly powerful after many years in the desolation of addiction. I know that I stayed in AA because I have finally found the club, the tribe, that I belong too. This   like other families is a group of people I love, but sometimes have problems with, fall out with, return to and see in a new light. It is an organic relationship. It has never been wonderful at all times but that says as much about me and my distrust of others, my insecure attachment as it does AA.

I had grown up not even feeling part of my family. The required psychic change happened to me in my first meeting I believe.  Others have commented on how I walked into the meeting a different person from the person who left the meeting. I had a spiritual experience of some sort in my first meeting, purely through identifying with the other recovering alcoholics in the meeting. Not about their drinking, but by identifying with their spiritual malady. I identified with there emotional disease and I realised that if they could find a solution then there was a chance, however small, that I could too. The first flickers of hope happened in that very first meeting.

I knew in my heart I had somehow returned home in a strange way. I had found my surrogate family, those who would help love me back to health and recovery.
Perhaps this is what Science is generally not getting about 12 step groups, the powerful therapeutic tool of talking with someone who has been where you have, who shares your disease and who can help you recovery, as they have. Even now sitting in an AA meeting is the most spiritual thing I do. More so that attending Chapel, visiting monks in isolated monasteries.

Identification with those in the same boat as you is profound. It tells you are not alone. It tells you I need to help you to help me. We are in this together, not you and I. Us, together.

It accepts you as you are, at your lowest ebb, at your rock bottom, your most degraded self. It offers your affection when you are your most unlovable, most wretched.

This for me was the key, being accepted into a group I knew I belonged in. My new home. My new secure attachment. I believe this secure attachment and the love you have for fellowships, sponsees and the love you can now show yourself and your family and friends and people in your life is that solution. To Love and be loved.

I felt in my active addiction I was not deserving of love, that you shouldn’t give me your love. I didn’t know how to give you mine. Now I have so much love inside of me. It is this love that has filled up the hole in my soul.

Okay, it has also increased my natural opioids, raised my dopamine via belonging, raised the GABA brakes in my brain. It has also increase my serotoninergic well being and happiness, it has lower my excitatory glutamate. It has restored more neuro-chemical balance in my head. By prayer and mediation and helping others it restores sanity, fleeting periods of homeostasis, balance, serenity. It most importantly reduces stress/distress, silences my addiction, long enough for me to think of others, help others. And there is not greater buzz that helping others. Love is the drug that I have been thinking off. Love is the solution.

Trust someone enough so that you can begin to allow them and God to love you and you will eventually love them back. A whole new world, full of love and being whole awaits.

The journey is from the crazy head to the serene heart. 

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

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/

They can fuck you up, your mum and dad.

They fuck you up, your mum and dad.
    They may not mean to, but they do.
They fill you with the faults they had
    And add some extra, just for you.

Phillip Larkin – This Be The Verse

Looking back on my own childhood it is easier now to observe the fertile ground from which my genetic seeds of alcoholism started to flourish. I have long maintained that growing up in a dysfunctional family environment did not create my alcoholism but certainly did not help. A family environment were emotional expression was limited and veered between sentimentality and  outright anger.

It is difficult to see how I learnt the essential adaptive skills of emotional regulation then; how to identify, label and express emotions freely without sanction, verbally, and non-verbally. For me emotions where something you cut off, experientially avoided, resisted. The more you did not let them get to you the tougher you were mentally somehow. Emotions were strangely dangerous things almost.

Emotions, having them, made you weak! People who indulged in them were weak.

I also grew up with a father who was a boxer and alcoholic (abstinent, thank God, via the local Church) who insisted emotions had to tolerated like a man, like some tough  hombre in a 1950s Western. I had a host of uncles and a Grandad who agreed and they all set out to toughen me up. I even had boxing matches with cousins at various homes to show how I was progressing!

When I started drinking I found that this tough guy routine was greatly enhanced. Alcohol made me bullet proof. I drank and grew up to manhood in one go. Or so I thought – I didn’t realise that I stayed at that emotionally  impaired 14 years old for nearly three decades later.

The worst effect on my emotional regulation  skills was my relationship with my mother who struggled with valium abuse most of her adult life. This meant she was emotionally distant a lot of the time. Wose than that, she mixed mawkishness with being cold as a stone. It was an insecure attachment.  You were never sure, emotionally, where you were at with her. It made me insecure, anxious and eventually very very angry. Cold blue angry.

But did this also have an effect on my ability to processing emotions. How could maternal emotional deprivation have an effect on my emotional processing skills? Andd how could this emotional processing difficulty affect the amount I craved alcohol??

I recently came across this article (1) which looked at this very question.  I refer widely from it here.

Attachment theory is a widely used framework for understanding emotion regulation as well as alexithymia, and this perspective has also been applied to understand alcohol use disorders. One hypothesized function of attachment is the interpersonal regulation of affective experiences (Shaver & Mikulincer, 2007; Sroufe, 1977).

One hypothesized function of attachment is the interpersonal regulation of affective experiences (Shaver & Mikulincer, 2007; Sroufe, 1977). In the development of alexithymia, attachment theories stress the importance of significant others in childhood (Krystal & Krystal, 1988; Nemiah, 1977; Taylor et al., 1997). Evidence suggests that alexithymia is related to dysfunctional parenting (Thorberg, Young, Sullivan & Lyvers, in press).

Insecure attachment is associated with alexithymia and both harmful drinking and alcohol-dependence (Cooper, Shaver, & Collins, 1998; De Rick & Vanheule, 2006; Thorberg & Lyvers, 2006; Thorberg, Young, Sullivan, Lyvers, Connor & Feeney, 2009). In addition, alcohol abuse has been hypothesized to be a consequence of alexithymia (Taylor, Bagby, & Parker, 1997).

Research on alexithymia (1) has found significant positive associations between alexithymia, difficulties identifying feelings, difficulties describing feelings and alcohol problems (Thorberg, Young, Sullivan, & Lyvers, 2009; Thorberg, Young, Sullivan, Lyvers, Connor & Feeney, 2010). Individuals with alcohol-dependence and alexithymia report more severe alcohol problems compared to those with alcohol-dependence alone (Sakuraba, Kubo, Komoda, & Yamana, 2005; Uzun, Ates, Cansever, & Ozsahin, 2003). They also have poorer treatment outcomes (Loas, Fremaux, Otmani, Lecercle, & Delahousse, 1997; Ziolkowski, Gruss, & Rybakowski, 1995).

Individuals may use alcohol to escape feelings of rejection and establish a “secure attachment base” (Hofler & Kooyman, 1996), given alcohol’s stress and anxiety reducing effects.

In this study (1)  results highlight the importance of alexithymia and difficulties identifying and describing feelings as related to preoccupation, obsessions and compulsive behaviors regarding drinking in those with alcohol-dependence. Or in more simple terms between alexithymia and craving.  In this study 32.4% of this alcohol dependent groups were alexithymic. This is less than previously reported prevalence rates of 45-67% (Thorberg et al., 2009).

In this study (1)  alcohol-dependence severity, alexithymia and insecure attachment were associated with more intrusive and interfering cognitions, ideas and impulses about alcohol, including an impaired ability to control these thoughts and impulses. This cognitively based “craving” as measured by the Obsessive Compulsive Drinking Scale (OCDS; Anton, Moak, & Latham, 1995), which is designed to assess obsessive thoughts and compulsive behavior toward drinking.

Hence there was a demonstrated relationships between alexithymia, craving, anxious attachment and alcohol problems in an alcohol-dependent sample. Higher levels of alexithymia led to a stronger desire for alcohol that was partially explained by an underlying mechanism, anxious attachment. One possible reason for this  it may reflect an impairment in affect regulation.

Findings of the RAAS-Anxiety scale measured insecure attachment as related to a current or previous relationship, these findings may suggest that worries about being rejected, not cared for or unloved lead to an increased craving for alcohol.

One explanation for this mediational relationship may perhaps be that increased relationship stress is associated with a fear of intimacy and anxious attachment that leads to increased craving and perhaps a stronger attachment to alcohol. In other words, the alexithymia of insecure attachment may cause a stress dysregulation which prompts craving particularly as craving is a consequence of dysregulated stress systems. Stress dysregulations is also implicated in increased or more chronic alexithymia as suggested by George Koob in various articles. This has also been observed in other studies – this relationships of negative affect (anxiety, negative mood and emotion) with both alexithymia and craving (Sinha & Li, 2007).

To summarise, the results of this study support important relationships between alexithymia, difficulties identifying and describing feelings in relation to alcohol craving. These relationships extend to significantly higher levels of obsessive thoughts and compulsive behaviors in relation to alcohol use and alcoholism severity amongst individuals with combined alexithymia and alcohol-dependence, compared with alcohol-dependence alone. This study identified anxious attachment as a potentially important mechanism, in the relationship between alexithymia and alcohol craving.

References De Rick, A., Vanheule, S., & Verhaeghe, P. (2009). Alcohol addiction and the attachment system: an empirical study of attachment style, alexithymia, and psychiatric disorders in alcoholic inpatients. Substance use & misuse,44(1), 99-114.