interpersonal theory on addiction

“Being Part of” Online?

Posted on by alcoholicsguide

INTERNET ADDICTION has become a prevailing problem in the modern wired society. One important line of research has examined the relationships among Internet abuse, social anxiety, and interpersonal relationships. Several studies have identified that people who are shy, have poor social skills, or experience a high level of interpersonal anxiety may be drawn to cyberspace relationships.

The social anxiety this study describes seems very similar to the “not being part of” or “not belonging to” that alcoholics and addicts frequently talk about. Many addicts say they never had the manual to know how to deal with other people hence it seems they had some form of social anxiety as the result of insecure relationships with primary care givers.  Hence they found “friends” via the mediation of alcohol and drugs and these substances suddenly seem to endow them with the “chemical keys” to unlock the ability to act socially with other people, to be part of or “to act extemporaneously” to quote Bill Wilson, to act spontaneously, to act as if we had shed our anxiety straight jacket. We all felt more social, wittier, etc even if we were not in reality.

I felt I was “more me” when I started drinking initially, that this was the “real me” not the grey version of me when sober!

Alcohol had boosted my neurobiology in some way, my blood flowed better around my veins, my stress chemicals reduced, the neurotransmitters that were reduced seem to be repleted. I seemed to grow more into my body, be more alert, be more loving to my fellow human beings.  I liked me more when drinking just as others seemed to.

I preferred this me, more than my sober me. Fact. Alcohol gave me something I could get by myself. This was my first “spirit awakening” in a sense. I could transform my self in minutes via substances and via certain behaviours. Spirit transformation.

Wears out. Drastically. Leaving me chronically addicted to everything.

I often wondered if I would be an internet addict myself if an adolescent now? The answer would be yes as I am an internet addict now!!

I use the internet so much it would be considered, by diagnostics, as internet addiction. I use it to write blogs, research, run my own business rather than to find cyber “love” but…I use it 7 hours or more every day! Is this internet addiction to add to my alcoholism, substance addiction, behavioural addictions, insecure attachment issues , PTSD etc.

When I engage in any behaviour I have to be aware of doing that behaviour way too much. If I want to do something, there is a sure fire guarantee that I will really, really want to do it more and more and….

This study (1) suggests “that the quality of parent–child relationship is indeed positively correlated to the quality of our participants’ interpersonal relationships and that frustrating interpersonal relationships may raise the level of social anxiety. In addition, interpersonal relationships, the parent–child relationship, and social anxiety all influence Internet addiction… Finally, the more social anxiety and discontent with their peer interactions the participants experienced, the more addicted they were to the Internet.

Other studies have explored whether the cyber-relationship substitutes for an unmet need in an actual relationship.3–5 Together, these studies indicate that cyber-relationships can provide a sense of belonging, warmth, and well-being.

InternetAddiction

A study by Bell et al. revealed that the parent–child relationship was a primary experience of the child, as parents retained a substantial influence on the development of adolescent social relationships outside the family (8).

Feldman and Wentzel also found that parental child-rearing style and social support from the family were positively associated with whether the adolescent was trusted or liked by his or her peers (9). These studies collectively suggested that warmth, support, acceptance, and love in the parent–child relationship are directly related to the child’s closeness to peers, satisfaction with peer relations, and acceptance by peers.

In this study, we identify predictors of Internet addiction by constructing a model from elucidating the linkages among Internet addiction, parent–child relationship, interpersonal relationships, and social anxiety. This finding is consistent with the positions of Suler and Young, who have said that addiction to the Internet is a reaction to poor adaptation in the real world (5,14).

Most individuals who are addicted to the Internet experience more social anxiety because of bad social skills and frustrated personal companionship, which in turn may be shaped by qualities of the parent–child relationship. Anxiety picked up from caregivers or parents in the early stages of development, however, can be overcome and social skills can be improved if people develop good relationships during adolescence(6).

References

1. Liu, C. Y., & Kuo, F. Y. (2007). A study of Internet addiction through the lens of the interpersonal theory. CyberPsychology & Behavior, 10(6), 799-804.

The Family Afterward…factors in relapse!

Posted on by alcoholicsguide

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.

In this two part blog we have considered evidence that shows intrapersonal traits (e.g. rejection sensitivity and low self esteem) and interpersonal environments (e.g. the family environment) can interact to increase an addict’s risk of relapse.

This study (1) concludes by proposing that substance-dependent individuals with high trait rejection sensitivity and a critical interpersonal environment are particularly vulnerable to relapse.

In the first part of this blog we looked mainly at intrapersonal (i.e. within the self) traits now we consider how these factors interact with interpersonal (relationships between individuals ) factors to often prompt relapse situations.

“Interpersonal Vulnerabilities to Addiction and Relapse

Perceived criticism (PC) and expressed emotion (EE) are related constructs that are used to measure criticism by family members directed toward the patient (36,37). EE—measured with a semi-structured interview—reflects the degree to which relatives refer to the patient in critical, hostile or over-involved ways (36).

O’Farrell et al. (36) found that alcoholic patients with high EE spouses are also more likely to relapse than their low EE counterparts. They proposed the development of a vicious cycle in which increased criticism leads to increased drinking, which leads to escalating criticism. They also found that behavioral marital therapy that aims to improve communication and decrease criticism reduced relapse in patients with high EE spouses (36).

The perceived criticism (PC) measure is operationalized using the single question “How critical is your spouse of you?” Similar to high EE, high PC—a far simpler measure that is less expensive to obtain than EE—significantly predicted relapse to substance use in a sample of alcohol dependent individuals (37).

Marital distress and spousal criticism are frequently associated with worse outcomes in treatment-seeking addicts (40,41). Family cohesion has been shown to significantly predict the severity of a person’s dysfunction resulting from drug use (42), and one study reported that spousal conflict was most frequently identified by male alcoholics as the cause of their relapse (43).

Booth et al. (40) showed that support from family and friends, specifically “reassurance of worth,” significantly predicted improved treatment outcomes even in patients with high rates of prior recidivism.

They argued that enhancing an alcoholic’s sense of self-worth would increase the individual’s likelihood of recovery and called for treatment interventions that focus on enhancing social support (40). Consistent with this approach, numerous studies have shown a positive association between supportive family and friends and improved drug and alcohol treatment outcomes and enhanced psychological functioning (44,45,46,47).

Individuals who are unable effectively to regulate the negative affective states elicited by interpersonal conflict are at greater risk of becoming substance dependent and to persist in their use of alcohol and drugs despite adverse consequences (48,49). For instance, fMRI studies have repeatedly shown that threatening social cues elicit increased amygdala reactivity. Sripada et al. (48) showed that alcohol attenuates this reactivity and hypothesized that alcohol’s ability to reduce stress and anxiety is mediated by its attenuation of threat processing in the amygdala (48).

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.”

As the Big Book suggests “All members of the family should meet upon the common ground of tolerance, understanding and love…Cessation of drinking is but the first step away from a highly strained, abnormal condition…”Years of living with an alcoholic is almost sure to make any wife or child neurotic. The entire family is, to some extent, ill.” Let families realize, as they start their journey, that all will not be fair weather….”

family-recovery

Indeed, the family needs to recover not just the obvious candidate of the alcoholic/addict. This is a family illness and everyone in the family needs to support each other in their recovery.  This hard earned wisdom often seems the profound and most profitable to all.

The NCADD  state the notion of family disease clearly …

“Alcoholism and drug addiction affects the whole family – young, teenage, or grown-up children; wives or husbands; brothers or sisters; parents or other relatives and friends.  One family member addicted to alcohol and drugs means the whole family suffers.  Addiction is a family disease that stresses the family to the breaking point, impacts the stability of the home, the family’s unity, mental health, physical health, finances, and overall family dynamics.

Without help, active addiction can totally disrupt family life and cause harmful effects that can last a lifetime.

Regrettably, no family is born with the knowledge of how to deal effectively with addiction.  It is a skill that must be learned and practiced daily.

But, with the proper help and support, family recovery has become a reality for millions!”

 

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.

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

3. https://ncadd.org/for-friends-and-family/family-disease-and-recovery

 

 

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Interpersonal Factors in Relapse – Part 1

Posted on by alcoholicsguide

“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.