The Impact of Attachment to Substance in Substance Dependent Individuals’ Psychotherapy Relationships: An Exploratory Mixed-Methods Study


To date, there are no comprehensive studies that have examined the concept of attachment to substance in a substance dependent population, and how it relates to one’s attachment relationship with others.  Specifically, it is unknown how an individual’s attachment to substance may influence the therapeutic relationship with their own therapist.  The current research adopted a mixed-methods approach toward exploring these under-researched areas by way of collecting psychometric data with a sample of substance dependent adults in an anonymous survey study, and a subset of that sample was interviewed in a follow-up study.  Results showed that Insecure Attachment to Substance significantly influenced the relationship between one’s Attachment-Anxiety and Preoccupied-Merger attachment to therapist, providing support for the expected mediation effects.  While no effect was found between Attachment-Avoidance and any style of attachment to therapist, Attachment-Avoidance was a significant predictor of Avoidant-Fearful attachment to therapist, and a significant negative predictor of Secure attachment to therapist.  Men were found to have stronger associations between Attachment-Anxiety and Avoidant-Fearful attachment to therapist, when compared to women.  All the clients interviewed experienced a Relational Dilemma, summarising their intra and inter-personal difficulties characterised by their ambivalence and insecurity, in dealing with others; and patterns of substance use.  Relationally, these individuals described significant struggles leading to approach and avoidance behaviours, as a function of their personal insecurities, and these difficulties were described to manifest with their therapists.  Overall, the findings supported the proposed model of Attachment to Substance, and the view that chronic and dependent substance use is an inadequate and futile attempt to compensate for the failure to receive adequate love and care from relationships with others.  Clinical implications were discussed.

Keywords:      Attachment to Substance, Relational Dilemma, Psychotherapy Relationship, Substance Dependence, Best Practice

Suggested Reading:

Addiction as an Attachment Disorder by Dr. Philip Flores