Welcome back. This is part II of my multi-part blog series wherein I review the 2014 edited volume entitled Addictions from an Attachment Perspective—Do Broken Bonds and Early Trauma Lead to Addictive Behaviours? We’ll start off looking at Chapter Two—Addiction: Treatment and Its Context—by Jason Wright. Let’s dive in.
Wright provides us with what he calls The Five Stages of a Using Career:
- Using
- Trying to stop
- First attempts
- Stopping, and
- Working through the underlying causes of the using
Wright covers each stage in some depth. I invite the reader to review this information if it is of interest to you. Wright does allow that at each stage the goal is to foster “a real and alive attachment connection to a living person” (more on this below). Interestingly Wright suggests that the attachments formed during stages two and three typically occur within institutional settings: “the state through the police, legal system, or social services, or to a voluntary organisation, twelve step, or community-based project.”
Wright then turns to the topic of “manualisation” in the area of addiction treatment. Wright defines manualisation thus: “The creation of treatments that are presentable in manual form so that they can be disseminated that way.” When I was working with troubled teens back in the 1990s within a behavioral health setting, I was forced to use a 60 page manual. Here in New Mexico our Child Protective Services is called CYFD—Child, Youth and Families Department. CYFD receives a lot of its funding from the federal government chiefly through various Medicaid programs. As a result, CYFD is forced to use manualised (keeping with the British spelling) treatment programs, which they, in turn, force on local practitioners and treatment clinics. A colleague of mine who used to work at CYFD told me that packaged treatment programs arrived at CYFD’s doorstep like a “flavor of the month.” Common Core is a manualised education program. Manualised programs of all stripes are in favor now because manualisation takes us down the road toward automation: programs delivered almost entirely by computers and other automated devices. Here’s how Wright describes the manualisation process taking place in the UK:
Over the last ten or twelve years, the state, in the guise of the National Treatment Agency (NTA) has had considerable impact on treatment, working toward manualisation … and assisting the process of scaling up interventions to meet a mass market. This has been developed in the funding frames of business culture and a medical model—I would say commodified model.
Wright continues thus:
The intervention of the state in this way, working toward manualisation and a one size fits all approach, which can be common to scaling up, presents a problem for the localism of experience and runs the risk of missing out on the particular or personal relationship found in psychodynamic thinking.
Wright goes on to tell us that when he works with addicts he makes a central assumption: the addict has made “an attachment to a dependable, but dead object.” As mentioned above, the goal, then, is to get the addict attached to an alive, living person. Wright sheds light on the addictive process (using attachment as a frame) when he gives us these two central tenets:
- Using is about making predictable what you are going to feel
- Using is about making predictable when you are going to feel
In essence, Wright suggests that the using process is about getting the predictability—especially as it concerns the regulation of emotions—that was not forthcoming in the early attachment and caregiving environment. But here’s the Faustian bargain the user makes: “[I]n order to have this dependability, you have to sacrifice your life, sometimes literally,” writes Wright. Here’s Wright’s “bottom line”: “The drug, the alcohol, or the behaviour comes first, everything else second.” Wright goes on to mention that the therapist cannot come close to providing for the client in the same way the object of addiction does. The object of addiction is purely predictable; therapists, being that they are human, are not.
Although a full discussion is beyond this review, Peter Fonagy and his colleagues will often talk about “purely contingent” interactions. Raising your arm is a purely contingent interaction. You only see yourself in purely contingent interactions. I would suggest that interactions with addictive objects are purely contingent interactions. In contrast, intersubjective interactions (those typically found in the social realm) are characterized by what Fonagy et al. call “nearly purely contingent” interactions. Self-other relationships can be found in nearly purely contingent interactions. In nearly purely contingent interactions, you may think about raising your hand but then you think about how the other person may react to that movement. There’s reflection. There’s not knowing. There’s anticipation. The reflection, not knowing, and anticipation of relating to another person are given up when one attaches to a purely contingent dead object.
Wright suggests that it could take as long as ten years for an addict to work through the underlying causes of addiction (Stage 5). Sure, much of that time could be spent in psychoanalysis, but Wright suggests that many therapeutic frames could be used such as “communal, social, or psychological.” “One could go to Scotland to plant trees,” Wright tells us, “become involved with the twelve step movement or smart recovery, or enter an analysis.” In the following quote, Wright sums up the process of healing from addiction using an attachment frame:
Seen from a broadly attachment point of view, there is a path of originating trauma, probably but not always early in life experiences, leading to a disturbed attachment state of mind [or, as Bowlby would put it, an Inner Working Model with respect to attachment]. Through attachment and dependence, relationship and a learned capacity to regulate affect, it is possible to separate and develop autonomous dependence on self and relate to others freely, seeking support when needed. This is an idealistic expression of what is a difficult and tortuous journey for all involved. My experience is that a group is needed to achieve this and as therapists we need to find our place in that group to be of real use.
Wright presents two vignettes to support the above journey. I invite the reader to read these vignettes. I’d like to finish up by turning to Wright’s comments concerning ritual. I have made similar comments concerning ritual in earlier posts. Turning now to Jungian psychology, Wrights makes the following statement:
Some Jungians, Meade (1993) [1] for example, would put forth the idea that the things that we become addicted to were at some point sacred. Alcohol, opium, tobacco, chocolate, etc. Some arguments in this context see addiction as an emptying out of ritual space and sacred space emphasising the failure of community to recognise changes in progress through the stations of life. This leaves the individual to routinely participate in a ritual encounter with death as symbol of transformation.
I’ll pause long enough to mention something horrific that happened here in Albuquerque that made national headlines. Six Albuquerque teenagers ages 14 to 17 engaged in “mobbing” behavior—randomly roaming through a neighborhood stealing items from cars and garages. One of the teens ended up killing a 60 year old man. According to reports (click on this link for an example), even after killing a man in cold blood, the teens continued mobbing and even bragged about the man’s death. [2] Is it possible that this is an extreme example of what happens when a group of adolescent males—cut off from any form of ritual—becomes attached to death as an addictive object. I cannot help but wonder if this type of mob provides some form of attachment or bonding for these adolescents. In talking to my friends about this horrific incident, they seem to be of the mind, “This is so beyond the human pale that it defies understanding.” Wright adds some possible insight to the above tragic incident when he says,
Using then becomes a dead ritual for initiation from one life stage to another, for instance girl to woman or boy to man, condemning the addict to repeat this encounter with death with each use [or mob behavior] in the hope of returning as a transformed being to a community that will see them in their new form. However the community is not there.
What has happened to community? That’s a topic beyond this review but I invite you to read Robert Putnam’s books Bowling Alone and Our Kids for an in depth discussion of the topic. I’ll end by giving Wright the last word: “[A] burgeoning underclass has been formed as corporate America shifted its industrial base to cheaper Eastern manufacturers leaving the traumatised, first black (using Crack), then white (using Crystal Meth), poor to enter the illegitimate economy [economist Jeremy Rifkin’s fourth sector] of drugs to survive. So class narratives are not entirely gone.”
In the next part we’ll look at Edward Khantzian’s Chapter Three—The Self-Medication Hypothesis and Attachment Theory: Pathways for Understanding and Ameliorating Addictive Suffering. See you then.
Notes:
[1] See Addictions from an Attachment Perspective for a listing of the references used.
[2] There was an update to this story on the evening news last night. A reporter interviewed the grandparents of one of the 14 year old teens. The grandparents said that the teen’s parents were never around because each was in and out of prison. The grandparents said that they effectively raised the boy. Apparently the teen was living in a group home in the days leading up to the mobbing incident. The grandparents said that the teen would run away from the group home and spend a few nights at their home before going back. After the mobbing incident the teen showed up at his grandparent’s house visibly shaken. He did admit that he engaged in stealing but had nothing to do with the murder. Still one cannot help but wonder if mobbing behavior provides for the need for attachment at some level.
