Welcome back. This is part IV 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 Four—Alcohol Misuse, Attachment Dilemmas, and Triangles of Interaction: A Systemic Approach to Practice—by Arlene Vetere. Let’s dig in.
Vetere starts out by quoting from Bowlby’s trilogy on attachment:
For not only young children, it is now clear, but human beings of all ages are found to be at their happiest and to be able to deploy their talents to best advantage when they are confident that, standing behind them are one or more trusted persons who will come to their aid should difficulties arise.
This is a great way of generally framing attachment relationships and functioning. Vetere then puts her own spin on how we should frame attachment. She writes: “Attachments are considered to be representational, about caregiving, comfort, and affection, and in adult relationships, about sexuality.” This quote by Vetere highlights an aspect of Bowlby’s thinking that is often overlooked: one of the challenges of attachment relationships is the balancing and harmonizing of behavioral systems—attachment, caregiving(receiving), sex—that are often at odds with each other. As Carole Pistole reveals in her 1999 article on attachment and teen pregnancy (contact the Foundation for a copy by permission), when behavioral systems cannot be effectively balanced and harmonized, one behavioral system may be used to “play out” this dysfunction. As an example, Pistole shows that when the sexual behavioral system comes “online” in the teens years, unintended teen pregnancy may result if there has been earlier trauma to the attachment and care receiving systems. I mention Pistole’s work because like Vetere, Pistole takes a systems view of attachment relationships and functioning. Vetere gives us this “take home” frame concerning attachment relationships and functioning (the same one Bowlby promotes in his book Affectional Bonds):
Attachment theory does not pathologise dependency in our relationships with key attachment figures, rather seeing autonomy and effective dependency as different sides of the same attachment coin.
Vetere uses family systems theory as a background for most of her insights. Vetere states:
[A] child’s relationship with her mother is influenced by both their relationships with the child’s father; a couple’s relationship is influenced by both their relationship with a respective parent; or a couple’s relationship is influenced by both their relationship with the alcohol bottle, and so on.
Throughout her chapter Vetere tries to convince us that we should frame the object of addiction as a “third person” in that this object is a placeholder for the early attachment relationship that was not forthcoming. Vetere offers up a number of intervention strategies informed by both attachment theory and family systems theory. I’ll leave the reader to check out this information at their leisure. One strategy did catch my eye: the family systems practitioner should endeavor to help the family system “integrate across our different representational systems and transform them by learning to give a good account of ourselves and others.” The Adult Attachment Interview (AAI) looks at how coherent a narrative is. If the narrative given by the person being interviewed is coded as being coherent, this carries a lot of weight as far as ultimately coding the person as displaying secure attachment. Again, we get this sense that attachment relationships, especially early on, are about integrating and harmonizing such things as behavioral systems—attachment, caregiving(receiving), and sex—and information streams such as nonverbal, imagistic, acoustic, visceral, or temporal. Vetere gets all of this when she tells us that “attachment representations are layered and it is believed they are held in different memory systems, that is, procedural memory, sensory memory, semantic memory, episodic memory, and integrative memory (Tulving, 1983).” 
Vetere gives us the two main reasons why an adult child may come to depend on an addictive substance such as alcohol:
- Growing up in a family context where people may not be trusted.
- Growing up in a family context where children are not taught to self-soothe.
As talked about in earlier chapters, the object of addiction carries such appeal because it is trustworthy, predictable, and it has the ability to regulate emotion. With apologies to Winnicott, the object of addiction is a “good enough” substitute primary attachment figure for those persons who grew up with a primary attachment figure that was untrustworthy, unpredictable, and largely incoherent.
Vetere reveals that growing up in a family context where alcoholism is a major component can create confusion for a developing child, confusion that impedes efforts to integrate and harmonize such things as behavioral systems and information streams. As an example, consider the family context where a parent (or parents) vacillates between being sober and inebriated: “For children this can create confusion, uncertainty, and unpredictability, particularly if there is no one to help them make sense of their different experiences…” (quoting Vetere).
“Transitions are opportunities for change,” writes Vetere, “and can be used to develop new responses, or generative scripts.” She continues thus, “Our beliefs and [mental] constructs [such as Bowlby’s Inner Working Models] tend to be less fixed at a time of crisis, and more malleable to scrutiny and open for change.” This agrees with the view that Hans Welling puts forward in his 2003 article entitled An Evolutionary Function of the Depressive Reaction: The Cognitive Map Hypothesis. Welling suggests that we look at certain forms of depression (such as the depression that often accompanies loss) as a good thing, not something to be easily and quickly medicated away.  Welling suggests that certain forms of depression accomplish two things:
- Opens up cognitive maps (like Bowlby’s Inner Working Models) to be changed or updated.
- Depresses our various behavioral systems so that we don’t go off into the world with Inner Working Models that are out-of-date.
The above may explain why addicts often have to “hit rock bottom” before they can change their lives for the better. Our nation arrived at a very tragic transformation point following 9/11, and some political pundits have argued that this opportunity for change on a national level was missed. And now the current version of the DSM (Diagnostic and Statistical Manual of Mental Disorders, version 5) has gone a long way toward pathologizing the normal depression that often accompanies loss of a loved one.
I’ll wrap up by providing the reader with this quote by Vetere that seems to sum things up:
Living in a context of chronic and unresolved high arousal makes it harder to think clearly and reflectively, and under conditions of threat, explanations may be simplified as a way of coping, along with a tendency to blame others.
Allow me to expand a bit on the above quote. During a workshop at the Menninger Clinic in Houston a number of years ago, the presenters talked about how when the brain is stressed, it has a hard time engaging in “mentalization,” which is a form of intersubjectivity or “minds knowing minds.” Mentalization has a lot to do with EF or executive function. We need robust EF to accomplish such things as being reflective or empathetic. We also need EF to update Inner Working Models. So, as Vetere suggests above, when we live or are raised in an environment of “chronic and unresolved high arousal,” our ability to do the following is compromised:
- Integrate and harmonize behavioral systems
- Integrate and harmonize incoming data streams such as nonverbal, imagistic, acoustic, visceral, or temporal
- Develop robust forms of EF such as empathy, reflection, making and updating cognitive models, mental time travel, appropriately focusing attention, mentalization, etc.
As Vetere suggests, we can recognize difficulties with integration and harmonization through simplified explanations (i.e., black and white thinking or all or nothing thinking) and a tendency to blame others. Vetere frames these as coping mechanisms, in essence, ways of trying to cope with difficulties centered on integration and harmonization, whether with behavioral systems or various data streams or both.
Dr. Ken Corvo, a social work professor at Syracuse University (and whose research efforts the Foundation supports) talks about how domestic violence behavior could be framed as a form of coping. Clearly violence and aggression (topics Bowlby talked about early in his career) are reduced or simplified forms of behavioral response. And as Corvo’s research suggests, substance abuse (especially alcohol abuse) is often associated with domestic violence behavior. Corvo has tried to put domestic violence behavior into an attachment frame by suggesting that DV behavior is about “individuals who are in pain” but yet “seek and need contact and comfort” (quoting Khantzian from part III). Sadly, these individuals are not able to appropriately find the contact and comfort they seek. Equally sad, contact and comfort then takes the forms of violence and aggression. This underscores one of the central tenets of psychological functioning: we will take contact and comfort in any form—be it from a bottle or a battle—rather than not having contact and comfort at all. In my opinion, these chapters on addiction and attachment point out the extent to which people will go to have contact and comfort regardless of the form.
Vetere concludes her chapter by again talking about family systems informed intervention strategies. I’ll leave the reader to avail themselves of this information if it is of interest.
In my next post we’ll look at two chapters:
1) Chapter Five—Taking the Toys Away: Removing the Need for Self-Harming Behavior by Lynn Greenwood
2) Chapter Six—Using “Intent” to Remedy Mal-Attachment by Bob Johnson
See you then.
 See Addictions from an Attachment Perspective for references.
 See Ernest Keen’s 2000 book entitled Chemicals for the Mind for more on this topic.