Alcohol Dependence and Avoidant Attachment – Implications for Therapy

Abstract

The literature review revealed co-morbidity between adverse childhood experiences, adult psychopathology and alcohol dependence, although causality was questionable due to multiple variables. The current study used 54 clients at the acute end of the spectrum of severe alcohol dependence from a specialist tertiary substance misuse service (clients) and a control group of 54 non-problematic drinkers from an NHS working population (controls) to examine possible differences in security of attachment and maladaptive schemas and investigated how early relational experiences influenced core beliefs regarding self, others and intimate relationships and therapeutic implications for severely alcohol dependent clients’ engagement in specialist services. The study was divided into two sections: (1) quantitative analysis using Feeney, Noller and Hanrahan’s (1994) Attachment Style Questionnaire to measure attachment style and Young’s Schema Questionnaire (Young & Brown, 2001) to measure maladaptive schemas in the domain of disconnection and rejection and (2) qualitative analysis, using Interpretational Phenomenological Analysis (IPA) to explore eight severely alcohol dependent clients’ subjective experiences of intimate relationships. Clients scored significantly lower in secure attachment style and significantly higher in both avoidant and ambivalent attachment style than controls and suggested overlapping between the two dimensions, known as ‘fearful avoidant’ attachment. Clients scored significantly higher than controls in all five sub-categories of maladaptive schemas in the domain of disconnection and rejection, namely mistrust/abuse, emotional deprivation, abandonment, social isolation/alienation and defectiveness/shame. IPA revealed common themes of negative parent-child interaction: physical and psychological abuse, neglect and explicit maternal rejection and emotional deprivation and hostile and abusive parent-parent interaction. These aetiological factors influenced fearful avoidant attachment and maladaptive core beliefs. Negation of children’s needs implicated an immaturely developed diffuseness of identity and defective self that inhibited formation of intimate adult relationships. A bio-psychosocial explanation suggested alcohol ameliorated hyper-vigilant anxiety and depression from adverse childhood experiences within a threatening family environment that implicated insecure attachment, maladaptive core beliefs and negative self-identity, inhibiting emotional intimacy. It advocated screening procedures and an integrated CBT and schema-based therapeutic approach for those at the more severe end of the spectrum of alcohol dependence deemed at risk of not engaging or disengaging prematurely from services.