The interplay of addictive behaviour, self-regulation, attachment, and childhood trauma
Introduction to addictive behaviour
Question: Consider the two examples below. Which example do you think demonstrates features of addiction?
Roger has grown up around alcohol. Further, he has fond childhood memories of drunken family members and their antics during social gatherings. Roger began drinking alcohol when he was 16, and his wife has commented on his tendency to drink to excess. The consequences of his alcohol use have ranged from mild (e.g. inconvenient hangovers) to severe (e.g. motor vehicle accident). Also, it has begun to impact his relationship with his wife and children negatively. Nevertheless, Roger continues to drink excessively despite having resolved to quit many times.
OR
Perry is a 20-year-old university student. She started playing video games after her classes as a way of relaxing and winding down at home. Initially, she limited her gaming time to 1 hour, between getting home and starting dinner preparations. Now the amount of time Perry spends gaming has increased dramatically, to upwards of 6 hours per day. Lately, Perry has been staying up late at night, skipping meals, and forgetting appointments to continue gaming. She has missed several practical placements as a result. Furthermore, she has insufficient placement hours to meet her study requirements, jeopardising her graduation.
Answer: Both the above cases are examples of addictions. Addiction is any behaviour (including drug-taking) in which a person finds pleasure and relief. Therefore, craving in the short-term, but suffering negative consequences in the long-term. Yet is unable to stop engaging in that behaviour despite the negative consequences.
Some definitions…
Traditionally, terms such as “substance abuse”, “dependency” etc. have been used interchangeably. Recently, the DSM-5 has abandoned the terms “abuse” and “dependence”, adopting the term “substance use disorder”. Addictions and substance-use disorders are now synonymous.
Substance-use disorders (SUD), or addictions, are patterns of symptoms that result from continued and prolonged substance use, despite experiencing problems as a result of use. SUD involve an inability to control the use of a substance (substance addiction – e.g., medications, illicit drugs). Another form is compulsions and behavioural addiction such as internet use or gambling. In this form, individuals can not stop engaging in a behaviour despite it causing psychological and/or physical harm and having adverse consequences.
The DSM-5 lists 11 criteria for substance-use disorders (pictured below). Based on the number of evident symptoms, patients are classified as either having a “mild” (2-3), “moderate” (4-5) or “severe” (6+) substance use disorder.
SUDs tend to be developed and further maintained by biological, psychological, social, and environmental maintenance factors. It is interesting to note that the above criteria are clustered into four separate categories:
1) Impaired control;
2) Social impairments;
3) Risky use;
4) Pharmacological,
and that only 2 out of 11 criteria are related to chemistry and neurobiology. The 9 remaining symptoms are all behavioural in nature. This indicates most features of SUD are behaviourally based.
Addictive behaviour is not the problem, but rather, an attempt to solve the problem…
Addictions may be disorders of self-regulation arising from exposure to trauma. In fact, it is common for patients suffering from PTSD to also have a substance-use disorder. Given this connection between trauma and addictive behaviours, it is worthwhile to take a deeper look into the nature of addiction.
How does addiction relate to trauma?
Trauma can manifest in many forms, including post-traumatic stress disorder (PTSD). PTSD includes symptoms such as reliving the traumatic event; avoidance (of situations associated with the event); excessive psychological arousal (such as anxiety, irritability, increased heart rate, lack of concentration), and pervasive negative changes in emotions and beliefs (e.g., guilt, fear, shame). These trauma responses are unpleasant to bear. Hence, individuals want to avoid these negative feelings. Substance abuse may be driven by the need to self-regulate such feelings. It’s an attempt to cope with the unpleasant thoughts and emotions associated with the trauma and triggered at the moment.
The role of attachment and early childhood experiences
Psychologically, humans have two innate needs: attachment and authenticity.
Attachment: the connection between humans (initially, between an infant and the caregiver)
Authenticity: the connection within humans – the connection with the ‘self’.
We need to have healthy levels of both attachment and authenticity to prosper, however, sometimes there is a deficit in one or both.
In early childhood, adverse events and traumatic experiences may result in trauma responses. These inhibit an individual’s development of emotional regulation and the ability to self-soothe.
For example, a child whose emotions are dismissed. The dismissal may include behaviours from the parent such as silent treatment. Thie child may interpret this as disapproving, unloving or withholding of affection.
A crucial part of survival in infancy and early development is attachment. To maintain the attachment the individual will tend to conceal their true emotional experience. In short, they suppress their authenticity in these moments.
How childhood traumata lead to addictive behaviour
One consequence is the compromised capacity to develop healthy emotional regulation and coping skills. Without the capacity to self-soothe, future reminders of the adverse events may trigger an individual’s trauma response. This results in a perceived need or desire to engage in behaviours that relieve or avoid these feelings. Considering the trauma symptoms covered above, it can be easy to imagine why such individuals may be desperate to find some way to cope. Especially a reduced capacity to self-soothe and self-regulate may incline individuals to turn to substance use to help provide relief from psychological pain.
In this way, psychodynamic theory views addictions as symptoms of something much deeper and aims to understand and uncover these early experiences to better address these problematic behaviours. Past events, thoughts, and circumstances shape our behaviours and result in unconscious processes (desires, motivations, internal conflicts, defence mechanisms) that can in turn cause a person to act in a particular way (e.g., drug-taking). Addressing and resolving the internal conflicts arising from past traumatic experiences can be helpful in understanding maladaptive patterns of behaviour and how they may be triggered by unconscious processes. Bringing these processes to light may bring about meaningful psychological change that then drives behaviour change (habits) and ultimately, recovery from substance use disorder.
If you are having problems with addictive behaviour, psychotherapy can be your solution. At COPE we offer services to treat addiction. Take the first step and contact us now.
For more information, also read our other blogs on this topic.
Written by I.A. Nikki Wiracita
References:
Verma, M., & Vijayakrishnan, A. (2018). Psychoanalytic psychotherapy in addictive disorders. Indian Journal of Psychiatry, 60(4), S485-S489. Doi: 10.4103/psychiatry.IndianJPsychiatry_16_18
Psychoanalytic psychotherapy in addictive disorders – PMC (nih.gov)
Psychodynamic approach to addiction treatment-1.pdf (deln1jxmpfoj4.cloudfront.net)
APA_DSM-5-Substance-Use-Disorder.pdf (psychiatry.org)
DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale – PMC (nih.gov)