Addictive disorders seem to me to be an attempt by the persons having them to make up for the deficits of difficulties in attachment. The big four of addictions are drugs (including alcohol), sex, food and gambling. There are other addictive disorders that some postulate, such as spending, fantasy, romance, work, exercise, etc.
To be more precise, the term “addiction” means a devotion to something. Thus, one may be addicted to studying attachment, for example, in that sense. Thus, a disorder arises when the addiction, or devotion, begins to interfere with other important areas of a person’s life, such as work, play, family, friendships, finances and so on. I use the term addiction in the remainder of this article to refer to addictive disorders, and “addict” to refer to the person with the addiction, unless otherwise indicated.
Addictive disorders can be identified in a simplified way by using the three C’s of addiction: Control- addicts typically experience a loss of control over the use of their addiction. This can be manifest in various ways: when they use it, how much or how long they use it, where they do it, and with whom they do it. Compulsiveness- thus the addict, in spite of making efforts to control or promises to themselves or others to abstain or reform their behaviour, nevertheless indulge in it, often despite their best intentions not to do so. Consequences- because of the loss of control, and the compulsive nature of the behaviour, negative consequences begin to accumulate. Sometimes it is the potential for negative consequences that accumulates, in terms of the impact on family, employment, and even the addict’s freedom if the behaviours are illegal.
In dealing with addictions, there were many questions that remained unanswered by the various approaches. Among these were: Why would someone pursue a course of behaviour that was destructive to themselves and others, especially once they had seen that there were other options available? Why would someone who had achieved sobriety, or abstention, for a certain period of time, revert their old behaviour, or “relapse”? Why would someone seem to conquer one behaviour only to pick up another addictive or dysfunctional behaviour? And finally, why would someone who had seemed to be successful at recovery go home one night and put a bullet in their brain, or as a dear professional colleague of mine did, take a fatal overdose of drugs?
Searching for answers to these questions led me to the field of attachment, and I think that attachment theory, and especially the DMM, provide the answers to those questions.
In my early days of using attachment concepts, about a decade ago now, I remember explaining the concepts of attachment to an addict with whom I was working. I found that simply explaining the concept, and how difficulties in attachment affects one in childhood and subsequent development, had great explanatory value for the client (and of course for me in understanding what was going on). As I finished explaining this to one client, he looked at me and said, delightedly, “Oh, you mean I’ve made my drug of choice my attachment object.” Well, that wasn’t what I had meant, but I realized that for him it was true, so he had educated me. His drug of choice had become what he was most attached to, at the expense of the legitimate attachment figures of wife and children. It had become his secure base, his safe haven, the one thing that helped him to deal with – or seem to deal with – his negative (and positive) feelings. And it had become his most important need: thus leading to one of the criteria of addictive behaviour of “maintaining supply.”
Today in dealing with addictions I no longer use a “medical model” which predicates addiction as a disease. The dysfunction makes sense when one understands the context in which it arose. Today I understand the etiology of addiction to lie in difficulties in attachment, leading to negative views about oneself, fractured or incomplete relations with others, a distorted world view via distorted perceptual filters, and a reliance on something other than nurturing relationships as a way to nurture self and others.