According to Flores (2012), evidence shows that prolonged SU can alter brain functioning, making many individuals unable to control their use of drugs and/or alcohol once they begin. For some, this loss of control over intoxicating substances can be rapid, insidious, and progressive (Flores, 2012). Because of their toxicity, the prolonged use of drugs and alcohol can compromise neurological functioning and erode existing psychological brain structures (Anton, 2010). Consequently, the interpersonal skills of individuals with SUDs begin to decay: Individuals who become dependent on substances cannot properly regulate their emotions, self-care, self-esteem, and their relationships (Anton, 2010).
According to Khantzian (2012), individuals with SUDs are in pain because they cannot properly regulate their emotions, self-esteem, relationships, and behavior. For example, as human beings we are ruled less by our instincts and more by our coping capacities, which are inherently acquired from the caretaking environment (Khantzian, 2012). Conditions for human survival and adaptation require a lifelong challenge of self-regulation (Khantzian, 2012). Possessing the ability to appropriately regulate emotions, self-esteem, relationships, and self-care are primary functions upon which our survival depends (Khantzian, 2012).
Individuals tend to use intoxicating substances in an effort to self-medicate the pain and distress associated with difficulties of self-regulation (Khantzian, 2012). Thus, managing relationships becomes increasingly difficult and can result in a heightened reliance on intoxicating substances, which eventually accelerates addiction response patterns (Anton, 2010). Attachment theory postulates that it is impossible for individuals to completely regulate their affective states (Flores, 2012).
According to Borelli, Goshen, Joestl, Clark, and Byrne (2010), there is limited literature examining the association between SUDs and attachment styles. Insecure attachment behavior may possibly predispose an individual to ineffective emotion regulation. Prolonged use of alcohol and/or drugs can be considered a self-medicating strategy intended to protect against or mitigate distress (Anton, 2010). Insecure individuals may be at risk of compulsive SU as a way of attempting to regulate their negative affective states (Flores, 2012). Fletcher et al. (2015) reported that fearful avoidant attachment can be associated with SUDs. For some individuals who are insecurely attached, drugs and/or alcohol might become the only attachment object in their lives (Fletcher et al., 2015). SU from an attachment perspective can be based on one simple premise: “Until individuals with SUDs begin to develop the capacity to establish mutually satisfying relationships with others, they remain vulnerable to relapse and an increased tolerance to substances” (Flores, 2012, p. 36).
Attachment theory recognizes that human beings are interactional and, for that reason, are consistently affected by their personal relationships and environment (Fletcher et al., 2015). When the ability to connect with others is damaged, some individuals might seek external emotional support and regulation from drugs and alcohol. Intoxicating substances are consumed in an effort to compensate for a vacuous and alienated sense of self (Khantzian, 2011). According to Fletcher et al. (2015), as the progressive use of addictive substances increases, the capacity to interact with others becomes further impaired, thus setting into motion the cycle of an SUD. Empirical literature provides compelling evidence for a relationship between unpleasant early childhood experiences and SUDs (Fletcher et al., 2015). The relationship between early childhood experiences and SUDs emphasizes the importance of applying attachment theory to SUDs.