Additional Findings

Upon review of the literature, there are four research studies that support the importance of strong maternal attachment.  The first study was conducted by Affi et al. (2012) and examined the associations between five different types of childhood maltreatment (e.g., physical, sexual, and emotional abuse, and physical and emotional neglect) and SUDs, which included alcohol, sedatives, opioids, cannabis, cocaine, hallucinogens, and nicotine.  Study data were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) and logistic regression models were investigated to demonstrate the relationship between childhood maltreatment and SUDs.  Study participants consisted of a United States nationally representative sample of adults, 20 years or older in age.  Results from this study found that all five types of childhood maltreatment could be associated with all of the men and women who had a diagnosed SUD.  Afifi et al. (2012) explained that several investigations have discovered substantial associations between childhood maltreatment and problematic SU in women.  These researchers further reported that past studies have indicated that the relationship between childhood traumas and SU might be especially strong for females (Afifi et al., 2012).  Childhood traumas such as abuse and neglect have been connected to an extensive array of unhealthy outcomes in later adulthood, including compulsive SU and psychological disorders (Sanders, 2011). 

Min, Farkas, Minnes, and Singer, (2014) conducted a study evaluating the effects of childhood abuse and neglect on SUDs and mental health illnesses in adulthood.  A structural equation model (SEM) was used to examine how avoidant coping behaviors might directly influence childhood trauma, adult SUDs, and psychological distress.  Study participants consisted of 285 mothers who had recently given birth at a large urban teaching hospital.  These mothers were found to be at high risk for acute SU: They either had previous involvement with the Department of Human Services or had a self-reported history of progressive SU (Min et al., 2014).  Study results concluded that women with a reported history of severe childhood trauma tend to (a) have lower levels of education, (b) regularly use avoidant coping strategies, (c) abuse intoxicating substances, and (d) have reported high levels of psychological distress (Min et al., 2014).  Women who had high levels of education reported less use of avoidant coping, less use of intoxicating substances, and had lower levels of psychological distress (Min et al., 2014).  Women who reported greater use of avoidant coping strategies had severe histories of chronic use of substances and acute levels of psychological distress (Min et al., 2012).  This study supports the stress reduction theory that individuals might use substances to suppress or escape from painful traumatic experiences in an effort to self-regulate their affective states.

Zafiropolou, Avajianou, and Vassiliadou (2014) conducted a study examining the possible connections between parental attachment and the presence of early maladaptive schemas or negative thinking and behavior in children.  Participants recruited for this study consisted of 636 adolescents, 11 to 15 years of age.  Study participants completed the Schema Questionnaire for Children (SQC), developed by Stallard and Rayer (2005), and the Parental Bonding Instrument (PBI), developed by Parker, Tupling, and Brow (1979).  The SQC was used to assess 15 early maladaptive schemas which were categorized in five domains and consisted of: “(1) disconnection and rejection (mistrust, abandonment, social isolation, deprivation, defectiveness, (2) impaired autonomy and performance (dependence, vulnerability, enmeshment, failure), (3) impaired limits (self-entitlement, insufficient self-control), (4) other directedness (self-sacrifice, subjugation), and (over vigilance and inhibition, emotional inhibition, unrelenting standards)” (p. 2).

The PBI is a self-report questionnaire with 25 different items, each item describing a parental attitude.  Two identical forms were completed by each participant for each parent.  Two dimensions of parental behavior, consisting of care and protection in addition to gender and age differences, and four types of bonding—optimal bonding, weak or absent bonding, affectionless control, and overprotection—were all evaluated.  Study results found that the frequency of maladaptive schemas can be influenced by various proportions of attachment related behaviors and that differences in unhealthy schemas might be associated with gender and age (Zafiropolou et al., 2014).  The results of this study provide empirical evidence that cognitive thought patterns developed in early childhood can be amalgamated with different styles of parental attachment and can have an effect on negative thoughts and behavior in children into adulthood (Zafiropolou et al., 2014). 

Mofrad, Abdullah, and Samah (2010) conducted a study examining the relationship between perceived parental rearing and attachment among 120 children (54 boys and 65 girls).  The average age of the children was 7 years old; they were randomly selected from an elementary school in Bushehr, Iran.  The Attachment Questionnaire for Children (AQC) was used to assess parent attachment styles.  The results from this study demonstrated that

securely attached children perceived their mothers as warmer (37%) than insecurely attached children.  Ambivalently attached children perceived their mothers as overly protective (13%), anxious (16%) and less warm (4%).  Avoidant attached children perceived their mothers as less warm (8%) and less protective (7%). Study results also demonstrated that children who were assessed as being securely attached perceived their mothers as being warm and less rejective. (Mofrad et al., p. 3)


The findings resulting from this study support Bowlby’s theory that an emotionally healthy and enduring relationship between child and mother can result in secure attachment. 

These four studies provide empirical evidence on the importance of secure attachment and the significant role attachment can have on healthy growth and development beginning in childhood and into adulthood.  The studies conducted by Affi et al. (2012) and Min et al. (2014) support the stress reduction theory that indicates a possible relationship between trauma and problematic SU that might also be especially strong for some women.

            The contents of this chapter were based on an empirical review of the literature and outlined the conceptual framework of this research study, which consisted of a detailed description of attachment theory, and emphasized the importance of secure attachment throughout infancy and into adulthood.  The research problem was closely examined, and this chapter commenced with additional literature review findings.  The proceeding chapter provides a rationale and a detailed description of all aspects of the research study methodology, comprising the study design, data collection methods, and data analysis procedures.


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