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Addiction as an Attachment Disorder
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"Addiction is a disorder in self-regulation. Individuals who become dependent on addictive substances cannot regulate their emotions, self-care, self-esteem, and relationships. In this monumental and illuminating text Philip Flores covers all the reasons why this is so. But it is the domain of interpersonal relations that he makes clear why individuals susceptible to substance use disorders (SUDs) are especially vulnerable. His emphasis on addiction as an attachment disorder is principally important because he provides extensive scholarly and clinical insights as to why certain vulnerable individuals so desperately need to substitute chemical solutions and connections for human ones.
The strength of Flores's paradigm of addiction as an attachment disorder is that it is a theory that effectively and wisely guides treatment, but at the same time, when properly implemented or practiced, the treatment resonates with and further enhances the theory. Flores's work here is an extraordinary one because, in parsimonious and clear language, he makes a major contribution to the literature and practice of effective psychotherapy in general and effective psychotherapy for the addictions in particular. He fills in all the gaps between theory and practice covering wide and ranging issues of what practice and empirical findings have to teach about the critical ingredients of AA, group therapy, and individual psychotherapy. This is a job well done because it helps students and experienced clinicians alike to always be mindful of how they bring their humanity to the distress and suffering of others. His theory of addiction as an attachment disorder makes it particularly clear how especially important this is for those suffering with addictive disorders. "
―Edward J. Khantzian, M.D., clinical professor of psychiatry, Harvard Medical School
A Jason Aronson Book
"Addiction is a disorder in self-regulation. Individuals who become dependent on addictive substances cannot regulate their emotions, self-care, self-esteem, and relationships. In this monumental and illuminating text Philip Flores covers all the reasons why this is so. But it is the domain of interpersonal relations that he makes clear why individuals susceptible to substance use disorders (SUDs) are especially vulnerable. His emphasis on addiction as an attachment disorder is principally important because he provides extensive scholarly and clinical insights as to why certain vulnerable individuals so desperately need to substitute chemical solutions and connections for human ones.
The strength of Flores's paradigm of addiction as an attachment disorder is that it is a theory that effectively and wisely guides treatment, but at the same time, when properly implemented or practiced, the treatment resonates with and further enhances the theory. Flores's work here is an extraordinary one because, in parsimonious and clear language, he makes a major contribution to the literature and practice of effective psychotherapy in general and effective psychotherapy for the addictions in particular. He fills in all the gaps between theory and practice covering wide and ranging issues of what practice and empirical findings have to teach about the critical ingredients of AA, group therapy, and individual psychotherapy. This is a job well done because it helps students and experienced clinicians alike to always be mindful of how they bring their humanity to the distress and suffering of others. His theory of addiction as an attachment disorder makes it particularly clear how especially important this is for those suffering with addictive disorders. "
―Edward J. Khantzian, M.D., clinical professor of psychiatry, Harvard Medical School
A Jason Aronson Book
364 pages, Hardcover
Published August 6, 2004
23 people are currently reading
468 people want to read
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Displaying 1 - 12 of 12 reviews
May 16, 2021
Attachment theory is a psychological framework for understanding human bonding and relationship, beginning in early life and continuing into adulthood.
Attachment refers to the need for and quality of human bonding.
Attachment is an evolutionarily hard wired feature of mammalian biology.
Attachment is particularly important to human survival.
Attachment styles (strategies for getting our needs met in relationships) vary between individuals and are shaped and reshaped (conditioned) in important relationships with others, starting in early life and continuing throughout the lifespan.
Attachment conditioning effects nearly every aspect of human psychology.
Human emotional life is founded on attachment conditioning.
Human emotional conditions significantly effect our cognitive functions (mostly a false distinction but go with me for the sake of brevity).
Many (if not all) of our beliefs and appraisals of our selves, others, and our place in the world are derived from attachment conditioning and it’s emotional and cognitive signature.
Attachment theory uses the construct of the ‘Internal Working Model (IWM) as an abstraction for understanding how our attachment style influences our mostly unconscious assumptions about life.
The IWM of a securely attached individual might read:
- I am worthy of love
- It’s safe to explore the world
- It’s safe to make mistakes
- My people will be there for me when I need them
Conversely, the IWM of an insecurely attached individual might read:
- I am unworthy of love
- The world is dangerous
- It’s unsafe to make mistakes
- I will be abandoned if am imperfect or vulnerable
Something like that.
Of course the details matter.
But you get the gist.
Here’s the cool part.
A persons IWM can change over time.
If you emerged from childhood all beat up.
You can take charge in adulthood and recondition that IWM. And good attachment oriented psychotherapy can help.
And it matters.
A lot!
If a person managed to “reprogram” their IWM from insecure to secure, they are apt to experience a much much different, much better, much less painfully alone life.
Same person.
Same world.
Different programming.
Different thoughts.
Different feelings.
Different behaviors.
Very different life.
This book is a deep examination of the role that attachment plays in addiction and recovery, including AA and psychotherapy.
Although this text is dated in some regards.
It’s core messages are durable.
(1) People Co-regulate:
We LOVE to think of ourselves as discreet autonomous individuals who “should” be able to derive stability, meaning and motivation from “within” and independent of others.
Flores challenges this notion is his assertion that people need each other to regulate, or rather ‘co-regulate’.
And furthermore, co-regulation is a built in feature (not a flaw) our biology, encoded in our DNA via millions of years of evolutionary conditioning.
(2) Insecure Attachment Confines:
The author asserts that addiction is commonly acquired because people feel anxious in relationship, and over utilize drugs and alcohol to artificially sooth and facilitate connection.
Addiction is a toxic virtual relationship that provides relief and confidence in the short term, but leaves the person deskilled and isolated in the longterm.
As long as the individual is caught in this trap, they will fail to gain the skills and self awareness needed to authentically connect with others.
Failure to learn and grow as a relational being in sobriety puts the individual at perpetual risk for relapse.
(3) Secure Attachment Liberates:
Being in healthy, supportive, flexible and appropriately boundaried relationships provides a stable platform for the individual to take an honest look within, identify what really matters, take healthy risks, reach past individual limitations, maintain focused efforts over sustained periods and achieve meaningful growth far beyond what could be achieved in impaired narcissistic isolation.
In Sum:
A crappy childhood and unhealthy adult relationships lead to insecure attachments that put the individual at risk for alcohol and drug use.
Alcohol and drug use damages the brain, and subsequently causes problems in mood, cognition and social functioning.
The downward spiral of addiction is perpetuated when the individual attempts to solve these problems with continued alcohol and drug use.
Until the addicted individual develops sufficient skills and relationships with self and with others, they will be at risk of relapse.
Early treatment requires that the addicted individual detach from their toxic attachment to substances, and attach to a healthy(er) individual and/or group.
Longterm treatment requires that the addicted individual change their internal working model in therapy and/or in AA, ultimately acquiring what Danieal Siegel refers to as “earned secure attachment.”
NOTE:
If earned secure attachment sounds like a booby prize.
It’s not.
Like anything else that you have to work hard to achieve.
Earned secure attachment is more valuable (awake and robust) than regular ol’ secure attachment.
In other words, people who have earned secure attachment can share their experience strength and hope with others in a way that “normies” simply can’t.
So much more to this book.
Can’t capture it all here.
If this sounds rad.
Best do yourself a fave.
Give yourself the gift of this powerful firmware upgrade.
And...
Read it.
FIVE (5/5) STARS 🌟
Attachment refers to the need for and quality of human bonding.
Attachment is an evolutionarily hard wired feature of mammalian biology.
Attachment is particularly important to human survival.
Attachment styles (strategies for getting our needs met in relationships) vary between individuals and are shaped and reshaped (conditioned) in important relationships with others, starting in early life and continuing throughout the lifespan.
Attachment conditioning effects nearly every aspect of human psychology.
Human emotional life is founded on attachment conditioning.
Human emotional conditions significantly effect our cognitive functions (mostly a false distinction but go with me for the sake of brevity).
Many (if not all) of our beliefs and appraisals of our selves, others, and our place in the world are derived from attachment conditioning and it’s emotional and cognitive signature.
Attachment theory uses the construct of the ‘Internal Working Model (IWM) as an abstraction for understanding how our attachment style influences our mostly unconscious assumptions about life.
The IWM of a securely attached individual might read:
- I am worthy of love
- It’s safe to explore the world
- It’s safe to make mistakes
- My people will be there for me when I need them
Conversely, the IWM of an insecurely attached individual might read:
- I am unworthy of love
- The world is dangerous
- It’s unsafe to make mistakes
- I will be abandoned if am imperfect or vulnerable
Something like that.
Of course the details matter.
But you get the gist.
Here’s the cool part.
A persons IWM can change over time.
If you emerged from childhood all beat up.
You can take charge in adulthood and recondition that IWM. And good attachment oriented psychotherapy can help.
And it matters.
A lot!
If a person managed to “reprogram” their IWM from insecure to secure, they are apt to experience a much much different, much better, much less painfully alone life.
Same person.
Same world.
Different programming.
Different thoughts.
Different feelings.
Different behaviors.
Very different life.
This book is a deep examination of the role that attachment plays in addiction and recovery, including AA and psychotherapy.
Although this text is dated in some regards.
It’s core messages are durable.
(1) People Co-regulate:
We LOVE to think of ourselves as discreet autonomous individuals who “should” be able to derive stability, meaning and motivation from “within” and independent of others.
Flores challenges this notion is his assertion that people need each other to regulate, or rather ‘co-regulate’.
And furthermore, co-regulation is a built in feature (not a flaw) our biology, encoded in our DNA via millions of years of evolutionary conditioning.
(2) Insecure Attachment Confines:
The author asserts that addiction is commonly acquired because people feel anxious in relationship, and over utilize drugs and alcohol to artificially sooth and facilitate connection.
Addiction is a toxic virtual relationship that provides relief and confidence in the short term, but leaves the person deskilled and isolated in the longterm.
As long as the individual is caught in this trap, they will fail to gain the skills and self awareness needed to authentically connect with others.
Failure to learn and grow as a relational being in sobriety puts the individual at perpetual risk for relapse.
(3) Secure Attachment Liberates:
Being in healthy, supportive, flexible and appropriately boundaried relationships provides a stable platform for the individual to take an honest look within, identify what really matters, take healthy risks, reach past individual limitations, maintain focused efforts over sustained periods and achieve meaningful growth far beyond what could be achieved in impaired narcissistic isolation.
In Sum:
A crappy childhood and unhealthy adult relationships lead to insecure attachments that put the individual at risk for alcohol and drug use.
Alcohol and drug use damages the brain, and subsequently causes problems in mood, cognition and social functioning.
The downward spiral of addiction is perpetuated when the individual attempts to solve these problems with continued alcohol and drug use.
Until the addicted individual develops sufficient skills and relationships with self and with others, they will be at risk of relapse.
Early treatment requires that the addicted individual detach from their toxic attachment to substances, and attach to a healthy(er) individual and/or group.
Longterm treatment requires that the addicted individual change their internal working model in therapy and/or in AA, ultimately acquiring what Danieal Siegel refers to as “earned secure attachment.”
NOTE:
If earned secure attachment sounds like a booby prize.
It’s not.
Like anything else that you have to work hard to achieve.
Earned secure attachment is more valuable (awake and robust) than regular ol’ secure attachment.
In other words, people who have earned secure attachment can share their experience strength and hope with others in a way that “normies” simply can’t.
So much more to this book.
Can’t capture it all here.
If this sounds rad.
Best do yourself a fave.
Give yourself the gift of this powerful firmware upgrade.
And...
Read it.
FIVE (5/5) STARS 🌟
January 29, 2015
A fascinating piece of work formulating addiction in terms of attachment theory. Flores presents an extremely compelling and powerful approach to addiction issues. Flores uses many helpful case examples to illustrate Attachment Oriented Therapy (AOT) and its' application to addictions. He reviews the work of Heinz Kohut and Self psychology and it's consistency with AOT as well as the philosopher Martin Buber and his theories on authentic relationship.
My only minor criticism is that whereas Flores shines in his astute observations on individual psychotherapy some of his case examples fall into the trap of portraying the partner of the addict in an unfavorable light which may perpetuate the common practice of undermining the partnership of the individual in therapy.
My only minor criticism is that whereas Flores shines in his astute observations on individual psychotherapy some of his case examples fall into the trap of portraying the partner of the addict in an unfavorable light which may perpetuate the common practice of undermining the partnership of the individual in therapy.
April 28, 2021
There's more to addiction recovery than abstinence and AA. There's also more to recovery than being labelled an addict or alcoholic. Unfortunately, this book does not go into any of this and strictly relies on the old "you're an alcoholic and you need AA" philosophy. Great if you subscribe to twelve step ideology, not great if you'd like a full picture to support all types of goals.
July 12, 2011
This is one of the best clinical text books I have ever read. Flores has turned the academia and research into clear and precise practical tools. I highly recommend the book to any clinician working with addicts of any kind.
November 30, 2022
DNF. I was excited to read this book, but Flores' work was filled with lopsided reporting of addiction research and too much speculation and opinion presented as fact. There is very little information about attachment in this text. It is pro-religiosity, adamantly twelve-step, and anti-harm reduction/moderation tactics. Flores is uncritical of the current climate of the addiction industry, which fails clients often. It speaks incredibly poorly of those with Cluster A disorders/traits.
July 20, 2014
Yes!
This excellent book discusses the root cause of addiction as attachment disorder. Think of smokers whose cigarettes are always close by, loyal soldiers in a box at-the-ready to support and comfort, when no one else can be counted upon.
An important read.
Eleanor Cowan, author of : A History of a Pedophile's Wife: Memoir of a Canadian Teacher and Writer
This excellent book discusses the root cause of addiction as attachment disorder. Think of smokers whose cigarettes are always close by, loyal soldiers in a box at-the-ready to support and comfort, when no one else can be counted upon.
An important read.
Eleanor Cowan, author of : A History of a Pedophile's Wife: Memoir of a Canadian Teacher and Writer
February 26, 2016
Good resource for clinicians!
September 7, 2023
I love this framework of addiction stemming from unmet childhood attachment needs. The audiobook was a little rough, I’d probably have rated it higher if I’d done hard copy. The details of application in treatment were somewhat lost on me but it nonetheless hammered home the importance of the relational aspect of therapy and has made me prioritize that even more than I already did. Also was a little totalitarian about 12 steps and abstinence but I get that a lot of that has to do with the importance of community.
February 15, 2018
A great overview of implications for addiction counseling from an attachment theory viewpoint. I wish there had been a bit more guidance regarding how to practically apply attachment theory in session with clients dealing with substance use concerns.
June 13, 2018
OUTSTANDING!!!
February 27, 2021
The book is full of examples, but they all come to the same conclusion. After halfway, I realized this was it, I wasn't going to learn anything else. I would still consider this book a good read.
January 21, 2025
Somewhere between 3 and 4, helpful but not game changing
Displaying 1 - 12 of 12 reviews