Attachment theory provides a framework initiated by John Bowlby in childhood and later expanded to include adult relationships (Bowlby, 1988). Attachment encompasses the cognitive and emotional processes that guide an individual’s interactions with themselves and others. Adult attachment styles are divided into four main groups: secure, avoidant, anxious, and mixed/unresolved (Mikulincer & Shaver, 2016). These attachment styles can influence individuals’ coping strategies and potential addictive behaviors.
Substance use disorders, according to the DSM-5, are defined as problematic use of alcohol, drugs, or similar substances (American Psychiatric Association, 2013). Research suggests that attachment styles are an important factor in determining substance use risk. Depending on attachment style, coping strategies for stress vary, which may influence individuals to use certain substances (Schindler et al., 2005).
The Relationship of Attachment Styles with Substance Use
1. Secure Attachment
Individuals with a secure attachment style have the ability to manage their emotional states and are active in seeking social support. Because these individuals have developed effective ways to cope with stress, they are generally less likely to use substances (Kobak & Madsen, 2008). For example, when faced with a difficult situation, someone with a secure attachment style manages to overcome it by seeking support from friends or family and does not turn to substances such as alcohol or drugs.
2. Avoidant Attachment
Individuals with an avoidant attachment style prefer to avoid close relationships and emotional attachment, preferring to remain alone and conceal their emotions. Research suggests that these individuals often tend to use substances with sedative effects (e.g., alcohol and benzodiazepines) when trying to cope with stress (Schindler et al., 2005). Avoidant individuals may turn to these substances to seek relief because they have difficulty forming emotional bonds.
3. Anxious/Worried Attachment
People with an anxious attachment style fear rejection and experience emotional volatility. It has been observed that these individuals prefer stimulants (caffeine, amphetamines, cocaine) or substances that provide emotional relief (alcohol, marijuana, nicotine) in their substance use (Stewart et al., 2000). Anxious attachment increases individuals’ need to cope with social and emotional pressures; substance use provides temporary relief and a desire for reward.
4. Mixed/Unresolved Attachment
People with a mixed or unresolved attachment style exhibit both a desire for closeness and an avoidance of closeness. These individuals often have a history of traumatic events and abandonment (Liotti, 2004). Research suggests that individuals with this attachment style are at increased risk for using a wide variety of substances. For example, they may seek both stimulation and relief by using both stimulants (cocaine, amphetamines) and depressants (alcohol, sedatives).
Psychodynamic and Clinical Perspectives
When the impact of attachment styles on substance use disorders is examined from a psychodynamic perspective, it becomes clear that the trust or trauma experienced by an individual in their childhood caregiving relationships directly influences their substance use habits in adulthood (Fonagy, Gergely, Jurist, & Target, 2002). According to psychodynamic theory, attachment experiences in childhood determine an individual’s ability to establish emotional stability, cope with stress, and, consequently, control risky behaviors.
Within this framework, individuals with secure attachment experiences develop natural and healthy ways to cope with emotional difficulties, while individuals with avoidant, anxious, or mixed attachment styles may not have sufficiently developed these abilities.
Individuals with an avoidant attachment style are shaped by the inadequate fulfillment of emotional needs in childhood and the emotionally distant or rejecting attitudes of their caregivers. Although these individuals may not consciously recognize this emotional emptiness and loneliness, they experience a deep sense of distress. In adulthood, they often turn to tranquilizers to satisfy this suppressed emotional craving. Central nervous system depressants such as benzodiazepines, alcohol, and barbiturates offer temporary relief and anxiety reduction for avoidant individuals. From a psychodynamic perspective, this substance use can be considered a temporary “venting” of repressed emotions and unresolved attachment needs. These individuals, who tend to avoid emotional intimacy, prefer to resort to substances rather than seeking social support.
Individuals with an anxious or preoccupied attachment style are often shaped by caregiver inconsistent behavior, excessive criticism, or fear of sudden abandonment during critical moments in childhood. This increases the individual’s fear of rejection and emotional volatility. In adulthood, individuals with an anxious attachment style tend to turn to stimulant and rewarding substances to cope with this profound emotional emptiness and uncertainty. For example, by using substances such as caffeine, marijuana, amphetamines, or alcohol, they obtain short-term reward and pleasure while also feeling emotionally “filled.” From a psychodynamic perspective, this behavior can be interpreted as an individual’s attempt to temporarily meet emotional needs that were not adequately met in childhood.
Individuals with a mixed or unresolved attachment style may exhibit both intimacy-seeking and intimacy-avoidant behaviors. These individuals often struggle with internal conflicts stemming from a traumatic or disorganized caregiving history. Individuals with this attachment style may exhibit a high-risk profile for substance use, both sedatives (alcohol, benzodiazepines) and stimulants (cocaine, amphetamines). From a psychodynamic perspective, this reflects an individual’s need to both fill emotional voids and reduce internal tension. A mixed attachment style may also lead an individual to view substance use as a “coping strategy” due to the constant triggering of past traumatic memories and unresolved emotional conflicts.
Clinically, the effects of attachment styles on substance use disorders play an important role in developing treatment and intervention strategies. In avoidant individuals, emotional suppression and loneliness-based use can be addressed primarily through supportive therapies and emotional awareness training. For individuals with an anxious attachment style, strengthening emotional stability, self-awareness, and stress coping skills is crucial. For individuals with a mixed attachment style, trauma-focused therapies, attachment-based interventions, and multifaceted substance use strategies should be implemented in conjunction.
Conclusion
Attachment styles are an important factor in understanding substance use disorders. While a secure attachment style is associated with lower risk, avoidant, anxious, and mixed attachment styles may lead individuals to turn to different types of substances. In clinical practice, examining attachment styles and understanding individuals’ motivations for substance use are critical for developing effective treatment and prevention strategies. Future studies should explore the effects of attachment-based interventions on substance use disorders in greater depth.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.
Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization and the development of the self. Karnac Books.
Kobak, R., & Madsen, S. (2008). Disruptions in attachment bonds: Implications for theory, research, and clinical intervention. Attachment & Human Development, 10(3), 273–290. https://doi.org/10.1080/14616730802221788
Liotti, G. (2004). Trauma, dissociation, and disorganized attachment: Three strands of a single braid. Psychotherapy: Theory, Research, Practice, Training, 41(4), 472–486. https://doi.org/10.1037/0033-3204.41.4.472
Mikulincer, M., & Shaver, P. R. (2016). Attachment in adulthood: Structure, dynamics, and change (2nd ed.). Guilford Press.
Schindler, A., Thomasius, R., Sack, P. M., Gemeinhardt, B., & Küstner, U. (2005). Insecure attachment and substance use in adolescence. Drug and Alcohol Dependence, 79(2), 153–164. https://doi.org/10.1016/j.drugalcdep.2005.01.005
Stewart, S. H., & Conrod, P. J. (2000). Anxiety disorders and substance use disorders: Dual pathologies and the role of anxiety sensitivity. Clinical Psychology Review, 20(2), 171–195. https://doi.org/10.1016/S0272-7358(99)00042-4