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Approaching Addiction Treatment Through an Attachment Lens

January 19, 2021
All Points North Lodge

Ryan Drzewiecki:

All right. So when we were looking at things through an attachment lens, we're really looking at ... We're really understanding that an attachment or that attachment is a basic human need. We are all born hardwired to attach to each other. If you've seen the videos of Konrad Lorenz and the ducks, this is the guy who was around when baby ducks hatched, and he was the first person that they saw and they followed him everywhere. There are some great YouTube videos of him swimming in ponds and all the ducks following him as he's trying to teach them how to be ducks, and him running in the fields and trying to teach them how to fly.

What Konrad Lorenz's work showed was that in this case, the baby ducks were really hard-wired for attachment. The first thing that they saw, they glommed onto. And we all think, "Oh, baby ducks are so cute. That's great." But what we find is that humans are essentially the same way. We're also hard-wired for attachment. A baby's going to stand absolutely no chance of survival whatsoever without the mother. So from the moment of birth, a baby is fine-tuned towards the mother. Sort of biologically wired to seek that out, and to, even from the moment of birth, analyze faces and engage in the social examination and learn how to garner social attention. That's why babies learn how to smile so early before they probably even know what it means to be happy, but they learned to smile because they see their mother's face smile, and they have some understanding that that's good, and that gets them what they want. Long story short, we're wired for attachment. We need that. And it doesn't go away after we stop being a child.

We regulate our emotional state through interactions with other people. As a baby, your emotions are usually either there and content or hungry and upset and stressed and angry. And you moderate that through learning how to communicate that hunger to your mother. But even as adults, we do the same thing. We have deep emotional states, and one of the most reliable ways to regulate those emotional states is through just the calming presence of another person. In some ways, that's sort of like the heart of therapy. Talking about my problems to somebody else usually makes them feel a little bit better. Having somebody who is pretty calm and level and empathic and understanding is a really great help at a simple level in moderating your emotions. Obviously, it gets a lot more complex than that, but other people are one of the best that we can regulate what we're feeling, and we can return our dysregulated emotional states back to a more regulated place.

I think we already referenced Maslow's hierarchy. I think there's a reason why he identified interpersonal needs as a need. A lot of times people see that hierarchy and they think, "Okay, I get food, I get water, I get shelter, I get why those are needs." Are interpersonal needs really needs? And the answers, yeah pretty much. If you want to be happy, healthy, and functional, we need those meaningful interpersonal relationships where we were able to be truly vulnerable, to truly be ourselves, to truly express what we're feeling. And when we don't have that, that's where a lot of times we end up struggling a lot with mental health. Because our brain is wired to regulate our behavior, to offer motivation, to seek out our needs, including interpersonal needs, and to reward us and to be rewarding to us when we meet those needs.

So if you're not having those kinds of deep and satisfying interpersonal relationships, your brain is going to send out those signals that are the foundation of anxiety and depression. It's going to tell you, "Hey, something's wrong, something's wrong, something's wrong." And if you don't do anything about that for long enough, that's what can oftentimes blossom into not feeling good, or can spiral down into being clinically depressed or having a generalized anxiety disorder. It can get to that point. So interpersonal relationships are a big piece of that.

Now where substances factor into all of that is that they can hijack this system, the internal brain mechanism that motivates us to seek out relationships, that rewards us when we do find a meaningful relationship, that operates via different chemicals in our brain, and alcohol and drugs can replicate that effect. So now all of a sudden I have something that's so reliable. I can feel good right away if I just drink, or if I get high, or if I use, or if I shoot up. Obviously, the problem with this is ... Well, there are many problems. Number one, there's the physical danger aspect of it. Number two, you get diminishing returns. You start to adapt and you start to get some tolerance. You have to use more and more and more, and it gets more and more and more dangerous. And also it's very artificial at the same time. Most users will tell you they're still chasing that high or that feeling of the very first time, it's never quite the same. And it doesn't quite replicate the deep and meaningful connections that you can create with another person.

A lot of people get to that point because they're frustrated because relationships are hard. You have to put time and effort into them, they're not always reliable. I might need somebody at a time when they need somebody and they're not able to meet my emotional needs, and that can get really frustrating. A lot of people who fall into addiction gets super frustrated with that and start to replace that with substances. But it's not a good working long-term strategy. And then what we also find is it falling into addiction makes that so much worse because it starts to consume your time. It starts to consume who you are. It's easy to let any and all relationships with friends and family deteriorate or fall apart. And then you're left addicted to a substance and completely cut off from what may be one of the best supports in your recovery, which is your interpersonal support system, deep and meaningful attachment to another person. So a lot of that is what would inform some of our treatment here.

Our therapists practice from a variety of different approaches, of course. We do a lot of cognitive-behavioral therapy and treatment because behavior change is the key to a lot of this, but we're looking at everything through an attachment lens. Both with our groups and individual therapy, we understand that the person is at a place where they more than likely have been cut off from those meaningful, deep attachments from having somebody to truly share who they are and what's going on for them. So many people in addiction are so consumed with shame. The idea of an honest, open, meaningful relationship is just terrifying, and we're seeking to help people get through that.

In therapy, we try to create the sort of connection that we want them to have. A connection that's deep and meaningful, but also has appropriate boundaries and connections where you can be honest with each other as well. And within the context of group therapy, we're helping people to really look at what they're doing in terms of the group. The group is a small family, it's a group of people and you can see an individual's interpersonal struggles emerge in the group almost immediately. They fall into a role it's similar to the role that they've been playing. A lot of people will withdraw and not really take part. And that tells us a lot where they're at. Or some people might interact with the group in any number of different ways, and we just try to hold up the mirror and we say, "This is what you're doing in the group. I wonder if this reflects the way that you are dealing with your own relationships in life. I wonder if this is similar to the way that you were relating to your parents or your family, or your loved one, or your friends. I wonder if the problems that you're having here with the community are very similar to the problems that you're having in general."

And, it's all attachment. What is your attachment style? Are you securely attached? Are you anxiously attached? Are you avoidant? We do see ... I think that avoidant style is pretty common with addiction, but so is the anxiety, and there's a lot of crossovers as well. These aren't discrete categories. So we seek to keep that attachment lens on through individual therapy, through group therapy, and through our focus on families. And that's something I think that's amazing that we do here at APN is we really get the families involved.

Each family has an assigned family therapist who works with that family to help to understand what's going on. Addiction and mental health problems seldom happen in a vacuum, and we're just trying to help the family to understand what role everybody plays in what's going on. And by doing that we're able to strengthen those attachment relationships within the family. We're able to focus on places maybe where a rift or a rupture occurs, or places where stronger boundaries might be more appropriate, or different ways that the family can come closer. Because that's our goal. Not to blame anybody or point any fingers, it's to help the family really come closer and learn to support each other. Because when a client leaves treatment, they're not going to have this amazing treatment team around them. We're teaching the family to be part of that treatment team, and we're teaching the client to be a meaningful part of that family as well.

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