Recent attachment research has indicated that besides the high relevance of early childhood experiences also biological variables account for the individually developing attachment style. Taken together, features of anxiety coping, personality style and temperament may correspondent with attachment and the development of distinct psychopathologies which may over time lead to alcohol addiction.
In fact our results demonstrate a high prevalence of insecure attachment styles in alcohol addicted inpatients (IAS) compared to normative samples (e.g.) with approximately two thirds of the sample having an insecure attachment style. No relevant sex differences were observed. According to the Ainsworth data which are still regarded as a standard usually approximately two thirds of a healthy sample is securely attached.
Conforming with our hypothesis and as previously described IAS subjects had significantly higher levels of trait anxiety according to the Spielberger-scale but not of state anxiety compared to alcohol dependent subjects with a secure attachment style (SAS). With regard to the correspondence of attachment style and anxiety coping we found that both IAS and SAS individuals were over-average sensitizers, continuously scanning the environment for potentially threatening stimuli in order to gain protective information. However, IAS subjects displayed a significantly higher expression of cognitive avoidance of stressful and anxiety inducing thoughts compare to SAS subjects who had average levels with regard to the normative distribution. This feature may give further evidence to the idea of alcohol addiction being an attachment disorder. It may give a certain hint on a less pronounced ability to control negative emotionality related to adverse stimuli in IAS alcoholics and the function of intake of GABAergic substances such as alcohol in order to control hyper-arousal leading to addiction over time. Anxiety disorders are a frequent comorbid condition in addiction and vice versa patients with anxiety disorders or high levels of trait anxiety are more prone to substance abuse and addiction, before all alcohol and benzodiazepines.
A higher prevalence of personality disorders in alcohol addicted patients compared to subjects without confounding axis-I diagnosis is a well known fact. The prevalence of personality disorders was lower than estimated in our sample (15.3%), there were 8 subjects with personality disorders in the IAS group and only one SAS individual who had a paranoid personality disorder. Despite the low n of this subgroup this may be a remarkable finding of potential importance for future investigations on connections of alcoholism and personality disorders indicating the probable importance of attachment style in this respect. Yet, this should be cautiously handled as a very preliminary finding due to a low n.
Timely regarding personality as a dimensional feature, results from the correspondence of attachment style and personality styles (according to the PSI) were obviously more remarkable. We found that IAS-subjects had far over-average scores on the dimensional distribution to the pathological pole compared to the SAS group which was fairly normative on all scales (all values between percent ranks 42–59). High expression on the subscales paranoid and schizoid indicate on suppression of positive and negative emotionality, low expression of positive emotionally and a low activity of the reward-system in IAS-subjects. This appears understandable seen from an attachment related point of view. It could be hypothesized that these individuals are socially reserved because of low expectations in positive outcomes of interpersonal relationships and therefore insecure attachment may promote this style and lead to alcohol as an enhancer of a stunted reward-system.
A corresponding low reward system, a high self-centeredness and low confidence in positive outcomes of own actions and interpersonal relationships would be a characteristic of IAS subjects who scored high on dimensions related to cluster-C pathologies such as dependent, insecure, negativistic and depressive. However, these assumptions should be regarded as speculative.
All items have been rated far over-average by the IAS group and significantly lower in the SAS group. IAS alcohol addicted subjects accordingly appear to be characterized by a highly active punishment-system, a low confidence in a positive outcome of own actions and a low ability to retain or stimulate positive affectivity under adverse stimuli and frustration. There is a high sensitivity for negative evaluation by others and own needs and interests are regularly neglected. SAS individuals, however, had a significantly higher expression on the kindness / histrionic subscale, indicating a more pronounced ability of SAS subjects to show positive emotions and to rely on the ability to produce positive consequences by own actions, especially in interpersonal relationships.
This is correspondingly mirrored by the group differences revealed by the Cloninger-scale.
IAS subjects have, compared to SAS alcohol addicted inpatients, a significantly lower expression of self-directedness. This may hint on a different inner working model for interpersonal relationships in IAS individuals. The fact that IAS had a numerically higher expression of self-transcendence may indicate that coping is more related to spirituality or externalization than to faith in interpersonal relationships and their potentially beneficial effects. SAS subjects are significantly higher scorers on novelty-seeking and lower on harm-avoidance giving further insights into connections between attachment style and personality features in alcoholism. However, both groups displayed a level of co-operativeness below the average of the normative sample, showing a hampered belief in being part of a social bond. And in contrast from the PSI-findings, no difference in reward dependence could be found.
Observations of overall potentially traumatizing or adverse events in adolescence were frequently found for both groups. These findings should be interpreted cautiously as the number of observations was altogether low. One limiting factor is surely the missing specification to certain periods of adolescence which was not assessed.
Another limitation of these results is the comparatively small sample-size and that the assessment of data was mainly based on self-rating scales. However, scores and the applied openness-scale were satisfactory. Gender differences within the IAS and SAS group were not computed due to the resulting small n. Results from studies on larger samples allowing the evaluation of certain subgroups should be promising and more conclusive.
In conclusion we found in alcohol addicted inpatients, according to our initial hypothesis, a correspondence of insecure attachment styles with high trait anxiety, more dysfunctional anxiety coping and dysfunctional personality styles. Besides to comparatively high prevalence of insecure attachment styles, personality disorders were more frequently found in subjects with insecure attachment styles.
The presented results imply the potentially high importance of attachment style in the characterization of alcohol dependent men and women because of its possible high relevance for (psycho-) therapeutic strategies, individual therapeutic abilities and comorbid conditions. By separation into attachment styles significant differences in potentially dysfunctional personality styles can be observed, giving a more differentiated characterization of groups than by diagnosing personality disorders exclusively. Future research should long to prove that attachment style might be an important feature in diagnosing distinct (therapy-relevant) subgroups of alcohol addiction. Clinical routine may profit from attachment style assessments. Insecure attachment styles in alcohol dependence may contribute to poorer outcome due to dysfunctional personality styles and anxiety coping behaviour.