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A meta-analysis of longitudinal associations between substance use and interpersonal attachment security.

ABSTRACT: Substance use has long been associated with close relationship distress. Although the direction of influence for this association has not been established, it has often been assumed that substance use is the causal agent and that close relationship distress is the effect. But research seeking to establish temporal precedence in this link has produced mixed findings. Further, theoretical models of substance use and close relationship processes present the plausibility of the inverse pathway-that insecure close relationships may serve as a vulnerability factor for the development of later substance problems. The current review applies an attachment-theoretical framework to the association between close social bonds and substance use and substance-related problems. Targeting longitudinal studies of attachment and substance use, we examined 665 effect sizes drawn from 34 samples (total N = 56,721) spanning time frames ranging from 1 month to 20 years (M = 3.8 years). Results revealed a significant prospective correlation between earlier attachment and later substance use (r = -.11, 95% CI [-.14, -0.08]). Further, cross-lagged coefficients were calculated which parsed auto-regressive effects, indicating that lower attachment security temporally preceded increases in substance use (r = -.05, 95% CI [-.06, -.04]). Analyses further indicated that the pathway from earlier attachment to later substance use was significantly stronger than that from earlier substance use to later attachment. Results also revealed several moderators of the attachment-substance use link. These findings suggest that insecure attachment may be a vulnerability factor for substance use, and indicate close relationship quality as a promising line of inquiry in research on substance use disorder risk. (PsycINFO Database Record

SUBMITTER: Fairbairn CE

PROVIDER: S-EPMC5912983 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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A meta-analysis of longitudinal associations between substance use and interpersonal attachment security.

Fairbairn Catharine E CE Briley Daniel A DA Kang Dahyeon D Fraley R Chris RC Hankin Benjamin L BL Ariss Talia T

Psychological bulletin 20180301 5

Substance use has long been associated with close relationship distress. Although the direction of influence for this association has not been established, it has often been assumed that substance use is the causal agent and that close relationship distress is the effect. But research seeking to establish temporal precedence in this link has produced mixed findings. Further, theoretical models of substance use and close relationship processes present the plausibility of the inverse pathway-that ...[more]

PMID: 29494194

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Project description:BackgroundResearch on parent-level factors linked to adolescent attachment security would inform interventions to prevent or reduce youth psychopathology and other negative outcomes. The current study examined one relevant parent-level variable: maternal interpersonal problems. Interpersonal problems, a key characteristic of personality pathology, are well described by the interpersonal circumplex (IPC) and have been shown to be associated with maladaptive adult attachment in close/romantic relationships; however, studies have not examined relationships with offspring attachment. Therefore, the first aim of the current study was to examine the relationship between maternal interpersonal problems and adolescent attachment insecurity. Based on previous evidence that parents' recalled bonding with caregivers is associated with the quality of bonding and attachment with offspring, the second aim was to examine whether mothers' recalled bonding with their own mothers partially explained this relationship.MethodsParticipants included 351 psychiatric inpatient adolescents (Mage = 15.26, 64.1% female) and their biological mothers. Logistic regressions tested whether maternal interpersonal problems were associated with Child Attachment Interview classifications (secure vs. insecure; secure vs. preoccupied vs. dismissing; not disorganized vs. disorganized). A mediation model (N = 210) tested whether the relationship between maternal interpersonal problems and adolescent attachment was mediated by the mother's recalled maternal bonding.ResultsMaternal interpersonal problems were associated with insecure (vs. secure), dismissing (vs. secure), and preoccupied (vs. secure) attachment. There was no significant relationship between maternal interpersonal problems and disorganized attachment. Mediation analyses showed that maternal interpersonal problems were indirectly related to adolescent attachment security via the mother's recalled maternal care, though only a small amount of variance (7%) in adolescent offspring attachment was accounted for by the model.ConclusionsResults provide the first evidence that maternal interpersonal problems are associated with higher likelihood of insecure attachment in adolescents. Therefore, researchers could consider drawing upon the IPC literature to further examine mechanisms of intergenerational risk and to tailor interventions aimed to improve parent-child relations and attachment. Additionally, findings highlight the mediating role of the mothers' recalled experiences with caregivers in the transmission of risk, suggesting attachment-based or mentalization-based interventions may be helpful for mothers with interpersonal problems and personality pathology.

Project description:Objective: Many women receiving substance use treatment report histories of interpersonal violence (IV) victimization, including physical and sexual assault. IV is a risk factor for mental and behavioral health difficulties such as posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Consistent with the self-medication hypothesis, PTSD may explain elevated SUD among IV survivors. Yet, few studies have investigated whether PTSD may have differential mediating effects for different substances, which has significant treatment implications. Methods: In 124 women (M age = 35.37, SD = 11.90) in substance use treatment, we examined PTSD symptoms as a mediator between IV and severity of different types of substance use, including alcohol, cannabis, cocaine, and opioid use. Participants completed self-report measures including the ASSIST, PCL-5, and LEC-5. Data were analyzed using path analysis in Mplus 8.3. Both dichotomous and continuous outcomes of problematic substance use outcomes were examined. Results: Most women (53.3%) reported problematic substance use with at least one substance, including opioids (39.7%), cocaine (13.0%), alcohol (9.6%), and cannabis (5.6%). Most (83.2%) of the sample reported at least one IV incident. On average, women reported clinically significant PTSD symptom severity. When problematic substance use was examined dichotomously, findings revealed significant indirect effects from IV exposure to opioid (β = 0.10, p = .010) and cocaine use (β = 0.07, p = .039) via elevated PTSD symptoms. There were no significant indirect effects for problematic alcohol (β = 0.03, p = .260) or cannabis use (β = 0.02, p = .562). When substance use was examined continuously, results revealed significant indirect effects from IV exposure to opioid (β = 0.09, p = .017), cocaine use (β = 0.09, p = .015), and alcohol use (β = 0.08, p = .020) via elevated PTSD symptoms. Indirect effects for cannabis use remained nonsignificant (β = 0.05, p = .100). Conclusions: IV survivors may be particularly at risk for opioid and cocaine misuse because of elevated PTSD symptoms. Treatments that integrate PTSD and SUD are needed to simultaneously target traumatic stress and substance use. Women with opioid and cocaine misuse may particularly benefit from trauma-focused exposure-based psychotherapy to reduce symptoms of PTSD, and thus, decrease opioid and cocaine misuse.

Dataset Information

A meta-analysis of longitudinal associations between substance use and interpersonal attachment security.

Publications

A meta-analysis of longitudinal associations between substance use and interpersonal attachment security.

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