Developmental model of addictions: integrating neurobiology and psychoanalysis through attachment

What is it about?

Although substance use and abuse may impact brain and behavior, it is still unclear why some people become addicted while others do not. Neuroscientific theories explain addiction as a series of between- and within-system neuroadaptations that lead to an increasingly dysregulating cycle, affecting reward, motivation, and executive control systems. In contrast, psychoanalysis understands addiction through a relational perspective wherein there is an underlying failure in affect regulation, a capacity shaped early developmentally. Considering recent findings suggesting the neurobiological overlap of addiction and attachment, it may be possible to integrate both perspectives into a developmental model through the lens of attachment. The goal of the present review is to evaluate the value of neurobiological and psychodynamic perspectives to inform our understanding of addiction, particularly substance-use disorders.

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Why is it important?

This review considers the value of synthesizing neurobiological and psychodynamic perspectives to better understand addictions, identifying potential pathways to the initiation of substance use, as well as mechanisms that may maintain substance use and abuse. The neurobiological approach allows biological mechanisms to be identified that may contribute to substance abuse and dependence; the psychodynamic approach provides an alternate framework for understanding relational and representational aspects of addiction within a developmental perspective. Attachment theory may present a unique opportunity to bring together these lines of enquiry, enabling an integrative developmental model of addiction with early experiences laying the foundation for psychological as well as neurobiological trajectories to substance use, abuse, and dependence. Fostering secure attachment bonds through sensitive parenting during childhood or through psychological interventions later in life may represent a unique opportunity to promote healthy socioemotional and motivational growth across the lifespan.

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