- Hardcover: 364 pages
- Publisher: Jason Aronson, Inc.; 1 edition (August 6, 2004)
- Language: English
- ISBN-10: 0765703378
- ISBN-13: 978-0765703378
- Product Dimensions: 6.4 x 1.1 x 9.4 inches
- Shipping Weight: 1.3 pounds (View shipping rates and policies)
- Average Customer Review: 18 customer reviews
- Amazon Best Sellers Rank: #1,046,230 in Books (See Top 100 in Books)
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Addiction as an Attachment Disorder 1st Edition
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This text excels in its discussion of how attachment theory informs the therapeutic alliance (what some would call 'professional use of self') and in explaining how and why therapy works. (PsycCRITIQUES)
At last a book has been written which brings to light what most psychotherapists and addiction counselors intuitively understand: addictive processes and attachment problems are intricately intertwined. For the addicted individual, relationships with substances supercede human relationships. Flores spells out the myriad ways in which addiction and attachment are connected, including how the two overlap at the biological, psychological, and social levels. Evolving out of this theoretical understanding, the book describes effective treatment strategies which can include 12-step programs, individual and/or group therapy. Like the best of clinical texts, this one brings abstract theoretical concepts to the experiential and practice levels. In so doing, Flores provides the reader with two books in one. He develops a general model for an attachment-based psychotherapy. Specific to the addiction field, he convincingly shows how relational problems, whether the cause or consequence of addictive behaviors, are best treated by developing the capacity for healthy interpersonal relationships. (Marilyn Freimuth, PhD, faculty member at the Fielding Graduate Institute and private practitioner in New York City)
It is indeed rare to find a thoughtful and scholarly blend of theoretical material and clinical wisdom in a single volume. Dr. Flores has integrated the critical elements of attachment and object relations theory, individual, group, and family interventions, relevant addiction research findings, and their therapeutic applications to the problem of substance abuse in a pragmatic and readibly accessible text. This unique book should be on the 'must read' list not only for mental health professionals but for anyone seeking a comprehensive understanding of contemporary therapy for addictions. (Henry I. Spitz, MD, director, Group & Family Therapy Programs, Columbia University, College of Physicians & Surgeons)
From the Publisher
Winner of the Gradiva Award 2005.
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When we fail to have secure relationships, we often try to find these needs in the wrong ways. We might use drugs or alcohol to manage our emotions or to give us a sense of confidence. This in turn destroys our relationships further. Thus, we have insecure attachment styles, when we are either avoidant/dismissing (counterdependent) or anxious/preoccupied or both. Dr. Flores alludes to the fact that addicts tend to be emotionally avoidant or counterdependent.
The book makes a good point that 12 step groups like AA help in fostering healthy attachments, which are important for an addict's recovery, though I felt the book was more of a promotion for Alcoholics Anonymous rather than expanding on attachment theory and how to treat addiction--it tried too hard to fit research on attachment into the 12-steps philosophy, though I do believe the 12 steps is very helpful. For example, I like the principles of surrendering control of our lives to a higher power as a way to achieve serenity and recognize that we have little control over our lives, though the book doesn't get much into that.
I like the author's point that addicts must learn they are not Gods (p. 98-99), as they have an "illusion of control." This is something I tell my clients all the time. He points out an existential approach that recognizes our human limits and need for others. He also criticizes Rene Descartes' mind-body dualism as incompatible with the research on the biology of emotion and attachment (106)--our emotions are stored and expressed physically. I liked the quote from Darwin (1871) that we need each other for survival: "For with those animals which were benefited by living in close association, the individuals which took the greatest pleasure in society would best escape various dangers: whilst those that cared least for their comrades and lived solitary would parish in greater numbers." Dr. Flores also quotes Stern (1985): "The essential state of human existence is togetherness rather than aloneness, with a most basic sense of connectedness, affiliation, attachment and security as givens." This reminds me of a quote I use from Genesis 2: "It is not good for man to be alone."
Dr. Flores points out that our society oftentimes puts too much emphasis on individualism and independence at the expense of our need for attachment. Our society damages children when we teach them to just get over their attachment injuries. Perhaps these are reasons why we seem to have a growth of addictions and personality disorders in the past decades. Dr. Flores is also interested in the links between addiction and narcissism as both seem to be due to deficits in self-esteem, which may be caused by shame or relationship traumas.
While Dr. Flores does not lay out many specifics for what an attachment-oriented therapy for addicts would look like, he does give some pointers. His primary treatment goal for addicts in recovery is to help them learn how to have secure attachments and to experience attachments because experiencing (experiential therapy) makes more of a difference at the implicit memory / emotional level. I affirm him on this as this is also my primary goal for therapy with addicts. Treatment such as individual and group therapy as well as AA can accomplish these by helping clients to be more emotionally aware and available in relationships and by fostering new attachments.
As a family therapist who treats addicts from an attachment perspective, I truly believe in the premise of the book that addiction should be treated as an attachment disorder, but perhaps I was hoping for too much. I felt that some of the theoretical presentation was diluted by other theories, particularly terminology from object relations theory, which is more psychodynamic, though it is a precursor of attachment theory. The book also read too much like a dissertation's literature review and lacked the balance that comes with either being exposed to a variety of literature or experience in the field. Much of the research was dated. For example, I felt that the book blames parents too much when I have seen the influence of siblings and especially previous relationships partners on our attachment styles. It also glosses over the fact that not everyone uses drugs or alcohol because of a bad childhood. Many times, the initial use is just for fun, though it becomes a maladaptive tool for managing relationships. An addict may have just made a bad choice, or associated with the wrong person, and it may have nothing to do with his or her parents. On the other hand, an addiction will become an attachment and destroy a person's ability to have healthy, secure attachments with people, which is why I still believe it is an attachment disorder. My point is that this book puts too much blame on parents.
The book was somewhat contradictory. On one hand, it says that "Someone can be attached and not be dependent" (p. 88) which is a bad assumption based on the theory. If one is to have a secure attachment, one MUST be at least interdependent. Avoidance (counterdependence) goes against secure attachment. But then it goes on to say that dependency isn't bad. So, which is it? Research in attachment theory recognizes and validates a healthy dependency, as long as a person is not basing their self-worth on the other person and is anxiously preoccupied in the other that it becomes controlling (codependence). Some emotional dependence is naturally a part of a relationship. Relationships will put us at risk of getting hurt, but that's a risk we must take.
While I like the thesis of Dr. Flores' book, I might recommend other books instead, like Dr. Dayton's book "Emotional Sobriety."