title: Insecure attachment and college-age alcohol use disorders. A case report.
abstract: Teens and young adults with insecure attachment may be remarkably susceptible to alcohol and substance use disorders. Particularly in the separation process of leaving-home and entering college, an underlying insecure attachment may manifest through symptoms of alcohol or drug abuse; as these young adults engage in what is perceived to be adult drinking behavior, they become too "attached" to the alcohol as a substitute for earlier, sporadically-available objects (usually parents). That is, they enact a similar relationship to this drug that they may have learned to have with an insecure parent: too close at times, but ultimately fostering guilt, dependence and destructive action. Fear of abandonment, rejection and negative judgment may be intensified in this age group as they struggle at the cusp of independence, but these issues are particularly relevant for insecurely attached teens. In this report, attachment theory is briefly described and applied to the assessment and treatment of a college freshman diagnosed with an alcohol use disorder. By engaging the patient in evaluating her actions and motives through the attachment model, the therapy helps her to channel help-seeking behavior appropriately, to establish expectations for consistency and reliability from significant people in her life and to feel safer without turning to alcohol as a crutch. An argument is made for the general application of attachment theory to alcohol and drug use disorders in this significant phase of young adult development.
authors.affiliation: Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10024, USA. kmkotov@earthlink.net
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Kotov
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications*; D001010:Anxiety, Separation; D005260:Female; D006801:Humans; D014481:United States; D014495:Universities