A developmental model of addictions: integrating neurobiological and psychodynamic theories through the lens of attachment

ABSTRACT

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.

KEYWORDS:

• Attachment
• Addiction
• Neurobiology
• Psychoanalysis
• Developmental Psychopathology

Disclosure Statement

None of the authors have any relevant financial disclosures. Dr. Potenza has consulted for Ironwood, Lundbeck, Shire, INSYS, Rivermend Health, Opiant/Lightlake Therapeutics, and Jazz Pharmaceuticals; has received research support (to Yale) from Pfizer, Mohegan Sun Casino and the National Center for Responsible Gaming; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse-control disorders or other health topics; has consulted for or advised gambling and legal entities on issues related to impulse-control/addictive disorders; provides clinical care in a problem gambling services program; has performed grant reviews for the National Institutes of Health and other agencies; has edited journals and journal sections; has given academic lectures in grand rounds, CME events and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse [Grant numbers R01 DA026437, R01 DA039136, R01DA035058];Anna Freud Centre [None];John Leopold Weil and Geraldine Rickard Weil Memorial Charitable Foundation [None];Mexican National Council for Science and Technology (CONACYT) [Grant number 600356]