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: Addiction; Attachment; Developmental Psychopathology; Neurobiology; Psychoanalysis.

Figure 1.

Developmental model of addiction. The genetic makeup of an individual defines the neurobiological and behavioural phenotypical variations of the structure and function of brain areas involved in reward processing, executive functioning, affect- and self-regulation. Phenotypes are both related to peri- and postnatal environments, and influence attachment experiences, representations and interactions. These, in turn, further influence the phenotypes and guide addictive behaviour based on the salience of social and addiction-related cues (i.e., cues related to alcohol, drugs, gambling or other addiction-related foci) and the developing reflective functioning capacity. Addictive behaviour is then learned and maintained via reinforcement and gene-environment interactions with a sociocultural context. Ultimately, vulnerability to said mechanisms is potentially transmitted to the next generation via parent-infant interactions, parental reflective functioning, as well as parental genetic and maternal perinatal contributions.