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ABSTRACT
This article presents a perspective on addiction that not only substantiates why group therapy is the treatment of choice for addiction, but also integrates diverse perspectives from 12-step abstinence-based models, self psychology, and attachment theory into a complementary integrative formula. Attachment theory, self psychology, and affect regulation theory characterize addiction as an attachment disorder induced by a person's misguided attempt at self-repair because of deficits in psychic structure. Vulnerability of the self is the consequence of developmental failures and early environmental deprivation leading to ineffective attachment styles. Substance abuse, as a reparative attempt, only exacerbates that condition because of physical dependence and further deterioration of existing physiological and psychological structures. Prolonged stress on existing structures leads to exaggerated difficulty in the regulation of affect, which leads to inadequate modulation of appropriate behavior and self-care and increased character pathology.
Addiction treatment has been intricately associated with group therapy for more than 60 years. Ever since alcoholism was first recognized as a diagnostic entity, its treatment has been provided in groups. Starting with Alcoholics Anonymous' (AA) establishment of the 12-step group movement in the 1930s, addiction treatment has shared a synchronicity and compatibility with group therapy. The two have been drawn to each other because of a very simple principle: Substance abusers usually respond favorably to group treatment and are more likely to stay sober and committed to abstinence when treatment is provided in groups. Any treatment modality that facilitates detachment from chemicals and attachment to abstinence will enhance treatment success. Remaining attached to therapy underlies a singularly influential principle of addiction treatment: the longer the treatment, the better the prognosis (Leshner, 1997; Project Match Research Group, 1997).
ADDICTION AS AN ATTACHMENT DISORDER
Addiction treatment specialists familiar with attachment theory (Bowlby, 1979) and self psychology (Kohut, 1976) recognize an inverse relationship between addiction and healthy interpersonal attachment. Certain individuals, because of intrapsychic or developmental deficiencies related to genetic and biological substrates, are vulnerable to environmental influences (i.e., substance abuse), which further compromise an already fragile capacity for attachment. Because of the potent emotional euphoric "rush" that alcohol and drugs produce, they are powerfully reinforcing and inhibiting of the more subtle emotional persuasions in a person's life. Consequently, the vulnerable individual's attachment to chemicals serves...