Addicted to Love: Exploring an Attachment Approach to Treat Addiction in Couples Therapy

Abstract

Addiction is among the most ubiquitous of mental health issues (Thege et al., 2016; Sussman et al., 2011), priming individuals for relationship distress and comorbid disorders (Bhatia & Davila, 2017; Whisman & Baucom, 2012). The popular medical model of conceptualizing addiction has paved the way for treatment options that are largely short term and focused on symptom management (Fletcher et al., 2015), and couples work is often considered counterproductive in early treatment or delayed until the partner struggling with addiction has had time to prioritize individual treatment. However, high rates of relapse (National Institute on Drug Abuse [NIDA], 2019) and burgeoning cross-addictions (Thege et al., 2016) suggest most current popular treatment approaches are failing to address the root causes of addiction. As rates of addiction continue to increase, it is imperative that therapists more readily access an attachment framework for conceptualizing and treating the biopsychosocial roots of this mental health issue. Intensive short-term dynamic psychotherapy (ISTDP) has emerged among psychoanalytic communities as one such approach based on attachment, but literature on its application in couples therapy is sparse. This study considered the experiences of ISTDP couples therapists who conceptualize and treat addiction as a defense rooted in insecure attachment bonds. Findings demonstrate that, if the goal of treatment is not only symptom cessation, but also to foster a secure attachment in couples therapy, then addictive behaviors may resolve on their own and with lower chances of relapse because the fuel for the addiction has been resolved.