Recovery from addiction is incredibly time consuming. The stakes are so high; people in recovery must spend their limited time, resources, and energy on treatments and practices that help the most. Support groups have been criticized, especially 12-step groups, for low or inconsistent results. Why should anyone serious about recovery bother attending?
Quite simply, recovery with others is easier than recovery alone.
Many psychologists have dedicated their careers to understanding attachment theory and how attachment styles can affect the ways people develop. Attachment theory examines the quality of infant relationships with their caregivers, and correlates these relationships with the quality of relationships people have later in life. Basically, the more securely an infant bonds with a caregiver, the more secure that infant will feel in other relationships later in life.
Psychologist Mary Ainsworth was the first to classify three attachment patterns or styles based on infants’ responses to the “strange situation” procedure, which involved a researcher observing the mother and infant in a series of 8 situations while hidden behind a one-way glass. The situations were a standard set of combinations of the mother, baby, and a stranger (mother and baby alone, stranger and baby alone, baby alone, etc.). The infant’s behavior was scored in each situation based on four types: proximity and contact seeking, contact maintaining, avoidance of proximity and contact, and resistance to contact and comforting.
Ainsworth developed the attachment styles based on the results of this experimental and scoring procedure. Attachment theory has since been expanded to evaluate adult attachment styles as well, and the 3-style framework has been expanded to 4 attachment styles: secure, anxious-preoccupied, dismissive-avoidant, and fearful-avoidant.
Attachment styles are extremely important because they describe the quality of a person’s relationships, which influence just about every aspect of a person’s life. A 2013 study of 5,692 people found that insecure attachment styles were associated with greater likelihood of suicidal ideation and attempt, and mental disorders overall. Secure attachment styles were associated with the opposite trend.
Dr. Philip Flores, a psychologist examining the importance of early attachment styles on the development of addiction, has written that substance use is an attempt to self-medicate the stress of ineffective attachment styles. Substance use ultimately results in further distance rather than the desired closeness and connection.
The primacy of social interaction is studied by neuroscientists as well. Neuroscientist Matthew Lieberman gave a Ted Talk on how social interaction is vitally important for healthy, fulfilling human lives, and may even precede food, water, and shelter in importance. In fact, increasing evidence suggests that social pain is processed very similarly to physical pain in the brain; the body processes social pain as a threat to existence.
A recent article in the New York Times, How Social Isolation is Killing Us, documents evidence of increased loneliness in America and the effects. Since the 1980s, the number of Americans who report loneliness has doubled, and that 1/3 of Americans over the age of 65 live alone. The article emphasizes that, “Loneliness can accelerate cognitive decline in older adults, and isolated individuals are twice as likely to die prematurely as those with more robust social interactions.”
So it’s clear that everyone benefits from social connection, but how much we need still goes unanswered. People with addiction still need to know whether support groups are worth the bother. While neuroscience is still working on understanding how psychotherapy, group therapy, and even basic social interaction works in the brain, psychologists are working on questions of efficacy.
Evidence indicates that support groups for addiction help people stay in recovery. Researchers in 2011 assessed 1,726 patients at 3, 6, 9, 12, and 15 months after residential treatment, and concluded that support groups help people in recovery change “people, places, and things,” reducing triggers for craving and relapse. The researchers published a follow-up study in 2012, analyzing potential reasons for improved outcomes, and found that patients surrounded by pro-abstainers were more likely to stay abstinent than patients surrounded by pro-drinkers. Another study in 2012 found that stronger AA group cohesiveness, a sense of belonging, predicted increased participation and abstinence in group members. Other researchers, in 2011, have taken a closer look at some of the reasons for support group successes, and found that AA groups may increase self-efficacy, a person’s belief that he or she can succeed and recover.
According to these studies, building stable social networks appears to yield better results for people in recovery than going it alone. So far, it seems, what matters most in addictions recovery groups is the level of belonging people feel. (Sebastian Junger explores the universal human need for belonging from a sociological perspective in his book, Tribe.)
While the research supporting recovery groups is not as conclusive as we would like, neuroscientists are currently testing the efficacy of oxytocin as a treatment for addiction. Known fondly as “the love hormone,” oxytocin performs many roles in the body. Oxytocin is naturally released in response to positive social situations, such as during childbirth and family bonding, and when seeing the face of one’s partner. Oxytocin is also found to be released in response to certain drugs.
“Heroin, it’s my wife and it’s my life”
– Lou Reed, “Heroin“
In 2014, a group of researchers chose to study prairie voles, Microtus ochrogaster, who are notorious for forming life-long partner bonds. From previous studies, the scientists knew that oxytocin is crucial for healthy pair bonding between prairie voles. When they gave the prairie voles amphetamine, the prairie voles failed to bond. Amphetamine had disrupted the oxytocin and dopamine pathways in their brains, responsible for partner formation. The researchers concluded that oxytocin and dopamine systems are important both for addictions treatment and for social bonding, probably for humans too.
Now scientists are investigating the use of oxytocin as a treatment for addiction. So far studies have documented that oxytocin alleviates withdrawal symptoms and craving (Mitchell et al., 2016; Baracz and Cornish, 2016; Peters et al., 2016; Sarnyai and Kovács, 2014; Stauffer and Woolley, 2014; Bowen et al., 2014; Carson et al., 2013). Preliminary evidence suggests that oxytocin may be effective for methamphetamine, alcohol, and opioid addictions.
The addiction-love connection is promising as a direction for neurobiological research, beyond oxytocin alone. We stand to improve our understanding of both addiction and love, and how even in healthy brains, love provides the most important incentive for human behavioral learning.
We don’t know whether oxytocin will continue to hold up as an effective pharmacological intervention for addiction. We don’t know either whether addicted individuals need supplemental oxytocin to gain satisfaction from social connection in recovery. We don’t know for sure whether people in recovery can get the same benefit from spending more time around others they care about. We don’t know how much social interaction any person needs, really, and it probably varies from person to person.
We do know that everyone needs some social connection to develop properly, and to be stable later in life. Studies examining the efficacy of support groups emphasize that belonging to a stable group, committed to recovery, improves a person’s chances of staying in recovery from addiction.
While we continue learning more, the safest bet is to recover together, not alone.