Attachment and Its Association to the Perception of Risk Factors for the Intergenerational Transmission of Substance Abuse Disorders

Background and Purpose: Substance use disorders (SUD) are known to run in families with a complex interplay between environmental, social and genetic risk factors. Yet there is limited research on how parents with SUD understand the intergeneration transmission of SUD. This has the potential to impact parenting strategies, infant and parental attachment, and openness towards preventative interventions. This study qualitatively examines how mothers in residential treatment for SUDs think about their children’s inherited risk of SUD and it examines if the mother’s attachment style is associated to their understanding.

Methods: Data from this study is drawn from a larger project examining treatment for caregivers with SUD and their young children ages zero to five being served by three child and family serving agencies in a Northeastern state in the United States. Agencies were selected based on their involvement in a new initiative to implement a Trauma-Informed Care intervention, the Attachment, Regulation, and Competency (ARC) model. Twenty-nine in-depth, semi-structured Working Model of the Child Interviews (WMCI) were conducted with mothers receiving treatment for SUD. The WMCI (Zeanah, Benoit, & Barton, 1986) assesses caregiver internal representations of their child and the relationship with the child. WMCI interviews were then clinically coded for attachment style. Then, in a separate process, qualitatively analyzed, using content analysis, to examine maternal concerns related to intergenerational risk for the development of SUDs in their children.

Results: Data analysis reveals that 29% of mothers report high levels of genetic anxiety about their children’s risk factors for developing a SUD when asked general questions pertaining to their thoughts about their child’s future. In contrast, 42 % verbalized that they actively did not want to think about their child’s future. Among mothers who report genetic anxiety, the vast majority show balanced attachment styles. Whereas avoidant and ambivalently attached mothers were more likely to articulate their unwillingness to think about their children’s future. An unwillingness to think about the future may be indicative of genetic anxiety but expressed differently, especially among mothers with an avoidant attachment style.

Conclusion and Implications: Findings suggest that many mothers with SUD express concerns regarding their children's future risk for developing a SUD. Further, these concerns may map onto attachment classifications. Parental anxiety about the intergenerational transmission of substance abuse may be an important component of intervention for SUD parents. To avoid self-fulfilling prophecies, psychoeducation related to the complexity of risk factors for addictions could alleviate some of these concerns. Further, examining parents’ worries for their children may provide needed insights for interventions to address parental guilt, shame, and anxiety. Parents with avoidant and ambivalent attachment styles may need to be differently engaged about these fears, given their desire to not think about the future. Finally addressing genetic anxiety can help impress on parents the importance of environments and sensitive caregiving to prevent their children’s future substance abuse.