Abstract
Background: There is convincing evidence that individuals suffering from Substance Use Disorder (SUD) often present insecure attachment patterns. In contrast, a strong therapeutic alliance in treatment of SUD has been found to lead to a more positive treatment outcome. However, insecure attachment has been observed to be linked with weaker therapeutic alliance strength. The primary aim of this explorative study was to gain initial insights regarding the influence of attachment and personality characteristics on therapeutic alliance and therapy motivation in SUD patients undergoing treatment at a therapeutic community. Furthermore, SUD patients were compared to healthy controls regarding attachment, personality and mood pathology.Methods: A total sample of 68 participants, 34 inpatients in SUD treatment and 34 age-gender and education adjusted controls, were investigated. Both groups filled in the Adult Attachment Scale (AAS), the Inventory of Personality Organization (IPO-16), and the Brief Symptom Inventory (BSI-18) questionnaires. Additionally, SUD patients filled in the Working Alliance Inventory (WAI-SR) and the adapted German version of the University of Rhode Island Change Assessment scale (FEVER).Results: In line with our assumptions, SUD patients exhibited a decreased amount of attachment security (AAS) which was related to higher personality (IPO-16) and mood pathology (BSI-18). Furthermore, correlational analysis revealed the WAI-SR dimension Bond being positively associated with more secure attachment. A strong task alliance was linked to the Action stage of change (FEVER) and decreased mood but not personality pathology.Conclusion: Our findings confirm the putative negative effect of attachment and personality pathology on therapy motivation and therapeutic alliance in addiction therapy as well as more specifically in therapeutic community treatment. Future research in enhanced samples might focus more on the long-term effects of the interaction of attachment, personality and therapeutic alliance variables.
Highlights
In 2019, nearly 26,000 people in Austria suffering from Substance Use Disorder (SUD) were in long-term outpatient or inpatient drug-specific treatment
In order to shed further light on the question why substance use disorders are assumed to be notoriously difficult to treat [1], we investigated possible differences regarding attachment and personality between healthy controls and patients diagnosed with SUD
We found SUD patients to differ significantly from an age-gender and education adjusted control group by exhibiting diminished attachment security, as well as higher amounts of personality and mood pathology
Summary
In 2019, nearly 26,000 people in Austria suffering from Substance Use Disorder (SUD) were in long-term outpatient or inpatient drug-specific treatment. Keeping patients in treatment is one of the main objectives in SUD therapy and correspondingly, the philosophy of drug-free therapeutic communities is to establish sustainable relationships by building on self-help and mutual-aid between patients. There is convincing evidence that individuals suffering from Substance Use Disorder (SUD) often present insecure attachment patterns. A strong therapeutic alliance in treatment of SUD has been found to lead to a more positive treatment outcome. The primary aim of this explorative study was to gain initial insights regarding the influence of attachment and personality characteristics on therapeutic alliance and therapy motivation in SUD patients undergoing treatment at a therapeutic community. SUD patients were compared to healthy controls regarding attachment, personality and mood pathology
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