Download Do addicts use substances to

Do addicts use substances to
compensate for the lack of
intimacy?
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Title of Study
Do addicts use substances to compensate for the lack of intimacy?
Abstract
Objectives: The purpose of this study is to examine whether addicts who have in
common impoverished intimate relationships expect that the use of substances
will provide soothing substitutes for intimacy.
Design: Two questionnaires are used in the study. The first; Descutner and
Thelen’s 1991 Fear of Intimacy Scale, (FIS) was used to identify impoverished
intimate relationships in the participant group. A second questionnaire; Emotional
Self- soothing Expectancy Scale, (ESES) was completed by the participants to
identify expectations that substances would provide a soothing substitute for the
lack of intimate relationships.
Methods: The participants were 24 substance dependant clients undergoing
treatment for drug dependency. The controlled group of 24 had professional and
semi-professional backgrounds and were similar in age and gender to the
participant group. The intention of the study was to discover whether the inability
to be intimate was a common trait in the sample and whether there was a
correlation for those deficiencies and any self-soothing substitute attachments to
substances.
Results: As expected the participant group reported high scores on the FIS tool
indicating ‘poor intimacy’ and low scores on the ‘good intimacy’ indicators.
Conversely the controlled group scored low on ‘poor intimacy’ and high on ‘good
intimacy. Participants showed an expectation
Conclusions: Refiguring addiction as a kind of intimacy is one way of making
sense of the intense relationships people can develop with substances …..”
(Keane 2004)
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Introduction
This research stems from a protracted study and interest of commonly applied
therapeutic interventions and a desire to contribute to their content and scope.
The current position regarding the treatment of substance dependency
henceforth referred to as drug 1addiction, ranges from dispensing substitute
medications at one end of the scale, to facilitating sophisticated therapeutic
interventions at the other. There is a plethora of theoretical data on the
underlying causes and symptoms described as both pre-onset and post-onset of
addiction and as many theories for interpreting them. In addition to this there is of
course the view that addiction is a brain disease; not specifically related to any
underlying causes other than a malfunction in brain chemistry, Erickson and
Wilcox (2001); McCauley (2003).
When applying the popular 12 Step approach used as a recovery tool in
Alcoholics Anonymous and Narcotics Anonymous and a number of other selfhelp groups dealing with addiction the belief is held that there is no cause for the
condition and that it is unproductive to look for things, or people, to blame. As
one addict unfolds a particular pathological trait or past experience it is
suggested that there will be a sober or drug free counterpart who will report no
addiction to substances. However, even though the author acknowledges the
success of the 12 Step philosophy and agrees that there are no single
determinants or causes of the condition this study will focus on identified
common traits in particular those pertinent to impoverished relationships. The
study will then seek to identify any expectancy that the use of substances may
relieve and compensate for the lack of intimacy. In addition the study will
investigate the possible culpability of others when applying attachment theory as
a framework for understanding intimacy and interpreting the results of the
research.
The expansion of addiction theory as a means of characterising problematic
desires, feelings and behaviors is a common feature of modern psychological
approaches to depression, stress and compulsive disorders (Lefever 2002).
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the sample refer to themselves as addicts
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The transference of the human need for intimacy into the attachment to form a
relationship of sorts with potentially addictive objects has widened as can be
seen by the expansion and growth of the self-help group, dealing with a wide
range of addictions; gambling, shopping, food, exercise, smoking, drugs, alcohol,
sex and many others. A common view of addiction is that it resides in the conflict
between the desire for pleasure and release from stress/problems on the one
hand and demands for control and performance on the other. Addictive desire is
now attached to rigorous activities such as exercise and work (Keane (2004).
She argues; “addiction is a dependence on external actions as a way of regulating one’s
feelings and sense of self.” (p193); and
‘feelings’ are brought into this model through
the notion that “it is our emotional frailties that make us susceptible to external mood
modifiers”. (p194)
The connection between addiction and intimacy as a common correlation
features significantly in addiction recovery materials. Nakken (1998) argues that
western thinking in modern society glorifies autonomy, self-reliance, self
centeredness and consumerism. Nakken distinguishes between “natural
relationships” to which people turn for support, love and growth, and addictive
relationships in which people rely on objects such as alcohol or drugs, or even
events such as sex or shopping to meet their emotional needs. Nakken argues
that “addiction is a process of buying into false and empty promises: the promise of
relief, the promise of emotional security, the false sense of fulfilment, and the false sense
of intimacy with the world . . . Finding emotional fulfilment through an object or event is an
illusion” (14–15.)
Nakken’s account suggests that addicts have an intimate
relationship of sorts with their drug of choice and insists; the formation of an
intense and emotional bond with things is the essence of addiction.
The DSM-IV manual used in the classification of dependency by many addiction
treatment professionals does not have a diagnostic category concerned with
intimacy although it does highlight links between intimacy and a number of
disorders. There is though a wealth of empirical evidence that connects
difficulties with intimacy as contributing to a number of psychological problems
(Berman and Margolin, 1992).
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According to Descutner and Thelen, 1991), fear of intimacy is a major risk factor
for many emotional problems, including those associated with substance abuse.
This thinking provides the theoretical framework for this enquiry.
Theories on intimacy
As there are many theories of addiction there also many authors and theories on
intimacy. Erikson’s understanding of intimacy in Sharabany (1994) is more
complex than the commonly held view of a simple equation of comfortable self
disclosure and close relationships. He emphasises two intrapersonal components:
the ability to make commitments to intimate relationships and the ability to develop
the emotional strength necessary to maintain them. In order to do this there is a
necessity to possess what he calls an ethical strength which allows the person to
be emotionally secure enough to put self interest aside and to pay the cost of
maintaining an intimate relationship in terms of being able to make personal
sacrifices.
When this theory is applied to addicts most theorists tend to leave out important
factors that ought to be taken into account concerning post-onset detrimental
effects. These are specifically though not exhaustively; the long term effects of
continued drug use on social functioning and the idiosyncratic properties of specific
drugs. For example, to include a cannabis or cocaine user in a research trial in the
same category as a heroin or 2crack cocaine user with regard to their functioning in
relationships may not be useful depending on the duration of their drug use. The
properties of cocaine; a stimulant drug are often reported as enhancing
performance in relationships specifically intimate encounters, (Morrison 2001),
whereas opiate users will report having no interest in relationships or sex within a
relatively short period of time using the drug.
Taking into account that admissions into treatment for dependency include a wide
range of substances it is clear that emotional and psychological effects can result
from continued use of most drugs. However, it could be argued that issues relevant
to relationships could be attributed to a particular drug lifestyle. For example, the
short-term effects and resultant overwhelming urge to repeat use immediately
Cocaine that has been heated with bicarbonate producing a small white lump or ‘rock’, hence the term ‘rocks’ is often
used to described it. It produces a popping sound when smoked; hence the name crack.
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following the dysphoric after effects off crack cocaine determines a lifestyle for the
user which leaves little time for interaction with others, in fact according to Carnes
(1983), “family and friends are abbreviated and sacrificed”. According to Morrison
(2001), “With continued acute use the euphoric effects lessen and the dysphoric effects
(anxiety, depression, fatigue) increase. Motivation diminishes to the point that the user is
interested in only one thing: obtaining more.” (100).
Unless the user is in a relationship
with a person whose lifestyle mimics their own there is little time available for
investing in the care needs of the other unless one is concerned with the shared
acquisition of the drug. In any case the self-centred obsessive desire to focus only
on the drug and its acquisition for personal use may even get in the way of sharing
their drugs. In the case of heroin use, obsession with the drug and its acquisition is
the same but the acute lack of any relational ties is often also apparent. (Pearson
1987).
Taking into account Erikson’s view of intimacy being about displacing self interest
and being able to pay the cost of personal sacrifice there appears to be little hope
for addicts who have already formed their attachment to drugs to engage in this
form of intimacy. The participants in this study were addicts whose drug use was
problematic enough for them to have entered treatment, their ability to demonstrate
self interest by this time would no doubt be seriously impaired.
The importance of the capacity to be intimate has been discussed in clinical
literature recently although it has been included less in the conceptualisation
process of intimacy and addiction (Seginer and Noyman 2005). In order to
develop therapeutic tools for the treatment of the psychological and emotional
aspects of addiction discussions will need to include investigations into
identifying reasons for the lack of intimacy in relationships as well as reasons for
how the fear of intimacy develops. There may be emotional damage to start with
due to unmet developmental needs resulting from poor parenting but as well as
viewing addictions as an attempt to repair these deficiencies, the resultant
compounding of those existing traits, or the deterioration of existing abilities need
also to be considered. For example, shame and guilt features amongst addiction
literature as it relates to relationship functioning. Lutwak et al (2003) believe that
fear of intimacy is a direct correlate of shame on the sense of self.
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Researchers have identified fear of intimacy as cause of the lack of intimacy
however it could be due to a person simply lacking the tools to engage in close
relationships even though the desire to engage is present. In this case the issue
is not so much fear as an inadequacy or resource deficit. Beck and BeckGernsheim (1995) believe there are other reasons for poor functioning in
relationships and the lack of intimacy generally. They believe that the process of
individualisation has created a destructive glorification of intimacy where
traditional bonds of religion, family and class have diminished and where the
traditional norms and roles no longer determine a person’s behavior. According
to these sociologists; individuals look to romantic love in a more self-seeking and
self-centred way; to provide stability, meaning and a sense of self. Even if one
were to give credence to this statement, if addicts do not possess the internal
structure necessary to acquire romantic love their sense of self could never be
defined in this way.
As indicated by a review of the literature the most common precursors to difficulties
with intimacy are attributed by some as to having strong implications on a person’s
identity or to dysfunctional attachments in earlier childhood (Adams & Archer 1994,
Hoefler and Kooyman 1996, Thorberg and Lyvers 2005). Those researchers who
adopt Erikson’s descriptions conceptualise it in terms of the qualities of
relationships (Craig-Bray & Adams, 1986).
Orlofsky, (1993) and Orlofsky, Marcia, & Lesser (1973) undertook in-depth
research using semi-structured interviews using five intimacy-status parameters
which ranged from ‘isolation’ to ‘intimacy’. The continuity between the stages
underlying the model were emphasised in support of the identity and intimacy
model. In support of the identity-intimacy viewpoint Erikson (1968) argues, ‘‘It is
only when identity formation is well on its way that true intimacy—which is really a counterpointing as well as a fusing of identities—is possible’’ (135).
Accordingly, the formation
of identity as a process focuses on the self and is a necessary condition for the
development of intimacy as a process centring on interpersonal relationships.
However, since intimacy is concerned with interacting with others whilst the main
theme of identity is the self, it also contains relational aspects. Similarly whilst the
main theme of intimacy is close relationship, it also contains aspects of self, so that
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according to (Dyk & Adams, 1987; Grotevant & Cooper, 1986); identity and
intimacy share common elements of individuality and connectedness. Studies that
measured the relationship between identity and intimacy (Adams & Archer, 1994;
Dyk & Adams, 1990) supported the link between them. These studies also showed
that Erikson’s (1968) view that the identity –intimacy link is gender-related was not
empirically supported (Seginer and Noyman 2005). Although not specifically
related to the identity-intimacy link there was evidence in the study presented here
to support a variance in gender differences resulting from the FIS tool.
Intimacy can be analogous to the idea of addiction when viewed as the reliance
on external factors to regulate our internal states of stress and discomfort. In
other words, it is necessary, in order to feel emotionally balanced, to feel good
about oneself in relation to those close to us. Addictions then are connections
which impact upon persons inter and intra-personal dynamic experiences and
which can then become destructive of other relationships. This creates a
recurring situation so that it is often difficult for drug counsellors in a therapeutic
setting to distinguish the origins of dysfunction in relationships as pre or post the
onset of addiction.
According to attachment theorists, the correlation for addiction to substances
forming a self-soothing substitute behaviour resulting from the lack of adequate
care or intimacy in childhood can be attributed as the primary desire before the
desire for drugs. Adams & Archer (1994), Hofler and Kooyman (1996) and
Thorberg and Lyvers (2005) assert that unmet needs to attach to a prominent
figure; typically a parent and more specifically a mother, from childhood continue
into adult life. Subsequently, if those needs for protection, security, affirmation
and belonging are present yet the necessary tools or abilities to engage with and
attach oneself to a significant other are not present, it is understandable that
compensation may be sought in the use of drugs. These abilities and features of
intimacy are referred to by Schaefer and Olson (1981), as openness, honesty,
self-disclosure, care devotion, mutual attentiveness, commitment, surrender of
control, dropping of defences and emotional attachment. Kohut and Wolfe (1978)
write; “Individuals whose nascent selves have been insufficiently responded to will use
any available stimuli to create a pseudo-excitement in order to ward off the painful feeling
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of deadness that tends to overtake them………” (416).
In their view, “the individual’s
inability to obtain self-soothing via transmuting internalisations (234)
is the reason they
look for relief from those tensions in the use of substances. They argue that it is
their inability to calm and soothe themselves. This leads them to look outside of
themselves this means that for those who eventually discover drugs by whatever
means will no doubt form attachments to them. Flores (1997) describes a phase
prior to this; he argues that an addict’s life is dominated by a deficiency in which
s/he would experience themselves as being empty and deprived. “They believe
that if only another would supply them with this deprived ‘refuelling’, they could become
whole and complete.” (235) His
explanation continues to describe how they will
always be disappointed because as adults they have not learned to move away
from infantile interpretations of interaction in relationships. Such interpretations
formed around basic beliefs that if a person disappoints us it is because they
don’t love us become counterproductive to forming long term satisfying
relationships. As such they become lonely and resentful and more importantly,
they have no understanding of the part they play in the process.
According to Flores (1997) and supported by Lefever (2000) due to the
frustration endured as the result of continued unsuccessful relationships;
perceiving others predominantly as withholding and rejecting, it can result in the
denial of an addict’s own limitations and lead on to the denial of any need for
relationships. Flores argues that until addicts are able to form positive
relationships with others they remain vulnerable to addiction. This avoidance of
need creates alienation from others and self and makes the notion of one addict
helping another not only a success for 12 Fellowships in terms of promoting
recovery but also assists in reversing the isolation of self from society. Isolation in
this case is viewed as being a consequence of shame and one of the driving
forces behind addiction. Flores (1997) asserts that the use of chemicals
enhances the denial and fuels grandiose defences keeping an addict isolated but
that the recovery process brought about by the12 Step programme reverses this
process by requiring individuals to honestly admit that they do need substances
to survive but more importantly; that their hope for future survival depends on the
help of others.
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In fig 1 below; adapted from Flores diagram (245), a simple diagram defines
active addiction as the denial of the need for others leading to a denial of the
need for drugs and recovery consequently leads from acceptance of the need for
drugs leading to the acceptance of the need for others.
Fig 1
1)
Addiction
2)
DENIAL OF NEED FOR OTHERS
(“I don’t need anyone”)
DENIAL OF NEED FOR ALCOHOL AND DRUGS
(I am not addicted to alcohol or drugs”)
1st Step - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------------------------------------1)
Recovery
2)
ACCEPTANCE OF NEED FOR ALCOHOL AND DRUGS
(“I am an alcohol or an addict”)
ACCEPTANCE OF NEED FOR OTHERS
(“I need other people”)
Intimacy referred to in this paper is concerned with the ability to form and sustain
close meaningful relationships which are important in terms of belonging to the
social and cultural structures of the particular societies we live in. In addition the
concept includes taking into account the emotional and psychological needs of a
person to feel significant, loved and secure. Theories which include an
investigation of the etiological aspect of these not only include attachment
theorists but also merge into biological issues, issues of identity, and our more
basic needs as identified by evolutionary theorists.
Research into impoverished relationships amongst addicted populations has been
widely discussed and there is clearly an interest with regard to intimacy and direct
correlates to substance dependency. Thorberg and Lyvers (2005) investigated this
is their study. They employed three questionnaires in their research presented in a
paper; Attachment, fear of intimacy and differentiation of self among clients in
substance disorder treatment facilities. The first questionnaire they used was the;
Revised Adult Attachment Scale, (Collins 1996) which was designed to measure
how comfortable the participants felt with closeness and intimacy. The second was
the one used in this study, the Fear of Intimacy Scale (Descutner and Thelen,
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1991) this was used to assess inhibition and capacity to disclose intimate feelings
and thoughts to significant others. The third was the Differentiation of Self
Inventory (Skowron and Friedlander, 1998) designed to evaluate individuals’
significant relationships. Their findings confirmed that addicts reported significantly
higher levels of fear of intimacy than the controlled group in the study.
Keene (2004) discusses the contemporary formulation of addiction as being
related to unhealthy feelings about the self originating from childhood pain or
neglect. Her views link with one of the four abilities required for intimate
relationships; the ability to seek care, the ability to give care, the ability to feel
comfortable with an autonomous self, and the ability to negotiate. Accordingly the
connectedness necessary for intimacy in relationships is formed from a healthy
attachment to the mother and subsequently to significant others throughout life. If
this attachment is not cemented due for example to the mother not being
available emotionally then the detached child focuses its need for care onto
objects such as drugs.
Expanding on theories of Addiction:
Interpreting addiction as a kind of intimacy can be a useful way of making sense
of the intense relationships that addicts develop with substances and with
activities. Using an addictions perspective within Keane’s (2004) framework of
disordered desire, it is not the objects of addiction that determine the disorder but
an intense and rigid relationship between the addict and their drug. According to
Keane (2004) the increasing acceptance of addiction as an all-purpose model for
explaining unruly and troubling desires needs to be challenged. The study
presented here is not attempting to provide an all inclusive meta-theory, nor
challenge existing theory, rather there is arguably a need here for a paradigm to
understanding intimacy which includes Keane’s perspective for understanding
addiction and problems with intimacy but also draws on a range of other
perspectives.
The model of substance dependence set out in the American Psychiatric
Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
provides a clinical diagnosis of addiction. This manual is often referred to by
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addiction professionals to assist in distinguishing those substance misusers or
abusers from those considered to be dependent or addicts. It is difficult for
treatment professionals and researchers alike to distinguish between the two
populations. There is often more clarity for alcoholism and alcohol abuse than for
such drugs as heroin due to the addictive properties of the drug. DSM-IV defines
dependence as a “maladaptive pattern of substance use, leading to clinically
significant impairment or distress” and identifies major elements of the impaired
control over use of a substance and harmful consequences such as health
problems; financial, legal and employment difficulties; and strained family and
social relations.
Fig 2 (Koob and Moal 2000)
Such elements are noted through behavioral patterns or subjective states—for
example, taking a substance in larger amounts or over a longer period than
intended; a persistent desire or unsuccessful effort to control use; a great deal of
time spent in obtaining, using or recovering from use of a substance; and
important social, occupational or recreational activities given up in favour of
substance use. Significantly, while the DSM-IV states that withdrawal and
tolerance are often present, these signs of physiological change are not
necessary to make a diagnosis of dependence and are not found with some
substances. This minimization or de-emphasis on biological elements
(withdrawal and tolerance) in the definition of addiction goes against widely held
views that it is the presence of “physical” as well as “psychological” dependence
that marks a true addiction.
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Disorders of Desire
According to this theory addicts come to rely on experiences to achieve a desired
state of being. They limit gratification from other sources usually brought about
as the result of conforming to society’s norms and rules for success. Examples
might include working hard to achieve exam success at school and college or
achieving career promotions after dedicated commitment to work but might best
be illustrated by a house buying scenario; saving for a mortgage; several years,
getting a mortgage, and paying off a mortgage, around 25 years. By opting out of
these life options due to over-involvement with a mood-altering activity in favour
of achieving shorter term gratification serious social impairment occurs. Keane
(2004) points out that the reliance on models of addiction to evaluate and
interpret harm, feelings of compulsion and obsessive involvement with mood
altering substances emphasises its inevitable enmeshment with cultural norms
and ethical judgments about what people should value and what makes life
meaningful.
According to this view an addict’s priorities are profoundly disturbed and instead
of caring about work or family or other ‘normal’ responsibilities they will devote
themselves to the destructive pursuit of pleasure or oblivion. The addict in this
scenario is the fundamental opposite of the ideal of the rational, productive and
self-reliant adult. Ultimately then, addiction is a condition marked by caring too
much about destructive and disruptive things and not enough about the
constructive things that help us develop and advance in terms of fostering natural
feel good factors.
The modern term of addiction as a description of unhealthy feelings, (usually
unhealthy feelings about the self originating in childhood pain or neglect), is a
viewpoint that feeds into or expands the paradigm of addiction used here. When
analysing addiction with regard to feelings; levels of contentment, versus
depressed, anxiety and stress versus feeling at ease with self and others or
feeling ill versus at ease in the world, then the pattern of drug use and the nature
of consumption becomes much less relevant to the condition and its treatment.
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Medical experts have also come to emphasise feelings as having important
significance for addiction. Psychiatrist Aviel Goodman (1993) argues that “all
addictions are manifestations of a single underlying pathology related to the inability to
self-regulate emotional states”.
Addiction then is a process in which behaviour that
can produce pleasure and also provide escape from internal discomfort is used in
an uncontrolled and harmful way. In other words, addiction becomes a
dependence on things external as a way of regulating one’s feelings and sense
of self.
However, according to Leshner (1999) the emphasis on feelings does not signal
the surrender of biology to psychology in the field of addiction. The dominant
focus on feelings exists alongside increasingly powerful neurobiological
explanations of how destructive attachments take hold of us (Wilcox 2001;
McCauley 2003).
Addictions have varying levels of scientific legitimacy and popular acceptance,
according to Shaffer (1999). An important determining factor is how successfully
a scientist can account for the effects of drugs in the brain that feature
neurotransmitters and neural reward pathways. In neuroscience addictions are
all evaluated in terms of chemical properties, even if no drugs are involved as in
the case of gambling or sex addiction. Specific meanings and cultural
interpretations of pleasurable activities are reduced to a scientific cause and
effect model (Keane 2004).
Thinking about addiction in this way however sub-human this approach may
appear has a lot to offer studies on addiction. For example it removes all moral
judgements and de-stigmatises addiction by explaining that addiction happens in
mid-brain rather than in the pre-frontal cortex where such things as love, morality,
decency, responsibility, spirituality, free will and conscious thought are
understood and acted upon.
According to McCauley (2006) the mid-brain is simply a way-station for incoming
sensory information on its way to the cortex. He argues that moral issues of
personality and behaviour and social learning variables can concur with addiction
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but they cannot cause addiction, nor can addiction cause them. This is
demonstrated in fig 3, 4, 5 following.
Fig 3
The Frontal Cortex: Defective in addiction
Fig 4
It does not handle

Love

Morality

Decency

Responsibility

Spirituality

Free will

Conscious thought
Mid-brain is a way-station for
incoming sensory
information on the way to
the cortex
Fig 5
The Drug becomes Survival at the level of the unconscious
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Addictions trigger the release of serotonin, dopamine and or endorphins in the
brain which manage our experiences of pleasure. The brain becomes dependent
on internal fixes referred to as endogenous, just as it does on psychoactive
drugs, exogenous. Our human need for stimulation may drive us to seek out
pleasurable experiences; although in a healthy person not as an obsessive
activity, but it cannot cause addiction. The compulsive behavior of the addict may
work through the same mechanisms of neurotransmitter activation as other more
socially acceptable rewarding activities but addiction is powered by a mid-brain
where needs for survival take place. According to Goodman (1993) feelings enter
the neurological model because of the belief that our emotional frailties make us
susceptible to external mood modifiers but if one goes along with McCauley then
susceptibility can only lead a person to try self-soothing or self-regulation, it is
actually the brain that decides.
Berlant’s (1998) description of intimacy as being similar to the idea of addiction in
terms of the reliance on external factors to regulate our internal states described
earlier does not bring any moral judgements. There are no derogatory
descriptions or suggestions of any abnormality. Addictions here are connections
which impact and transform but like all intimate bonds they can become
destructive of other relationships. Also that dependency on others, including what
Berlant calls, non-human others, is a condition of life and not necessarily an
ailment to be cured. Thinking about addiction in this way allows us to discuss the
disruptive potential of the neurological account of compulsion, which identifies
valued and damaging pleasures as products of the same natural and necessary
process.
Acknowledging the prominence in modern society of ideals of physical and
emotional independence and separation from family our needs for connection
can be difficult to manage and relationships with people or things often go wrong.
Addiction makes sense as a way to understand compulsive attachments in a
cultural context which glorifies autonomy and self-reliance on one hand and the
rewards of romantic love and material possessions on the other. This view clearly
presents the high costs of losing self-control in a society where for the young, it is
considered cool to let yourself go and party.
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The move in the last decade to understand all addictive disorders as
fundamentally the same in their structure and etiology can obscure the complex
and often contradictory nature of the types of consumption. In addition, it does
not capture the numerous forms that failure to conform to these norms can take.
Nevertheless, models of addiction, whether based on neurotransmitters or
theories of intimacy, have the potential to be useful critical resources. They can
render irrelevant the distinctions between normal and abnormal and natural and
unnatural behaviour or give credence to addiction as an ethical and political
force.
Attachment Theory
The application of attachment theory to this study of adult drug dependant close
relationships provides a framework for understanding feelings and behaviours.
Working models (Bowlby 1973) are central to this approach. They are presumed
to guide how people operate in relationships and how they interpret their social
world. The present research directly explores this by incorporating attachment
style into a paradigm that also includes other models of intimacy concerned with
the developmental processes and patterns that affect feelings and behavior. This
study was designed to provide insight into the inhibitors of intimacy in addicts and
their attempts to self-repair attachment theory provides a valuable framework for
pursuing this.
Attachment theory is used here as a framework for understanding and
interpreting the data in the study. According to Collins (1996), every situation we
meet with in life is constructed in terms of the representational models we have
of the world about us and of ourselves. Information reaching us is selected and
interpreted in terms of those models, its significance for us and for those we care
about is evaluated in terms of them, and responses to situations are made with
these models in mind. According to Bowlby (1980), how we interpret and
evaluate each situation determines how we feel.
Thus, when adults engage in new relationships, they carry with them a catalogue
of past experiences both personal and interpersonal. These experiences affect
how they think, feel and behave in relationships. According to attachment theory
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frameworks for interpreting intimacy begin to develop during early parent-child
interactions and are then carried forward into adult relationships. They then
become a mind-map for how individuals manage their relationships and view the
world around them.
Bowlby (1973) coined the term working models to describe internal
representations of the world and significant people, including the self that begin
in infancy. Thus models are largely formed by the emotional caregiver's
availability and responsiveness to a child's needs. Whether infants’ attempts to
gain comfort and security are met determines the decisive classification of
secure, avoidant or preoccupied, within this theory. Cassidy (2001) argues that
‘secure attachment’ facilitates the ability to form intimate relationships and to
seek care and that models that begin their development in childhood are likely to
remain influential in adult life. This is because over time, experiences are
absorbed as beliefs and expectations about the warmth and responsiveness of
others and about the worth of self. These beliefs are then used to predict and
interpret the behaviour of others and to behave in old ways in new situations
without first evaluating them as unique experiences.
Secure adults are those described as comfortable with intimacy, willing to rely on
others when needed and confident and accepting of being loved and valued.
Avoidant adults on the other hand are those who are uncomfortable getting close
to people and depending on others although they tend to be unconcerned about
whether others will accept or reject them. The preoccupied adults possess a
strong desire for close relationships but generally experience difficulty depending
on others and, according to Cassidy, also tend to worry a great deal about being
rejected and abandoned.
Other studies showed that adults with different attachment styles differed greatly
in the way they viewed themselves and the world around them. Collins and Read
(1990) found that people with a more secure attachment style were higher in selfworth, more confident in social situations, and more self-assertive. Secure adults
also had more positive beliefs about the world around them and generally viewed
others as trustworthy, dependable, and well intentioned. Those with a more
preoccupied attachment style had low self-worth, self-confidence, and
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assertiveness and their view of others was much less positive and trusting. They
also believed that people had little control over their lives, and they viewed others
as complex and difficult to understand. Avoidant adults tended to have positive
views of themselves; high self-worth and assertiveness, although they saw
themselves as less confident in social situations and were not confident in
interpersonal encounters. They also had negative views of human nature; not
trusting others as trustworthy or dependable.
Studies generally found that secure adults reported more positive relationship
experiences than preoccupied or avoidant adults. Secure individuals generally
described their relationships as intimate, stable, and satisfying. In contrast,
avoidant adults tended to report low levels of intimacy, commitment, and
satisfaction, whereas preoccupied individuals reported jealousy, conflict, and
high levels of negative emotional experiences.
Peoples’ emotional responses and response patterns play a central role in
attachment theory. Cassidy (2001) argues that secure attachment is associated
with the capacity to participate in successful intimate relationships and that four
key abilities are required for participation in intimate relationships. These are; the
ability to seek care, to give care, to feel comfortable with an autonomous self,
and the ability to negotiate and choose the level of intimacy one intends to
engage in. Accordingly, intimacy is sharing and making one’s innermost self
known as well as accepting the innermost self of another. “It is being able to tell
both the good and bad parts of oneself, to tell of anger, ambivalence, love; and to accept
both the good and the bad parts of another, to accept anger, ambivalence, love. It is to
share the self: one’s excitements, longings, fears and neediness, and to hear of these in
another”. (122)
Thus, in order to be intimate a person must be capable of care-
seeking (123).
This means that a person must be able to turn to appropriately selected others
effectively when needed. This skill is learned by secure children who experience
parents as loving responsive and supportive. A second requirement is to be able
to trust that the self is loveable; determined by being valued in childhood.
(Research undertaken by Sroufe (1977) showed higher self-esteem for pre-
19
school children who were positively attached to their mothers than those who
were not)
Consequently, positive experiences further the capacity for intimacy by making
children confident enough to seek care because they feel worthy of receiving
care. (Cassidy 2001) Secure individuals will therefore bring a set of expectations
to new relationships that are conducive to allowing intimacy to be negotiated and
if chosen, to be developed.
The adaptive approach
The scope of theory related to drug dependency relates to diverse processes in
diverse areas, from tolerance and sensitivity in the dopamine system to the effect
of attachment on life’s coping strategies. The adaptive approach can provide a
useful analytical framework for examining specific underlying effects of addiction.
For example, with the dopamine system, the difference between independent
functioning and adaptive functioning in addition to the importance of the
environment in shaping the functional design of the system both come from
adaptationist thinking. (Lende and Smith 2002)
According to Lende and Smith (2002) an evolutionary approach can help in
developing our understanding of certain therapeutic interventions, for example,
therapies that deal with initial resistance to treatment due to deviance or denial
such as motivational interviewing (Miller & Rollnick 1991) are likely to be
effective. They need to be followed by more focused interventions which help to
develop better self-regulation and longer-term behavioral and life strategies. The
strongest submission in their studies is that; “until interventions deal with the
adaptive nature of the short-term life strategies individuals have developed, risk for
substance abuse—given how drugs signal immediate salience—will remain high as
individuals continue to seek short-term pay-offs” (455.)
They examine three
components to drug use and abuse; a biological mechanism comparable to
McCauley’s brain disease model, a developmental course equivalent to the
attachment model and a social development concept based on issues such as
dominance, submission and social dependence. Their paper outlines how
attachment affects self-regulation and examines also how inequality affects drug
20
abuse. From this perspective issues of social dependence and manipulative
behaviors play a role in relationships with drugs. The paper concludes with an
analysis of how the adaptive approach applies to interventions to treat addictive
behavior.
The impact of environment
Peele (1985) stressed that addiction relates to an experience constructed jointly
from pharmacological, individual, and socio-cultural sources. It is an experience
that is the interactive product of social learning involving physiological events as
they are interpreted, labelled and given meaning by the individual (Lindesmith
1968). The traditional view of the way to develop a successful future is to
emphasise restraint in terms of pleasure seeking in favour of a long-term
investment for security in later life. This conventional view offers few immediately
or short-term wins. For those with poor attachment whose world is not a secure
place it may make more sense to them to maximise short-term benefits. The
immediate short term effects of drugs may arguably offer the soothing,
stimulating, and motivating properties experienced by those experiencing the
eventual rewards for their restraint.
Negative emotional states like anxiety and interpersonal conflicts, feelings of
frustration, anger and social pressure can create an environment where drugs
are believed to be a positive amelioration of negative internal and interpersonal
feelings. In this context, the person desires the state drugs seem to provide even
if the ensuing state is actually not rewarding (Marlatt & Gordon 1985).
Attachment and regulation
Problems in parent and child attachment are related to drug use and abuse
through the developmental impact on self-regulation (Brook, Whiteman and Finch
1993). Parents are supposed to help children to modulate emotional states and
reduce internal tension (Cicchetti et al. 1996). This is adaptive because via the
parent it allows a child to match environmental patterns as well as safeguarding
against possible failure and the adverse psychological effects caused if these are
not addressed and remedied. (Hofer 1994). Parents who lack sensitivity and
21
appropriate reaction may fail to help to reduce tension and stress. In these
unconstructive attachment situations, emotional regulation involves inherent
trade-offs and “…makes non-optimal strategies of managing emotion expectable,
perhaps inevitable, in a context of difficult environmental demands and conflicting
emotional goals’
(Thompson and Calkins 1996 - 179).
According to this theory, when confronted by insensitive and damaging care
children generally manage to regulate on their own without the emotional support
parents ought to provide. According to (Brown 1998) though, this can often result
in a fragile regulatory system, which is a major risk factor for future substance
abuse. This can happen through poor emotion and attention regulation as well as
difficulties with self-consciousness, according to (Lende and Smith 2002) the
“addictive experience provides regular, stimulating and controlling effects and
compromised homeostatic systems can reorient around drug consumption” .
Thus, a
person with deficient self-regulation due to poor parental care can find in drugs
what has been missing, but according to Peele (1985); “none the less was
evolutionarily expected”. (452)
Drug use and deviance
Within evolution theory, the life history model predicts that children with less
access to resources are at an evolutionary disadvantage and will mature more
rapidly. Adolescents facing conditions of underprivilege “will take greater risks to
gain an immediate evolutionary advantage.”
They argue that this risk-taking includes
using drugs but also consists of “expensive or dangerous adult-like behaviours such
as early reproduction, high-risk resource acquisition; theft, ……in other words, general
deviance”
(Wilson and Daly 1985- 71).
Early attachment problems then can set up this developmental path which places
great emphasis on immediate gains. These problems lead to adolescents
adopting short-term strategies and becoming involved in more mature and or
untraditional behaviors for resource acquisition. These behaviours are often
enmeshed with sub-cultural values around peer affirmation and popularity and
‘street-cred’. Experimenting with drugs can form a part of this deviant behaviour.
Often young adults are compromised in their ability to handle the high-risk
behaviors they have become dependant upon for survival. Under these
22
conditions young adults focus on immediate issues with the resultant effect of
high vulnerability to deviance and to drug use.
Drugs often offer an escape from negative and depressive feelings or difficult
stressful situations (Cooper et al. 1995). In general individuals do not engage
consciously in dependent behavior with drugs, but rather fall into it as they
personalise the relationship with the drug and project learned dependent patterns
onto it. As addicts build a close relationship with a drug without recognising the
negative effects of the relationship, they will focus on the personal benefits of
drug use such as the release from depressive feelings. This argument is
supported by three assumptions: (Bourgois 1995); that in some cases drug
dependency is related to unequal social and economic conditions; that people
have the ability to displace patterns learned from interpersonal behaviours onto
objects (Krystal 1994) and that addicts tend to personalise their relationships with
drugs, often through symbolism (Anderson 1994). Thus, when addicts lend
human qualities to drugs and project patterns of behaviour from other areas of
their life onto them, their behaviour will be built upon, and will continue to develop
on, the very foundation of dependence.
Expectancy Theory
People generally begin to experiment with drugs because they expect to have a
positive experience. Those experiences range from heightened feelings of
euphoria to peace and calm concerning present circumstances. In order for a
person to identify drugs as something that will reduce their resource deficit in
relationships they must first encounter the drug. Few people come to their first
drug experience from a position of ignorance; children have already acquired
definite expectations about alcohol, for example, long before they ever drink it
(Orford 2001). Social Learning theorists refer to the acquisition of new
knowledge and behaviours by observing a model as a rapid and highly efficient
way of producing new learning and picking up complex social behaviours and
cultural norms. Peer group influence and experimentation in early stages of drug
use before the neuro-psychological processes take a hold and addiction is
formed is often neglected according to Sargent (1992), “Few writers appear to have
23
recognised that pleasure is a main motivation for the use of drugs, for they are too busy
seeking a deficit in the individual…….” (74).
Self-regulation can be defined as a person’s capacity to regulate their own
behaviour by using internal standards and self-evaluative assessments. It can
explain why behaviour continues despite a lack of external environmental
rewards. In the process of self-regulation humans make self rewards depending
on the achievement of a specific internal standard. If there is a discrepancy or
even a perceived discrepancy between internal standards and performance then
an individual will be motivated to change either the standard or the behaviour or
both. Addicts could be described as having a great deal of self-regulation. A large
part of their time and effort is devoted to obtaining the drug, using it and
concealing its use from others. Self-regulating could also be equated with coping.
Some addicts may use drugs or alcohol in order to cope or self-regulate
themselves with internal standards that are difficult to cope with due to past
trauma.
According to social learning theorists, the person, the behaviour, and the
environment are all thought to be continually interacting and influencing and
being influenced by each other. Each of the individual components can change
the nature of the interactions at any time, and in different situations each of these
components can assume dominance. White et al 1990 have outlined an
interactive model in fig 6 which explains alcohol consumption from a social
learning theory perspective.
Fig 6
PERSON
SOCIAL ENVIRONMENT
Affective states, Cognitive intellectual
Proximal Influences: Family, Friends,
capacity, Genetic factors, Coping
Colleagues.
resources, Values, Goals
Distal Influences: Socio-cultural group
membership, mass media institutions
DRINKING BEHAVIOUR
ALCOHOL
Pharmacological actions,
Perceived actions and experiences
24
According to social learning theory self-efficacy expectations are primarily
cognitive mediators that determine whether or not a person will engage in a
particular coping response. If self-efficacy regarding a particular coping skill is
high they will be more likely to use it in an attempt to cope with life. But if it is low
the person will be more likely use some other coping strategy with which they
feel more comfortable. Self-efficacy is a perception or a judgement of one’s
capacity to execute a particular course of action required to deal effectively with
an impending situation (Abrams and Niaura, 1987). There are two components of
self-efficacy: outcome expectations and efficacy expectations. An outcome
expectation is an estimate that a particular outcome will occur. An efficacy
expectation is a person’s belief that they can carry out the necessary course of
action to obtain the anticipated outcome.
Social learning theory views substance dependency as a basic failure of coping
(Abrams and Niaura 1987). This could be due to a combination of inappropriate
conditioning, reinforcement contingencies, modeling of inappropriate behaviours,
failure to model appropriate coping skills and reduced self-efficacy with regard to
behaviours that enhance coping.
Ellis (1988) believed that an adolescent’s decision to experiment with drugs was
influenced by beliefs perceived by the peer group and that lack of self-efficacy
could lead to difficulty in refusing. He believed that negative emotions based on
irrational beliefs together with an inability to tolerate frustration or other negative
emotions set the stage for using drugs as a means of coping with negative
emotions
Fig 7
Webb et al 1993: The Relationship among Social Factors, Expectancies and Alcohol Use
SOCIAL FACTORS
Peer influence,
Parental attitudes
EXPECTANCIES
ALCOHOL
USE
INTRAPERSONAL FACTORS
Tolerance of deviance,
Sensation seeking
25
Methodology
Design
Two questionnaires are used in the study. To establish the variance in
impoverished intimate relationships in the participant compared to the controlled
group both groups completed Descutner and Thelen’s Fear of Intimacy Scale,
(FIS). This tool has been validated as a reliable test/re-test measurement of
individuals’ anxieties about close dating relationships. In their study Descutner
and Thelen (1991) compared the self-report data from the questionnaires with
the individuals’ therapists’ ratings about their clients’ fear of intimacy. A second
questionnaire; Emotional Self- soothing Expectancy Scale, (ESES) was
specifically designed for this study. This tool was completed only by the
participant group to identify any expectations that drugs would provide a soothing
substitute for intimate relationships. The results were also intended to contribute
to the debate on why addicts turn to or form attachments to substances. Both
groups were given the materials to complete in their own time. The participants
completed theirs on the treatment facility premises in order to register their
details in the office to ensure receipt of the store voucher given for taking part.
The controlled group were more leisurely in their response; the time calculated
for all returns was circa three and a half weeks.
Participants
The participants were 24 substance dependant clients attending abstinence
based recovery services using facilitated 12 Step programmes in Bradford West
Yorkshire. Invitations to take part in the research were issued by staff working at
the relevant facilities. There was also a discussion relating to the purposes of the
investigation and issues of anonymity and confidentiality were explained.
Participants were asked to give only their initials and date of birth under the
Personal Details section of the questionnaire. Full names were retained against
initials by the treatment facility staff in order that store vouchers could be
distributed on completion. The group comprised 12 male and 12 female and ages
ranged from 23 to 43 with a mean age of 30.5 years. Seventeen participants
described themselves as being White/British, 1 as White/Irish, 1 Mixed Race
Asian, 1 Mixed Race Afro/Caribbean, 1 Asian British, 1 Asian, 2 as Afro
26
Caribbean. Six had been using drugs for 0-5 years, 10 for 5-10 years and 8 for
10-15 years. (See fig 35)
Heroin and Crack Cocaine were the most commonly used drugs; 21 of the 24
reported using Heroin as their first drug. Of those; 19 also used Crack Cocaine.
Fifteen reportedly used Cannabis; 11 reported Ecstasy (MdMa) use, 8
Amphetamine, 3 Cocaine, 6 Alcohol, 3 Benzodiazepines, (Diazepam), and one
person reported non-prescribed Methadone as ‘drug use’. No one reported as
using only 1 drug; 1 person reportedly used 6 drugs.
Fig 8
Type of Drugs Used
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Crack
Crack
Crack
Crack
Crack
Crack
Crack
Crack
Cannabis
Cannabis
Cannabis
MdMa
Amphetamine
Cannabis
MdMa
MdMa
MdMa
MdMa
Amphetamine
Amphetamine
Amphetamine
Cannabis
Cannabis
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Crack
Crack
Crack
Crack
Crack
Crack
Crack
Crack
Crack
Crack
Crack
Amphetamine
Alcohol
Cocaine
Alcohol
Methadone
Alcohol
Cannabis
Cannabis
Cannabis
Cannabis
Cannabis
Cannabis
Cannabis
MdMa
MdMa
Amphetamine
Amphetamine
Benzodiazepines
Benzodiazepines
MdMa
MdMa
Cocaine
Alcohol
Amphetamine
Alcohol
Alcohol
Cannabis
MdMa
Cannabis
MdMa
Cocaine
Benzodiazepines
The controlled group of 24 had professional and semi-professional backgrounds
with no self-reported history of substance misuse problems. They were similar in
age and gender to the participant group and approximately 50% of the group
worked in positions associated with drug dependency; the remainder were
friends and colleagues enlisted by them. Ages in this group ranged from 19 to 45
with a mean age of 31.25 years. Eighteen described themselves as White British,
3 as Afro/Caribbean British, 2 as Asian and 1 as Mixed Race Asian.
27
Apparatus
Two questionnaires were used in the study. Both the participants and the
controlled group completed ‘QUESTIONNAIRE 1’. ‘QUESTIONNAIRE 2’ was
only completed by the participants. In order to anonymise the information, a table
was attached asking for personal details; initials, date of birth, gender, and
ethnicity. The participants were asked for information on substance use history
and types of drugs used. The controlled group were asked for information
regarding their professional status. A letter to both groups was also attached to
the questionnaire/s explaining the procedure and purposes of the study.
Questionnaire 1 represented Part A and Part B of Descutner and Thelen’s 1991
Fear of Intimacy Scale, (FIS). In addition a second questionnaire was completed
by the participants; the 3Emotional Self-soothing Expectancy Scale, (ESES). This
was used to identify any expectations that the use of substances would provide a
substitute for intimate relationships. The titles of the questionnaires were not
revealed to the groups. This was to prevent any possible influencing of
responses. The title of the second questionnaire; Emotional Self-soothing
Expectancy Scale was particularly suggestive of the enquiry and it was
anticipated, may have affected responses.
The FIS tool was used because of its popular use as a research instrument.
Items on the questionnaire were developed from other extensively used test
measures. Eight items were included from Holt (1977) and two modified from
Erickson’s subscales, (Descutner and Thelen 1991).
Procedure
Invitations to take part in completing the self reporting questionnaires were
issued by staff working in the respective treatment facilities. The participants
used in this study had previously taken part in research from a number of
universities. It was explained that information would be anonymised. They were
given a £5 store voucher because previous researchers had obliged in this way,
the controlled group were also given a voucher. Both groups were informed that
they would be given access to the finished paper.
3
designed and so named specifically for this study
28
A letter attached to the questionnaire explained the purpose of the study and the
questionnaires provided instructions for completion. The FIS questionnaire was
in two parts; Part A and B. Part A comprised questions 1-30 and Part B 31-35.
4Part
A Instructions: [were as follows] “Imagine you are in a close, dating
relationship. Respond to the following statements as you would if you were in
that close relationship. Rate how characteristic each statement is of you on a
scale of 1 to 5 as described below, and put your responses on the answer sheet.
Part B Instructions: Respond to the following statements as they apply to your
past relationships. Rate how characteristic each statement is of you on a scale of
1 to 5 as described in the instructions for Part A. Note. In each statement “O”
refers to the person who would be in the close relationship with you”.
Fig 9
1
not at all
characteristic
of me
2
Slightly
characteristic of
me
3
moderately
characteristic of
me
4
very
characteristic of
me
5
extremely
characteristic of
me
The participant group were asked to follow the same procedure for the second
questionnaire (ESES). This was designed to measure the expectancies of the
effects that came with the use of drugs. The questions were designed to disclose
the expectation that use of substances would substitute for the poor quality of
close relationships. The questionnaire had 30 questions; 7 were red herrings
designed to distract from a conscious and immediate connection with any
intended outcome. These seven are shown here in fig. 10:
Fig 10
2.
When I take drugs I like listening to music
7.
When I take drugs I am not interested in going clothes shopping.
11.
I take drugs because my friends take them
14.
When I take drugs I am not interested in reading the papers or watching the news on TV.
When I take drugs I bathe less
I try to sort my problems out when I take drugs
I feel less lazy when I take drugs
16.
23.
30.
4
Instructions taken from the Fear of Intimacy Scale tool cited in Descutner and Thelen 1991
29
Of the remaining 23 questions 10 were correlated with questions in the FIS;
Fig 11
FIS QUESTIONS
1
I would feel uncomfortable telling 0
about things in the past that I have
felt ashamed of.
2
I would feel uneasy talking with 0
about something that has hurt me
deeply.
4
If 0 were upset I would sometimes be
afraid of showing that I care.
5
9
11
12
15
24
28
I might be afraid to confide my
innermost feelings to 0.
A part of me would be afraid to make
a long-term commitment to 0.
I would probably feel nervous
showing 0 strong feelings of affection.
I would find it difficult being open with
0 about my personal thoughts.
I would be afraid to take the risk of
being hurt in order to establish a
closer relationship with 0.
I would be afraid that I might not
always feel close to 0.
I would sometimes feel uncomfortable
listening to 0's personal problems.
ESES Questions
21
When I take drugs I expect to be able to cope
with feelings of shame and guilt associated
with things from my past
24
When I take drugs I expect to feel more
comfortable telling my experiences, even sad
ones, to O
5
When I take drugs I expect to be more able to
show those close to me that I care when they
are upset
1
When I take drugs I expect to be less afraid to
confide my innermost feelings to people
13
When I take drugs I expect to be less afraid to
make a long-term commitment in a
relationship.
9
When I take drugs I expect to feel more at
ease telling 0 that I care about him/her.
22
When I take drugs I expect to find it easier
being open with 0 about my personal thoughts.
15
When I take drugs I am less afraid of rejection
in relationships.
25
8
When I take drugs I expect to be able to have
a feeling of complete togetherness with 0.
When I take drugs I expect to be comfortable
discussing significant problems with 0.
Results
When the FIS total scores for the participant group and the controlled group were
added together there was only a small variance in score of 50. This was due to
some of the items in the Scale being marked with an X to show they had been
reversed and therefore produced a negative score. An X item, for example; “I
would feel comfortable telling O…………” or; a non-X question “I would be afraid
of telling O………….” By adding the total scores of positive and negative
responses the effect was that overall the scores evened themselves out with only
a variance in score of 50.
The participant group reported high scores on the items reporting ‘poor intimacy’;
the non-X items, and low scores on ‘good intimacy’ indicators the X items.
Conversely the controlled group scored low on ‘poor intimacy’ and high on ‘good
intimacy. When the X items were scored separately and excluded the non-X, the
score variance increased to 466.
30
Fig 12
FIS RESULTS: Total score variance, participant group and controlled group X and Non-X
total variance
Questions:
1-30
1018
Questions:
31-35
194
Total: 1-35
Total scores for FIS: Participant Group:
Female
Male
Total
970
1988
202
396
1172
2384
Total scores for FIS: Controlled Group:
Female
Male
Total
1074
1084
2158
141
135
276
1215
1219
2434
Scores: X questions, Participants:
Female
Male
Total
528
480
1008
*
*
*
1008
Scores: X questions, Controlled:
Female
Male
Total
742
732
1474
*
*
*
1474
Scores: non-X questions, Participants:
Female
Male
Total
490
490
980
194
202
396
684
692
1376
332
352
684
141
135
276
473
487
960
Scores: non-X questions, Controlled:
Female
Male
Total
* All 31-35 items were non-X
Variant
1212
50
466
416
The X items pointed to positive feelings, attributes and behaviours. For example;
X19 “I would feel comfortable trusting O with my deepest thoughts and feelings.”
On this item the difference in score was 40; participant group 56 and controlled
group 96. Item X22 also had a 40 score difference; “I would be comfortable with
having a close emotional tie between us.” Participant group 66 controlled group
106. (See fig 18).
The scores for the non-X items indicating poor functioning in relationships,
showed a variance of 416. This provided evidence to support the hypothesis that
the drug dependant group, (participants) had more impoverished relationships
than the controlled group.
Because the non-X and X items signify opposites they have been presented
separately. Fig 13 and 14 represent the non-X items of Part A and Part B of the
FIS. (Part B does not contain any X items). They show the variance in score for
31
each question based on the totals for each category; female participant, male
participant, female controlled group, male controlled group. Fig 17 represents the
X items contained in Part A. (Tables show total variance in descending order).
Fig 13
11.
15.
2.
4.
13.
9.
5.
28.
1.
12.
20.
23.
24.
26.
16.
FIS RESULTS: Variance; participant group and controlled group, non-X items in
descending order – (Part A)
Pg
Pg
Pg
Cg
Cg
Cg
TOTAL
TOTAL
F
M
F
M
I would probably feel nervous showing
37
33
70
19
20
39
0 strong feelings of affection.
37
38
75
23
23
46
I would be afraid to take the risk of
being hurt in order to establish a
closer relationship with 0.
38
35
73
22
23
45
I would feel uneasy talking with 0
about something that has hurt me
deeply.
30
25
55
12
15
27
If 0 were upset I would sometimes be
afraid of showing that I care.
30
32
62
17
17
34
I would feel uneasy with 0 depending
on me for emotional support.
34
34
68
20
25
45
A part of me would be afraid to make a
long-term commitment to 0.
35
35
70
26
23
49
I might be afraid to confide my
innermost feelings to 0.
25
27
52
16
18
34
I would sometimes feel uncomfortable
listening to 0's personal problems.
35
43
78
28
33
61
I would feel uncomfortable telling 0
about things in the past that I have felt
ashamed of.
34
27
61
21
23
44
I would find it difficult being open with
0 about my personal thoughts.
25
33
58
17
24
41
I would sometimes feel uneasy if 0 told
me about very personal matters.
33
25
58
23
19
42
I would be afraid of sharing my private
thoughts with 0.
36
30
66
26
26
52
I would be afraid that I might not
always feel close to 0.
27
34
61
22
27
49
I would be afraid that 0 would be more
invested in the relationship than I
would be.
34
39
73
40
36
76
I would feel comfortable keeping very
personal information to myself.
TOTAL
Fig 14
35.
33.
34.
32.
31.
490
490
980
332
352
Variance
31
29
28
28
28
23
21
18
17
17
17
16
14
12
<3
684
296
Variance results; non-X questions in descending order – (Part B)
(REFERENCE TO PAST RELATIONSHIPS)
I have done things in previous
relationships to keep me from
developing closeness.
There are people who think that I
am afraid to get close to them.
There are people who think that I
am not an easy person to get to
know.
I have held back my feelings in
previous relationships.
I have shied away from
opportunities to be close to
someone.
TOTAL
TOTAL BOTH COLUMNS; NON-X
39
39
78
23
24
47
31
39
41
80
25
30
55
25
34
35
69
22
23
45
24
43
45
88
37
28
65
23
39
42
81
34
30
64
17
194
202
396
141
135
276
120
684
692
1376
473
487
960
416
32
The highest variance, (fig 15) was for item 11; total pg >31. Pgf, >37, cgf >19,
pgm >33, cgm >20. The cgf feel the least nervous showing strong feelings and
affection. The cgf would feel the most nervous.
Fig 15
11.
I would probably feel nervous
showing 0 strong feelings of
affection.
Pg
F
Pg
M
TOTAL
Pg
Cg
F
Cg
M
TOTAL
Cg
37
33
70
19
20
39
Variance
31
The surprising anomaly was item 16 which is arguably ambiguous. This
produced a contra value of <3 on the total score. Cgf >40, pgf 34, pgm 39, cgm
36. The scores indicate that the cgf would feel most comfortable keeping
personal information to themselves and the pgf would feel the least comfortable.
Since this is included in the negative measures; non-X questions, it appears as
though this should be counted as a poor intimacy indicator. However it could be
argued that this question could be interpreted as having a healthy and positive
implication and in the context of the consistency of the variance of the remaining
items it has not been interpreted as demonstrating a poor intimacy indicator by
the controlled group.
Fig 16
16.
Fig 17
X19.
X22
X7.
X29
X17
X10
X21
X27
X18
X30
I would feel comfortable keeping
very personal information to myself.
34
39
73
40
36
76
<3
Variance; participant group and controlled group, X questions in descending order –
(Part A)
Variance
Pg
Pg
Pg
Cg
Cg
Cg
F
M
TOTAL
F
M
TOTAL
I would feel comfortable trusting 0
with my deepest thoughts and
30
26
56
46
50
96
40
feelings.
35
31
66
54
52
106
40
I would be comfortable with having a
close emotional tie between us.
28
29
57
47
49
96
39
I would have a feeling of complete
togetherness with 0.
38
28
66
55
50
105
39
I would feel at ease to completely be
myself around 0.
35
26
61
48
50
98
37
I would not be nervous about being
spontaneous with 0.
33
34
67
51
51
102
35
I would feel comfortable telling my
experiences, even sad ones, to 0.
33
29
62
47
50
97
35
I would be comfortable revealing to 0
what I feel are my shortcomings and
handicaps.
36
38
74
55
54
109
35
I would feel comfortable about
having open and honest
communication with 0.
31
33
64
51
46
97
33
I would feel comfortable telling 0
things that I do not tell other people.
39
41
80
56
54
110
30
I would feel relaxed being together
and talking about our personal
goals.
33
X6.
X25
X8.
X3.
X14
I would feel at ease telling 0 that I
care about him/her.
I would be comfortable telling 0 what
my needs are.
I would be comfortable discussing
significant problems with 0.
I would feel comfortable expressing
my true feelings to 0.
I would not be afraid to share with 0
what I dislike about myself.
TOTAL
36
34
70
51
48
99
29
38
26
64
46
43
89
25
37
38
75
48
50
98
23
38
36
74
47
42
89
15
41
31
72
40
43
83
11
528
480
1008
742
732
1474
466
Variance in score for positive indicators was more significantly marked; items
X19 and X 22 showed a variance of 40. Item X19; pgt 56, cgt 96. Cgm >50, cgf
>46, pgf >30, pgm >26. Cgm were most comfortable trusting O with their deepest
thoughts and feelings, pgm was the least comfortable. Item X22; pgt 66, cgt 106.
Cgf >54, cgm >52, pgf >35, pgm >31. Cgf were most comfortable having a close
emotional tie, pgm were the least comfortable.
Fig 18
X19.
X22
I would feel comfortable trusting 0
with my deepest thoughts and
feelings.
I would be comfortable with having
a close emotional tie between us.
Pg
F
Pg
M
Pg
TOTAL
Cg
F
Cg
M
Cg
TOTAL
Variance
30
26
56
46
50
96
40
35
31
66
54
52
106
40
Item X14 showed the lowest variance for total score; 11. Here the controlled
group males scored highest indicating they would not be afraid to share with their
partner what they disliked about themselves. However, the participant group
females scored 1 point higher than cgf and pgm scored significantly lower with a
score of 31 against the highest of 43; attributing most of the variance to pgm.
Fig 19
X14
I would not be afraid to share with
0 what I dislike about myself.
41
31
72
40
43
83
11
Regarding Erikson’s assertion (1968) concerning gender variation; results of this
study did show a difference in scores, particularly in response to certain
questions.
34
Fig 20
FIS RESULTS: Total score gender variance, pg and cg; X and Non-X
Questions:
1-30
1018
Questions:
31-35
194
Total: 1-35
Total scores gender variance pg:
Female
Male
Total
970
1988
202
396
1172
2384
Total scores gender variance cg:
Female
Male
Total
Gender variance X questions, pg:
Female
Male
Total
Gender variance X questions, cg:
Female
Male
Total
Gender variance non-X questions, pg:
Female
Male
Total
Gender variance non-X questions, cg:
Female
Male
Total
Fig 21
1074
1084
2158
48
65
53
13
24
28
33
41
24
37
1474
194
202
396
332
352
684
53
1008
*
*
*
490
490
980
87
1215
1219
2434
*
*
*
742
732
1474
M
1212
141
135
276
528
480
1008
Variant
F
684
692
1376
141
135
276
473
487
960
Variance in gender scores; female/male participant and controlled group
Total scores variance
Pgf
Pgm
53
87
Cgf
Cgm
48
65
>34
Gender variance X questions
53
<17
13
24
28
>40
Variance non-X questions
33
>4
41
24
37
<8
<13
Fig 22 - 31 set out variants for the participant group in descending order
differentiating non-X from X items and male from female.
Fig 22
1.
20.
26.
16.
13.
28.
Gender Variance, pgm/pgf - non-X descending order (PART A)
I would feel uncomfortable telling 0 about things in the past that I
have felt ashamed of.
I would sometimes feel uneasy if 0 told me about very personal
matters.
I would be afraid that 0 would be more invested in the relationship
than I would be.
I would feel comfortable keeping very personal information to
myself.
I would feel uneasy with 0 depending on me for emotional support.
I would sometimes feel uncomfortable listening to 0's personal
problems.
Pg
Gender
variance
Pg
F
Pg
M
TOTAL
35
25
43
33
78
58
M
8
8
27
34
61
7
34
39
73
4
30
25
32
27
62
52
2
2
F
15.
I would be afraid to take the risk of being hurt in order to establish a
closer relationship with 0.
TOTAL
I would be afraid of sharing my private thoughts with 0.
I would find it difficult being open with 0 about my personal
thoughts.
I would be afraid that I might not always feel close to 0.
If 0 were upset I would sometimes be afraid of showing that I care.
I would probably feel nervous showing 0 strong feelings of
affection.
I would feel uneasy talking with 0 about something that has hurt me
deeply.
TOTAL
23.
12.
24.
4.
11.
2.
37
38
75
1
33
34
25
27
58
61
8
7
36
30
37
30
25
33
66
55
70
6
5
4
38
35
73
3
32
33
Fig 23
5.
9.
I might be afraid to confide my innermost feelings to 0.
A part of me would be afraid to make a long-term commitment to 0.
35
34
35
34
0
0
0
0
Items 5 and 9 showed no gender variance. On the non-X items there was only
a one point difference for total scores, however when distinguished there were
some significant variables; items 1, 20 and 23 had an 8point difference. This
showed males to be more uncomfortable telling 0 about things in the past they
felt ashamed of and more uneasy telling 0 about very personal matters.
Conversely females were more afraid of sharing private thoughts with 0.
(Part A) – relating to current relationships; non-X
Of the non-X category only item15; (I would be afraid to take the risk of being
hurt in order to establish a closer relationship with 0), had a difference in score
of only (1>m); pgf >37, pgm >38. There was a difference of 2 (2>m) in the
score for item 28 (I would sometimes feel uncomfortable listening to 0's
personal problems), pgf >25 and pgm >27. There was also a 2 factor variance
for item 13, (I would feel uneasy with 0 depending on me for emotional
support), pgf >30, pgm >32; (2>m). Item 2 (I would feel uneasy talking with 0
about something that has hurt me deeply), was the only item with a variance
to the factor of 3; pgf >38, pgm >35, (3>f). Item 11 (I would probably feel
nervous showing 0 strong feelings of affection) varied to the factor of 4; pgf
>37, pgm >33 (4>f).
Items 4 and 16 varied to a factor of 5. Item 4; (If 0 were upset I would
sometimes be afraid of showing that I care) showed pgf >30, pgm >25; (5>f).
Item 16, (I would feel comfortable keeping very personal information to
36
myself) showed pgf >34, pgm >39; (5>m). Item 24 showed a 6 factor
variance, (I would be afraid that I might not always feel close to 0), pgf >36,
pgm >30; (6>f). Items 12 and 26 both confirmed a factor of 7. Item 12, (I
would find it difficult being open with 0 about my personal thoughts), pgf >34,
pgm >27; (7>f). Item 26, (I would be afraid that 0 would be more invested in
the relationship than I would be), pgf >27, pgm >34; (7>m).
(Part B)
The total variance factor for Part B; relating to past relationships was 8
with the highest individual item factor of 3. All variance factors related to
higher male scores; (8>m). Female participants reported only slightly less fear
of intimacy for Part B items.
Fig 24
31.
32.
33.
34.
I have shied away from opportunities to be close to someone.
I have held back my feelings in previous relationships.
There are people who think that I am afraid to get close to them.
There are people who think that I am not an easy person to get to
know.
I have done things in previous relationships to keep me from
developing closeness.
TOTALS
35.
Fig 25
X25
X14
X29
X17
X19.
X21
X22
X3.
X6.
X7.
X8.
39
43
39
34
42
45
41
35
3
2
2
1
39
39
0
194
202
0
8
Gender Variance, pgf/pgm - X items descending order
I would be comfortable telling 0 what my needs
are.
I would not be afraid to share with 0 what I dislike
about myself.
I would feel at ease to completely be myself
around 0.
I would not be nervous about being spontaneous
with 0.
I would feel comfortable trusting 0 with my
deepest thoughts and feelings.
I would be comfortable revealing to 0 what I feel
are my shortcomings and handicaps.
I would be comfortable with having a close
emotional tie between us.
I would feel comfortable expressing my true
feelings to 0.
I would feel at ease telling 0 that I care about
him/her.
TOTAL
I would have a feeling of complete togetherness
with 0.
I would be comfortable discussing significant
problems with 0.
37
Pg F
Pg M
Pg
TOTAL
variance
38
26
64
F
12
41
31
72
10
38
28
66
10
35
26
61
9
30
26
56
4
33
29
62
4
35
31
66
4
38
36
74
2
36
34
70
2
28
29
57
1
37
38
75
1
M
57
X10
X18
X27
X30
I would feel comfortable telling my experiences,
even sad ones, to 0.
I would feel comfortable telling 0 things that I do
not tell other people.
I would feel comfortable about having open and
honest communication with 0.
I would feel relaxed being together and talking
about our personal goals.
TOTAL
33
34
67
1
31
33
64
2
36
38
74
2
39
41
80
2
9
The variance was more notably marked for the X items denoting positive
feelings attributes and behaviours. Females demonstrated more skills over
males in their interactions in intimate relationships. On the Scale there were
no zero factor scores for variance. Fig 26 shows X7, X8 and X 10 as reporting
v ~ 1; (1>m).
Fig 26
X7.
X8.
X10
I would have a feeling of complete togetherness with 0.
I would be comfortable discussing significant problems with 0.
I would feel comfortable telling my experiences, even sad ones, to 0.
28
37
33
29
38
34
1
1
1
Fig 27 notes v ~ 2 for items X3, X6, X18, X27, and X30. X3 and X6 = pgf >2;
(4>f). X18, X27, X30 = pgm >2; (6>m).
Fig 27
X3.
X6
X18
X27
X30
I would feel comfortable expressing my true feelings to 0.
I would feel at ease telling 0 that I care about him/her
I would feel comfortable telling 0 things that I do not tell other people.
I would feel comfortable about having open and honest
communication with 0.
I would feel relaxed being together and talking about our personal
goals.
38
36
31
36
36
34
33
38
39
41
2
2
2
2
2
Items X19, X21 and X22 note v ~ 4. X19 and X21 = pgf >4; (8>f).
X22 = pgm >4; (4>m).
Fig 28
X19.
X21
X22
I would feel comfortable trusting 0 with my deepest thoughts and
feelings.
I would be comfortable revealing to 0 what I feel are my shortcomings
and handicaps.
I would be comfortable with having a close emotional tie between us.
30
26
4
33
29
4
35
31
35
26
4
Item X17 notes v ~ 9, pgf>9; (9>f)
Fig 29
X17
I would not be nervous about being spontaneous with 0.
9
Items X14 and X29 note v ~ 10; X14 – pgf >10, X29 – pgf >10; (20>f).
Fig 30
X14
X29
I would not be afraid to share with 0 what I dislike about myself.
I would feel at ease to completely be myself around 0.
41
38
31
28
10
10
38
26
12
Item X25 notes v ~ 12; pgf >12, (12>f).
Fig 31
X25
I would be comfortable telling 0 what my needs are.
38
ESES Results
The ESES contained 30 items. Items 2, 7, 11, 14, 16, 30 were red herrings
not connected with any intended enquiry, (see fig 8). They have not been
considered or included in the study. Items 12 and 20 shown in Fig 33 are the
same item reversed and have been dealt with separately. The results of the
remaining 21 items are shown below in fig 32. Results are shown for male,
female and total scores in descending order.
Fig 32
3.
18.
8.
19.
21.
17.
10.
24.
1.
15.
22.
4.
6.
9.
5.
13.
26.
27.
25.
29.
28.
ESES RESULTS; in descending order
When I take drugs I expect to feel better about things that have hurt me
deeply in the past.
When I take drugs I expect to feel more at ease with people.
When I take drugs I expect to be comfortable discussing significant
problems with 0.
When I take drugs I expect to feel better about myself and my
circumstances.
When I take drugs I expect to be able to cope with feelings of shame
and guilt associated with things from my past.
When I take drugs I expect to feel more comfortable just being myself
I don’t care about my problems when I take drugs
When I take drugs I expect to feel more comfortable telling my
experiences, even sad ones, to 0.
When I take drugs I expect to be less afraid to confide my innermost
feelings to people.
When I take drugs I am less afraid of rejection in relationships.
When I take drugs I expect to find it easier being open with 0 about my
personal thoughts.
When I take drugs I feel fine on my own
I like taking drugs on my own
When I take drugs I expect to feel more at ease telling 0 that I care
about him/her.
When I take drugs I expect to be more able to show those close to me
that I care when they are upset.
When I take drugs I expect to be less afraid to make a long-term
commitment in a relationship.
When I take drugs I feel alone
When I take drugs I expect to be able to express my true feelings about
things easier.
When I take drugs I expect to be able to have a feeling of complete
togetherness with 0.
I like other people more when I take drugs
I like myself more when I take drugs
TOTAL
I never call my friends when I take drugs
I call my friends more when I take drugs
F
M
TOTAL
60
44
47
43
107
87
40
45
85
41
43
84
46
38
84
36
46
82
45
40
35
40
80
80
39
40
79
39
37
40
42
79
79
35
34
35
43
40
39
78
74
74
33
40
73
37
36
73
36
34
37
35
73
69
37
29
66
30
25
803
31
29
818
62
54
1621
37
24
38
26
75
50
Fig 33
12.
20.
Participants were asked to rate their answers from not at all, to, extremely
characteristic of me. As fig 34 shows; some participants were consistent; KHf
and IWm responded by admitting that it was extremely characteristic of them
to never call their friends and not at all characteristic to call them more.
39
Others were significantly inconsistent as can be seen by the response made
Fig 34
Initials
Gender
MG
KH
IW
AZ
KE
AD
DJD
MM
JW
JS
JC
SF
KES
GH
JG
BS
SJH
RH
KG
BH
MT
CR
HS
RC
F
F
M
M
F
F
M
M
M
F
F
F
F
M
M
M
F
F
M
M
M
F
F
M
Item 12;
never call
5
5
5
5
4
4
4
2
2
3
3
5
1
5
4
4
3
2
2
2
2
1
1
1
Item 20;
call more
1
1
1
2
1
1
1
3
1
2
1
5
1
4
3
2
1
2
2
1
1
4
4
5
by SF who responded by saying
that it was extremely characteristic
of her to call her friends and
extremely characteristic of her not
to. GHm responded in a similar
vein. Similarly, KESf was unlikely to
never call, whilst at the same time
being extremely likely to call more.
MGf and RCm were entirely
consistent with their responses
albeit in reverse.
For both groups represented in fig 32, the highest scores, f=60, m47 on the
ESES scale were in response to item 3, When I take drugs I expect to feel
better about things that have hurt me deeply in the past. Items 18, 8 and 19
were the next highest with female to male ratios in scoring remaining similar.
The lowest scores were for items 29; I like other people more when I take
drugs, f=30, m=31, and for 28; I like myself more when I take drugs, f=25,
m=29. There were 24 participants who could have scored 5; extremely
characteristic of me, allowing for a total score of 105 for 21 items. The highest
score was 96f and the lowest was 39f; both these participants belonged to the
10-15 years duration of drug use category. The highest scores indicating
higher expectations that drugs will ease; or soothe discomfort or ease; soothe
situations and feelings were in the 5-10 years duration category. Apart form
the highest female score of 96 the remainder had the least expectations
rating; 15th 16th 17th 19th 22nd 23rd and 24th. Conversely the 5-10 years
category showed the highest expectations rating; 2nd 3rd 5th 6th 7th joint 8th 10th
40
and joint 11th The 0-5 years duration category had medium to poor
expectations apart from m=85 who was the exception and rated 4th.
Fig 35
Initials
Gender
Total Scores
Order
no.
Duration of drug use
SF
KH
DJD
BS
RH
JG
MG
AZ
HS
AD
IW
RC
CR
GH
BH
KG
MT
JS
JC
KE
KES
JW
MM
SJH
F
M
M
M
F
M
M
F
F
M
F
M
F
M
F
F
M
M
M
F
M
F
F
F
96
67
62
58
49
43
41
39
90
86
83
82
79
78
78
77
73
73
85
71
69
50
47
45
1
15
16
17
19
22
23
24
2
3
5
6
7
8
8
10
11
11
4
13
14
18
20
21
10-15
10-15
10-15
10-15
10-15
10-15
10-15
10-15
5-10
5-10
5-10
5-10
5-10
5-10
5-10
5-10
5-10
5-10
0-5
0-5
0-5
0-5
0-5
0-5
Types of drug used
H, C, Am, Can, Alc
Coc, Am, MdMa,
H, C, Alc
H, C
H, C, Alc
H, C, Alc
H, C, Am, Can
H, C, Coc, Can, MdMa, Alc
Am, Can, MdMa, Alc
Meth, Am, Can, MdMa
H, C, Can, Bzo
H, C, Can, MdMa, Bzo
H, C, Can
H, C, Am, Can, MdMa
H, C, Am, Can, MdMa
H, Am, Can, MdMa, Bzo
H, C, Can
H, C
H, C
H, C
H, C
H, C
H, C, Coc, Can, MdMa
H, C, Can, MdMa
This table shows which things are in the whatsit and what sit and they are
Fig 36
3.
18.
8.
19.
21.
17.
10.
24.
1.
15.
22.
4.
6.
9.
5.
13.
26.
27.
25.
29.
28.
Past hurts
Dropping of defences
Self disclosure
Dropping of defences
Dealing with shame
Openness
Contentment
Self disclosure
Self disclosure
Surrender of control
Openness
Isolation
Isolation
Care for others
Care for others
Commitment
Isolation
Openness
Dropping of defences
Care for others
Self care
41
F
M
TOTAL
60
44
47
43
107
87
40
41
46
36
45
43
38
46
85
84
84
82
45
40
39
39
37
35
40
40
40
42
80
80
79
79
79
35
34
35
33
37
36
34
37
30
25
43
40
39
40
36
37
35
29
31
29
78
74
74
73
73
73
69
66
62
54
The remaining 21 questions included some correlates with the questions in
the FIS.
Fig 37
FIS QUESTIONS with corresponding
Q. Nos
1
2
4
I would feel uncomfortable telling 0
about things in the past that I have
felt ashamed of.
I would feel uneasy talking with 0
about something that has hurt me
deeply.
If 0 were upset I would sometimes
be afraid of showing that I care.
ESES Questions with corresponding Q. Nos
score
score
78
84
24
73
I might be afraid to confide my
innermost feelings to 0.
9
A part of me would be afraid to
make a long-term commitment to 0.
11
I would probably feel nervous
showing 0 strong feelings of
affection.
I would find it difficult being open
with 0 about my personal
thoughts
I would be afraid to take the risk of
being hurt in order to establish a
closer relationship with 0.
I would be afraid that I might not
always feel close to 0.
24
I would sometimes feel
uncomfortable listening to 0's
personal problems.
73
9
70
61
79
15
75
When I take drugs I expect to find it easier
being open with 0 about my personal
thoughts.
When I take drugs I am less afraid of
rejection in relationships.
79
25
66
8
52
When I take drugs I expect to be able to
cope with feelings of shame and guilt
associated with things from my past
When I take drugs I expect to feel more
comfortable telling my experiences, even
sad ones, to O
When I take drugs I expect to be more
able to show those close to me that I care
when they are upset
When I take drugs I expect to be less
afraid to confide my innermost feelings to
people
When I take drugs I expect to be less
afraid to make a long-term commitment in
a relationship.
When I take drugs I expect to feel more at
ease telling 0 that I care about him/her.
74
22
66
28
79
13
68
15
73
1
70
12
80
5
55
5
21
85
When I take drugs I expect to be able to
have a feeling of complete togetherness
with 0.
When I take drugs I expect to be
comfortable discussing significant
problems with 0.
Now I’m gonna look at individuals who scored high on these.
My sample did not go through the DSM1V manual to see if they were addicts
or substance misusers and I would expect to find some misusers who scored
freaky scores
Discussion
As expected the participant group scored high for poor intimacy demonstrating
more impoverished relationships than the controlled group. The highest score
for the participant group was for question 32 in Part B of the FIS; “I have held
back my feelings in previous relationships.” Analysis of the response to this
question needs to be considered in view of the fact that at the time of taking
42
part in the study none of the participants were in relationships. 5This being due
to rules regarding relationships at the respective treatment centres attended. It
may be reasonable to assume therefore that participants were referring to
their most recent past relationships when giving their responses.
The results were presented showing the variances between participants and
controlled group. The responses with the biggest variance were; item X19, “I
would feel comfortable trusting 0 with my deepest thoughts and feelings.” The
total for the participant group was 56 and for the controlled group 96 out of a
possible score of 120.
Gender variance was taken note of and for item 1 “I would feel uncomfortable
telling 0 about things in the past that I felt ashamed of”, the males in both the
participant group and the controlled group were seemingly more afraid than
the females. In item X25 “I would be comfortable telling 0 what my needs are”,
there was a 12 point variance in male to female ratio; with females feeling
more uncomfortable disclosing their needs.
The results for the ESES showed higher expectations for relief from past
hurts, and expectations for feeling more at ease with people. Expectations
were higher for increasing ability for dropping of defences and enhancing self
disclosure. Caring for others and self care were low on the list of expectations.
Participants with the highest expectations for self soothing were those in the
5-10 years duration of drug use category and those with the least were in the
10-15. This fits with the view of Marlatt and Gordon (1985), that drug use often
continues far beyond the positive effects and amelioration of negative feelings
has ceased and when the resulting state is not rewarding. It also fits with what
is commonly reported by heroin addicts with a protracted drug using history;
that they just take it to feel normal without having any positive expectations.
According to the attachment theorists the controlled group scores in this study
qualified them as secure adults; comfortable with intimacy, confident and
accepting of being loved and valued.
5
Both Day Treatment Programmes attended by the participants follow the principles of the 12 Step Fellowships;
specifically that recovery depends to a large extent on abstaining from romantic relationships for the first 12 months
of recovery.
43
The participants on the other hand showed signs of having a very insecure
attachment style. They were inhibited in their ability to show feelings of
affection, be close to, or depend on others. This was consistent with other
evidence that drug dependency is associated with relationship problems.
(Skowron and Friedlander 1998)
Collins and Read (1990) found that people with a more secure attachment
style were higher in self-worth, more confident in social situations, and more
self-assertive. Secure adults also had more positive beliefs about the world
around them and generally viewed others as trustworthy, dependable, and
well intentioned. Those with a more preoccupied attachment style had low
self-worth, self-confidence, and assertiveness and their view of others was
much less positive and trusting. They also believed that people had little
control over their lives, and they viewed others as complex and difficult to
understand. Avoidant adults tended to have positive views of themselves; high
self-worth and assertiveness, although they saw themselves as less confident
in social situations and were not confident in interpersonal encounters. They
also had negative views of human nature; not trusting others as trustworthy or
dependable.
Studies generally found that secure adults reported more positive relationship
experiences than preoccupied or avoidant adults. Secure individuals generally
described their relationships as intimate, stable, and satisfying. In contrast,
avoidant adults tended to report low levels of intimacy, commitment, and
satisfaction, whereas preoccupied individuals reported jealousy, conflict, and
high levels of negative emotional experiences.
Peoples’ emotional responses and response patterns play a central role in
attachment theory. Cassidy (2001) argues that secure attachment is
associated with the capacity to participate in successful intimate relationships
and that four key abilities are required for participation in intimate
relationships. These are; the ability to seek care, to give care, to feel
comfortable with an autonomous self, and the ability to negotiate and choose
the level of intimacy one intends to engage in. Accordingly, intimacy is sharing
and making one’s innermost self known as well as accepting the innermost
44
self of another. “It is being able to tell both the good and bad parts of oneself, to tell
of anger, ambivalence, love; and to accept both the good and the bad parts of another,
to accept anger, ambivalence, love. It is to share the self: one’s excitements, longings,
fears and neediness, and to hear of these in another” . (122)
Thus, in order to be
intimate a person must be capable of care-seeking (123).
This means that a person must be able to turn to appropriately selected others
effectively when needed. This skill is learned by secure children who
experience parents as loving responsive and supportive. A second
requirement is to be able to trust that the self is loveable; determined by being
valued in childhood. (Research undertaken by Sroufe (1977) showed higher
self-esteem for pre-school children who were positively attached to their
mothers than those who were not)
Consequently, positive experiences further the capacity for intimacy by
making children confident enough to seek care because they feel worthy of
receiving care. (Cassidy 2001) Secure individuals will therefore bring a set of
expectations to new relationships that are conducive to allowing intimacy to be
negotiated and if chosen, to be developed.
45
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