Addicted and Attached: A Neglected Perspective on Neuroscience Research Linking Addiction and Love

International Neuroethics Society Essay Winner, 2016


July 13, 2017

Each year the International Neuroethics Society (INS) holds a Student/Postdoc Essay Contest to promote interest in neuroethics among students and postdocs early in their academic careers. This is one of the two winning essays for 2016; the other is by Kaitlyn McGlothlen.

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 The 2016 INS Student/Postdoc Essay Contest winners Kaitlyn McGlothlen and Monique Wonderly, center and right, received a Michael Patterson Neuroethics Travel Stipend, presented by Dr. Michael Patterson, pictured left. Photo courtesy of INS

By Monique Wonderly, Princeton University Center for Human Values, postdoctoral research associate in bioethics

Introduction

Recent neuroscience research strongly suggests that addiction and romantic love share similar neural substrates. Theorists have adduced these findings to argue that some paradigmatic cases of interpersonal love can be usefully construed as addictions and thus, like more typical cases of addiction, as viable candidates for medical treatment. A related proposal that has been neglected in the relevant literature is that some paradigmatic cases of addiction might be plausibly construed as (pathological) emotional attachments. In what follows, I consider and defend a version of this proposal. Specifically, I suggest that many substance addictions represent hyper-attachment orientations toward their objects, and this has important implications for how addiction should be understood and treated.

Neural Overlap between Addiction and Love

Addiction and romantic love share strong similarities at the levels of phenomenology and psycho-behavioral structure. Addicts and lovers alike often employ terms like “euphoria” and “bliss” to describe what it feels like to engage with the relevant objects, while invoking feelings of “longing” and “despair” to capture the experience of being deprived of such engagement (Earp et al forthcoming; Lewis 2015; Burkett and Young 2012). Also, addicts and lovers exhibit similar patterns of cognition, motivation, and action toward the relevant objects. Elements of these patterns include obsessive thoughts, intense cravings, and engagement-seeking behaviors (Lewis 2015, Fisher et al 2010).

Perhaps unsurprisingly, addiction and romantic love also share deep neural commonalities. The neural responses of lovers toward their beloveds often resemble those of addicts toward the objects of their addictions. The very sight of one’s beloved can cause increased activity in brain regions correlated with craving in cocaine addicts, including the ventral tegmental area, accumbens core, an area of the accumbens-ventral pallidum, and an area deep in the middle frontal gyrus (Frascella et al 2010, 305).  Numerous studies suggest that addiction and romantic love have similar neural signatures, both of which implicate reward pathways involving the release of dopamine and other neurochemicals (Earp et al forthcoming; Lewis 2015; Fisher 2014; Fisher et al 2010; Frascella et al 2010; Insel 2003).  In a recent review, neuroscientists, James Burkett and Larry Young, posit a “deep and systematic concordance” between the brain regions and neurochemicals involved in addiction and love (Burkett and Young 2012, 2). 

On one approach, these findings support the view that some cases of interpersonal love might be usefully construed as addictions. Several theorists have taken this tack, suggesting that some kinds of love might be potential candidates for addiction treatment (Earp et al forthcoming; Fisher 2014; Burkett and Young 2012). On another compatible, though under-explored approach, the aforementioned findings support the view that some paradigmatic cases of addiction might be plausibly construed as emotional attachments. This view, while unconventional, can yield interesting insights relevant to the neuroethics of addiction. 

Substance Addictions as Emotional Attachments

While many agree that persons can become addicted to behaviors, prototypical addictions generally have substances as their objects. Describing someone as “attached to a drug” may sound odd, but theorists sometimes do employ such locutions. Psychologist, Philip Flores, variously describes some addicted patients as “attached to chemicals” and “attached to alcohol” (Flores 2004, 4, 34-36). Neuroscientist, Marc Lewis, describes one addict as having “bonded with meth” (Lewis 2015, 74). On my view, it is plausible to characterize some addicts as emotionally attached to particular substances. To see why, let’s begin with an account of attachment.

According to what psychologists call “attachment theory,” human infants typically develop a special bond with their primary caregivers. This bond is characterized by a set of evolutionarily adaptive behaviors that provide the infant with a sense of security. The attached infant attempts to remain in close proximity to her primary caregiver, treats her as a ‘‘secure base’’ from which to safely explore unfamiliar surroundings, seeks her out for protection as a ‘‘safe haven’’ when threatened, and protests separation from her (by clinging, crying, etc.). (Bowlby 1969/1982). Interestingly, psychologists have noted that versions of these behaviors also typify adult long-term romantic partnerships. Adults typically seek proximity to their romantic partners and protest (prolonged) separation from them. Our romantic partners also function as secure bases and safe havens for us. When they are nearby, we feel more competent exploring new environments and taking on challenges. Also, when distressed, we tend to turn specifically to our romantic partners for support (Mikulincer and Shaver 2007; Collins et al 2006). This conception of attachment has since been expanded to include attachments to objects and ideas, a broadened sense of security, and an emphasis on engagement with (rather than mere proximity to) the relevant object (Wonderly 2016).

Central to attachments of this sort is the notion of security. In an earlier work, I argued that the relevant sense of security is not identical to a mere feeling of safety or comfort (Wonderly 2016). Drawing on psychological literature, I suggested that security be understood as a kind of confidence in one’s well-being and agential competence (Maslow 1942; Blatz 1966; Ainsworth 1988). In colloquial terms, without our attachment objects, we often feel “out of sorts,” off-kilter, “no longer all of a piece,” etc. Engagement with our attachment objects helps us feel “on solid ground,” more stable, and more competent. As these descriptions illustrate, a reduced sense of security has an affective, or emotional, element tied to one’s agency. Individuals whose felt security is compromised often feel emotionally fractured and as though they are unable to get along in the world as well.

Given the above, we can define one type of attachment as follows. To be attached is (1) to have a relatively enduring desire for engagement with a particular object, where (2) such engagement typically increases one’s felt security and (3) prolonged separation from the object typically reduces one’s felt security. With this account in hand, we can now assess the plausibility of construing substance addictions as emotional attachments.

Let’s begin with (1). Do addicts have a relatively enduring desire for engagement with a particular object? Importantly, “engagement” is an intentionally broad term meant to capture a variety of possible interactions between attached individuals and their attachment objects. For example, one might converse with a person, cuddle a blanket, contemplate an idea, or even engage with an activity like running by doing it – i.e., by running (Wonderly 2016). In many cases, substance addicts appear to have a relatively enduring desire to engage with (drink/inject/smoke) a particular substance (alcohol/heroin/cocaine), as opposed to just any substance that would produce a similarly pleasing effect.

Now consider (2). Does engagement with the substance, so construed, tend to enhance the addict’s felt security in the relevant sense? In many cases, it would seem so. Consider, for example, that philosopher, Owen Flanagan, described his drug of choice as providing a “safe-haven feeling,” allowing him to escape a kind of “existential anxiety” (Flanagan 2011, 275). Addicts also often recount how they began using precisely because the substance allowed them to feel “self-confident,” “courageous,” “masterful,” making one’s direction “clear-cut” and putting one “at ease” in social interactions (Knapp 1996, 5; Lewis 2015, 144, 176, 178; Anonymous 2001, 502). These descriptions suggest a strong connection between the substance and the addict’s felt security.

Finally, as per (3), going without the relevant substance often results, not only in physical pain, but in addicts feeling off-kilter, out of sorts, etc. Philosopher, Francis Seeburger, explains, “Whenever addicts are practicing their addictions, then by definition, they feel ‘all right.’ In contrast, whenever addicts are not practicing their addictions, it feels to them as if something is wrong…In some way that they cannot further specify, things just feel out of joint to them” (Seeburger 1996, 55). While perhaps not all addictions have this feature, it seems likely that many do.

If the preceding analysis is correct, then it is plausible that many substance addictions represent emotional attachments. Doubtless, some will remain unpersuaded. One might retort that substance use often reduces the addict’s felt security. I agree that this does occur, but it does not undermine the present proposal. Something might enhance an individual’s felt security in some respects, while reducing it in others. Think here of the abused spouse who realizes that leaving her husband would, all things considered, improve her security and well-being but cannot bring herself to leave because in some elusive sense, she just doesn’t feel “alright” without him.

One might also protest that my view conflicts with more intuitive, standard conceptions of addiction. On one such conception, addicts do not have security-based emotional needs for particular substances, but rather they have persistent, pleasure-oriented desires for certain drugs that confer pleasing bodily sensations. On this view, if an addict feels more secure when using, and less secure when not using, it is only in the senses that a pain sufferer feels more “secure” (i.e., better and more competent) when taking analgesics and that a hungry person feels “insecure” without food. The emotional richness of such experiences seems negligible.

While this worry is understandable, I want to suggest that the standard picture is ill-equipped to capture many cases of substance addiction. In his memoirs, Lewis emphasizes both the emotional character of addiction and its security-related aspects. He writes, “The drug… stands for a cluster of needs: in my case, needs for warmth, safety, freedom, and self-sufficiency” (Lewis 2013, p. 256). Consider also that addicts sometimes characterize their addictions in terms of their relationship with the substance. Lewis explains that for one addict, “quitting meth was like turning his back on a friend or lover” and caused him “heartbreak” similar to the sort that typifies romantic break-ups (Lewis 2015, 167-168). The Big Book of Alcoholics Anonymous is rife with examples of individuals referring to alcohol as a friend or companion (Anonymous 2001, 310, 389, 447). On a recent NPR radio program, one health department worker and former heroin user explained, “Heroin has always been a great companion for people that are dependent…Best friend. It can talk to you…” (Cornish 2/24/2016). These attitudes do not seem consonant with viewing the object of one’s addiction merely as a source of pleasure or emotionally comparable to one’s (typical) orientation toward food or painkillers.

Thus, there is a substantial basis for construing some substance addictions as emotional attachments to their objects. Importantly, the relevant kind of addictions represent pathological, hyper-attachment orientations, as opposed to ordinary emotional attachments. Their constitutive desires tend to be especially recalcitrant and intense, and their security-laden affects, especially severe. Such addictions often involve – in addition to emotional attachment – other features such as chemically-induced, artificial neural reward signals, physiological tolerance, and withdrawal syndromes. Yet, these features, while complicating the picture, need not obscure the central role played by emotional attachment.

Implications

If, as I have urged, some addictions represent security-based emotional attachments, then the need for felt security likely plays a significant role in motivating many addictive behaviors. This conflicts with the view that addictive motivation is primarily a matter of pleasure-oriented desires – a view often thought to be supported by neuroscientific research findings (Foddy and Savulescu 2007; 2010). Felt security is not reducible to mere pleasure, just as felt insecurity differs from both the physical pain of withdrawal and the mental discomfort associated with unfulfilled desire. Psychologists have long suspected that the need to restore and maintain a sense of security typically enjoys a kind of primacy over other human needs (Bowlby 1969/1982; Collins et al. 2006; Mikulincer and Shaver 2007). Because of the import of one’s felt security, individuals are prone to experience the need for their attachment objects as especially compelling. This feature, then, might partially account for the conative force of some addictions. This could help to provide a new ground for mitigated moral and legal responsibility for certain addictive behaviors and explain their recalcitrance to treatment options that neglect their security-related emotional underpinnings.

First, ethicists sometimes suggest that an individual’s moral and/or legal responsibility for violating a norm (at least partially) depends on the extent to which we could reasonably expect the individual to refrain from violating the relevant norm (Watson 1999). Those who are unpersuaded that an addict’s strong desires to consume some pleasure-conferring substance can undermine his or her moral or legal responsibility might be more moved by the motivating role of security-based attachment. Psychologists have suggested that when one’s sense of security is severely compromised, the typical human being is less able – and sometimes wholly unable – to recognize and to respond to other needs and values (Mikulincer and Shaver 2007). Thus, if the drive to restore and maintain one’s sense of security is operant in motivating addictive behaviors, then we have added cause to suspect that in some cases, it might be unreasonable to expect the addicted individual to refrain from – and to hold him or her fully responsible for – performing (some of) those behaviors. This will of course depend on the details of the particular case.

Also, conceiving of some addictions as security-based emotional attachments might also have implications for how best to treat the relevant forms of addiction. For example, it would favor approaches that supplement detoxification with therapy and neuropharmaceuticals aimed specifically at addressing the addict’s diminished felt security. While this would commend some approaches that are fairly common – e.g., individual counseling and anti-anxiety medications – it might also support some methods that are less conventional. Here I have in mind oxytocin treatment and attachment therapies that might help addicts replace attachments to their substances with more productive security-building relationships and activities (see, for example, McGregor and Bowen 2012 and Flores 2004).

Conclusion

I have argued that there that some addictions are aptly construed as (disordered) security-based emotional attachments. I have also suggested that viewing addiction through the lens of emotional attachment helpfully illuminates neuroethical perspectives on the nature and treatment of addiction. Further investigating the emotional structure of addiction can aid our understanding of its motivational force, the responsibility of addicts, and the best treatment options.