Reactive attachment disorder (RAD) is a condition that develops in infancy or early childhood, characterized by a pattern of disturbed and developmentally inappropriate attachment behaviors. Moreover, the child never or rarely seeks comfort, protection, support, or nurturing from an attachment figure, such as parents. In extreme cases, and if left untreated, RAD can persist into adulthood.
Long-lasting social and emotional disturbances characterized by two of these:
- Minimal emotional and social responsiveness to other individuals
- Minimal expressions suggesting positive emotions
- Frequent bouts of unexplained sadness, irritability, or fearfulness, or irritability that occur even when the individual is involved in interactions with others
According to the DSM-V, inadequate caregiving experiences, as evidenced by one or more of the following criteria:
- The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
- Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
- Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with child-to-caregiver ratios).
Problems if the Disorder Remains Unaddressed
It has been suggested that children affected by this disorder who do not get adequate treatment may not develop secure attachments with adult caregivers, causing significant problems later in life. These can include relationship problems and an increased risk of substance abuse and developing various other physical and psycho-emotional issues. However, large-scale studies with sufficient data don’t exist at this time.
There is very little supporting data connecting substance use disorders specifically with a childhood diagnosis of RAD. Still, there is some evidence suggesting a link between an increased risk for substance use and a diagnosis of RAD—particularly if the disorder is not effectively treated.
The condition is usually treated in childhood using therapy and by having the child consistently interact with a concerned caregiver so that he or she can begin to form a meaningful bond. Often, when therapists and caregivers exercise extreme understanding and patience with the child, long-term development of secure emotional attachments between the child and caregivers can transpire.
The Relationship Between Substance Abuse and Reactive Attachment Disorder
The first line of evidence that persons affected by unresolved attachment issues can later be at an increased risk for developing substance abuse issues comes from research regarding the relationship between having a trauma- or stressor-related disorder, such as RAD, and an increased risk of engaging in problematic substance.
A well-established risk factor for substance abuse development is the early experience of extreme neglect, abuse, stress, and a diagnosis of reactive attachment disorder requires that the person has a history of extreme stress or neglect.
Another line of evidence suggests that individuals diagnosed with RAD in childhood may be at risk of developing substance abuse issues if the disorder cannot be addressed. There is an association between various forms of substance abuse and dysfunctional efforts to foster relationships. In fact, some investigators have actually labeled substance abuse issues as forms of dysfunctional relationships between the individual and substance of choice.
Moreover, the person seeks solace from using drugs or alcohol that they would typically try to obtain from close personal relationships with others. Instead of leaning on a parent, spouse, or other loved ones for emotional support, they bury their feelings via substance abuse.
Therefore, persons with a childhood history of RAD that have not been treated or fully resolved may develop long-lasting attachment problems and clinical depression that could place them at an increased risk of abusing intoxicating substances.
The clinical features of unaddressed RAD as they manifest in adults are not well documented, but some sources suggest that additional potential issues can occur, such as the following:
- Impulsivity in many behaviors
- Resistance to guidance and affection from others
- Problems with trusting others
- Problems with anger and resentment
- Difficulties processing positive feelings
Getting Help for Addiction and Mental Health Disorders
Substance abuse and co-occurring mental health disorders should be addressed simultaneously using a comprehensive, long-term treatment program, such as those offered by Just Believe Recovery, that includes a variety of evidence-based therapies and activities, such as the following:
- Behavioral therapy
- Peer group support
- Individual and family counseling
- Health and wellness education
- Substance abuse education
- Relapse prevention
- Experiential activities
- Aftercare planning