Childhood trauma and attachment styles among substance abusers in Turkey

Background: Early trauma exposure is well known to significantly increase the risk of developing a number of psychiatric disorders, especially addiction in adulthood. Literature has shown insecure attachment styles can be correlated with substance abuse. However, there is a lack of research on the relationship between childhood trauma and attachment styles among Turkish substance abusers. Objective: The aim of this study was to evaluate the childhood trauma and attachment styles of alcohol/substance abusers. Methods: A cross-sectional study was conducted from April 2014 to December 2015 in Ege University Department of Psychiatry alcohol/drug dependency unit. Participants included 289 substance abusers. All participants were assessed using a Childhood Trauma Questionnaire and Experiences in Close Relationships Scale. Analysis of variance, correlation and t-test were performed to determine childhood trauma and attachment styles among substance abusers. Data were collected from these 289 patients, and descriptive analysis was employed. While data on childhood trauma were collected using the Childhood Trauma Questionnaire, data on attachment styles were collected using the Experiences in Close Relationships Scale via a structured questionnaire. In order to determine the difference between the sociodemographic variables and childhood trauma score, t- and ANOVA tests were calculated. Pearson coefficient correlation was computed to assess the relationship between the childhood trauma scores and attachment style scores. Stepwise regression analysis was used to determine the effective variables on childhood trauma. Results: The mean age of the participants was32.5±11.0. Patients had higher scores in emotional abuse (31.22;SD 6.9) and emotional neglect (49.86; SD 8.4) subscales than in the other subscales in the Childhood Trauma Questionnaire. Patients with substance abuse reported high scores for anxious attachment style (65.20; SD20) in the Experiences in Close Relationships Scale. Sexual abuse subscale scores differed according to the duration of substance use (F = 2.61, p = 0.026). Substance abuse was significantly associated with childhood physical abuse (t=2.43, p=0.016) and sexual abuse (t=2.13, p=0.034). There were relationships between avoidant attachment and physical abuse (r=0.154, p=0.009), emotional abuse (r=0.131, p=0.025), physical neglect (r= 0.151, p=0.019), and emotional neglect (r=-0.151, p=0.010). Significant correlation was found between anxious attachment and emotional neglect via Pearson correlation analysis (0.226, p=0.001). Stepwise regression analysis reveals that both the age at which alcohol use started and avoidance attachment were strong predictors of physical abuse and physical neglect. Conclusions: Our study found that substance abuse was significantly associated with childhood physical and sexual abuse. Physical abuse, physical neglect, emotional abuse and emotional neglect were associated with avoidance attachment, while sexual abuse was associated with anxious attachment. The findings suggest that attachment may be an important factor to further understand and address alcohol/substance use among alcohol/substance users with a history of childhood trauma. Trauma therapy may help prevent relapses in alcohol/drug dependency. [Ethiop. J. Health Dev. 2019; 33(4):250-258] Key words: Childhood trauma; attachment styles; substance abuse, Turkey