Joanna E. Chambers MD, Susan M. Perkins PhD, Kelly M. Mosesso MA, Azziza Ahdoot MA, Camila L. Arnaudo MD, R. Andrew Chambers MD
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This study determined how ACEs and insecure attachment are associated with each other, and how they may predict treatment engagement in an integrated dual diagnosis treatment clinic.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A sample of <i>n</i> = 264 patients entering a university-affiliated addiction psychiatry clinic underwent diagnostic intakes supplemented by assessments of attachment styles (Anxious/Avoidant, using the 36-item Experiences in Close Relationships-Relationship Structures (ECR-RS) scale) and childhood adversity (10-item Adverse Childhood Experiences Questionnaire (ACE-Q) scale). Compliance with psychotherapy versus medication appointments was tracked for 6 months post intake.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>ACE-Q scores (median of 4) were significantly associated with higher anxious and avoidant attachment scores and the number of mental health diagnoses. Only one in five patients obtained 75% or higher compliance rates with psychotherapy; two in five achieved 75% or higher compliance with medication appointments. Greater anxious attachment predicted lower show rates for both psychotherapy and medication appointments, whereas greater avoidant attachment predicted lower compliance for psychotherapy only.</p>\n </section>\n \n <section>\n \n <h3> Discussion and Conclusions</h3>\n \n <p>This study confirms the linkage of ACEs and insecure attachment patterns in dual-diagnosis patients seeking integrated addiction psychiatry care. Insecure attachment patterns differentially predicted lower appointment compliance, particularly for psychotherapies.</p>\n </section>\n \n <section>\n \n <h3> Scientific Significance</h3>\n \n <p>Childhood trauma and associated adult attachment dysfunction warrant further investigation not only as causes and correlates of mental illness and addiction but also for improving treatment engagement, therapeutic attachments, and recovery outcomes.</p>\n </section>\n </div>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":"34 3","pages":"334-341"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajad.13673","citationCount":"0","resultStr":"{\"title\":\"Adverse childhood experiences, insecure attachment, and appointment compliance in an outpatient addiction psychiatry treatment population\",\"authors\":\"Joanna E. 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Adverse childhood experiences, insecure attachment, and appointment compliance in an outpatient addiction psychiatry treatment population
Background and Objectives
Suffering adverse childhood experiences (ACEs) increases the probability of developing adult mental illness, addictions, and insecure attachment. This study determined how ACEs and insecure attachment are associated with each other, and how they may predict treatment engagement in an integrated dual diagnosis treatment clinic.
Methods
A sample of n = 264 patients entering a university-affiliated addiction psychiatry clinic underwent diagnostic intakes supplemented by assessments of attachment styles (Anxious/Avoidant, using the 36-item Experiences in Close Relationships-Relationship Structures (ECR-RS) scale) and childhood adversity (10-item Adverse Childhood Experiences Questionnaire (ACE-Q) scale). Compliance with psychotherapy versus medication appointments was tracked for 6 months post intake.
Results
ACE-Q scores (median of 4) were significantly associated with higher anxious and avoidant attachment scores and the number of mental health diagnoses. Only one in five patients obtained 75% or higher compliance rates with psychotherapy; two in five achieved 75% or higher compliance with medication appointments. Greater anxious attachment predicted lower show rates for both psychotherapy and medication appointments, whereas greater avoidant attachment predicted lower compliance for psychotherapy only.
Discussion and Conclusions
This study confirms the linkage of ACEs and insecure attachment patterns in dual-diagnosis patients seeking integrated addiction psychiatry care. Insecure attachment patterns differentially predicted lower appointment compliance, particularly for psychotherapies.
Scientific Significance
Childhood trauma and associated adult attachment dysfunction warrant further investigation not only as causes and correlates of mental illness and addiction but also for improving treatment engagement, therapeutic attachments, and recovery outcomes.
期刊介绍：
The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.
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