Attachment styles and sense of coherence as indicators of treatment adherence and completion among individuals with substance use disorder.

Background: Substance use disorder (SUD) is a growing public health concern in Sweden. Various treatments for SUD exist, with motivational treatment, cognitive behavioral therapy, and relapse prevention being the nationally recommended approaches. Attachment theory and the salutogenic theory with its core concept, sense of coherence (SOC) provides valuable insights into individuals' available personal resources and their potential for adherence to treatment. The aims of the present study were to examine attachment styles (secure, insecure-avoidant, and insecure-anxious) and SOC (overall and dimensional - comprehensibility, manageability, and meaningfulness- scores) in individuals with SUD; to explore potential correlations between these constructs ; and to assess their predictive value for treatment completion.

Methods: Clinical data were collected between 2014 and 2023 from 164 clients at a Swedish outpatient clinic for addiction who initiated the intensive, integrated treatment program. The sample comprised 109 men and 55 women, aged 18 to 72 years (M = 40.71). Data were gathered using validated self-report instruments (the Attachment Style Questionnaire and the Sense of Coherence Questionnaire). Statistical analyses included descriptive statistics, correlation analysis, and logistic regression.

Results: Individuals with SUD predominantly exhibited an insecure-avoidant attachment style. The four dimensions reflecting insecure attachment (discomfort with relationships, relationships as secondary, need for approval, and preoccupation with relationships) were negatively correlated with overall SOC and its three components.  In contrast the secure attachment dimension (confidence in self and others) showed  positive association with SOC. The strongest associations were found between the manageability component of SOC and all attachment dimensions. The insecure-anxious attachment style showed the strongest association with early dropout from treatment, while higher manageability was significantly associated with  an increased likelihood of treatment completion.

Conclusion: The predominance of an insecure-avoidant attachment style among clients undergoing intensive, integrated treatment for SUD underscores the importance of reinforcing a secure attachment and strengthening SOC to facilitate treatment completion. These findings highlight the need for comprehensive, integrated social and psychiatric care for individuals with SUD.