The Science Behind “The Restoration Inn”
by Reya Ingle, Psy.D.
Providing a Safe Place for Women to Heal
Practical Recovery’s newest residential treatment home, The Restoration Inn, opened in late September this year to provide substance misuse treatment for women in a safe and supportive environment. The Inn maintains Practical Recovery’s signature non 12 step approach and commitment to individualized, self-empowering treatment for substance misuse and co-occurring disorders including relationship issues and trauma. The Restoration Inn is purposefully small with only four beds to allow for a true homelike environment. The small size of the home and the individualized focus remove the possibility of unobserved lack of true engagement in treatment as might occur in a large facility. At The Restoration Inn, client motivation, or lack of it, is easily observed. Treatment at the Inn includes 10 hours of individual and at least 10 hours of group therapy per week. Our clinicians use evidence-based therapies including CBT, DBT, and EMDR in combination with holistic practices like Somatic Experiencing, mindfulness, meditation, acupuncture, massage, yoga therapy, and hypnotherapy. Our goal is to treat the whole person – mind, body, and spirit.
A Look at Attachment Theory
Attachment Theory is the primary foundation of the therapy provided at The Inn. Bowlby (1969) theorized that attachment was an emotional connection to another person that serves the biological drive for survival. A person’s need for physical safety in order to survive is best fulfilled in relationship to other people. As an evolutionary construct, attachment is part of a biological system in human beings to ensure survival. Attachment supports safety and nourishment in infancy through proximity to the primary caregiver, social protection throughout later development and reproduction in later life (Ainsworth, 1989). The main tenet of attachment theory is that when a caregiver is responsive to an infant’s signals of distress, either emotional or biological, a sense of security is developed. This security allows the person to explore the world and create further social attachments (Bowlby, 1969). Beyond the biological drive for survival, the goal of the attachment system is an internalized state of felt security (Ainsworth, Blehar, Waters, & Wall, 1978; Cobb & Davila, 2009; Collins & Read, 1990). Felt security provides confidence in a person’s own ability to manage distress.
Attachment Theory and the Role of Substance Use
A growing body of research (see Caspers, Cadoret, Langbehn, Yucuis, & Troutman, 2005; Flores, 2004; Höfler & Kooyman, 1996; Panksepp, 2010; Priddis & Wallace, 2011; Schindler, Thomasius, Sack, Gemeinhardt, & Küstner, 2007) indicates that disrupted attachment systems and substance misuse are highly correlated. Distress tolerance and emotion regulation are developmental processes that begin with interaction with the primary attachment figure. Panksepp (2010) explained, “It is also becoming clear that adverse early social experiences can epigenetically change brain systems to make anguish a part of an individual’s emotional landscape for the rest of his or her life” (p. 158).
Priddis and Wallace (2011) found that drugs regulated anxiety and distress when subjects lacked the ability or resources to manage difficult emotion on their own. Panksepp (2010) argued that there would be no substance misuse in humans if the substances did not serve an affective purpose. Further, Flores (2004) suggested it is impossible for humans to regulate emotions for long periods of time on their own and that they require social connection to be soothed. Difficulty in relationships, both family and social, increases the likelihood of substance use as a substitute for connection.
Those who struggle with substance misuse typically have disrupted attachment and/or trauma in their lives. They are likely to use drugs as a substitute attachment relationship to soothe distress. Substance use allows for the termination of relationships, literally or figuratively, that cause pain and do not meet the human need for safe connection (Höfler & Kooyman, 1996). Drug use provides positive affects similar to those produced in secure attachment relationships. However, there is a fundamental experience that substance use cannot provide. “It is a sad but incontrovertible fact that our biological needs cannot be met narcissistically, by mere feeling of reward versus actual achievement of reward” (Zellner, Watt, Solms, & Panksepp, 2011, p. 5). Biology drives us to be connected to others and provides a great sense of pleasure and belonging when relationship is achieved. There is no substance at this time—and there is never likely to be one– that can create the experience of achievement of connection at a biological level. Zellner et al. (2011) described the relationship between substance misuse and attachment when they wrote, “attachment is a primary form of addiction, or perhaps more accurately, addiction is a deranged form of attachment” (p. 6).
Soothing the Distress
As Clinical Director at The Inn, my goal is to create a safe and consistent environment to serve the safe-haven attachment function that allows our residents to feel supported and cared for while being vulnerable and challenged on a daily basis to internalize their own sense of felt-security. Clients are able to process developmental and situational trauma knowing that they are in a safe place where support is available at all times. Clients at The Inn leave treatment with the lived experience of distress being soothed either through the use of learned coping skills or through reaching out for support from safe social connection. As clients develop a sense of security and competency in managing their own distress, the functional purpose of substances in their lives is fundamentally changed. When asked about the program and the treatment experience that can be expected by clients at The Restoration Inn, I find myself quoting Art Williams: “I’m not telling you it’s going to be easy – I’m telling you it’s going to be worth it.”
Ainsworth, M. S. (1989). Attachments beyond infancy. American Psychologist, 44(4), 709-716. doi:10.1037/0003-066X.44.4.709
Ainsworth, M., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Oxford, England: Lawrence Erlbaum.
Bowlby, J. (1969). Attachment and loss: Vol. 1 Attachment. New York, NY: Basic Books.
Caspers, K. M., Cadoret, R. J., Langbehn, D., Yucuis, R., & Troutman, B. (2005). Contributions of attachment style and perceived social support to lifetime use of illicit substances. Addictive Behaviors, 30(5), 1007-1011. doi:10.1016/j.addbeh.2004.09.001
Cobb, R., & Davila, J. (2009). Internal working models and change. In J. H. Obegi & E. Berant, (Eds.), Attachment theory and research in clinical work with adults (pp. 209-233). New York, NY: Guilford Press.
Collins, N. L., & Read, S. J. (1990). Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58(4), 644-663. doi:10.1037/0022-35184.108.40.2064
Flores, P. J. (2004). Addiction as an attachment disorder. Lanham, MD: Jason Aronson.
Höfler, D., & Kooyman, M. (1996). Attachment transition, addiction and therapeutic bonding: An integrative approach. Journal of Substance Abuse Treatment, 13(6), 511-519. doi:10.1016/S0740-5472(96)00156-0
Panksepp, J. (2010). Evolutionary substrates of addiction: The neurochemistries of pleasure seeking and social bonding in the mammalian brain. In J. D. Kassel, J. D. Kassel (Eds.) , Substance abuse and emotion (pp. 137-167). Washington, DC: American Psychological Association. doi:10.1037/12067-006
Priddis, L. E., & Wallace, M. (2011). Exploration of intergenerational aspects of affect regulation in the context of substance abuse. The Family Journal, 19(2), 147-153. doi:10.1177/1066480710397121
Schindler, A., Thomasius, R., Sack, P., Gemeinhardt, B., & Küstner, U. (2007). Insecure family bases and adolescent drug abuse: A new approach to family patterns of attachment. Attachment & Human Development, 9(2), 111-126. doi:10.1080/14616730701349689
Zellner, M. R., Watt, D. F., Solms, M., & Panksepp, J. (2011). Affective neuroscientific and neuropsychoanalytic approaches to two intractable psychiatric problems: Why depression feels so bad and what addicts really want. Neuroscience and Biobehavioral Reviews, 35(9), 2000-2008. doi:10.1016/j.neubiorev.2011.01.003