Parental Attachment in Early Adolescents and the Risk of Substance Use Disorder

Multiple psychological and social stressors bias development toward substance use disorder (SUD). Children of parents with SUD typically experience chronic stressors (e.g. resulting from neglect or habitation in disadvantageous environments), which presage the children’s SUD. Substance use onset as a coping mechanism to chronic stress is consistent with the self-medication hypothesis. Preliminary evidence suggests that attachment buffers the effect of chronic stress, including through biological mechanisms. Attachment is defined as the level of enduring affective bond toward and engagement with another person. Attachment to a caregiver begins during infancy, emanating largely from a caregiver’s responsiveness. In adolescence, attachment level is derived from the confidence in the availability and assurance of access to a caretaker. During childhood, high attachment to a caretaker facilitates development of emotional regulation, putatively reducing risk for SUD and other problem behaviors. To illustrate, low parental attachment predicts antisocial behavior in community samples and high attachment correlates with less antisocial behavior in children exposed to domestic violence and abuse. In contrast, data regarding the relationship between parental attachment and the development of SUD is limited. This study tested whether parent attachment statistically mediates heritability of SUD. Participants were recruited at age 10-12 years and followed up to age 22 (past the age of peak substance use onset). Participants were recruited according to having a father with an SUD related to an illegal substance (High-Risk; n=344) or no psychiatric illness (Low-Risk; n=350). The sample (72% male), had a mean age of 11.41 (SD=.91) at recruitment, and was 73% European-American and 24% African-American. Exploratory factor analysis of youth-report measures replicated the latent construct of attachment to father that was previously reported for older adolescents. Attachment to father at age 10-12 was correlated with frequency of smoking cannabis (r=-.19) and tobacco (r=-.20) and drinking alcohol (r=-.09) at age 19. While controlling for risk group, a 42% increased odds (p<.001) of offspring SUD onset by age 22 was found per standard deviation decrement in attachment to father at age 10-12. Attachment to father also partly mediated the relationship between father SUD and offspring SUD. A risk-group-by-attachment interaction was found such that only in High-Risk participants was lower attachment to father associated with SUD onset (OR=1.64, p=.002). Taken together, these findings suggest that weak paternal attachment is a predictor of SUD and support applying attachment theory SUD prevention research with High-Risk young adolescents.