Study Links Attachment Issues to Teen Substance Use

A research synthesis adds to a growing case for treating adolescent substance use as inseparable from the poor emotional awareness and relational struggles that often sit underneath it, a core principle behind dual diagnosis treatment.

Researchers reviewed 15 qualitative studies from 2015 and 2025 that drew on Iranian and international samples to examine how attachment patterns shape substance use in adolescents ages 11 to 19. The analysis, led by researcher Bahareh Mahooti using a formal meta-synthesis method, found that avoidant attachment and emotional isolation act as common pathways linking early relationship problems to substance use disorder.

Addiction Connects to Mental Health

The researchers describe a pattern in which adolescents who experience chronic emotional unavailability from caregivers, even a lack of parental response, develop what they call avoidant internal working models. This is a psychological term for deep-seated expectations that others won’t be there when needed. That pattern often produces alexithymia, or difficulty identifying and naming one’s own emotions, along with a strong preference for self-reliance and discomfort with intimacy.

According to the synthesis, adolescents frequently turn to substances to numb the distress of unmet emotional needs and simulate a sense of belonging within peer groups. This process artificially creates emotional states they lack in their relationships. 

The researchers describe this as a form of chemical secure base, though they caution that this substance-based coping tends to deepen the very isolation it’s meant to relieve, since substance use often damages trust with family and peers.

Co-Occurring Emotional Struggles

This isn’t a clinical diagnosis in the traditional dual diagnosis sense of a named mental health disorder alongside substance use disorder, but the same principle applies. Treating the substance use alone, without addressing the underlying relational and emotional drivers, tends to produce weaker outcomes. 

The researchers point to existing data showing that 50% to 70% of adolescents relapse within the first year following treatment. They argue that standard approaches such as cognitive behavioral group therapy and motivational interviewing, while valuable, don’t always reach the attachment-related roots of the behavior.

Facilities That Treat Depression and Addiction

The synthesis highlights attachment-based therapy as a promising complement to existing adolescent treatment protocols. In this approach, the therapist works to become a consistent, responsive presence to help the adolescent build earned security through coregulation. This is the shared process of naming and working through emotions that they previously suppressed.

Adolescents in the studies described concrete shifts in trust over the course of attachment-based therapy, moving from guarded self-reliance toward a tentative willingness to depend on someone else. Researchers frame this as identity reconsolidation, in which teens start to see themselves as worthy of care rather than defined by shame.

Family-based treatment, which is already a recognized approach for adolescent substance use, complements this model well. Family involvement can help repair some of the early relational patterns like stress and trauma the research identified as a root cause.

Families researching residential treatment centers or outpatient programs for a teenager may want to ask providers directly whether their programs incorporate attachment-based or relationally focused therapy. Coordinated care among experts can assist adolescents who seem emotionally withdrawn or have a history of unstable caregiving relationships.

Comprehensive Treatment for All Age Groups

Parents and caregivers concerned about a teenager needing rehab don’t need to wait for a crisis to seek an evaluation. Comprehensive behavioral health providers can assess both substance use and the emotional patterns that may be driving it.

Starting treatment is simple. Call 800-908-4823 (Sponsored) to chat with a specialist about local resources. You can also browse our directory for treatment centers in any neighborhood in the country.

Author

Quentin Blount

Content Manager

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Quentin brings nearly a decade of experience as a writer, editor, and digital publisher to his role as Content Manager for Rehab.com. He aims to help people better understand their treatment options by creating engaging and informative content that is user-friendly, factually accurate, and optimized for search engine visibility. In his free time, Quentin enjoys the company of his friends, family, and his dog, Coop.

Editor

Peter Lee, PhD

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Peter W.Y. Lee is a writer and historian of American history during the Cold War. His primary focus is the relationship between youth and popular culture and its impact on U.S. society during the twentieth century. He has published widely on how the public has used popular culture as a mechanism to address political and social shifts throughout time