J Behav Addict. 2017 Dec 1;6(4):534-544. doi: 10.1556/2006.6.2017.086.
Estévez A1, Jáuregui P1, Sánchez-Marcos I1, López-González H1,2, Griffiths MD2.
Abstract
Background
Risky behaviors have been related to emotional regulation and attachment, which may constitute risk factors for developing an addictive behavior. However, there may also be differences between substance and non-substance-related addictions.
Aims
This study aimed to examine the relationship of emotional regulation and attachment, with substance (alcohol and drug abuse), and non-substance-related addictions (gambling disorder, video game addiction, and problematic Internet use) in adolescents and emerging adults. The study also aimed to examine gender differences for such predictors.
Methods
The sample comprised 472 students aged 13-21 years recruited from high schools and vocational education centers.
Results
Findings demonstrated that emotion regulation was predictive of all addictive behaviors assessed in this study (alcohol and drug abuse, gambling disorder, video game addiction, and problematic Internet use), whereas attachment predicted non-substance-related addictions (gambling disorder, video game addiction, and problematic Internet use). In addition, gender differences were found, with females scoring significantly higher in maternal and peer attachment, whereas males scored significantly higher in gambling disorder and video game addiction.
Conclusion
The findings may be useful for preventive and clinical interventions conducted with youth regarding addictive behaviors.
KEYWORDS: addiction; alcohol; attachment; behavioral addictions; emotion regulation; substance addictions
PMID: 29280395
Discussion
This study explored the relationship between potentially addictive behaviors (both substances and behaviors), and their relationship with emotion regulation and attachment. The results demonstrated that substance addictions (alcohol and drugs) and non-substance addictions (Internet, video games, and gambling) were all positively correlated. In this regard, many studies have previously found correlations between gambling and substance use (e.g., Kausch, 2003). Furthermore, a study carried out among a sample of minors (mean age: 12.5 years) found that a large percentage of those scoring higher on problem gambling were cigarette smokers and alcohol drinkers (Míguez & Becoña, 2015), a finding reported in other studies (e.g., Griffiths & Sutherland, 1998). This study complements such studies but also provides additional evidence on the relationship of substance addiction with other less-studied behaviors, such as problematic Internet use and video game addiction, which only a few studies have investigated (e.g., van Rooij et al., 2014). Existing literature suggests that individuals with substance abuse are more likely to engage in sensation-seeking activities (Quigley & Leonard, 2000), with Internet use and video gaming being two activities that might fit such a profile. It should also be noted that among adolescents, in particular, when one problem behavior increases, the likelihood of the occurrence of other problem behaviors also increases (Donovan & Jessor, 1985; Griffiths & Sutherland, 1998).
This study also demonstrated that emotion regulation was positively correlated with addictive behaviors (i.e., gambling disorder, problematic Internet use, video game addiction, alcohol abuse, and drug abuse). This supports findings from previous research that has associated emotion regulation with impulse control (Schreiber et al., 2012), addictive behaviors (Coffey & Hartman, 2008), substance use (Gardner, Dishion, & Connell, 2008), and gambling disorder (Elmas, Cesur, & Oral, 2017; Williams, Grisham, Erskine, & Cassedy, 2012). Difficulty in emotion regulation is characterized by experiencing challenges in controlling overriding impulses toward negative feelings, engaging in goal-directed behavior, and retrieving efficient emotion–regulation strategies (Berking et al., 2011; Gratz & Roemer, 2004). Some studies have shown that individuals with difficulty in emotion regulation engage in addictive behaviors to avoid or regulate negative feelings and emotions (Aldao, Nolen-Hoeksema, & Schweizer, 2010; Ricketts & Macaskill, 2003). It also appears plausible that individuals might engage in behaviors that prolong or extend positive emotional states, if they demonstrate poor regulation over their emotions or lack alternative ways of responding (Williams & Grisham, 2012).
Regarding attachment, father and mother attachment had a negative correlation with problematic Internet use and video game addiction, whereas peer attachment correlated negatively with video game addiction. These findings align well with previous studies that have noted that attachment patterns characterized by preoccupation are associated with risk behaviors in adolescents (Kobak, Zajac, & Smith, 2009; Monacis, de Palo, Griffiths, & Sinatra, 2017), although such research has not explored the relationship in behavioral addictions. For instance, in the case of problematic Internet use, it could be argued that adolescents might use Internet more excessively due to an insufficient attachment to their parent figures. Consequently, new technologies may offer safer environments for adolescents to develop their self-esteem and identity (Herrera Harfuch, Pacheco Murguía, Palomar Lever, & Zavala Andrade, 2009). Similarly, as online video games facilitate gamers to participate using alternative virtual identities, making them feel better than who they truly are (Gainsbury, 2015), it could be the case that adolescents with problems use video games as a shelter or escape (Vollmer, Randler, Horzum, & Ayas, 2014). Consequently, non-substance-related addictions may be related to the need for relational satisfaction in adolescence.
The predictive role of emotion regulation and attachment was also explored in this study. Emotion regulation was a predictor for all addictive behaviors assessed (both substance and non-substance related). The findings also demonstrated that control was the most powerful predictor. This finding supports previous studies on adults with gambling problems for which emotion regulation, and especially control, also predicted problem gambling as well as alcohol and drug abuse (Jáuregui, Estévez, & Urbiola, 2016). Research has shown that individuals with low emotion regulation are more likely to engage in addictive behavior, or find harder to discontinue such behavior (Sayette, 2004). Emotion regulation has also been associated with gambling as a form of escape, especially among those with long-term deficits of emotion regulation (Weatherly & Miller, 2013). A number of studies have also noted that emotional states, such as lack of enthusiasm (i.e., apathy), can be at the root of problem Internet use (Esmaeilinasab, AndamiKhoshk, Azarmi, & SamarRakhi, 2014). This concurs with the findings of a systematic review by Kun and Demetrovics (2010), which indicated that a lower level of emotional intelligence is associated with more intensive smoking, alcohol use, and illicit drug use. Consequently, the findings from this study align well with the existing literature on addictions, and emphasize the importance of emotion regulation in predicting substance and non-substance-related behaviors.
Poor attachment predicted gambling disorder, problematic Internet use, and video game addiction. These results are relatively novel in the context of behavioral addictions and attachment, although some preliminary studies had already pointed out such relation (e.g., Monacis et al., 2017). Furthermore, Xu et al. (2014) found in a sample of 5,122 adolescents that the quality of parent–adolescent relationship and communication was closely associated with the development of adolescent Internet addiction. In the same study, authors also found that maternal attachment factors were more significantly associated with addiction onset than paternal attachment, something also demonstrated in this study in the case of maternal attachment and problematic Internet use. If early age attachment patterns have an effect in the development of adult life relationships (Hazan & Shaver, 1987), Internet use could be used to compensate for the need to form new relationships, rewarding individuals with a sense of belonging and group identity (Estévez et al., 2009), all of which is closely related to attachment. Individuals with secure attachment are characterized by the self-acceptance of their own emotional needs (Wallin, 2015). On the contrary, individuals with non-secure attachments (e.g., anxious-avoidant) pay little attention to their emotional needs and do not feel they can rely on somebody else’s support. This could propel them to avoid interpersonal relationships (Malik, Wells, & Wittkowski, 2015), and reinforces the assumption that behavioral addictions may be understood as a form of escape and compensation from dissatisfactory relationships (Vollmer et al., 2014). Disturbed parent–child interactions cause difficulties in affect regulation, difficulties in separation/individuation, and interpersonal difficulties. Furthermore, they are viewed as antecedent variables in the development of addiction (Markus, 2003). If an individual feels unlovable and neglected and has developed a negative self-concept because of negative relationships during childhood, the individual can try to avoid this by engaging in a potentially addictive behavior (Pace, Schimmenti, Zappulla, & Di Maggio, 2013). Within a clinical framework, it has been proposed that attachment theory (Bowlby, 1973) can help to elucidate the development of addictive behaviors, and that addictive behaviors can be viewed as attachment disorders (Schimmenti & Bifulco, 2015). Moreover, research has shown that at-risk gamblers and pathological gamblers report higher levels of fearful attachment than non-problematic gamblers (Pace et al., 2013).
Another aim of the study was to examine whether gender explained differences in attachment and the other variables under examination. Results indicated that females scored significantly higher in maternal attachment and peer attachment, whereas males scored significantly higher in relation to gambling disorder and video game addiction. Previous research has demonstrated that gender has an influence in the cognitive profiles of adolescents. For instance, female adolescents show a greater degree of preoccupation concerning how they think they are going to be evaluated and perceived by others, being especially aware of the interpersonal conflicts around them (Laursen, 1996). In addition, female adolescents show greater insecurity about their own self-efficacy in resolving conflicts (Calvete & Cardeñoso, 2005).
Many studies have noted gender differences in the prevalence of gambling disorder (e.g., Shaffer, Hall, & Bilt, 1999; Stucki & Rihs-Middel, 2007). Some explanations for this difference include men’s motivation to stay in control, the ludic component of gambling, sensation seeking, and the prospect of a big money win. However, women utilize gambling as a way of coping with personal problems, such as solitude, boredom, and dysphoric emotional states (Ruiz, Buil, & Moratilla, 2016). These characteristics could help to explain greater male prevalence in gambling disorder. In regard to emotion regulation, no significant differences were found between men and women except for awareness. These results differ from previous studies showing that women rely more on social support strategies and rumination, whereas men tend toward avoidance, passivity, and suppressing emotions (Blanchard-Fields & Coats, 2008; Schmitt, 2008; Vierhaus, Lohaus, & Ball, 2007). However, further research is necessary to understand the evolution of emotion–regulation strategies throughout the period of adolescence (Zimmermann & Iwanski, 2014), particularly because adolescents typically need to face emotion–regulation difficulties without having completely developed the emotional resources and tools to efficiently deal with them (Calvete & Estévez, 2009; Steinberg, 2005).
This study is not without its limitations. First, the cross-sectional design limits the causal implications derived from the study, as opposed to a longitudinal design, which might have offered a clearer picture of the temporal impact of each variable. Similarly, adolescence is an identity-building period in which children gain independence and autonomy from their parental figures. Hence, the familial relationships might feature extraordinary characteristics during this period of time. In addition, the sample was a non-clinical group selected from the general Spanish adolescent population, and therefore, in principle, the participants did not score higher than average in any of the studied behavioral addictions. A sample comprising clinical participants might show if the results reported here can be replicated in patients diagnosed with behavioral addiction problems. Furthermore, this study relied on self-reported measures and is therefore subjected to well-known biases (e.g., recall bias and social desirability bias). Furthermore, latent factors such as attachment are complex phenomena that are difficult to represent by standard questionnaires, and the use of complementary techniques to identify attachment constructs may help to enrich the results of future studies. It is also important to note that the use of the SOGS-RA for assessing problem gambling does not allow for contrast with studies that have utilized other diagnostic screening instruments. Furthermore, a few studies have reported some problems associated with this instrument in accurately assessing problem gambling in adolescent populations (Ladouceur et al., 2000; Langhinrichsen-Rohling, Rohling, Rohde, & Seeley, 2004).
Conclusions
Despite the aforementioned limitations, this study demonstrated that emotion–regulation difficulties predict substance and non-substance-related addictions, whereas poor attachment is a predictor of non-substance addictions in adolescents. In addition, gender differences explain variations in non-substance addictions, in addition to peer attachment and mother attachment. This study provides novel evidence for future research concerning the risk and protective factors involved in both substance and behavioral addictions.
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