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EDITORIAL published: 12 July 2022 doi: 10.3389/fpsyg.2022.964671 Editorial: Human Connection as a Treatment for Addiction 1,2,3 4,5,6 7 Andrea D. Clements *, Human-Friedrich Unterrainer and Christopher C. H. Cook 1 2 East Tennessee State University, Johnson City, TN, United States, Uplift Appalachia, Johnson City, TN, United States, 3 4 Strong Brain Institute, East Tennessee State University, Johnson City, TN, United States, Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria, University Clinic for Psychiatry and Psychotherapeutic Medicine, 6 7 Medical University Graz, Graz, Austria, Department of Religious Studies, University of Vienna, Vienna, Austria, Institute for Medical Humanities, Durham University, Durham, United Kingdom Keywords: addiction, addiction treatment, human connection, multidisciplinary views of addiction, attachment and addiction, religious and spiritual addiction views Editorial on the Research Topic Human Connection as a Treatment for Addiction The aim of this Research Topic, Human Connection as a Treatment for Addiction, is to bring together scholars from various ﬁelds to explore the question of whether intentionally increasing meaningful, caring interaction between people may reduce substance and/or non-substance related addictive behaviors. Previous research supports the role that social connection may play in the initiation and maintenance of addiction in both animals and humans (van der Eijk and Uusitalo, 2016; Christie, 2021). Animal models have shown that neuro-hormonal development, speciﬁcally the endogenous opioid and oxytocin systems, is shaped by early experiences possibly explaining the link between early adversity and later substance use patterns (Panksepp, 2004; Machin and Dunbar, 2011; Panksepp and Biven, 2012), and rodents with access to social interaction use fewer substances than those that are isolated (Crofton et al., 2015). In humans, having a cohesive support/social network and healthy attachments in childhood predict low risk of later addiction (Heilig et al., 2016; Christie, 2021). Treatment and recovery regimens that often foster connection such as 12-step programs and therapeutic communities Edited and reviewed by: have shown beneﬁt in reducing substance use (De Leon and Unterrainer, 2020). While having Stephen Sammut, Franciscan University of Steubenville, early, close human connection such as maternal/child bonding seems to predict low risk of United States problematic substance use, lack of such connection often predicts increased risk. Adverse Childhood Experiences (ACEs) including neglect or disruptions in attachment have repeatedly *Correspondence: Andrea D. Clements been shown to predict later addiction (Felitti, 2004) and individuals who are addicted to substances email@example.com are often socially excluded and marginalized, ﬁndings which have been supported neurobiologically (Heilig et al., 2016). Individuals decrease pursuit of interpersonal connections and social bonds Specialty section: when they use substances that activate opioid receptors (substances of abuse and treatment This article was submitted to medications such as methadone, buprenorphine, and naltrexone) (Inagaki et al., 2015; Torres, Health Psychology, 2019; Toubia and Khalife, 2019). Granted, problematic substance use can be initiated or fueled a section of the journal by some types of social interaction, such as aﬃliation with a substance using social network, thus Frontiers in Psychology the investigation of qualitative aspects of human connection is paramount. Received: 08 June 2022 With this strong foundation of previous research, a next logical area of research is to investigate Accepted: 22 June 2022 whether fostering healthy human connection can actually be used as an intervention or treatment Published: 12 July 2022 for addiction. Our goal of exploring this question across disciplines was achieved as this issue Citation: includes contributions from addiction science, neurobiology, psychology, anthropology, theology, Clements AD, Unterrainer H-F and ethics, philosophy, ACEs, science, nursing, psychiatry, criminology, education, chemistry, political Cook CCH (2022) Editorial: Human science, preventative medicine, and public health. In order to impose structure on this widely Connection as a Treatment for Addiction. Front. Psychol. 13:964671. varying group of articles, we will group them into three sections according to focus: theoretical, doi: 10.3389/fpsyg.2022.964671 methodological, and empirical. Frontiers in Psychology | www.frontiersin.org 1 July 2022 | Volume 13 | Article 964671 Clements et al. Editorial: Human Connection as a Treatment for Addiction SECTION 1: THEORETICAL and the clinical community. Communities of faith have long been seen as a potential source of social support for Wesselmann and Paris pull together previous research on the those living with addictions as part of their treatment and relationship between trauma and problematic substance use, recovery. The healthcare community currently manages much recommending that “social exclusion” should be considered a addiction treatment, thus fostering communication among these form of trauma. They propose that treatment providers consider constituencies is important. The authors recommend employing social exclusion as trauma and attempt to “treat” the social trauma informed principles in health communication. They exclusion as a way to reduce substance (mis)use. Addressing propose that improving faith/science/clinical collaboration to social exclusion as a risk factor for substance (mis)use supports address addiction could increase the availability of people able the idea that “social inclusion” or increasing human connection to develop meaningful, caring relationships with people living as a treatment may have merit. with addictions. A much more narrowly focused theoretical piece by The article by Beck et al. begins with an overview of mutual Anugu et al. connects the endogenous opioid system with support groups, emphasizing that they are characterized by human connection in autism. Anugu et al. propose that one interpersonal relationship and are typically quite helpful for those reason individuals on the autism spectrum avoid interpersonal in recovery from problematic use of many types of substances. interaction is because they have high opioid tone, meaning that The authors describe a phone app that can be used to monitor they either overproduce endogenous opioids or need lower levels activity and aid in evaluating the eﬀectiveness of a particular non- of opioids to remain at homeostasis. This case study reports on a faith-based mutual support recovery program, Self-Management trial of naltrexone to block the ability of opioids to activate opioid and Recovery Training (SMART) Recovery. Tools such as this receptors in an autistic patient. Naltrexone treatment was shown can be valuable as the veracity of a theory of connection as to eﬀectively improve the ability to interact interpersonally. treatment for addiction is tested. In the remaining four theoretical articles, the role of social Finally, Fuchshuber and Unterrainer report on the connectedness is addressed from the perspective of neuro- development of a short version of the MI-RSWB 48 (Unterrainer psychoanalytic as well as evolutionary psychology. In humans, et al., 2010), with the number of items reduced from 48 to 12. as in all mammals, social connectedness can be identiﬁed as a Therefore, the MI-RSWB 12 includes four subscales (instead very strong negative predictor of mental illness in general, and of six in the long version of the scale): Hope, Forgiveness, in addictions in particular. All four papers independently refer to General Religiousness and Connectedness. The instrument the seminal work of Jaak Panksepp and colleagues. should be particularly useful in clinical settings, for example, Alcaro et al. give an evolutionary and neurobiological to further explore the role of spirituality in the treatment of overview of the development and maintenance of addictions. addiction patients. The authors point out that a shortcoming of most neurobiological explanations of addiction leave out the interpersonal/sociocultural aspects. Giacolini et al. link SECTION 3: EMPIRICAL neurobiological research with both primate and human interpersonal interaction, which is also supportive of the idea that Our goal in this Research Topic is ultimately to motivate lack of healthy connection contributes to addiction. Ringwood empirical study that will conﬁrm whether or not improving et al. pick up the idea that the SEEKING system is hijacked human connection is a viable treatment for addiction. Nine and that MAT keeps it hijacked. Accordingly, interpersonal articles are included that empirically test various aspects of this relationships are discussed as a potential antidote to addictive idea. A few of the papers were very closely aligned with the overall disorders. Lastly, Mosri emphasizes social connection (to theme of this Research Topic and some investigated very targeted treatment providers and others) as necessary to address the topics that support very speciﬁc aspects of the theme. The social, psychological, and neurological problems associated article by Warren et al., reporting ﬁndings from a retrospective with addiction. Therapeutic Community (TC) chart review, said that TCs are an example of an intervention that attempts to create interpersonal connection to reduce substance use. Although a study of a SECTION 2: METHODOLOGICAL very speciﬁc outcome, type and amount of feedback given after Of the four methodological articles included in this Research receiving feedback, it does give an excellent overview of the TC Topic, three involve instrument/app development and three model in addressing addiction. TC s are an established addiction involve collaboration with communities of faith or measurement treatment intervention that supports interpersonal connection as of some aspect of spirituality. Clements et al. report on an a way to curtail substance use. initial validation of an instrument used to assess readiness of Another fairly focused article by Menglu et al. assessed church congregations to address addiction. If human connection whether Tai Chi improves ﬁtness and cognition in individuals is found to be a viable treatment for addiction, having individuals who use methamphetamine. Rather than approaching Tai Chi willing to make such connections is paramount and the faith as a spiritual practice, the authors treated it as exercise. This community is a potential source of such individuals. well done randomized controlled trial found that the control A second article by Clements et al. identiﬁes communication group declined in both ﬁtness and cognition, but both remained challenges among the faith community, the scientiﬁc community, stable for the Tai Chi group. Cognitive deﬁcits are a great risk Frontiers in Psychology | www.frontiersin.org 2 July 2022 | Volume 13 | Article 964671 Clements et al. Editorial: Human Connection as a Treatment for Addiction of methamphetamine use, so these ﬁndings are an encouraging addiction reported lower satisfaction across all three variables, addition to the treatment literature, though the explicit link to but those in recovery from substance use did not diﬀer from human connection is absent. non-users. This supports that people can reestablish social Two qualitative studies are included. Snoek et al. concluded, connections (social life satisfaction) in recovery. after conducting qualitative interviews with alcohol misusing Finally, two articles examined the relationship between parents, that the parents would have appreciated having a trusted attachment and substance use. Burgkart et al. found that a person intervene in their use. This supports the idea that having secure attachment system predicts increased use of appropriate close interpersonal relationships could lower drug use. If people emotion regulation strategies. This ﬁnding conﬁrms previous who know and care about the substance or alcohol using parent, literature that emphasizes the importance of considering the they may intervene, and the person who is using the substances attachment dimension in therapeutic interventions. In contrast, may feel more apt to listen and thereby curtail use or seek help. no association with substance use was found in the study. Respondents were clear the message should come from a trusted However, it must be said that substance use was very low in this person, implying that a relationship must be developed prior sample. Rübig et al. emphasize the importance of attachment, and to intervention. suggest that disruptions in attachments may impede treatment Meulewaeter et al., in a qualitative study of substance-using eﬀectiveness. They suggest that assessing attachment style prior adults who grew up in a household with parents who were to therapy initiation is important and that enhancing therapeutic addicted to substances, found several themes. As children, alliance for people with insecure attachment is important. This respondents felt lonely, neglected, and stigmatized. Their supports the idea of connection being important in addiction social connections were inﬂuenced by parental addiction. treatment and that having attachment issues could inhibit Substances were available in the home and respondents treatment success. were given great amounts of freedom to go places with In summary, the results of our Research Topic of articles friends, many of whom used substances. The parental point to a signiﬁcantly positive inﬂuence of the feeling of neglect found aligns with ACEs work (Felitti, 2004) and connectedness with people on the treatment of addictive the attachment insecurity reported by Rübig et al.. Both the disorders. We have approached the topic very broadly, using lack of supervision and great freedom shows how lack of a bio-psycho-socio-spiritual model of health and illness to give connection with a caring, guiding adult can lead to problematic space to diﬀerent perspectives. Further work could focus in substance use. particular on a more precise characterization of the concept of Yang et al. report by applying structural equation modeling, “human connection” not only in relation to addictive disorders that perceived social support may increase resilience to perceived but beyond. stress in addiction patients. Social support could be considered in the future as a potentially beneﬁcial variable for mental health in AUTHOR CONTRIBUTIONS the treatment of addiction. Three of the empirical articles directly address the theme All authors listed have made a substantial, direct, and intellectual of social connection. Best et al. studied 1,313 individuals and contribution to the work and approved it for publication. found that more human connection and higher quality human connection predicted higher levels of recovery capital and greater ACKNOWLEDGMENTS growth in recovery capital, thus supporting the idea of human connection as treatment for addiction. The authors wish to thank all of the many authors who Christie et al. compared non-substance users to substance contributed to this Research Topic. Having so many disciplines users who used alcohol, marijuana, methamphetamine, non- represented contributes to its strength and is a testament to how prescription opioids, and prescription opioids on social, vital multidisciplinary eﬀorts will be to addressing substance- romantic, and general life satisfaction. Respondents in active related issues. REFERENCES Subject%20Matter%20Articles/Drugs%20and%20Alc/ACE%20Study%20- %20OriginsofAddiction.pdf (accessed June 24, 2021). Christie, N. C. (2021). The role of social isolation in opioid addiction. Heilig, M., Epstein, D. H., Nader, M. A., and Shaham, Y. (2016). Time to connect: Soc. Cogn. Aﬀect. Neurosci. 16, 645–656. doi: 10.1093/scan/nsa bringing social context into addiction neuroscience. Nat. Rev. Neurosci. 17, b029 592–599. doi: 10.1038/nrn.2016.67 Crofton, E. J., Zhang, Y., and Green, T. 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Oxford: Oxford University Press. Frontiers in Psychology | www.frontiersin.org 3 July 2022 | Volume 13 | Article 964671 Clements et al. Editorial: Human Connection as a Treatment for Addiction Panksepp, J., and Biven, L. (2012). The Archaeology of Mind: Neuroevolutionary Conﬂict of Interest: The authors declare that the research was conducted in the Origins of Human Emotions. New York, NY: W. W. Norton & Company. absence of any commercial or ﬁnancial relationships that could be construed as a Torres, N. (2019). Testing a neuro-evolutionary theory of social bonds and potential conﬂict of interest. addiction: methadone associated with lower attachment anxiety, comfort with closeness, and proximity maintenance. Front. Psychiatry 10, 602. Publisher’s Note: All claims expressed in this article are solely those of the authors doi: 10.3389/fpsyt.2019.00602 and do not necessarily represent those of their aﬃliated organizations, or those of Toubia, T., and Khalife, T. (2019). The endogenous opioid the publisher, the editors and the reviewers. Any product that may be evaluated in system: role and dysfunction caused by opioid therapy. Clin. this article, or claim that may be made by its manufacturer, is not guaranteed or Obstetr. Gynecol. 62, 3–10. doi: 10.1097/GRF.00000000000 endorsed by the publisher. Unterrainer, H. F., Ladenhauf, K. H., Moazedi, M. L., Wallner-Liebmann, S. J., and Fink, A. (2010). Dimensions of religious/spiritual well- Copyright © 2022 Clements, Unterrainer and Cook. This is an open-access article being and their relation to personality and psychological well-being. distributed under the terms of the Creative Commons Attribution License (CC BY). Personality Individ. Diﬀer. 49, 192–197. doi: 10.1016/j.paid.2010. The use, distribution or reproduction in other forums is permitted, provided the 03.032 original author(s) and the copyright owner(s) are credited and that the original van der Eijk, Y., and Uusitalo, S. (2016). Towards a ‘sociorelational’ approach publication in this journal is cited, in accordance with accepted academic practice. to conceptualizing and managing addiction. Public Health Ethics 9, 198–207. No use, distribution or reproduction is permitted which does not comply with these doi: 10.1093/phe/phw013 terms. Frontiers in Psychology | www.frontiersin.org 4 July 2022 | Volume 13 | Article 964671
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