Childhood Adversity and Hazardous Drinking: The Mediating Role of Attachment Insecurity

Background: Harmful alcohol use is associated with disease and mortality. Identifying new determinants of harmful drinking may aid the 16.3 million adults who have alcohol use disorders. Childhood adversity is associated with alcohol use, but is not amenable to change. Attachment insecurity (anxiety and avoidance) may be associated with alcohol use and may be a target for modification or used to personalize interventions. Objectives: This study aims to (a) identify the association between attachment insecurity and harmful drinking, (b) determine if attachment insecurity may mediate between childhood adversity and harmful drinking, and (c) test sex as a moderator between attachment insecurity and harmful drinking in the mediation relationship. Methods: Adult primary care patients (N = 348, 60% women) completed a cross-sectional survey study using validated measures in 2012. Statistical analyses were performed using Hayes's PROCESS macro in SPSS. Results: Childhood adversity was reported by 61% of the cohort and 18% endorsed harmful drinking. Attachment anxiety was associated with harmful drinking (p >.001), but attachment avoidance was not (p =.11). Attachment anxiety may mediate between childhood adversity and harmful drinking (95% CI:.03-.14). Sex did not moderate the relationships between attachment anxiety and harmful drinking in the mediation relationship (women: 95% CI:.031-.179; men: 95% CI:.003.-.182). Conclusions/Importance: Attachment anxiety may mediate between childhood adversity and harmful drinking in both men and women. Attachment anxiety may be a potential therapeutic target for people with a history of childhood adversity.