A critical literature review of research on attachment and psychedelics: Synergies and research implications

Abstract

Attachment theory suggests that early-life interactions with caregivers define lifelong outcomes, including mental and physical health, problematic substance use, and well-being. However, little is known on how the resulting attachment orientations interact with outcomes of a novel treatment approach, psychedelic-assisted psychotherapies, or non-clinical psychedelic use. This critical literature review synthesizes key empirical and theoretical research on attachment and psychedelics published by November 30 th , 2024, with a focus on learnings and epistemological approaches. Primary peer-reviewed studies mentioning both attachment and psychedelics were retrieved from EBSCO Discovery, Academic Search Complete, Academic Search Premier, Alt Health Watch, APA PsychInfo, HealthSource – Nursing/Academic Edition, Medline with Full Text, and Psychology and Behavioral Sciences Collection. A total of 21 articles were included in the review. Identified themes included 1) attachment as a predictor and outcome of psychedelic effects, 2) relationality, romantic relationships, and sexual functioning, 3) traumatic attachment, trauma, and grief, 4) broader clinical implications of psychedelic use, 5) calls to expand attachment-psychedelic research into studies of religion, spirituality, and the unconscious, and 6) Passionate Attachment for substances. Common limitations were demographic homogeneity of samples (white, male, heterosexual, high-income), reliance on self-report, inconsistent study conditions, uncritical utilization of positivist approaches, and not discussing limitations, epistemologies, or positionalities. Further incorporation of attachment constructs into psychedelic research and vice versa can improve our understanding of attachment’s clinical implications for psychedelic-assisted interventions’ outcomes and elucidate the effects of such interventions on individuals’ attachment. Suggested theoretical expansions for this field seem promising. More attachment-psychedelic research is needed in diverse populations utilizing rigorous methodologies. It is crucial to increase awareness of applied epistemological approaches and encourage reflexivity in both researchers and readers.