The Roles of Family Functioning, Attachment Status, Emotion Regulation Skills and Traumatic Experiences in Adolescents with Substance Use Disorder and Their Potential Effects on Polysubstance Use

Background Polysubstance use during adolescence represents a severe form of substance use disorder (SUD) and is associated with poorer clinical outcomes. Although family functioning, attachment insecurity, emotion regulation difficulties, and childhood trauma have each been linked to adolescent substance use, their relative contributions to polysubstance use remain unclear.Objectives This study aimed to examine the associations between family functioning, attachment, emotion regulation (ER) difficulties, and childhood trauma in adolescents with SUD, with a focus on their roles in polysubstance use. We hypothesized that ER difficulties would independently predict polysubstance use after controlling for other variables and explored mediation (via attachment) and moderation (via peer attachment) effects.Methods This cross-sectional study included 54 adolescents receiving inpatient treatment for SUD. Validated self-report measures assessed family functioning, attachment to parents and peers, emotion regulation difficulties, and childhood traumatic experiences. Polysubstance use was defined as the intentional use of two or more substances meeting diagnostic criteria within the past year. Associations were examined using partial correlations with false discovery rate correction and hierarchical logistic regression. Exploratory mediation and moderation analyses were conducted.Results Emotion regulation difficulties survived as the only variable reaching threshold in exploratory analyses, although estimates were imprecise and should be interpreted cautiously. While healthier family functioning initially appeared protective, this association was attenuated when childhood trauma was included in the models. Family dysfunction was associated with insecure parental attachment and higher levels of emotional and physical abuse and neglect. Attachment variables neither independently predicted polysubstance use nor mediated or moderated the observed associations.Conclusions Emotion regulation difficulties may be associated with polysubstance use in adolescents with SUD. Trauma exposure may undermine family-level protective effects, possibly pointing to the need for trauma-informed, emotion regulation–focused interventions in adolescent addiction treatment.