Addiction-centered neuroaffective relational model (NARM-AC): Addressing relational trauma in the treatment of addiction and compulsive disorders

Statement of the Problem: Addiction treatment models have historically emphasized symptom reduction, behavioral management, and abstinence-focused interventions while often insufficiently addressing the underlying relational and developmental trauma associated with substance use disorders and compulsive behaviors. Emerging evidence increasingly links adverse relational experiences, attachment disruption, chronic shame, emotional dysregulation, and developmental trauma to addiction vulnerability, relapse patterns, and treatment resistance. Despite advances in trauma-informed care, many treatment environments continue to separate trauma treatment from addiction treatment, leaving significant gaps in continuity, emotional integration, and long-term recovery outcomes.

Methodology & Theoretical Orientation: The Addiction-Centered Neuroaffective Relational Model (NARM-AC) is an adaptation of the NARM Training Institute NeuroAffective Relational Model (NARM), an evidence-informed therapeutic approach originally developed for the treatment of complex and developmental trauma. NARM-AC integrates attachment theory, psychodynamic theory, somatic mindfulness, interpersonal neurobiology, and relational neuroscience into an addiction-focused framework. Rather than conceptualizing addiction primarily as pathology or behavioral dysfunction, NARM-AC examines substance use and compulsive behaviors as adaptive survival strategies rooted in disruptions of identity, connection, affect regulation, and relational development. The model emphasizes present-centered clinical inquiry, relational attunement, nervous system regulation, shame reduction, and increased capacity for agency and connection.

Findings: Preliminary implementation observations within addiction treatment and trauma recovery settings suggest that integrating relational trauma treatment directly into addiction care may improve therapeutic alliance, treatment retention, emotional regulation, and patient engagement while reducing chronic relapse cycles driven by unresolved developmental trauma patterns.

Conclusion & Significance: NARM-AC proposes a paradigm shift in addiction treatment by positioning relational and developmental trauma as central organizing factors in addictive processes rather than secondary co-occurring issues. The model offers an integrative framework for trauma-informed addiction treatment that may increase continuity of care, deepen therapeutic engagement, and improve long-term recovery outcomes across substance and process addictions.