those with avoidant attachment and anxious attachment will show markers of increased distress during attachment and non-attachment stressors compared to those securely attached. Health behaviours According to attachment theory people with insecure attachment have less effective strategies for dealing with negative emotions compared to people with secure attachment. One way in which insecurely individuals may try to regulate their distress is by using strategies or behaviours that are attractive for their short term relief but may have deleterious risks over years like eating, drug use or risky sex. In a survey of 356 primary care patients in Toronto, rates of smoking, harmful drinking and obesity, were all found to be highest in those with the most severe anxious and avoidant attachment. Both attachment anxiety and attachment avoidance have been linked in separate studies to increasing the risk of eating disorders and substance use in adolescents. Eating A review of attachment and eating disorder literature in 2010 showed rates of insecure attachment to be approximately 70% in eating disorder populations in contrast to the 30-40% prevalence in the normal population. These rates are similar to those found in other mental health populations. The review noted small trends for anxious attachment to be more highly associated with binge-purging symptomatology and avoidant attachment to be more highly associated with restrictive. The relationship between high attachment anxiety and disinhibited eating, or binge eating, has also been found in non-clinical and pre-bariatric surgery populations. The disordered eating in insecure attachment does seem to have implications for overall health as well, with one study demonstrating a relationship with higher body mass index and another demonstrating a higher risk for metabolic syndrome at midlife. Drug Use Recreational substances provide a powerful external means of regulating affect. Insecure attachment is considered to be one of the chief psychological constructs associated with increased risk for drug use. A small study in Germany found that drug users were less likely to be secure than non-drug users and that heroin users in particular had a markedly high rate of fearful attachment. Researchers believed that these findings were in keeping with the "self-medication" hypothesis of drug use and that heroine, as opposed to other drugs of abuse, may target attachment distress more readily by acting more directly on the opioid system. Jaak Panksepp hypothesized in the 1980s that endogenous opioids are responsible for the warm, affiliative, interpersonal feelings that come with social