People are all made up differently. Science has proven that we each have unique DNA. Further research has shown that our unique DNA can contain genes that control pretty much everything about us, from eye color to personality traits. You can simply observe some families and clearly see the same physical characteristics, and even similarities in personalities, throughout generations. The same goes for many of the things you CAN’T see, like genetic disorders.
One of the first things you do when seeing a doctor is give them your family medical history. They ask about this, in addition to your personal medical history, because they know that you can be predisposed to having certain diseases based on what’s in your DNA. Medical research shows that plenty of things, such as heart disease, diabetes, and even some cancers can be in your genetic makeup. Some will lie dormant until triggered by some environmental factor or injury, others will be active from day one. Our DNA is so complicated that scientists are still trying to figure it all out. What they do know tells us that our bodies and minds are much more complicated than most of us realize.
These diseases that can be in your genes all have something in common: They don’t all affect everyone, and those who are affected, can all be affected differently.
Cancer exists, we know this- but, not everyone gets cancer, and out of those that do- it’s different for everyone. Some people can get treatment and it will go away, and all is well. Others fight it to the end with everything they have, yet still lose the battle. We don’t know for sure what causes this person to get cancer, but not that person, or why it aggressively attacks some people, and barely affects others.
We know there are risk factors all around us everyday, yet we still go about our lives, exposing ourselves for a million different reasons.
A certain level of risk has become socially acceptable otherwise we’d all be living in the woods, growing our own food, away from anything toxic.
High blood pressure and diabetes are similar in how they can affect each person differently. Some people can eat whatever they want and never end up with diabetes, or high blood pressure. Others can eat like an average American, and end up dealing with one, or both. Some can even eat healthier than the average American, and still end up dealing with those medical issues. With both conditions, you can be born with the them, so you never even have a chance to prevent it.
For those who have a family history of diabetes and high blood pressure, the odds are higher that they will have to deal with these conditions at some point in their life, whether they eat healthy, or not. Eating healthy may delay the onset and lessen some of the affects, but can’t always prevent it completely. It’s become acceptable to eat good food, even if it isn’t healthy food, and take that risk.
Why the impromptu health/biology/genetics lesson, you ask? Well, because I needed to remind you of those things most of us learned at some point in school before addressing my point. Before we get there, though, just a bit more.
See, one of those diseases science has determined that you can be genetically predisposed to is alcoholism. (NOTE: I am aware they have changed the terminology to alcohol use disorder, but I’m choosing to stick with alcoholism.) They’ve done quite a bit of research on alcohol, and have found that you are more likely to become an alcoholic if your parent, or grandparent, was an alcoholic, even if you were never actually exposed to them drinking.
How Genetics Play a Role
According to the Alcohol Addiction Center, the biggest risk factor for alcoholism is family history. This has become widely accepted as fact. So much so, that children of alcoholics who are given the correct professional help are counseled to never even try alcohol because it’s 40%-60% more likely they will become dependent.
The risk is increased if someone is raised in an environment where they see people using alcohol. So not only do your genes matter, so does how you were raised, and other factors, such as mental health.
Very simply put, Alcoholism changes the way your brain and body does things. These changes in genes can be passed down through the generations so that when they take that first drink, their body immediately goes into “alcoholic mode” and starts optimizing the body for processing alcohol instead of doing what it’s meant to.
The genes that are passed on have already learned how to slip into this mode very easily, so when someone takes that first drink, there are a couple of things that happen:
- The body immediately minimizes the bad effects, and maximizes the good feeling. Getting drunk feels way better to them than someone who didn’t already have a predisposition to alcoholism.
- The urge to drink again once the first one wears off is stronger than it may be for someone else. It can feel nearly impossible to resist once they’ve already tasted it.
- They’re able to seemingly “handle their liquor,” even the first time.
Someone that is not predisposed to alcoholism is more likely to be able to drink socially without their body jumping straight to alcoholic mode because there aren’t any genes to be triggered. They have to create those changes by habitually consuming alcohol over a period of time. Those predisposed to alcoholism don’t have that luxury.
We’ve seen it over and over: An average group of friends, relatively happy, no major childhood trauma or secrets, all go off to college and do the normal partying thing. Most of them manage to grow out of that stage and get more responsible, but one or two just can’t quite shake their partying habit.
At first, they’re the “slacker” of the group, and it may even be a running joke with the friends. Then, it gets so bad people start mentioning they need to cut back a bit, so they start hiding how much they’re consuming. Eventually, they’ve isolated themselves from everyone because they don’t want people to see how much they drink, and that they’ve become a full-fledged alcoholic.
If you’d take the time to research the history of the ones who just can’t shake the habit, you’d very likely find that someone in their family was an alcoholic. If not, then they probably have some very painful experiences they are trying to forget, or a mental health issue they are attempting to manage.
Research has proven that people who have a family history of alcoholism:
- Have been shown to have less of an ability to resist cravings
- Experience less warning signs telling them when they’ve had enough.
- Have unusual levels of serotonin, which is a mood-regulating neurotransmitter. Meaning, the second alcohol is introduced into their system, they want it more, and are less likely to be able to resist it, than someone without a family history of alcoholism.
The same principles they’ve found behind alcoholism apply to addiction, which is why the debate about whether it’s a choice or disease shouldn’t really be a debate. For some reason, people have a really hard time seeing this. Ironically, I’ve even heard alcoholics talking about drug addiction only being a choice.
This is where you have to see addiction the same way you do cancer, diabetes, high blood pressure, alcoholism, and every other disease out there that can be influenced by your genetics. You can have a predisposition to them all in your genetic makeup.
Addiction is the same, but unfortunately, a bit more complicated because it can not only happen from using illegal drugs, it can happen from legitimate medications prescribed for serious conditions. As with alcoholism, risk is increased if there is a family history, and it can also be compounded by mental health conditions.
Mental Health & Addiction
There are several mental health issues that people use both medications and street drugs to manage, but there is also the psychological aspect of an “addictive personality” that can come into play. I know that term is both controversial and kind of confusing, but basically it means that someone without a family medical history of addiction, and who doesn’t have mental health issues, can possibly get away with dabbling in drugs without becoming a full-fledged addict, while someone with those issues could be hooked off of just one mistake to try a drug.
I spent several years studying psychology, and have read in depth about the arguments against using the terminology. My own definition and understanding of an addictive personality is this: You can have an addictive personality without it having anything to do with a substance. I’ve known people who had to have an obsession of some sort. Whether it be a person, movie, show, food- it doesn’t really matter. They go from one obsession to another because they can’t be without one.
Whenever someone with those tendencies adopts bad coping mechanisms and starts drinking or doing drugs, the combination of that personality trait with the destructive traits of alcohol or drug addiction make for a level of addiction that is significantly harder to break than if that personality trait wasn’t there. I’ve witnessed this myself over and over.
This graphic doesn’t cover all the risk factors, nor can it tell you how significant each will be to whether or not addiction takes hold, but it can give you an idea of your risk as compared to someone without any of these factors.
In reference to recovery, it means that some people are able to go into rehab, work the program, and never have to go back; while others will be in and out of every rehab they can find, but still seem like there is no chance they’ll ever stop. These are usually the people whose lives have completely crumbled, but they still continue using. No amount of repercussions seem to matter.
These are the people that many of you want to let die because they have been revived so many times. They’re also the ones who probably have the LEAST control over their addiction.
Out of those who do stay in recovery, some can work their program and eventually maintain their life without continual therapy and use of program resources. Some can go through the detox process, walk away, and never look back. Others have to make it a constant conscious effort to stay sober every single day, and have to go to meetings and be involved heavily in the recovery community in order to maintain their sobriety. Others have to leave the people and area they were in while in active addiction completely because they can’t be around anything that will suck them back in. (More on recovery in my next piece in this series.)
All of this shows us that addiction can clearly be triggered or exacerbated by choices we make, just like many other things I mentioned, BUT it IS a disease. A disease that needs to be treated fully in order for recovery to happen. That requires determining the underlying cause for the addiction and treating that, because it’s what really matters. An addict can get clean, but if they don’t learn how to handle life, and make better decisions, they’ll very likely just end up using again the next time life gets hard, or the next time their traumatic memories surface.
For the Skeptics
By now, I’m sure the skeptics are still saying “It still starts with the choice to do the drug.”
Yeah, technically it does, but that choice isn’t necessarily to do a drug, sometimes it is, yeah- but, it can also be just the decision to have a simple drink with friends after a long day, which is something completely normalized by society. That may be enough to trigger that gene, if it’s present. Once the disease is triggered, it can take control of your urges, reasoning, and alter decision-making.
“So they should stay away from everything.”
You DO realize things like anaphylactic shock technically start with the choice to do whatever action makes someone encounter an allergen, right? We don’t try to say allergic people should just be left to die when exposed, like some say about addicts who overdose. Why? Because there are so many things that could cause one to have an allergic reaction that it’s unreasonable to blame people for being exposed before they realize whatever could hurt them is present.
It really is the same concept in cases of people with a predisposition to addiction. Our society makes social drinking acceptable, which means just about everyone is offered at least a drink at some point. Even that one drink is enough to start someone with a predisposition to alcoholism or addiction down a dangerous path, yet we continue to normalize social drinking while complaining about the opioid crisis in our country. Saying that addiction is ONLY a choice is also like saying juvenile diabetes is a choice. It isn’t. It’s your body’s immune system attacking your pancreas.
They know genetics play a huge role in Type 1 Diabetes, and there is no way to prevent it because you can’t avoid food completely. When you are affected depends on when you are exposed to whatever triggers it, but it’s near impossible to know what that trigger will be.
Not exactly the same, but very similar to addiction for someone predisposed, or any of the additional risks I’ve discussed. The true difference is, with addiction, there isn’t a standardized test they can use to tell you to be extra careful and doctors don’t take the time to educate children about what a family history of alcoholism or addiction means.
This is generally left to the parents to handle, and if they don’t, the alternative is to find out when it could be too late. There isn’t a big enough emphasis on teaching people about this aspect of addiction. Even with a standardized test to detect diabetes, there are still many times a person doesn’t know until symptoms show themselves, even with all the education we have about it. Doctors immediately start treatment and education, friends and family start being concerned and will even take part in keeping them healthy.
Yet we persecute addicts and say it is all by their choice, and that they are worthless and should be left to die.
Are you seeing how that should be something we are correcting, yet?
If there is an “addictive personality type” on top of a family history of addiction, or any additional mental health issues, the risk of becoming addicted to anything that gives pleasure is even higher. Research shows people with any of these conditions have abnormal dopamine levels that cause problems regulating emotions and pleasure.
Mental health conditions such as bipolar, generalized anxiety disorder, and borderline personality disorder, can contribute to alcohol and drug use because people will try to manage the symptoms of these conditions. They’ll also turn to them for coping with grief, depression, trauma, and many of the other bad things we go through in our lives. Trying to cover the symptoms, thoughts, and feelings associated with all of the above leads to the repeated use of whatever drug or drink that works, thus leading to the physical dependence on the drug, and the rewiring of their brain, or triggering of the genes already there.
Addiction From Legitimate Prescriptions
Another aspect of addiction is the medical side. There are many drug addicts out there who became addicted because they legitimately needed pain medication to treat an injury, or chronic pain. If they already have an increased risk because of family history, then the first prescription starts off the problem, because it exposes them to a drug that stimulates the genes that are just waiting to be triggered. For someone without the predisposition, it may take a bit longer for them to get addicted, but eventually they will. Once they aren’t able to get the relief they need, they’ll move on to something stronger, whether they get it from a doctor, or the streets. The end result will still be the same as if they were just a recreational user.
It is possible to for even those with a family history to safely use medication to control pain. There just needs to be far better education and monitoring of the situation. Not just pill counts and drug tests. I mean continual therapy throughout the entire time of use, and a structured step down program for when it’s time to stop taking them.
For chronic pain patients, a structured monitoring system should be in place that really works to make sure the medications are being used appropriately, and to occasionally assess whether they are adequately controlling the pain. Part of the reason patients turn to street drugs is because they aren’t getting enough pain relief. Doctors have to recognize that keeping the pain controlled is necessary- not just something to make someone more comfortable.
If patients have addiction specific education and counseling in place, from day one, that continues as long as they are taking an addictive substance, the odds of them managing their pain without straying to street drugs will be higher. Some doctors already use similar programs, but they focus too much on the wrong aspects, and just hand out pamphlets with the information instead of giving it the attention that is required to actually help the problem.
We have to make some pretty big changes in how we do things if we don’t want the next few generations to turn out even worse than we are now. Since addiction is such a complex subject, it would be a long, confusing article to discuss all aspects in one piece, but there is so much more to it. This article the second piece of a series I’m writing about addiction. Each will be linked here when they are finished. I hope you’ll take the time to read them all when they are finished, and understand the full scope of the addiction crisis in this country.
- General discussion- “Addiction: Why You Should Care” written by me, but published on Vocal
- Types of addiction (because NO it’s not all the same,) and the need for different types of recovery (will link when published)
- ideas for how to address the underlying causes, and the changes that we have to make if we want to see a real improvement in the opiate crisis (will link when published)
- Information on the need to help manage chronic pain safely in patients.(will link when published)