A Basic Addiction Primer
Addiction is a chronic, progressive, and sometimes fatal disorder with both genetic and environmental roots. It manifests as a compulsion that drives an individual to continue to behave in a way that is harmful to self and loved ones, despite an intense desire to halt that behavior.
It is a disease of "more" -- an active addict needs an increasing amount of substance to get high and is unable to cease usage without painful withdrawal symptoms. This is true whether the addictive substance is a drug -- such as alcohol, tobacco, marijuana, cocaine, or heroin -- or a behavior, such as gambling or sexual promiscuity.
Addiction transcends economic, social, racial, religious, occupational, or age groups. Addicts are not visually identifiable; it is impossible to pick out an alcoholic, drug addict, or the people who enable addictive behavior (co-dependents) from a gallery of photographs.
Alcohol, tobacco, and other drug abuse is costly. More than $275 billion dollars are spent annually in the United States on medical and social issues related to addiction. These costs include related crime, loss of work time, medical expenses from health-related injuries or illnesses, property damage, and treatment.
There is no known cure for addiction. Relapse is a part of the disease and may be triggered in a variety of environmental and emotional ways. Life-long monitoring is necessary, yet with appropriate identification, treatment, and self-care, an addict can live a productive substance-free life.
We know that addiction runs in families, but how is this "disease" transmitted? Is a person born with an "addiction gene" or with an "addictive personality," or is addictive behavior taught by family and society?
This classic question of nature vs. nurture is answered with a qualified "both."
Genetics of Addiction
There is evidence that heredity plays an important part in increasing the likelihood of an individual developing an addiction to illicit drugs, alcohol, and tobacco.
Researchers have compared alcoholism rates of adoptees born to alcoholic parents with those born to nonalcoholic parents. One study found higher alcoholism rates (two to three times higher) in sons whose natural parents were alcoholics than in sons whose natural parents were non-alcoholics.
Twin studies offer additional evidence. Monozygotic (identical) twins share an identical genetic makeup while dizygotic (fraternal) twins share, on average, only 50 percent of genetic similarities. Studies of male twins find that identical twins have 50 to 200 percent greater rates of alcoholism than fraternal twins. The abuse of sedatives, stimulants, cocaine, and opiates also follows this pattern and is associated with genetic predisposition.
is Also a Factor
Although both adoption and twin studies indicate that genetic factors contribute to a predisposition for addiction, they do not tell the entire story. Environmental factors also can increase the risk for developing addiction and/or assist in the development of resiliency skills that protect an individual from beginning to use addictive substances.
Many professionals focus primarily on environmental risk factors as determining a child's vulnerability to substance use and other behavioral health problems. These include demographics (geography, economics, crime rate, quality of schools) and familial factors (genetics, family addiction, family parenting skills).
A child from an urban, poor neighborhood with a high crime rate and poor school system is more likely to begin using chemical substances than his demographic opposite. Having a family history of addiction, living with active addicts, and being inadequately parented also increases the risk of using and abusing substances.
But not all kids from high-risk environments become casualties. When characteristics of successful (non-addicted) adults who came from at-risk backgrounds are studied it is found that these adults developed strengths (resiliency factors) that became survival tools.
Basic resiliency factors involve self-esteem and sound decision-making skills. Many school systems have developed curricula to foster this quality, but the primary garden of resiliency is the family.
Findings consistently show that the more adolescents feel a mix of unconditional love and loving boundaries (also called "loving control" or "loving autonomy"), the less likely they are to experience substance abuse and related problems.
Most critically, the longer initiation into substance use is delayed, the less likely addiction will result.
There is a saying that we cannot chose our family but we can choose our friends. Similarly, we have little ability to change genetic inheritance but we can support school and community prevention programs that effectively delay first use of alcohol and drugs and strengthen resiliency in at-risk youth.
If we couple prevention efforts with providing adequate treatment for those already addicted (and their families), a significant step toward addressing the disease of addiction will occur.
Copyright 2003 Judy Shepps Battle