Addiction: An Equal Opportunity Disaster

Source: Pixabay/geralt

As a boy, my friend and coauthor James B. made a solemn promise to himself: I will never be like my father. His father was addicted to alcohol and routinely broke the promises he made to James, letting him down or ignoring him altogether.

But James began binge drinking in high school, and in his junior year of college, he added cocaine to the mix. Somewhere along the way, he crossed the line from heavy use into addiction, setting in motion a self-perpetuating brain disorder from which he could not extricate himself.

As a doctor, I have treated hundreds of young people and adults who have made a similar journey, and not one of them set out to become an addict. Instead, almost universally, they tell themselves (and often me) one of the most common myths of uncontrollable craving. It will never happen to me. Many hold fast to this conviction in the face of repeated medical warnings—and long after they have developed a serious problem.

Like James, these patients think strength of character and willpower are a sufficient hedge against addiction. They believe that uncontrollable craving is a runaway train that hits others—people with weaker personalities, less self-awareness, and poor discipline. If there’s a problem, I’ll see it coming and get off the tracks. This misperception allows otherwise sensible people to drink heavily or use other drugs without caution or concern.

Other myths likewise reinforce the notion that addiction is something that happens to other people. These include:

Myth: There Is a Preexisting Addictive Personality

Those of us who work with addicted individuals know that some personality traits show up with remarkable frequency: compulsivity, narcissism, dishonesty, loss of self-control, manipulative behavior, and so on. This pattern reinforces the belief that some people are more vulnerable to addiction because of their ‘addictive personality.’

Although some evidence exists for a genetic link between substance abuse and the traits of impulsivity and sensation seeking, no one has been able to identify a personality type that is at risk for addiction. Instead, a definitive sixty-eight-year study documented by Dr. George Vaillant at Harvard confirms what many addiction professionals have long experienced. The development of an ‘addictive personality’ is a consequence and not a cause of uncontrolled craving.^[i]

Myth: There Is an Addiction Gene

Genetic factors play a role in addiction, but the nature and extent of their influence is not known. Periodically, yet another news report announces that scientists have discovered an ‘addiction gene,’ but there is no known direct cause-and-effect relationship between uncontrollable craving and any gene or set of genes.

If and when researchers map out a specific genetic profile for addiction, it will likely be a family of genes that increases risk—in the presence of other known risk factors. Even in the absence of genetic risk factors, however, individuals who expose their brains to frequent high levels of alcohol and other drugs are at high risk for addiction.

Myth: Heavy Drinking or Occasional Drug Use Is a Problem for Other People—Not Me

In fact, no level of alcohol or other drug use is entirely risk free. Uncontrollable craving is an equal-opportunity disaster with little regard for gender, race, class, or personality, and we all share at least one risk factor: For every person, in every situation, abusing alcohol or other drugs is always dangerous.

“It’s like playing Russian roulette, but worse,” says James. “With Russian roulette, you know there’s a bullet and it’s dangerous. When it comes to alcohol and other drugs, most of us don’t know that the gun is loaded—and that the chamber could be full.”

Early Intervention: The SBIRT Screening Tool

The most effective way to prevent addiction is to prevent or interrupt heavy drinking and other drug abuse. Fortunately, a screening tool known as SBIRT (Screening, Brief Intervention, and Referral to Treatment) is now available that combines early identification of heavy drinking with immediate intervention. By asking a series of nonthreatening questions, the interviewer can diagnose heavy drinking, and depending on its severity, recommend appropriate intervention and treatment.

Although SBIRT is not designed to diagnose addiction, it can dramatically and permanently reduce alcohol abuse in adolescents as well as adults. More research is needed to confirm the effectiveness of the SBIRT method with other drugs, but initial findings are promising.