My last post was about neurodiversity, and it brought up some great discussion! Now I want to bring all this back to addiction.
I’m at this Writers’ Festival in Sydney Australia, extremely jet-lagged, flogging my book, doing radio interviews a couple of times a day, and the same question keeps coming up: Is addiction genetic? I mean, do you think you became an addict because of the way you were made? Not everyone is vulnerable to addiction, right? So there’s got to be something in the basic brain plan that makes you that way. Right?
I don’t think so.
There is simply no gene or combination of genes that is linked with addiction as a trait. That doesn’t mean that genes are not part of the enormously complex causal bouquet that does result in addiction. But the genes that are correlated with addiction are genes for traits like impulsivity. And even these correlations are often weak or inconsistent. Some traits – impulsivity, maybe neuroticism, maybe low frustration tolerance – do help describe an individual who will, when things get tough, tend toward addiction more than the next guy. But impulsivity also puts you “at risk” for bungee jumping. And nobody is saying that bungee jumping is genetic.
A lot of people are doing good research on genetic factors that predispose toward addiction, and I’m not saying this work is irrelevant. But so far, the result seems to be a lot of small pieces of a very large puzzle. So let’s go back to impulsivity, where the water is clearer.
Impulsivity, the opposite of inhibitory control, is known to be correlated with inherited (genetic) factors. And the lynchpin of this correlation is believed to be brain mechanics. Well, what else could it be? So a recent study, which claims to be the largest of its kind ever conducted, looked at the brain activation patterns underlying impulse control in early adolescence. The researchers identified multiple brain networks involved in impulse control…which of course means they’re involved with its opposite – impulsivity. But each network was associated with a different style or type of impulsivity. Moreover, activation in one of these networks correlated with early drug or alcohol use, while activation in a different network correlated with ADHD symptoms. Already this shows that an individual’s particular brand of impulsivity (and the hardware underlying it) lends itself to a different constellation of problems.
Of most interest, the pattern associated with early drug use (reduced activation in the lateral OFC) was not a result of drug-taking but a predisposing factor. Does that mean we are beginning to discover the neural recipe for addiction? No! It means that a particular style of impulsivity predisposes teens to experiment with drugs or alcohol. It probably predisposes them to experiment with a lot of other things, including sex, travel, maybe graffiti, maybe tree-climbing, and quite possibly bungee jumping. And notably, this particular brain pattern was not linked to any genetic variant. Again, not surprising. These are the brains of kids who have already grown up in their own particular environments, and brains rewire themselves with experience. These brain patterns were not preformed in the womb. So genetic links, which are often insubstantial to begin with, have to step aside to make room for the role of experience – no matter what.
In a nutshell: Genetic links? Yes. Genetic determinism? Not at all. The relations between genes and brain structures help – among many other factors – to build personality dispositions. They do not build addiction. Addiction is an outcome, a result of a particular set of life experiences, a learned pattern of thought and behaviour. There are many brands of misfortune, both inside and outside our bodies, that can move us toward this outcome.
Yesterday I was interviewed with another author in front of 200 people, and he and I were encouraged to take off from the questions and start our own conversation. I met this guy in the lobby, a half hour earlier. His name is Lemon Andersen – um yeah, his first name is Lemon – and he’s this short, slender, cool looking poet dude from Brooklyn, with a Hispanic accent that makes him even more cool. His style of oral performance is related to “slam poetry,” he’s been mentored by Spike Lee, and he won a Tony in his mid-twenties. Now he’s in his mid-thirties. His parents met at a methadone clinic in Brooklyn. They were both long-term junkies, and they both died of AIDS.
Lemon has never taken drugs. He sold them, to get by in an impoverished housing project, but he never took them himself.
We were in the same session because we both had a lot of addiction in our past lives. But when I first met this guy, I wondered if there’d be any rapport. The Beat poet and the dowdy professor? As it turned out, we practically fell in love with each other on-stage. Maybe because we’ve both struggled to get away from drugs. Maybe because we’ve both found a calling that helped keep us sane. Do you know why Lemon has never touched drugs? Because he was afraid to. Simple as that. With all that genetics working against him – so you might think – he took a different path. His own path.
That’s what we all do, whatever it is we’re made of and wherever it is we come from. Masters of our fate? No. But we create our own masterpiece – ourselves – from the multidimensional palette of genes and environment.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Wow. Just wow. Love this post, love everything about it. You manage to distill the most complex scientific ideas into nuggets of easily-understood information and you do it with grace and passion. I think you’re on to something, professor. The way you integrate developmental stage issues (i.e., early adolescence and why this might be a pivot point for some of these impulsivity predispositions ) with neuroplasticity (the brain is always changing with real-life experience, no matter our genetic starting point) and your personal understanding of will, craving, and “meaning-making” () is awesome.
Also? Love the Lemon story. I for one would love to hear more about your experiences at this conferences and the interesting people you’re meeting.
Hi Alese. Thanks for your kind words. I enjoy this blogging thing so much….I can do it — in fact there’s nothing else I’d rather do — when I’m tired and disoriented. I hardly slept last night, given all the excitement of the Festival and a body that still thinks it’s in Europe. Nighttime? No, I don’t think so. Must be a solar eclipse. So I finally got out of bed at 4:30 and wrote this post instead.
I’ll tell you more about Lemon, but you should read the link I included in the post: a NYTimes article, very nicely crafted. It tells about Lemon’s upbringing in a Latino slum in Brooklyn. In fact, his own particular building was so down and out that it was shunned by the neighbouring slums. But his house was different, he told me. Even though mom was a junkie, she kept the place neat as a pin and sparkling clean, and there was food on the table, delicious food, until there wasn’t.
Lemon thinks very highly of his parents. He sees their addictions as experiments gone bad rather than blistering weaknesses. He sees them as Beatniks, evolved, poetic beings, who didn’t fit into the straight world. And yet, and yet. He says he grew up in the methadone clinic. Mom and Dad got their methadone cocktail in one line, the kids got their Kool-Aid in the other. He thought nothing of it. They’d click glasses, say Cheers, and toss down their juice. Later, when his parents were sick with AIDS, Lemon developed his own habit. He loved the taste of his parents’ meal replacement formula — milkshakes, yum!
But he watched his mom wither away with AIDS, early in the epidemic, when treatment was extremely spotty and extremely rough on the body. It sounds like she was a beautiful woman, warm, dynamic, exuberant, and classy, and the poem he read about watching her die brought tears to everyone.
We talked about a lot of things, before during and after the event. But what struck me the most was the parallel between his discovery of art (and the theatre world’s discovery of Lemon) and my own discovery of academia. Neither of us were on drugs at those moments in our lives. But we were each shaky, each trying to find ourselves after our worlds had been devastated by addiction. So here’s Lemon, in jail for dealing, getting up at dawn as part of a special “boot camp” program for youth reform, at Rikers Island no less, and he’s digging it. He’s saying: bring it on! I need the discipline, I want to learn how to be a man, I just want to learn. He says, time is the one thing he had plenty of, while in prison, so he used it to remake himself. And I was a newcomer in grad school, my second time around, saying Bring it on! I want to work 14 hours a day. I want to be productive, I want to be smart, and I’ve got nothing better to do. We each had mentors who picked us up and carried us forward, into adulthood. For him it was Spike Lee, for me it was Professor Otto Weininger. Both of them said: I don’t care where you’ve been, you’ve got what it takes, so let’s get moving.
So he and I bonded — an unlikely pair of misfits who found something special to do with our lives. So that we wouldn’t have a chance to slide backward, wouldn’t even look behind us, so that the rumblings of drugs became faint echoes from another world.
“Genetic links? Yes. Genetic determinism? Not at all. The relations between genes and brain structures help – among many other factors – to build personality dispositions.”
I think this sentence captures my thoughts on the topic most accurately. No, there’s certainly not a “magic bullet” that we can pinpoint as the predisposing neural factor underlying the development of addiction. I often laugh to myself when I hear others talk about “well, I was a good student; my children are good students; I certainly have high executive control; I must have the ‘protective’ endophenotype and thus have no need to worry”. Coming from a ridiculously conscientious student with an addictive disorder, that is DEFINITELY not the case.
As you pointed out, of course there are genetic predispositions that may lead to difficulty in dealing with strong emotions, significant life stress, etc. There are SEVERAL pathways that can lead to these disturbances. I find it interesting in group discussions that many of us with the same addiction have some of the same fears in life (social rejection, self-hate), but we interact in diverse ways. Some of us are quiet, some of us outspoken and encouraging of others, some of us are angry and dominating. It’s almost reflective of the brain thing. There’s this element of self-inadequacy that is common to us all, like the impulsivity networks, but the way we arrive at this self-defeat is through different neural paths. Wouldn’t it be interesting to see how different neuronal disruptions may correlate with different personality phenotypes of addicts? Could we use that to develop better therapeutic interventions?
All in all, I see potential for this Factor Analysis stuff. We must peruse the same science websites. I recently stumbled upon the posted article as well :).
Funny, I also had “high executive control”. I was very conscientious about my rock collection, my stamp collection, and my chemistry set. Though I did enjoy making and igniting mini-volcanoes with my chemicals. Maybe that was a foreshadow. Anyway, I take your point: high executive control is no more a sure-fire protective factor than high impulsivity is a surefire risk factor when it comes to addiction.
You link this, very wisely I think, to the idea of multicausality or equifinality — fancy terms for the fact that many roads lead to Rome. We addicts do pop up with very similar weaknesses, as you describe, fear of rejection and self-hate possibly being at the top of the list, but we get there in very diverse ways. Which means that we express those weaknesses in very diverse ways, which means that we get addicted in very diverse ways, which means — no doubt — that we recover in very diverse ways.
So impulsivity is related to self regulation? Epigenetics (genetic predisposition x environment) can set us up increased impulsivity because of trauma, stress, etc. Despite our social rhetoric about ‘addicts’ it appears We might venture that Lemon experienced a consistent and nurturing, albeit, brief, in the eyes of some, attunement (I know I harp about this) with his parents that contributed to his capacity to curb his own impulsivity in that regard (never mind the emotionally significant experience of watching those he loves suffer a consequence of their drug use). I know I make the link sound simple here and I don’t mean to but essentially Marc you are saying it is environment/experience that tempers the impulsivity valve. I recall driving around with my mother smoking in the car as a kid thinking I hated it and I would never smoke. I did smoke for years but my sisters had the same experience and never did.
My thought is that both impulsivity and its opposite — self-regulation — are conferred both by genetics and experience. You get both the disposition to take risks and the skills to control them, and they come side by side, both variants of overlapping (but not identical) circuitry. And neither is exclusively a function of genes or of environment.
You don’t make it sound simple. Not at all. You recognize that the patterns that lead to one result or another — e.g., addiction of abstinence — cannot be generalized. They are incredibly subtle, singular, and unpredictable. To me this is the most fascinating thing. Who could have predicted that Lemon’s experience of nurturance would stand up against his experience of wanton disregard and loss, to give him what he needed to stay clean?
Marc, I could have predicted it in retrospect (Ha! — Isn’t that always the way! 😉 ) … I also received the gift of nurturance … sustenance … cherishment — there was always at least one person — and often, an animal — who genuinely loved me and allowed me to love them also. That love was, is, my saving grace. (I believe that our capacity to love is innate, and our ‘doing’ of love is learned.)
… About regulation. Yes, there’s the ‘self-regulation’ that we can learn and practice (the mastery of self) … and then there is the involuntary (metabolic) regulation that, at its base, keeps us alive and functioning. The wisest treatments for traumatic injury include (re-) learning how we can quiet our nervous system into a state of genuine rest (‘effortless effort’) … I think these lessons are primary for addiction recovery as well — To quiet the derangement of function and regulatory process that occurs through trauma (could it be said that addiction is a form of traumatic injury?) … Perhaps, in one sense, addiction could also be seen as the organism’s increasingly desperate attempts to regulate its functions, to maintain homeostasis …?
As so many of us have written here — a ‘right treatment’ is as singular as the person … and I know one thing for sure: If I hadn’t been loved, I would have died. And now, as an adult in my mid-50s, I must love myself, no matter what; even as every day I still harm my wellbeing in many small ways (who among us is completely pristine, eh? 😉 ), I also love my wellbeing *and my existence* in small ways. My home is filled with reminders of those who have loved me — those who have *insisted* on my life. Every day I look around and actively sense the love we have expressed, the reality of this choice we make to love, and the radiant warmth my body responds and remembers with — it always begins at the heart.
Sometimes I think that addiction is, in one way, a lovelorn response to being left … a response to primal bereavement (i.e., your experience at Tabor –> ‘What I lost was a sense of security.’ [pg. 17])
In some traditions that ‘sense of security’ is known as ‘the ground of being’ … and it’s as real as the substance we stand on. When that goes … every gyroscope that points us home goes haywire, because home is *gone* —
… so maybe ‘recovery’ can be seen as ‘re-covering the ground of being’ that we need under our feet in every sense. (Consider how people love to garden 🙂 )
Another thought: Could addiction also be an automonic / autoimmune reaction to an ingested substance that the body senses is toxic?
… A book that would complement yours beautifully: *A General Theory of Love* by Thomas Lewis, MD, et al.
I believe that your shedding light on the phenomena of addiction is bringing up the possibilities of prevention and treatment. We probably all know of some families with addiction problems that seem to be genetic to some degree, my own for instance. Then there are completely straight families with seemingly random occurrence of addiction, Marks family comes to mind, I think? The story of Lemon is fascinating and touching but even if he was genetically predisposed he was wise enough to avoid the damage he witnessed. Not to take away from his story but his biological father may be unknown, junkies aren’t know for being monogamous.
In discussing addiction and genetics it strongly resembles the discussion of another disease we call cancer. Genetic predisposition, lifestyle , drinking koolaid in the methadone clinic ect. Niethar disease is simply genetic , like baldness or poor spelling both of which I inhereted and gave to my offspring for instance, but both diseases certainly have some familial pattern of inheretince. Addiction is not so much an organic disease like cancer but more of a mental chemical imbalance like depression. I think it is well know that mental disorders of many sorts have some genetic component as well. Keep in mind I have no idea what I am talking about, but find the subject very interesting. I know that many addiction experts don’t believe it is a disease and I respect that, but it must have some genetic aspect.
Has anyone ever got a bunch of lab animals addicted to some drug then see if the addicted animals choose to maintain their addiction? It would be interesting to see if humans are the only species dumb enough to choose to maintain their addiction.
If you google: animal studies drug addiction, you will get a slew of results. For example, http://www.drugabuse.gov/publications/addiction-science/preventiondevelopment/animal-studies-show-difference-in-response-to-drugs-abuse-in-early-expos
Thanks, this is important information. NIDA posts a lot of very relevant research findings.
Doug, I agree that addiction has some genetic aspect yet is not a disease. It’s helpful that you list a number of partly-inherited characteristics, one of which is clearly a disease — cancer — while the others — e.g., baldness and spelling problems — clearly are not. This gives us some perspective on the power of inheritance, and they help us keep in mind that genetics (or inheritance) doesn’t care about our categories. Cancer, baldness, cognitive weaknesses, all have SOME genetic contribution, but the DNA in our cells doesn’t have a manual as to how we should classify them.
Please see my reply to Jaliya’s comment, below, where at the end I tell the story of Masha and her high risk of cancer. Although the tendency is certainly in her genes, whether she gets it or not will be determined by subtle environmental variations, maybe in her diet, or the air she breathes, or even the way her mind works.
And regarding lab animals, check out my description of Rat Park, both in my book (chapter on Night Life in Rat Park) and in this blog. The lonely rats chose morphine, the ones with lots of social companionship did not. Environment seemed to be all that mattered, since their genetic makeup was considered identical.
Re: baldness, glitches in spelling ability … and a propensity towards addiction? — Anomalies? Variations on the Theme of the Human Condition? 😉
“The lonely rats chose morphine.” –> Says *so* much …
Rats that we make “lonely” choose morphine wow now I understand addiction. I thought addiction was a treatable and preventable disease not unlike depression, but now I know it’s a choice of the forced to be lonely. But seriously, if it isn’t a disease, what is it?
Perhaps, when some people or rats are not happy they choose a chemically induced form of happiness, that becomes an addiction. They have a hard time stopping this chemical happiness, and some are able to stop and some are not depending on circumstance. Even the ones who do stop have become diseased (see Webster) and carry this disease forever. Many lose and the disease takes their life over ,some (mark for example) win the struggle but are forever impacted by the disease.
I am open to suggestion as to the classification of addiction, but it is what it is. Unless your bill Clinton and it depends what is is.
Please don’t take me too serious I am just fascinated but admittedly ignorant of the subject.
Doug
In my family we have what I call the “torchbearer addict.” This is the addict that has crossed the line, has become unmanageable and everyone else in the family can “tut-tut” and point fingers and look down their noses and say “Yes, I may drink quite a bit and use drugs, but at least I’m not as bad as [insert name of the torchbearer d’jour here].
Torchbearer addicts are always female, we start using between 12-16 and we rapidly progress to injecting opiates, usually heroin. Now that looks like a pretty clear case of genetics having *something* to do with the addiction, right? One would think so. Except that one of us “torchbearers” is adopted. From Korea. We share no DNA.
I found that to be a interesting pattern when considering my own addiction and how it relates to my family patterns.
That is one heck of a torch to bear. It is probably more than coincidental that this behavior starts around the time of puberty. Your family may not share its family specific DNA with the adopted torchbearer, but we as a species all share a significant amount of genetic material. In fact I am told that 99% of our DNA is identical to that of the chimpanzee. Last time I tried swinging through the trees I nearly broke several bones. That 1% of genetic material that makes us human must be something very special. At the risk of sounding sigmund fraudian like, there could be someone ,perhaps a male ,in your family who unknowingly triggers this torch bearing phenomena. Regardless of what causes it I appreciate your sharing this information.
The animal studies referenced by Jeannie P in this blog are (thanks Jeannie) fascinating and I recommend you take a look. I honestly had no idea that such scholarly journals on addiction even existed. The NIDA talks about addiction being a disease with familial tendencies as if it is a foregone conclusion. I have reinvented the wheel many times in my life, I hope this isnt one of them.
By the way when I tried swinging through the trees I was sober, it was just an impulse (?) of some sort.
Have a great day
Doug
Doug and China, The story from behavioural genetics is DEEPLY intertwined with that of family cultures. Even twin studies suffer from those confounds. There are powerful cross-generational similarities in individual traits that have nothing to do with genes but which are entirely dependent on a family’s way of operating. For my family, there was a sort of moralistic vigilance, which my cousins, my brother and I all feel, and which we trace back to our grandmother. Somebody’s watching, judging….I can feel it.
I’m assuming, given China’s torchbearer tale, that family habits were the culprit — perhaps a tendency to “pick the one with the problem” and then offload any low-hanging shit (tree metaphors again?) on that person.
Another fascinating batch of thoughts here! — Oh, dear … perhaps I am becoming addicted to this blog … It’s now one of my daily reads 😉
‘… the enormously complex causal bouquet’ — gorgeous phrase. Marc, if you haven’t already, read Thomas Lewis, et al’s book, ‘A General Theory of Love’ … It is, like your book, a masterful ‘bouquet’ of science and story. The neurobiology of love and attachment is explored with a style that is similar to yours …
Impulsivity. As Alese suggests, is the natural impulsivity of early adolescence a developmental ‘predisposition’ in itself? … Is this the most formidable time in a human life for the possibility of addiction to gain a hold … and is continual impulsivity, long beyond adolescence, a lynchpin of use becoming abuse?
I wonder about what may have already been laid in place in a particular brain, long before puberty … As you write, ‘Genetic links? Yes. Genetic determinism? Not at all.’ I wonder about ‘not at all’ –> I think of two people I’ve known most of my life. One is alcoholic; in retrospect, he’s said that somehow he knew he was ‘in trouble’ with alcohol from the moment he took his first sip at around age 10. Another person knew at the age of four that she was ‘different’ — the difference being her sexuality; when she was thirteen, she encountered the word ‘lesbian’ for the first time, and CLICK! — her nine-year knowledge of difference had a name. What, then, can we call these variants in human experience? … Perhaps they are simply the ‘fingerprints’ of personhood, singular templates laid in place … mysteries that we’ll never quite be able to explain.
Your new friend Lemon certainly gives us a ‘pivot point’ to consider: his choice, based in fear, to not ingest drugs. That’s also been a pivot point for me. Like Lemon, I witnessed addiction in my original family. Like Lemon, I said ‘No!’ for all time to hard drugs. Fear as a motivator: yes. Also: an intrinsic knowing of what would keep me sane. Once upon a time, for a few years, I *did* crave alcohol, and I drank to excess. I was stopped in my tracks by one of the alcoholics in my family … and I’ve never looked back. ‘There but for the grace of all kinds of influences and pivot points go I’ …
You write of callings — both yours and Lemon’s. Callings that engage you deeply with all manners of intelligence, relation, and engagement. Yes, those callings do keep us sane … 🙂
Thank you for another marvelous post … and I hope the jet lag is easing!
I just finished an early morning reading of these fine posts,
and how a fear of drugs has been a deterrent for some. It just speaks to the immense unknown (by the user) potency of the variety of drugs on the user.
If I choose to enter that world, I don’t know what I’m getting into, like getting swept into a whirlpool. Whatever genetic factors I have may result in whether I am overwhelmed and get caught up in it over my head.
And I’ve had this recurrent dream since adolescence: of spying a beach with massive surf, and trying to reach it, to climb down a cliff and jump in, so that I could be tossed and tossed by those perilous waves. I had this dream before I became a drug-user, and I still have it today.
Hi Jaliya. And thanks for another marvellous comment. Did you know that “marvellous” has two spellings? I just figured that out. The Americans drop one of the l’s. Typical. And thanks for your good vibes. You’re not such a bad writer yourself: “‘fingerprints’ of personhood, singular templates laid in place” indeed!
Regarding adolescence as a time of normative impulsivity, that’s certainly true. Jeannie P above provided a link to the NIDA website, and (while I’m not crazy about their use of “disease”) the following link is to the page that presents statistics on the initiation of drug use in adolescence:
http://www.drugabuse.gov/publications/addiction-science/preventiondevelopment/addiction-developmental-disease-usually-begins-in-adolescence
In fact, given the stats, how can we think of drug use in terms consistent with the notion of disease? Unless adolescence itself is a disease — an idea which has occurred to most of us at one time or another. Then again, I suppose we could think of adolescence as an age ripe for “catching” addiction, just like November is a month ripe for catching a cold. I’m not trying to be snide. I think the debate is meaningful.
Anyway, when the baseline shoots way up at a certain age, as does the onset of drug-taking in adolescence, what happens to individual differences or the genetics which may (or may not) be related to them? What’s that Kipling line? “If you can keep your head when all about you…are losing theirs…” My guess is that genetic differences get swamped by the experiential madness of adolescence. In other words, rather than getting triggered or exacerbated, genetic predispositions may shrink in significance. I really don’t know — it’s just a guess.
Your examples are extremely compelling. Even chilling. For differences to be so deeply established, before adolescence, we surely must think more seriously about built-in neurodiversity. Now, that still doesn’t mean it’s genetics. Homosexuality, at least in males, has been linked to the action of sex hormones on the fetus. Nothing genetic about it. And check out China’s comment above. A “torch-bearer” addict, part of a family tradition, with zero genetics behind it. That makes me think of the incredible power of the family culture, as a foundation for each child’s developmental journey. Look at the power of that culture in your own family — a power to shape your behaviour re addiction — in a direction opposite to what the genetic gypsy would have seen in her crystal ball.
Still, my mom was an impulsive woman. A firebrand, according to some. And I decided to climb up on the roof of our house at the age of three — just for kicks. Later, I became a druggie. And I’ve never really stopped taking chances.
I haven’t read the Thomas Lewis book, but I just picked up a fascinating book, here at this book festival, called “Blood Matters”. It’s by a woman named Masha Gessen, who seems like one of the most courageous people I’ve met in a long time. Her and Lemon. By some sort of synchronicity, she slipped a note under my door so that we could meet for an interview. So I met her and we talked for an hour. That night, back in my room, I looked at the one book I’d bought the first day of the festival — one of perhaps a thousand on sale — well before I got her note. It was her book! (Now I want to say, in honour of my friend Tom Gelsthorpe: Coincidence? I think not!) Anyway, she carries a genetic variant that exposes her to HIGH risk of ovarian or breast cancer, something she got straight from her mother’s DNA. That’s what her book is about. Her whole life has been massively perturbed by this one crazy gene, from her mother’s early death to her own fears and struggles, right down to the horrendous choice about whether to have a “preventive” mastectomy.
I just discovered Masha’s blog. She is amazing! http://latitude.blogs.nytimes.com/author/masha-gessen/
So, yeah, genes. I need to learn to respect them and understand them, a lot more than I have.
Here’s another take on addiction, from a philosophic (largely Platonic) perspective … Seems that what was called ‘self-mastery’ then is known as ‘self-regulation’ now. Interesting thoughts on will, compulsion, choice, and willingness to engage with substances already known to do harm.
Hmm … the ‘willingness to engage’ … to engage with a substance, with its effects … but seemingly unable to engage with likely consequences. Even as we can’t predict the / a future, we *can* imagine consequences …
http://philosophynow.org/issues/90/Addicts_Mythmakers_and_Philosophers
Some of us can, at least most of the time. But there’s this thing called “delay discounting”, whereby we discount future outcomes in favour of present ones. What feels good now is…..all that’s in mind….see the marshmallow test and so forth.
You guys are awesome. One of the most intelligent threads I’ve read in ages! So much to think about. For now though, just wanted to throw in an N=1 data point: perhaps meaningless, perhaps anomalous… or not. I wonder what you think.
By most standards, I think I was brought up with a healthy, strong attachment to my mother, a reasonably loving father, a less-than-neurotic family upbringing with heaps of love and encouragement and, most importantly perhaps, my family’s absolute certainty that I rocked their world and was bound to do the same for the rest of the world (I have of course learned otherwise many, many times since I left home). Also? I don’t like taking stupid risks. I don’t really like big-time risks at all. I like fun and adventure, but really? Just to a point. I am not impulsive at all. I have followed a straight and narrow path of academic achievement leading to more academic achievement until I became an… academic. I smoked a joint or two in adolescence. I don’t think I drank more than a few beers until I hit college. I would no doubt score at the basement level on conventional measures of impulsivity: I have loads of executive control when it comes to IQ and marshmallow tests. But give me a chance to feel better, more often, RIGHT NOW, with little effort and with no harm to others? Bring it on! I have no doubt that I have addiction issues. I have no doubt that I crave, want, like, need and fight those urges daily. So what gives? I get Lemon, I get addicts who come from places of shame and suffering. I get genetic loading and being caught at the right place during the right developmental stage for blamo! All of it to work into a hard habit to break. But I really don’t get why I have had addiction issues given these tried and true causal models of addiction.
Thanks for this, Alese. But I wonder if you can tell us more…. What addiction issues do you have no doubt about? What exactly do you crave, want and like? What urges do you fight? Is it drugs, drink, or what? Of course you should only divulge what you want to divulge, but in this anonymous community, why not?
I think you’e a particularly interesting “case” if I may be so bold. I recently got a comment from someone on my Psychology Today blog that made me stop and think. She’s had lot of experience with addicts and addiction, and she thought that addicts come in two types: those who develop a habit out of usage — who slip into addiction just by doing it, perhaps socially, perhaps out of convenience — and those who have the genetic (or otherwise-acquired) blueprint stamped on their character from an early age (see Jaliya’s comment above). This latter group she describes as the true addicts, those who become deep-down dependent and find it very hard to stop — or at least to stop craving. Whereas the first group can juggle the whole thing, stop more easily, and play more with the feelings.
So by her definition, it sounds like you’d fall into the first group. You’re not “the type” — you just fell into it haphazardly. But I wonder: are there really two types? If you agree that you’re a type 1 (not an addictive character, just happen to like/need/want it when you can get it), then do you think you’ll necessarily stay a type 1? Or do you think there’s a continuum? Do you think you could slide all the way along until your cravings are there for good, and the exit strategy becomes much more challenging?
That seems a really important question, because it gets at the fundamental issue of where exactly does addiction COME FROM?
I’m reminded here of what you wrote in your book, Marc, about the human brain’s intrinsic vulnerabilities … No doubt we *all* crave, urge, want, and hanker for something … a depth psychologist might at this point suggest that it’s the collective unconscious or the soul … something ineffable that we all have and long for in common (a scholar of mysticism might speak of the experience of God as Absence). Different ways of perceiving and understanding something already laid in place, something universal —
That *craving* … that and the brain’s inlaid vulnerability … that gets us close to the mystery, I think … You wrote on page 17 of your book that you experienced the loss of ‘a sense of security’ when you went to a boarding school … ‘There was no safety in my world, no home, no peace. Currents of anxiety fractured every mood.’ — A basal loss of relation, place, belonging; the experience of exile, in a sense. Any mammal goes into shock with the loss of these forms of sustenance … and since the experience of exile, of such fundamental loss, is something we all have in common, too, the question becomes ‘How is it that some people can survive, adapt, and even thrive a loss of existential ground … and some cannot?’ –> These are questions also being asked in trauma studies … Such losses, especially if they are constant/cumulative, batter the organism’s ability to rebound and restore itself …
Where does addiction come from? Perhaps, simply, it comes from being human … and/or being primate; being mammal. Being human AND … (insert your life’s countless factors here.)
The deeper we go into the brain’s mysteries, the more mysterious they become … 😉
Yup, I was in shock, as much as any young animal torn away from its attachment objects (family and troupe). But as you say, some survive this wrenching experience way better than others. Due, I’m sure, to personality factors already on-line as well as the exposure to substances, availability of drugs vs. friends, peer culture, etc (your “countless factors”). Had I moved to, say, a liberal arts college that specialized in creative writing, rather than Berkeley, California in 1968, things might have been substantially different.
Alese, you say something here that’s pivotal …
‘…give me a chance to feel better, more often, RIGHT NOW, with little effort and no harm…’ — It’s the ‘no harm’ that grabs me. The line between use and abuse is drawn where harm is done …
The overriding culture (the contemprary ‘Western’ — primarily American? — culture) exerts constant force on us all to WANT, RIGHT NOW, with little effort … and an ‘ethic’ of doing harm is a dominant influence as well (thinking here of a culture of competition, conflict, and war in perpetuity) …
I wonder, then, about how and what we (collectively, en masse) model, teach, and transmit to our young ones about harm … regardless of what our official models and institutions tell us.
What did any of us learn — really *get* — about doing harm when we were young …?
Excellent point. We are trained in impatience and our lessons in “doing no harm” seem to amount to “harm reduction” at best. So 6-year-olds will try for a goal, kicking the ball from where it can’t possibly get to the net, because they want the feeling of scoring NOW. And the idea of passing it to another team-mate? No chance. I’ve found that about as hard to build in to my kids as table manners.
I wonder if other cultures build in different training. If so, we ought to see the results, in a population that is not particularly attracted to drugs or booze. Anyone have any thoughts on that?
It seems hazardous to step into the quagmire of heredity and addictions. However, it is most likely true that there is a genetic correlation with addictions in a large percentage of people. And on a personal level I can’t avoid the topic entirely; my maternal grandfather was probably an alcoholic and my mother and my brother also had at least strong tendencies to addictions. So, I’m stuck with my genes. But so what?
Nobody is talking about a single gene or a sealed fate, so what good is it to know about a genetic predilection to addictions? Right now; not much good. Because we’re looking at a combination of many genes and a swath of the population so wide as to overwhelm distinctions of race, class and culture. Genetics is not anytime soon going to provide a great new way to determine the vulnerability of our youth to addictions. Nobody’s doing that with that with the sufficient knowledge of their lives that we already have. And neither have adult addicts benefited from the search for the smoking gun.
Correlation is not causation, says Richard Lewontin, who’s maybe the greatest living geneticist. At a talk in 2004 he urged the audience not to fall for “genomania” saying that genetics won’t solve the mysteries of human nature, because “life is not a controlled experiment.” He recommends that we be sceptical about claims about the behavioural implications of our genetic make-up are often bad science in service of questionable but entrenched societal values. (Lewontin’s talk, called “Should People Believe What Scientists Say? The Problem of Elite Knowledge in a Democratic Society” was at the Penn Humanities Forum, University of Pennsylvania on April 14, 2004, and was cited by Ania Loomba in an essay called “Human Nature or Human Difference” one of ten very excellent essays in Human Nature: Fact or Fiction, edited by Robin Headlam Wells and Johnjoe McFadden ((Continuum, 2006)).
Using genetics to explain and predict behaviour is fraught. For one thing, in real life, genes require a certain specific environment for their expression, and we’re talking here about a richly complicated internal environment, and that means that there can be some reasonable expectation of our being able to strike some balance between authority and responsibility over that genetic expression. That’s good; choices are good. But what’s bad is that cheap and popular theories about the genetics of addictions have been counter-productive to the promotion of recovery, because while no reputable scientist says that genes predetermine an addicted outcome, there is still a great tendency among many addicts to rationalize and self-victimize using this disease model. And along with that rationalization sometimes there comes a permission to relapse.
The history of the disease model is all tangled up in history of the 12-Step movement. AA is based on it; the anonymity is their response to the shame of it. And a truly unfortunate corollary to this shame is that this organization representing tens of millions of addicted subjects is impenetrable to researchers and public policy advocates.
AA maintains that alcoholism is medically different from other drug and behavioural addictions. Apparently it is, see the quote below, but so what? All expressions of addiction have particular physiological aspects. These are correlates, many of them symptoms; not causes. In the case of alcoholism a quite insignificant piece of medical information, a simple correlate, has supported the tendency among many in AA to exclude from their organization people who suffer from the other addictions. That’s why there is a Cocaine Anonymous, a Narcotics Anonymous and numerous other 12-Step groups, all of them working the identical program from the same Big Book. It’s sad; there is an older generation in AA, individuals with twenty-five and more years of sobriety who could have much to offer as sponsors and role models. Here’s one such wise, former-addict:
When I drank and you smelled the booze on my breath, it was my liver at work. But here is the break point, the source of my misery and the end of poetry: My liver has an inherited liver enzyme abnormality that inhibits the normal process of metabolism. The two principle enzymes, alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH), vary in small ways in the livers of alcoholics. In addiction, there are two liver metabolites, 2,3-butanediol and 1,2-propanediol, that are present only in the alcoholics’ livers. If you are an alcoholic you’ve probably got them, and if you’re not, you definitely don’t [his italics]. The end result of all this is that my live has devised an alternate way of metabolizing alcohol, known as microsomal ethanol oxidating system (MEOS). This means that my liver is better at processing alcohol into acetaldehyde than a normal liver. That’s the good news. The bad news is that my liver is less efficient at eliminating it than it is at producing it. Toxicity happens. When I drank the lights grew mellower, the music was softer, people seemed gentler and wiser, and I couldn’t find my way home.
It need not be so. The disease model is not germane to the benefits of the 12-Step program. Believing in ‘toxicity happening;’ seems to me is just a way of finding false consolation in shallow science. Leaving this aside, the writer of the words quoted above is a trustworthy guide. He is William Alexander and the quote is from Cool Water: Alcoholism, Mindfulness and Ordinary Recovery (Shambhala, 1997). When someone in AA, like William Alexander, says “toxicity happens” why not we just say “shit happens” and accept that there’re lots of ways to make the lights grow mellower, the music softer… and to lose our way home. I say for the time being why not let’s leave genes to geneticists; they’ve got our number and they’ll call if they come up with something we can use. Which is not yet. It’s important not to confuse the study of addictions, their causes and conditions, which will include genetics, with the practice of recovery. Understanding the former presents very interesting problems; the latter is a rich mystery. So, for today, while we’re on the path of recovery, let’s just say “shit happens” and get on with real and ordinary well-being.
I’ve gone on at great length but I can’t resist a postscript. It’s not impossible that bacterial and viral correlations will be discovered with addictions; and because of the potential value of this knowledge, it shouldn’t be dismissed offhand. There is work ongoing in the viral and bacterial aspects of MS, for example, various mental illnesses, even of obesity. So says Bill Bryson in The History of Nearly Everything (Anchor Canada edition, 2004), citing the periodical Science, “Do Chronic Diseases Have an Infectious Root?” (September 14, 2001).
John, I agree, a lot of very useful thoughts here. I can’t respond in depth, but I agree mostly that genetic arguments are hard to make useful at the level of individual lives. There are exceptions: Masha Geshen’s recent book, Blood Matters, describes a very serious genetic anomaly that gives her a high risk of cancer. (see above) That is surely affecting many of the choices she makes in life. But the genetic correlations with various mental “disorders” and certainly with addiction, are often weak, often unreliable (one study shows one thing, another study shows something quite different), and I would say ALWAYS mediated by personality variables, as I wrote above. And, as you say, gene expression is ALWAYS mediated by environmental variables as well. So let’s work on environments and how they interact with personality types. That would be the best use of our (societal) energy.
Correlation does point to causation, but usually in ways that are NOT simple and clear. Also, causation at the population level is a radically different idea than causation within an individual life. If you take a bit of aspirin a day, you are less likely to get a heart attack or stroke. That’s a population level statistic, and it does point to at least one segment of a causal chain. But out of a thousand people, taking aspirins may only make a difference in 5 or 10 individuals, maybe fewer. The correlation is that low.
Then, as you say, So what? So maybe someday we’ll be smart enough to do preventive treatment for teens whose genes and behaviour both look problematic. But that won’t be for a long time to come.
Re AA…yes, the logic is often so twisted that it’s not worth going through. I still don’t say AA is useless, not at all, but I wouldn’t bother studying their philosophical manifesto or conceptual models….they don’t make sense to me either. I don’t think even they know why AA works for some and not others.
SORRY! I misspelled her name. Masha Gessen, Blood Matters, Granta Books in the UK and Harcourt in the US. I have learned more about genetics and its power to shape, alter, dominate people’s lives from this little book than from everything else I’ve read on the topic….combined.
At least go visit her blog on the NYTimes website. There it lists several other books she’s done. A very energetic, very productive woman, pumping out courageous, factual, beautifully written accounts on a variety of topics, from biology to politics, while waiting for her genetic time-bomb to go off — or not.