Understanding Addiction

Is addiction heritable? Separating fact from fiction

Written by

Marc

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Hi all. I haven’t written anything since New Year’s, and I guess it’s time to crank up the blog machine. I can see that we have a lot of new readers. I want to welcome you newcomers as well as ye olde and faithful — I hope there’s something here for you and I hope you’ll join in the dialogue with comments.

I just got an email from someone confused about the genetic roots of addiction. I get questions like this all the time. It’s a big issue that nobody’s very clear on. To be honest, I’ve been somewhat confused about the heritability of addiction too. One of the things I’ve found most confusing is that the heritability estimate keeps showing up in the 40 – 60% range, for drug addiction and alcoholism. How can it be that high, when most experts agree that the idea of an “addictive personality” is just plain wrong?

maiaOver the past month I’ve been reading an advance copy of Maia Szalavitz’s latest book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction (St. Martin’s Press, upcoming). Maia is one of today’s brightest, most insightful commentators on addiction and related issues. She’s been writing articles for the popular press (e.g., The Fix) as well as scientific publications (e.g., Nature) for years. In her new book she explains addiction as a learned style of thinking, a coping style that isn’t working, or a developmental disorder — a rigid system of behaviours and beliefs cemented together over development. Her focus is mainly on trauma — hurtful, often devastating events impacting on the lives of children/adolescents and/or their families. Yet despite (or maybe because of) this emphasis on environmental forces, her explanation of genetic factors is as smart and as accurate as they come.

The Big Three.

There are really just THREE things to keep in mind:

  1. Yes, heritability can be in the 50% range for many different addictions. That means that identical twins (with the same genetic makeup) share a strong inherited tendency to become addicted. Specifically, if one twin becomes addicted, there’s a 50% probability that the other one will too, and the commonality has to come from their parents’ DNA (and possible “epigenetic” influences too). The rest of that 100% is made up of environmental factors.
  2. This 50% figure is actually very typical of personality traits in general, such as the famous “Big Five” traits, like sociability or extroversion.
  3. And yet the 50% figure for a genetic influence on addiction does NOT come from any single trait. There is no such thing as an addiction trait or addictive personality!!!

So how do we explain that 50%?!

bignosesLet’s say you and your brothers have big noses, or bad teeth, or muddy coloured eyes… And let’s say that this tendency comes from your shared DNA — which would not be surprising if it’s a trait you all share. Because you all carry the “big nose” gene, your chances of getting hot dates in college are diminished. You each have a strike against you.

Now let’s say that another set of brothers (or sisters) is congenitally shy, or has poor colour vision and thus poor taste in clothes. These are other genetic factors that might increase the risk of sitting home alone on Saturday night.

sadnose.monkeySo we’ve got at least two radically different genetically-loaded traits that predict the same outcome. If we were doing a study on genetic factors that contribute to a diminished social life, both traits would show up as predictive. And if each one correlated 50% with its appearance in a twin brother, then it wouldn’t matter that we pool them together in our study, because genetic studies always pool individual traits and add up how much of any outcome is shared by family members (specifically,  family members living apart, since that’s the only way to isolate the contribution of genetics).

ivyThe last thing to note is that, if you were unfortunate enough to carry the colour-blindness gene and the big nose gene, then you and your sibs would have an even higher chance of a disappointing sex life, unless these traits happened to work together in a particularly charming combination (Leonard Cohen?) And even though that’s very possible, it wouldn’t matter much. Genetics is sort of a dumb science and all it cares about are averages.

So what traits predict addiction?

Several. The strongest predictors are (1) an impulsive or antisocial personality style, and (2) an anxious, overly-sensitive, perhaps OCD personality style. Note that these personality clusters are almost perfect opposites: the brash, uncaring person vs. the anxious, neurotic person. In fact, they may be based on opposite extremes of chromosomescertain ingredients in the chemical recipe of personality: too much dopamine or too little serotonin for the anxious kid; too little dopamine or too much serotonin for the impulsive thrill-seeker (who needs to try harder to feel excited). Yet both these traits ratsincrease your odds of becoming an addict, and both are (partly) heritable. Which is to say they are shared between parents and children and between siblings (who carry much of the same DNA).

According to Maia Szalavitz in her new book, there’s a third heritable package that strongly predicts addiction: a combination of  reckless drive on the one hand and sensitivity to failure or loss on the other. Maia says that this disposition was her royal road to addiction, and I believe it was mine too. And by “royal road” I don’t mean a direct cause but a causal contributor — one variable among many. Like me, Maia is a developmental thinker, and she sees these genetic predictors as early conditions that can lead down many different roads, depending on environmental kidscircumstances.

Next post I’m going to go into a lot more detail on how these very different personality styles can make one more vulnerable to addiction, and how other personality (and environmental!) factors can make one more resilient. And I’m going to remind you that these factors can interact with each other in all kinds of interesting ways.

 

 

Comments

53 responses to “Is addiction heritable? Separating fact from fiction”

  1. Paul Smith

    Wow! I think you have answered the question.

    Even being disposed to the shyness gene or having a big nose can cause insecurities in regards of dating and acceptance by the opposite sex.
    Possibly leading to isolation through anxiety or a fear of rejection.

    Drug use can be a compensatory strategy to ameliorate the above feelings and behaviour.

    As most of us have idiosyncrisities in our genetics that can lead to insecurities are we not all genetically disposed to addiction ?

    Reply
    1. Terry

      Hi. in my observations of myself and many others in working with addicts the main trait I see is that in almost all cases some degree of anxiety state is present and the chemical or behaviour, and we should never forget that addiction is only partially about drug use – most addictions are not drug use based – is an attempt by the individual to feel more safe and secure and anxiety free, even though the inverse often happens, anxiety is produced in the end by the drug or behaviour. anxiety is more likely transmittable through generations either via DNA or learning and is NORMAL. addictions therefore in my view are a normal human adaption to stress. we will never deal with them while ever we see these behaviours as abnormal. anyone without a habit of some sort is not OK.

      Reply
      1. Marc

        If you mean a drug habit, I wouldn’t go that far. But there’s good evidence to show that kids who never try drugs have worse outcomes (social, educational, financial) than kids who do. The urge to explore different feeling states is certainly universal, and as you say, so is the urge to minimize anxiety in any way possible.

        Reply
        1. Terry

          thanks – no I don’t mean everyone should have a drug habit but I do mean everyone has habits which are the potential precursors to addictions and our habits, apart from being there to save the brain time and effort, are also security blankets – we are more comfortable when routine is in place – one of the hallmarks of severe addiction is a lack of routines other than the drug getting and using routine which has taken over all other habits – and yes there does seem to be a human need to be experiencing different consciousness at least once a life, with some of us attracted to doing that all day every day – here the meditative ability of behaviours such as gambling etc. is fascinating – the drug can be extrinsic or intrinsic. thanks Mark

          Reply
          1. Carlton

            Terry,
            You wrote:

            “and yes there does seem to be a human need to be experiencing different consciousness at least once a life.”

            In a way, “experiencing a different consciousness” may be a better word than “recovery” for what was experienced
            when some people recovered.

            Curious if there are any readers here that would relate to that
            phrase.

            Reply
            1. Terry

              Thanks Carlton – in a way anything different is a different consciousness – drug use in my view is an attempt to feel different; usually better than the current un-drugged state – then the drug journey is undertaken and if that leads to addiction then that is likely to again lead to negative consciousness as the drug disappoints through overuse and then when the internal self decision to stop use (or do something different) occurs then yes consciousness again is changed for the better (at least for awhile until the old reasons – anxiety – which have never really left – return – or another addiction takes its place). I don’t agree with the term recovery – it is medicalised and doesn’t recognise the benefit drugs have had on an individual rather it sees the whole process as a problem rather than as the user sees it as a solution. in my work I prefer the term – change – people change, behaviours change, attitudes change and one day hopefully the useless war on drugs will change

              Reply
              1. Carlton

                Yes, it is normal to attempt to feel different, but certain avenues can become imprisoning over time, such as the various things considered addictions, (meaning not just drugs 🙂

                I think one of the profound realizations during the recovery process, is the realization that that the body is not a thing to escape, but a unique, lived experience.

                Also, the possibly surprising realization that one can feel different, even in an un-addicted state.

                The discovery that one can feel different , even in an un-addicted state, and also have their capacities and competence intact, could be one reason a percentage of people that were addicted, do not become re-addicted or relapse.

                Reply
                1. Terry

                  Carlton – its interesting that many I work with, and in my own experience, seem stoned sober, and I often wonder why they may need drugs in the first place – I think addiction actually creates a different consciousness that as you say when realised is present in the sober state leads one to be happy in their now stoned sober state – drugs become redundant – I find many mature out of addiction in their 40’s.

                  Reply
                  1. Carlton

                    Terry,
                    Not being of the medical or scientific field, or even being involved in a recovery approach anymore, I have difficulty describing things properly for the people that are professionals.

                    Seeking different states of consciousness can be as simple as putting on a radio, or opening the shades, etc.

                    In other words, most people, most of the time, are seeking, or making a different state of consciousness, rather than that of straight reality.

                    Yet to people in the first stages of recovery, being sober or being stoned is the only black and white reality that seems to to exist, where “Stoned” = Gonzo, and and “Sober”=straight, cold reality.

                    Yet audiences at halls and theaters world-wide, or people in front of TVs, computer, reading books, etc.. people are in engaging in altered states of consciousness of various degrees.

                    These types of observations, and others came up a few years ago, at a dinner party where the topic of addiction and recovery came up and was talked about in new ways.

                    Rather than perceiving addictions roots to be of a nefarious nature, other origins was considered.

                    In fact, key aspects of a new model for addiction came to light that evening, and I have been trying to
                    put it into clear, communicative words since then.

                    Sometime this year I am going to propose posting it here, on UNDERSTATING ADDICTION,
                    because it is not recovery approach per se, and I think it will resonate with Marc’s Ideas, such as the recognition of self-trust, etc.

                    Reply
                    1. Terry

                      you are right Carlton – much of the difficulty is in the description – science struggles with subjectivity – scientific facts don’t describe addiction least not from the addicts consciousness and many of the explanations disease or otherwise fail to resonate with the users who often see a vastly different Problem than those who ascribe to knowing a right way to live. as I have just mentioned in another reply – addiction could be a normal human response to stress and often may save many from insanity

        2. Eric

          I once heard someone say, “be careful where you find your pleasure, or sense of well-being. Ask yourself, is it sustainable, readily available or do I need to get it from someone else, and will it lead to consequences that will steal that very sense of well-being?” Drugs weren’t my problem, they were my solution. But that state just wasn’t sustainable. I love your desire, acquisition, and loss progression. It’s a good test for any learned reaction to stress.

          Reply
    2. John Smith

      Hello All,
      I found this website were people can blog about all types of addiction and they even have help line. http://www.youraddictiontube.com

      Thank you

      Reply
  2. Tim Greenwood

    Very cool ideas. I like the idea that there is not an Addictive Personality but that certain traits work together like some sort of synergy. It looks like the genetic work is much more complicated and that geneticists will have to identify traits if present and combined will make addiction a possible challenge.
    I continue to work with tools that I have found in NLP and Tony Robbins and have discovered personal success in addressing addictive behaviors through the tools that I have found in this toolbox. Through these tools used every day kind of like Bill Murray in Groundhog Day I have managed to have given up drinking alcohol altogether (used to be problem and trigger) – have not drunk in 3 years – other than communion wine and that is no longer a trigger. Also used to have serious eating problem and sugar and sweets were triggers. Have learned and chosen to give up eating these in public situations and have been successful. I have discovered that these tools work as long as I in a committed fashion do the work I need to do each day. I recognize that these old addiction can and will flare up if I do not do the work – writing, vigilance, daily mediation and prayer. But if I do the work the fruits are far beyond just not being addicted. There is clarity, insight and wisdom.
    This is the two edged sword of addiction – The Path of Excess can Lead to the Palace of Wisdom but only if one embraces the Responsibility of Vigilance and the Work. This is my own personal experience. Thanks for the work Marc.
    One other thought about “Inheritability”. For those in recovery. I have 4 young children and they have seen me give up alcohol to be a better person. They see and experience this as a valid choice. Most are in their teens or about to enter teens and several have explicitly said they do not intend to drink. Don’t know if this will be the case but there is powerful role modelling that they are experiencing. One of my twin daughters 2 years ago chose to be a vegetarian out of conscience and I believe my example had something to do with this
    This I believe is something heartening for those in recovery – the impact that we can have on those closest to us. Things are passed down not only through Genes but also through Memes – powerful ideas and actions manifesting deeper truths.

    Reply
  3. Waringa Wagema

    Since reading your book the Biology of Desire, I have quit a 4 year smoking and drinking habit which for the longest time I considered a disease, and particularly one of genetics, seeing as both my parents are alcoholics.

    Your book really empowered how I look at my life as a total of my habits and tweaking my habits here and there has me free from a life dictated by drug use.

    Quitting alcohol and cigarettes through change of habits had me think about the issue to do with genetics. In my view, I do not necessarily think that genetics has much to do with addiction. I don’t think you inherit a trait called addiction, I think what is inherited is coping skills.

    If we are to argue that environmental factors contribute to the likelihood of becoming addicted.
    Is it possible that observing how your parents/guardians cope with life issues, keeping in mind that coping skills are not things we are actively taught but rather skills left to observation & personal initiative, could directly or indirectly result in addiction?

    Reply
    1. Marc

      As mentioned in my post, no, you don’t inherit a trait called addiction. But that doesn’t mean that genetics has nothing to do with addiction. This is the kind of logic I was trying to get away from.

      We are so unaccustomed to seeing grey areas in the addiction field — myself included. But the whole damn thing is grey,

      Reply
      1. Waringa Wagema

        Your’e right, addiction has been painted as this black and white space.
        So how would you propose going about convincing people that this is in fact a very grey area especially for people like me, who keep succumbing to old schools of thought.

        What hacks do you use every time you find yourself thinking black and white?

        Reply
        1. Carlton

          Waringa,

          Here is an analogy of how Black and White thinking, relating to an addiction may become irrelevant in a persons life.

          When addicted , the primary thoughts, feelings and beliefs, hinge on the following type of Black and White thinking;.

          “I must drink” or I must not drink”.

          Now, most human beings have experienced one or more significant relationships in their lives.

          When you were actively engaged in the relationship, especially when the relationship was changing,
          The following would have been an example of similar Black and White thinking:

          “I must be with him/ her” or I must Not be with him/her”.

          Yet most of us can look back a relationship and realize that this Black and White thinking no longer occurs… in fact it may no longer be a relevant thing to you, because realizations have occurred, and things have changed.

          With addiction, the realizations and changes is referred to as the persons recovery process, and it is as personal and as individual as the relationship.. or end of a relationship, that each of us can plug into the above scenario.

          Reply
  4. Gary

    This actually confirms, for me, what I had thought all along, which is, drug use is the symptom what’s the problem!~ I’ve been noted for saying that long before I developed a “drinking problem” I developed a “thinking problem” about drinking. Again, environmental factors, in my opinion, and in my upbringing certainly played a significant role in my own behavior in terms of alcohol, tobacco and other drug use. I also tend to have some of the traits described, such as, sensitivity to failure, which, in turn was salvivic motivating me to want better and to change.

    I think the term “Dis-ease” really fits here regarding the level of turmoil and coping ability in dealing with anxiety.

    Despite the fact that on both sides of my family there have been a long lists of alcoholics I took my last drink August 17th, 1988. I feel It is also important for me to note that Alcoholic’s Anonymous was significant in my “Discovery Process” even though I haven’t attended any meeting for the past 15 years I’ve never forgotten.

    However, labels like alcoholic or drug addict ought never define the person that you are, these are things that happen as a result of repeat behavior despite the consequences. “If” that’s all I ever am then perhaps I limit myself and the potential to discover the numinous energy that resides in the core of my being.

    I do believe that in order to change it was important to wipe the slate clean and to actually look at how I contributed to the pain in my life, ask forgiveness of others and to forgive myself!~

    Reply
    1. Mary

      Appreciate your insights thanks.

      Reply
    2. Nina

      Thank you for this.

      Reply
  5. Dave

    OMG! Anxious, oversensitive. Impulsive. Since boyhood! Now 74, and trying to figure it all out. Thank you for your book and this blog. Of the many obsessive behaviors I have tried, including alcohol, the only one that stuck is sex. But “sex addict”? I guess I agree with Gary.

    Reply
  6. Fred

    In his book, In the Realm of Hungry Ghosts, Dr. Gabor Maté includes an appendix called “Fallacies of Adoption and Twin Studies”. He points out that adoption and twin studies that purport to demonstrate a genetic origin of addiction (and other mental disorders) tend to ignore the confounding effect of environment. In utero trauma caused by maternal stress (which could be presumed higher in cases where adoption occurs), as well as attachment trauma that occurs pre-adoption (the adoption may have occurred only after failed attempts at keeping the family together), or due to the adoption itself (interrupted bonding), may in fact be the actual source of the correlations that show up later.

    These insights do not invalidate the interesting pursuit of identifying personality traits that may incline one toward addiction. But they do call into question whether the “heritability” rate of 50% is actually due to the genes themselves. Any child whose medical history showed up in these twin study databases probably experienced heightened levels of developmental trauma in utero or shortly after. That trauma may be what’s causing most of the addiction.

    Reply
    1. Marc

      Good points, Fred, and I used to concur that the conclusions re genetics were exaggerated or misguided. Now I see things differently. Genetics makes causal contributions to just about everything, from your tennis game to your bathroom habits. The fallacy is to imagine that genetics is some monolithic force that works the same way in everyone.

      Reply
      1. Fred

        Yes. It’s not monolithic. The genes determine the potential traits one may express, and the developmental environment shapes how those traits actually manifest. It would seem a simple study to see if children who were adopted have a higher likelihood of developing addictions than similar children raised with their birth families. This would offer a sense of how important a factor the adoption itself is when interpreting these studies.

        Reply
        1. Marc

          Except that the fact of being adopted, the characteristics of adoptive families in general, the adoptive sibline and all kinds of other factors would be conflated. This kind of study is just never simple. In fact, those who have looked for the genetic antecedents of addiction have never found more than very weak correlations with particular traits, because of the wash of other variables.

          Reply
    2. Adoptee

      Fred there is plenty of evidence showing adoptees are four times higher than the general population of having addictions. Plus, adoptees have been shown to have higher rates of incarcerations, suicide, mass murders and kill their parents than the general population.

      Reply
    3. Richard A. Radcliffe

      Your comments on other sources of variation contributing to what is interpreted as genetic in twin studies are actually not correct. Twin studies are conducted as monozygotic vs. dizygotic. If monozygotic twins show a higher concordance than dizygotic twins for (name your trait), the conclusion is that the trait has some degree of genetic influence. Environmental factors (e.g., “in utero trauma” or “attachment trauma that occurs pre-adoption”) are assumed to be more or less equivalent in the two groups and are therefore controlled.

      On another note, I’m surprised that this apparent “nature vs. nurture” discussion is even taking place among what appears to be a very educated and thoughtful group. I received my initial training as a behavioral geneticist over 20 years ago and we never talked about behavioral outcomes as being the result of strictly nature or nurture; it’s a combination of the two. For people who understand genetics AND neurobiology AND behavior, this is kind of a duh concept (that both nature and nurture contribute).

      I think the problem for lay people is the way genetics research is presented in the media (and on the rare occasion by the egotistical scientist); i.e., “they” just discovered THE gene for this, that or the other. However, such a thing generally does not exist, especially for behavior. By and large, genetic variance for complex traits such as addiction, anxiety, depression, etc. are not controlled by a single large effect gene; rather by many small effect genes.

      Professor Lewis is absolutely correct in his explanation that there is not necessarily an addiction trait but rather the genetic component comes from something else that has a genetic underpinning. You can say this is a failing of genetics research, but the reality is that genetic influences do not always manifest directly and, moreover, genetics research does not uncover those indirect pathways, at least initially. A geneticist will ask the question “is there a genetic influence on addiction?” The answer of yes is widely supported in the human and animal scientific literature; however, the true genetic “cause” of addiction is not always apparent nor is it particularly easy to discern. It could be a comorbid trait such as anxiety or something else.

      It is also very important to note that genetics absolutely does not dictate one’s behavioral outcome. Genetics, like environmental circumstances (upbringing, “peer pressure” cultural context, education level, etc.), is viewed as a “risk factor”. I can use as an illustration the most well-known genetic effect on alcoholism: the Aldh2*2 mutation which occurs at a very high frequency in Asian populations. Many of you are familiar with this mutant form of Aldh2 (aldehyde dehydrogenase) which is a key enzyme in the metabolism of alcohol. Those with one or two copies of the mutant gene accumulate acetaldehyde, the first metabolite of alcohol metabolism, when drinking. Acetaldehyde is toxic and causes people to flush and become nauseous among other things and so they tend to not drink. So the mutant allele is a “protective” factor much like growing up in a loving family environment is also protective. But neither of these things completely prevent someone from becoming an alcoholic as evidenced by the small percentage of people with two copies of the mutant allele who do in fact become alcoholics. This is a gene with a huge effect size on drinking behavior, but most of the genes (which to date are mostly unidentified) have much smaller effects. Again, genetics, even very drastic cases like Aldh2*2, do not dictate the final outcome – they only (potentially) contribute to it. And bear in mind, this works both ways: a person may have zero risk alleles (“alleles” are different versions of the same gene) and yet because of an unfortunate confluence of environmental risk factors, may still become an alcoholic.

      That brings me back to the original issue of genetics research. Although conceptual and technical advances of the last 10 years or so are starting to really get at the molecular level of the genetic basis of behavior, genetics research mostly can just say yes or no, there is or is not a genetic component to addiction or whatever. It’s not quite as simple as that, but it’s close.

      One final point. A goal of genetics research is to identify the gene variants that contribute to variation in a trait such as addiction. But that is not be any means the only goal. We are also trying to understand the underlying neural circuitry and genetic approaches have been used for decades to try to tease out the molecular basis of all life processes, including behavior. I suspect that many of the commenters here will disagree with me, but understanding the molecular basis of behaviors, especially where it overlaps among behaviors, will be a powerful tool in developing efficacious behavioral or pharmacological treatment strategies for those with psychological problems.

      Reply
      1. Marc

        Hi Richard.
        I know my explanation was inaccurate. I was describing concordance, not heritability….I meant to get across the idea without getting into how the calculations are made. And as for nature plus nurture, I totally agree. My favourite example comes from STephen PInker’s question: Where does the music come from? The CD (input, thus nurture) or the CD player (preexisting structure, thus nature)? Oh, you say it comes from an interaction between them? That’s just plain silly. They are aspects of the same system.

        But your second last paragraph is most important, I think. Behavioral genetics is a clunky sort of science which mostly just says yes or no to each of the questions it asks — does a relationship exist or not?

        And yes, the molecular basis of behaviour…an obviously profound goal. Once we make real progress in this direction, the question of whether addiction is a disease or not will have long stopped making sense.

        Reply
  7. William Abbott

    The idea of an addictive personality has been largely debunked and wisely so as it supports the idea in the afflicted of this problem somehow being ” fated”

    Of course there is heritabilty which might add a predisposition to becoming addicted but its a crap shoot as to whether you get it or not

    I have 2 children- both their parents and all 4 of their grandparents had alcohol problems; neither of them (now in their 40’s) do now. Go figure

    And bottom line , unless this is your passion to understand this, is what difference does it make? If you get it, figure out a way to get rid of it. Its a problem yes, but finding the solution is paramount.

    Reply
    1. matt

      I like how the epigenetic factors change (or make moot) the whole nature-nurture argument. Like how predisposing chromosomes might get flipped on developmentally, and then the “flipped on” chromosome markers get passed on to the carriers progeny. It’s not either-or. It can be both.

      That might not get rid of the problem, but could have a lot to do with prevention.

      Reply
      1. Marc

        It sure helps explain multigenerational patterns that just can’t be accounted for entirely by environmental or standard genetic mechanisms.

        Reply
  8. Heather

    I can understand how certain personality traits can make you more likely to become an addict, but I think there are other factors that have to line up. Pretty much anyone could pick one or two of those personality traits listed and identify. I’m inclined to think that anyone, given the right set of circumstances, could become an addict, but not everyone will.

    Nobody in my family was an alcoholic. Drinking was an occasional celebratory thing and throughout my teens, twenties and thirties it was for me, too. Despite a broken engagement, disappointments in career and a period of being alone, it never occurred to me to turn to alcohol to cope. I was much better at self-examination and comforting myself in those days, perhaps because I felt good about myself.

    In my mid-40s, in a crumbling marriage, feeling stuck and being daily criticised, my self-worth began to crumble and the occasional drink for the purpose of celebration gradually became something to take the edge off my feelings. Once it was linked to feeling better that’s when it started to become a compulsion, and my relationship with alcohol changed. Two of my children have several of those personality traits mentioned. I can’t change the fact that they have seen me abuse
    alcohol, but I hope the fact that they see me beat the addiction may prevent them from following suit.

    Reply
    1. Marc

      Heather, that’s exactly what I’m trying to say. These genetic predispositions are only part of the picture. Environmental impacts, especially the nasty kind you’re describing, have an enormous impact as well. Genes and environments don’t exactly interact, though that’s a convenient way of thinking about it. But in reality, they are two inroads into a single process, and that process is DEVELOPMENT.

      Reply
  9. Gina

    “The strongest predictors are (1) an impulsive or antisocial personality style, and (2) an anxious, overly-sensitive, perhaps OCD personality style. Note that these personality clusters are almost perfect opposites: the brash, uncaring person vs. the anxious, neurotic person.” Wow! I think this may perfectly explain why “tough love” is so effective for some and so very destructive for others. I’ve suspected this for a while but I’ve never seen it addressed in print. I see so many unnecessarily polarized arguments about this in various online support groups, whether pro or con. Seems to me this kind of information could go a long way toward helping to shape an individualized course of treatment or care for an individual.

    Reply
    1. Marc

      Yes, Gina, that’s it exactly. These are very different “types” and they need very different kinds of help. Those with impulsive personality (disorder) — antisocial is an extreme version — do need a lot of rules and structure. Those who are oversensitive and already feeling shitty, rejected, ashamed, etc, what they need most is a sense of being okay, connected, forgiven, loved.

      Excellent point!

      We should keep in mind that genetics does not create “types” …it creates tendencies or initial conditions. Experience, and the way that experience is organized and made sense of…is what creates the “finished product” of one’s personality typology.

      Reply
      1. Heather

        That does explain why different approaches appeal to different people. I had to stop reading one book that was aimed at helping people who had quit to stay quit, because the author kept using words about the addict like “immature” and “irresponsible”. It was making me feel bad about myself and the key thing for me in being able to recover is feeling positive about myself and like I can do this. Thanks for that.

        Reply
        1. Carlton

          Heather,
          Yes, how a specific recovery approach “appeals” to an individual is the most important point.

          A prescribed or mandated recovery approach may not be in Cahoots with the individual.

          For instance, for some people, the life-long disease model can imply that you can drink and/or use for the rest of your life, because you can periodically say the disease “overwhelmed you”, and you just have to re-start your day-count over and over.

          Yet for others, a non-disease model can imply that without maintaining feelings of fear and diligence, you will periodically be “pushed over the edge” and relapse.

          This topic dovetails into Bill Abbott’s Post on this blog:

          A Doctor’s view on what Doctors CAN’T do for addicts

          Whether addiction is, or is not a disease may not be make a difference to on a person-to-person basis.

          The most important point is that the individual feels in-cahoots, or
          that the recovery approach ultimately “appealed” to them.

          Reply
  10. Leonard Busenah

    Thank you. This is a very educative piece, indeed.

    Reply
  11. Carlton

    Marc,
    Thanks for these thoughts from the advance copy of Maia Szalavitz’s latest book.

    Question:

    If there was information of this nature available before, or during your struggle with addiction, how do you think it would have effected, or changed your own experience?

    Reply
    1. Marc

      Hi Carlton. Sorry for the late reply. The answer is: not at all. In my teen years this would have gone over my head. Besides, I really didn’t know what type of person I was until much later. And since I was never “pure” impulsive or “pure” anxious/sensitive, I wouldn’t have been a typical candidate for addiction. And even if I had been, what would I have done about it?

      Reply
      1. Carlton

        Hi Marc, Yes, same here.

        However, in hindsight, during the actual addiction, this kind of information could have even added to the looming sense for destitution, hopelessness, that was happening.

        Curious if there are readers who would find this info helpful before, during or after their own experience with addiction.

        Reply
        1. Marc

          Good question. But my view is that too much emphasis on “types” can indeed lead one to feel more fatalistic about one’s path. Possibly not very helpful.

          Reply
          1. Carlton

            Yes, agree, singling out “types”, does not seem helpful.

            In fact, there was an infinite spectrum of “types” of people can be found attending the different recovery programs, at least the ones I joined at some point, such as AA, SMART. St Judes, and Cornerstone.

            Hearing personal accounts of the lives and of their addiction, (called Qualifications in AA, Check-ins in SMART) , they had little in common, on a whole.

            There was no particular common thing, such as Age, sex, lifestyles, education, etc, etc.

            This is another fact that suggests that a new model for addiction is out there.

            Perhaps an over-arching model that integrates the other models of addiction in new Paradigms, and the various models will no longer  be in contradiction, but integrated into a larger framework.

            Reply
  12. matt

    Something about Maia Szalawitz’z stuff…
    I’ve run into this “anecdotal correlation” in meetings. There are some people who are extremely motivated by tracking sober time. Days, weeks, months…tracking time, the more the better. They typically know their exact sober date, when they finally stopped for good. It appears to be very motivating for them.

    There is another group– to which I belong– who are not motivated by this and, in fact, it can be triggering. It gets to the sensitivity to failure and loss. For this group, the over emphasis on sober dates is not a good thing. I discovered this the hard way going in and out of programs. I’m of the ilk:

    “Just let me do this thing”
    “I don’t know when my sober date is. I don’t care. I know ballpark, and that’s good enough. My wife knows my sober date. I just need to keep going.”

    I kept relapsing and realized I was doing what everyone else was telling me to– except me.

    The point is, most treatment programs (and the general public) equate sober time with success. It’s a result not a cause. It is important to identify, which kind of person you are. Are you motivated by accruing sober time? Or does it actually set you up for failure? I do this as an exercise in groups now, just so that people who might not have considered it, realize where they are on the continuum and can catch themselves if it’s jeopardizing their recovery.

    Reply
    1. matt

      …and I think the reckless, risky behavior is also linked to this, as well as procrastination/perfectionism. But that’s another story…

      Reply
  13. Marcus

    If what is studied is alcohol addiction, crack addiction, whatever specific addiction, its probably in this 50% range. Addiction to what ever addictor is most likely the same as well. IMHO, this is far too myopic, and thus misses the forest for the trees. Addictability, however, would result in much higher genetic influences, environment only selecting out of the available addictors. Also, iatrogenic physical dependence is normal, predictable & is very different than addiction and that distinction needs to be made for accurate results.

    Reply
  14. BlakeC

    I’ve always had mixed thoughts on this topic. I work as an admissions director at a Drug/alcohol treatment center. Part of my job is to do the initial screenings (Bio/Psycho/Social Part 1) and as a part of that screening we ask if there is any family history of addiction. For some reason, I always find myself shocked when they say “no, I’m the first in my family.” I’m probably shocked because I come from a long line of addiction in my family so I’ve always thought of it as hereditary to help explain my addiction issues but my eyes have been opened that it’s not always the case. It’s become quite apparent to me that addiction can stem from both nature and nurture.

    Thank you for this article as it was enlightening for me to learn some of the statistical data presented here

    -Blake C.
    Treatmentcandor.com

    Reply
    1. Marc

      The disease model of addiction and the rehab industry it’s based on both tend to exaggerate the hereditary story of addiction. But the predictors are actually pretty weak, and as I explain here they often include completely opposite predispositions. Often modeling of parental behaviour gets mistaken as a hereditary association. Children living through their parents’ addiction become addicted, then become parents, and their children…etc., etc. So let’s be careful what we attribute to the genes. It’s often a facile explanation for a very complex problem.

      Reply
  15. Lynn

    Hmmm. I’ve been reading the comments and puzzling at the same time. I was an addict. My brother died an addict. We were the first in our family with addiction issues. But we both experienced a similar childhoods. We dealt with an unstable environment, separation, real or at least experienced rejection. Personal pain.

    I had the advantage of five years of psychiatric therapy. My brother did not. I finally had to face my issues and forgive myself and those around me. My brother never could. I hated him when he died. He left small children and asked me to make sure they were okay. I thought he should have been stronger, but it was an impossible ask.

    He was in constant emotional pain stemming from his own actions, but which resulted from deeply seated experiences in his early childhood. I don’t know what would have finally helped him. I only know what helped me. I do know that the release from pain we both experienced during our addictions kept us alive. I’ve asked this question before, but “how does this happen?”

    Reply
    1. Marc

      Hi Lynn. I have no idea what kind of answer you’re expecting if any at all. The question “how does this happen?”, if by that you’re referring to the destructive nature of addiction, is the foundation of a huge glut of books, articles, posts, and discussions. We’re all trying to figure that out. Can you be more specific?

      Reply
  16. lifecuredrugs

    What Is Pirfenidone?

    Pirfenidone is a doctor prescribed medication used to treat people with a lung infirmity called idiopathic aspiratory fibrosis (IPF).

    FDA underwriting of two new meds for idiopathic pneumonic fibrosis (Pirfenidone and Ofev) offers new look for after patients who live with this lethal, sad sickness.

    The U.S. Sustenance and Drug Administration has supported pirfenidone, a TGF-beta amalgamation inhibitor for the treatment of patients with idiopathic pneumonic fibrosis (IPF).

    Before taking Pirfenidone

    Before you start treatment, tell your master if you:

    have liver issues

    have kidney issues

    are a smoker

    have some other remedial conditions

    are pregnant or plan to end up pregnant. It isn’t known whether the medicine will hurt your unborn kid.

    are breastfeeding or plan to breastfeed. It isn’t known whether the prescription goes into your chest deplete. You and your authority should pick if you will take Pirfenidone or breastfeed.

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    Take this medication correctly as your pro educates you to take it.

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    If you overdose, call your master or go to the nearest facility emergency room quickly.

    Your master should do certain blood tests before you start treatment.

    What Should I Avoid While Taking Pirfenidone?

    Avoid light. Pirfenidone can make your skin unstable to the sun and the light from sunlamps and tanning beds. You could get a genuine sunburn. Use sunscreen (SPF50) and wear a top and pieces of clothing that cover your skin if you should be in sunshine. Banter with your master if you get sunburn.

    Keep away from smoking. Smoking may impact how well the medication capacities.

    Pirfenidone Side Effects

    Pirfenidone may cause bona fide responses, including:

    liver problems.Call your master instantly if you have unexplained symptoms, for instance, yellowing of your skin or the white bit of your eyes (jaundice), diminish or dim hued (tea shaded) pee, torment on the upper right 50% of your stomach locale (waist), depleting or injuring more successfully than normal, feeling tired. Your expert will do blood tests to check how your liver is working in the midst of your treatment.

    affectability to light (photosensitivity) and rash.

    stomach problemssuch as infection, heaving, detachment of the guts, heartburn, acid reflux, and stomach torment may occur. Tell your master quickly if your stomach issues disintegrate or don’t clear out. Your pro may need to change your part.

    The most outstanding side effects fuse tendency drained, cerebral agony, wooziness and decreased or loss of appetite.These are not all the possible responses. For more information, ask your pro or pharmacist.Call your expert for remedial advice about responses. You may in like manner report responses to the FDA.

    In what way Should I Store Pirfenidone?

    Store the tablets at room temperature between 68°F to 77°F (20°C to 25°C).

    Keep in a solidly closed compartment.

    Safely dispose of any Pirfenidone that is out of date or never again required.

    Keep all prescriptions a long way from children.

    Reply
  17. Skin Whitening Tablet

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    Reply
  18. MADELEINE HERRON

    Thanks for the information about call centers. It is always great to read about this ever-changing industry.

    Reply

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