Addiction, Genetics, Heredity, Life, Environment

By: Michael Stone, MD, Addiction Medicine Specialist,
Director, Cornerstone of Southern California

I hope you read and enjoyed my previous article. Now you should know how I define addiction. I will describe how you got the problem and the physical nature of the disease.

Addiction is a brain disease. Addicts have physical changes (differences) in their brain chemistry which cause addict behavior, addict feelings, moods and drives. These changes are at the deepest level of the brain where one cell "talks" to another cell by sending messages (chemical messengers called neurotransmitters) to each other. How did these changes happen?

Genetics; Hereditary: We know that you can be born with these changes already set up in your brain because you have inherited the genes (and therefore the changes) to be an addict. This is similar to people who are born with the gene makeup to be a diabetic who needs insulin, an asthmatic or a person with high blood pressure. The more addiction there is in your family, the more likely you will be born with it. Therefore, when you look intensely at your family you may see an alcoholic, a gambler, a workaholic, a sex addict, an overeater, an "illegal drug" addict (cocaine, heroin, marijuana etc.) or even a "legal drug" addict, e.g. Vicodin, Valium, Xanax, etc. Whichever addiction your family has and the closer that that relative is in the bloodline to you, then, the greater the chance you will inherit it.

Life; Environment; Family Dysfunction: Here there are two possibilities. You can be born, as above, with a strong genetic/hereditary factor, you can be born with a slight genetic factor or you can be born with none at all. This is where what happens to you in your life (your environment) and your family relationships can cause the changes in your brain chemistry that lead to the disease of addiction. The key to you getting addiction from life is getting "HIGH," feeling really, really good - from some chemical or some action or behavior that you did. If you drink alcohol and you feel fantastic, fabulous, great, unbelievable, super relaxed, can talk to anyone, no longer scared, can socialize, can date etc. this is getting "high" from alcohol as opposed to having a drink and feeling relaxed and comfortable. If you drink a lot and don't get a hangover or sick, that is, no negative physical problems from heavy drinking, then addiction is more likely. If you have both factors - really getting "high" from drinking and don't get too sick, then you could be heading towards addiction.

This also goes for using any other "it". For example, if you feel great from an illegal drug when you try "it" or a behavior like gambling, sex, exercise, then you are more likely to become an addict than a person who does not like or does not get great positive feelings from the chemical or behavior. If you don't like the effect of cocaine you are not going to get addicted to it. If you don't like sex or gambling, you are unlikely to end up addicted to one of them either. Remember, life is not perfect and our knowledge of addiction is still in its infancy, but there is no doubt in my mind that all of the above have a lot to do with the development of addiction in anyone.

Remember also that "getting high" for one person may not be the same as "getting high" for someone else. For some people "getting high" is getting rid of their anxiety, stress, or fear. For others it is avoiding situations and unpleasant feelings and emotions. Still others, want to avoid relationships, intimacy, responsibility, or pain. So you can see that tranquilizers, sedatives, sleeping pills, painkillers, narcotics, and muscle relaxants - all of which can lead to a "high" feeling - can lead to addiction, whereas medications such as antibiotics, blood pressure pills, and diabetes pills (which can also make you feel better but not "high") do not lead to addiction.

If you drink alcohol and feel really good (high), then you drink again or drink more to get that feeling over and over. If you now find you have a compulsion, craving or strong drive to drink alcohol and sometimes when you drink you lose control and create problems for yourself and others, then, clearly, addiction is developing. If you continue repeating this cycle then addiction has set in. Within this cycle the chemical neurotransmitters in the brain change and addiction occurs. This process can happen the first time you drink, or it can take many years to develop. The stronger the hereditary/genetic factors that are in you, the sooner addiction develops relative to your first contact with "it" (your drug or behavior).

Trigger; Catastrophe: If something happens suddenly to you, something very good or very bad, it can lead to using alcohol, drugs, or behaviors that otherwise would never have been used before or would not have been used to that degree. Example:

A serious accident necessitating high doses of opiates, tranquilizers or muscle relaxants causing a brain chemistry change in the neurotransmitter system can lead to addiction.

The sudden death of someone close to you or other significant loss, e.g. house burned down, loss of job or relationship, can lead to heavy drinking or drug taking, which again can cause the change in the brain chemistry which leads to addiction.

A great promotion at work, winning the lottery, or a big inheritance can also lead to increased drinking or drug usage, triggering the chemical brain change leading to addiction.

There are people who, because of their hereditary factors and their life/environment will never develop addiction. Then there are others who, because of differnet hereditary factors and life/environment circumstances, are predisposed to becoming addicts.

Denial: So now you have been told you are an addict or you have found out you are an addict. The immediate response is No! No way! Not me! Impossible! Mistake! This is one aspect of the condition, well known in the addiction field, called Denial. Why does denial occur in just about every addict at the beginning and why does it continue to rear its ugly head over months and years? You are born into this world innocent and are then trained by "life." You lose your naivete and develop "beliefs." Some of those beliefs are that addicts and alcoholics (the same condition) are bad people, are weak-willed, are sinners, are cowards, are dirty, are difficult, are crazy, and are not wanted around, are disliked or even hated. Then someone tells you or you find out you are an addict, "one of those people" you have learned all of your life until now to despise. You have always felt better than "those sort of people." This is not good for your self-esteem; this is not a pleasant surprise; this must be wrong - an obvious mistake - DENIAL. You would be an unusual person if you did not show and feel this denial. It is going to take one major personal shift to accept this unwanted fact - you are an addict.

This, by the way, is the beginning of Step 1 of the program of Alcoholics Anonymous - Acceptance. The problem of denial and the process of working through it is extremely important and usually will not occur unless you actively work on it. You can attend Alcoholics Anonymous or the specific Anonymous meeting dependent on your specific addiction.

You can go into addiction treatment. You can get help from Rational Recovery or your religious leaders. You can use whatever works for you, but you must actively work through your denial and reach acceptance. Doesn't it make sense to be educated about this disease you find yourself with? The alternative is to continue the denial and remain active in your addiction (continue to drink alcohol, do drugs, gamble, etc.) or stop the alcohol, drug, or behavior and be clean or dry or abstinent, but never understand and accept the disease. Remember how you felt when you learned that you were an addict. Recognize that the only way to get your self-esteem back, and improved, is to actively participate in a recovery process. You could work on and resolve all the direct problems you find you have because of your active addiction. The only way to get your self-esteem back, once you have accepted the diagnosis of addiction, is an active recovery program. I believe education and treatment of both you and your significant others is also very important. This can include Al-Anon and all the family programs attached to the other Anonymous programs as well as the family programs in all good addiction treatment centers.

Addiction is a disease which, when treated, can be inactive (in remission). It is caused by a brain chemistry change that is often genetic and/or brought to the surface by life and sometimes specific triggers. I believe it is not your fault that you have this disease, neither is it anyone else's fault, but it is now your responsibility to get the help, treatment, and recovery available to all addicts. Hopefully your significant others will work on their denial/acceptance and need for help just as you do.

What can you hope for? What should be your goal? Sobriety followed by recovery. There will come a day when you will be proud of your recovery, surrender to your disease, and be thankful that you are a recovering addict. This is because this disease is chronic, powerful, progressive, and often fatal, but when treated, causes you to go through a fantastic life change which would probably never happen if you were not an addict. Thus, your terrible disease of addiction can lead you from hell to a fantastic life once the denial is broken and acceptance, surrender, and education happens, leaving you a grateful recovering addict.

MICHAEL STONE, MD, Addiction Medicine Specialist
Cornerstone of Southern California

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Addiction the Disease

How do you know if you have this disease?

How do you know if a loved one, a colleague, an employee, a friend, or your cellmate has this disease? There are endless definitions but here is mine. There are five pieces of the puzzle and all have to be present to be sure it is an addiction.

First - compulsion. This is not all the time, it is not every day but it is obvious. The cocaine addict gets the urge to use cocaine, the alcoholic craves a drink and the Vicodin addict is driven to get the pills. Addicts get the compulsion to do "it" (what they are addicted to) ...

Second - they do "it". I believe it is possible to be an... Read More »

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