Why do some people become addicted but some don’t?

Why do some people become addicted but some don't?

It's weird. I have one sibling - my sister. We both have the same parents and grandparents, we both grew up in the same home, went to the same schools, ate the same foods. But I cannot take a drink or use a drug without becoming hopelessly addicted, but she is fine. I was staying at her place for a week, and one night she had a glass of wine. I didn't partake, because I am in recovery and I know that one drink and I'll be right back where I was before, suffering under the lash of drugs and alcohol. It just about drove me crazy watching her slowly sip her glass of wine through the evening and not even finish it by the time she went to bed. It didn't drive me crazy because I wanted some, I am far enough into my recovery that my desire to drink or use is lifted. It drove me crazy because I couldn't understand how someone could just sip one glass of wine all evening and then not even finish it. And then, the unfinished bottle remained in the fridge the rest of my visit. How could she not down it? If I have even a taste of alcohol, I am gone. I down it quickly and keep drinking until either I am incapacitated or it runs out. And then I want more. Why am I like that but my blood sister is not even a little affected?? Data from the United States National Institutes on Drug Abuse (NIDA) shows that by the time we pass age 25 more than 87% of us have used alcohol, and more than 50% of us have used drugs. So why isn't 87% of the population addicted to alcohol and 50% addicted to drugs? (To see the data from the NIDA Click Here).

What makes us who we are

There are two things that make us who we are: one is "nature" and the other is "nurture." Nature is our genetics, our DNA that we inherit from our parents. Nurture is our environment: the things we are exposed to in life. This is things like our up-bringing, our education, our friends, our life experiences, our nutrition, our life situation, and so on. Besides nature and nurture, I'm going to add one thing that contributes to whether we become addicted to substances or not. It is something that is also influenced by both nature and nurture: other mental health difficulties. The first time anyone tries alcohol or another drug, it’s a voluntary choice. We may be coerced, or even tricked into it, but in most cases it’s by choice. We might get drunk or high, have a good or a bad experience, and the next day we carry on with our lives until the next time we choose to do it again. But in some people, at some point a switch gets flipped within the brain and the decision to use is no longer voluntary. After initial exposure, no one gets to decide how their brain will react to drugs or alcohol. So why do some people develop addiction, while others don’t? The answer lies partly in the brain.

The obsession-compulsion of addiction / alcoholism

Addiction to a substance or behavior develops because of its effects on the brain chemistry, particularly the "reward" chemical dopamine (see my post "The Brain in Alcoholism and Addiction" Click Here). Tolerance to a substance develops because as our addiction progresses, dopamine has less impact on the brain’s reward center. We find that our substance of abuse no longer gives us much pleasure, and we have to take more of it to obtain the same dopamine “high.” At this point the obsession and compulsion that is alcoholism/addiction takes control. It is then that this villainous “obsession” and its evil buddy “compulsion” takes over. The pleasure associated with an addictive drug or behavior subsides – yet the memory of the high becomes overpowering (the obsession) and great anxiety over the need to recreate the high (the compulsion) take over, driving us to go after it. The normal thought processes, logic, needs, motivations, and desires of the brain become derailed – the brain is now addicted. It is not the desire for the experience of pleasure from an addictive substance or activity alone that makes us addicted. Otherwise, we would all be addicted: everybody wants to experience something pleasurable. Dopamine does more than give us the sensation of pleasure; it is also involved in learning and memory. In an upcoming post, I'll be discussing how learning and memory are key elements in the transition from enjoying something to becoming addicted to it.

Our genetics

Our genes – our DNA that we inherit and which affect who and what we are – play a major role in deciding which of us is susceptible to this process and have the correct brain wiring for it to occur to such a degree that it tips the scales over to the point where addiction occurs. That is why a family history of addiction and mental health problems are risk factors for addiction. Current estimates are that genetics are responsible for 40-60% of our becoming addicted to a substance or behavior. These estimates have been further broken down for different addictions, and go as high as over 70% for cocaine addiction. To learn about how our genes lead us to addiction / alcoholism, see my post "Is there an alcoholism/addiction gene?" Click Here. For now suffice it to say that even though genetics make up such a large part of what makes us become alcoholic/addicts, having a lot of addiction in the family definitely does not mean that we will become addicted. As well, if we are addicted it definitely doesn't mean that our children will necessarily be addicted. See my genetics post to find out why that is and what to do to avoid "bad" genes.

Our environment

As well, our life experiences and environment play a major role in tipping the scales. That is why things such as poor nutrition, exposure to abuse, parental drug use, our friends, our neighborhood, poverty, life stressors, and so on are risk factors for addiction. Some environmental factors play a particularly strong role in leading us to substance use and addiction. Exposure to drugs or alcohol while a fetus, traumatic events (abuse, injury, loss of a loved one), and early exposure to drugs or alcohol, are examples. A colleague of mine (Dr. Mehmet Oz) says "genetics load the gun, our environment pulls the trigger." I think that captures the interaction between nature and nurture. However, many alcoholic/addicts have had all the best in life, all the best of opportunities, and no family history of addictions, while many people who grew up in horrible conditions born of parents who have addiction issues go through life without. So, nobody is immune to addiction, and nobody is guaranteed to become addicted.

Mental health factors

Mental health problems (depression, anxiety, bipolar disorder, PTSD, schizophrenia, etc) are closely tied to addiction and alcoholism. Very closely tied. In fact, the medical community considers addiction/alcoholism to be a mental health disorder. Officially, it's known as "substance use disorder"... the terms "alcoholism" and "addiction" are not proper medical terminology. Whatever. The brain chemistry, genetics, causes, and symptoms of addiction/alcoholism are very similar to those of mental health disorders. To learn all about this, see my post "The Link Between Mental Health and Alcoholism/Addiction" Click Here. So, it is not surprising that they are so intertwined. Mental health disorders go largely unrecognized and untreated for many reasons (see the link in the last paragraph). But, in many cases we don't have a chance at getting better from either unless they are both addressed. Many people come to use substances as they attempt to self-medicate symptoms of a mental health problem. Developing a mental health disorder is a large factor in determining if we will use and become addicted to a substance.

What really matters

It's good to understand why we are the way we are. However, in the end what really matters is that we are addicted to alcohol or drugs, or both, and we need to deal with it. Using our genetics or our life path as an excuse or a reason to keep using or drinking, or to decide that we are incapable of getting clean and sober, is a death-trap, and it's absolute crap. The addicted mind is searching for ways to rationalize our substance use, and to keep us from stopping. We can't let the reasons we are here be its tool to use against us. And, it does no good to be angry and sorrowful over the bad things from our past that brought us to where we are. We can't change those things, so it's pointless to obsess over them. Instead, we need to accept where we are and decide to move forward. All of us can recover. We don't have to let the things that brought us here keep us from getting out. [caption id="attachment_495" align="alignnone" width="225"] To learn more about the science and psychology of addiction and recovery, and to understand why alcoholics and addicts behave the way they do, see the author's book The Alcoholic / Addict Within[/caption] Available for sample or purchase in paperback and ebook editions at amazon.com (Click Here).