How does it all start? My thoughts on addiction causes and substance abuse

February 27th, 2010

I was talking with a friend the other night, and he asked me my opinion about the line between addiction and normal behavior. He was wondering whether I think that everyone who looks at porn is a sex addict.

I don’t. (see some of our posts on sex addiction here)

Still, the conversation made me feel like writing something about my views on addiction causes. So here goes:

For the addicts who are still unaware, the line between normal- and addictive-behavior tends to blur again and again until it seems like more of faded smudge on their life. For those looking at addicts from the outside, the line normally seems so clear and so far away that they rarely believe it can be crossed back again.

I don’t personally believe that addiction per se is where things started for most people. By this I mean that no matter how hard we look, I believe that we will never find the elusive “addiction gene“, genes, or trigger.

Having been in the thick of it, I think that substance abuse is nothing but one possible outcome of set of circumstances, both biological and environmental, that lead some individuals down a particular path.

Impulsivity and other addiction causes

As I mentioned in earlier posts, addiction, at least to drugs (and I believe other addictions as well) is very closely related to a set of psychological conditions that have to do with impulse control problems.

I believe that individuals with increased impulsivity are simply more prone to putting themselves in situations that are inherently dangerous to their well-being. A simple example from non-drug related behavior might be one-night stands.

A typical person with no impulse control issues may hold off on sex if the only option was to have it unprotected. They may think to themselves “I need to stop, this could seriously affect the rest of my life.”

A person who has a reduced ability to control initial impulses may have the exact same thought and yet go through with the action, leaving them feeling remorseful and anxious the next day, but still having put themselves at risk.

This is a very common occurrence among sex-addicts. The thoughts are there, the knowledge is there, the ability to connect those to actions is seriously lacking. While some people make moral judgments about this fact, I’ve seen enough research that connects this problem to biological processes and genetics that I’m now resigned to the fact that at least on some level, the issue is physical and neurochemical.

Addiction help – Cures, treatment, and solutions

Still, I think the battle is far from lost. I strongly believe that education, informed by actual knowledge rather than misguided mythology, can put people in a better position to deal with the issues even if their source is outside of their control.

Even aside from pharmacological treatments (as in medications) that can help, there are endless ways to help people learn to be in better control of their actions once they are aware of their initial deficit. That is how AA and many other support groups function. People within them ask others about decisions they’re making BEFORE they act on them.

We know already that when it comes to drugs, the equation changes once the person starts using regularly and for long periods of time.

Chronic substance abuse further breaks down the brain’s ability to control impulses by reducing functioning specifically in the prefrontal-cortex; the part of the brain right behind your forehead which is thouught to be the center of the brain’s control tower.

The cycle seems too obvious: Impulse control difficulties leading to dangerous behavior which leads to further impulsivity issues and so on…

The treatment, like the progression of the condition itself, needs to be long. I don’t believe that any 30 day treatment program will be able to resolve a condition that took years to develop. Still, the issue of treatment will come up again here. This is enough for now…

Question of the day:
Do you have any insights from your own experiences as to how addiction develops?

Posted in:  Drugs, Education, Food, For others, Opinions, Sex, Tips, Treatment Tags: addiction causes, addiction gene, Drug addiction, drug treatment, genetics, impulsivity, problem drug use, Sex, substance abuse

Ancestry, Addiction, and trauma – Addiction research into genetic differences based on race

February 23rd, 2010

We all know that drug use and drug related crimes are a big problem within African American communities. It’s not a secret, but it can be interpreted very differently by different people. Do the differences between African Americans and Americans from European descent mean that Black people are simply meant to have more problems?

A recent study suggests that at least when it comes to addictions, the opposite might be true.

A genetic study of addiction and ancestry

Researchers at the New Jersey VA (Veterans’ Affairs) office collected data from 407 addicted African American patients as well as from 457 comparison participants at a local hospital’s ophthalmology clinic. Like in most studies of this nature, both groups was screened for other psychiatric problems and participants from the control group were excluded from the study if they showed any signs of addiction problems themselves.

The researchers then used 186 different genetic markers that relate to ancestry to determine the proportion of African, European, and Asian descent for each participant. After following this up with some questionnaires about childhood trauma and an estimations of participant socioeconomic status (things like income, education, age, etc.), the researchers ran analyses to see if African ancestry was related to drug problems, childhood trauma, and poverty.

The ancestry of the participants was verified to be mostly (average 80%) African, with European, Middle East, and Central Asia contributing between 5% and 7% more.

What did they find?

The first interesting finding was the fact that patients with alcohol, cocaine, or opiate dependence had lower proportion of African ancestry than non addicted individuals. The differences ranged from 5% to 3% but certainly reached significance levels. Since its already known that Europeans are more likely to show alcohol, but not drug, problems, the researchers checked to see if that was the factor responsible for the difference – it wasn’t.

Interestingly, even though childhood abuse or neglect were very much related to addiction in this sample (as we’ve talked about before), there was no relationship between African Ancestry and abuse or neglect.In fact, the two factors that were almost significant (childhood physical and sexual abuse) showed trends similar to those for addiction – African descent was associated with lower problems in those areas.

The final, and not surprising finding, had to do with an association between African ancestry and lower socioeconomic status. The differences in these categories were significant for income and education. This finding can almost serve as a validity check on the whole experiment, since census data has long shown lower SES for African Americans in the united States.

What does this all mean?

Okay, I know this isn’t necessarily the easiest study to understand, so let’s break it down:

Given the known drug problems among African Americans, the researchers wanted to know if African descent could have something to do with underlying genetic factors that make it more likely that Black individuals will end up as drug addicts. There are a host of genetic differences between Europeans, Asians, and Africans, and this was a way to get at a lot of them in one shot. The problem is that African Americans are also poorer than many European Americans, and since poverty is a known risk-factor for addiction, meaning it makes it more likely that someone will end up an addict, the researchers were interested in separating the two. They threw trauma in because it, like poverty, has already been shown to be related to addiction.

The results seemed to indicate that the two factors (poverty and addiction) as indeed separate. While African descent was associated with more poverty, it was actually found to be associated with less drug, and alcohol problems. This suggests that it’s the poverty, and all the factors associated with it, that may be driving the higher addiction rates among African Americans and not some predisposition to drug problems.

The good news is that this suggests that efforts at improving the SES and quality of life for African Americans in the United States will indeed lower their substance abuse rates. In fact, when it comes down to it, this research suggests that European Americans are the ones we need to watch for in terms of genetic risk for addiction.

As always, limitations

As usual, we need to remember that these are associations and don’t prove causality. Also, given the very specific sample used (veteran addicts), the results should be replicated in other populations. Lastly, remember that the ancestry-based differences weren’t huge, but given the fact that this was a strictly African American sample, that’s probably part of the package. Again, more research with  broader populations should help to resolve that.

Citation:

Francesca Ducci, Alec Roy, Pei-Hong Shen,Qiaoping Yuan, Nicole P. Yuan,  Colin A. Hodgkinson, Lynn R. Goldman, and David Goldman (2009). Association of Substance Use Disorders With Childhood Trauma but not African Genetic Heritage in an African American Cohort. American Journal of Psychiatry, 166, 1031-1040.

Posted in:  Alcohol, Cocaine, Education, Opiates Tags: african american, ancestry, Black, cocaine, european, genetics, opiate, race, SES, socioeconomic status, trauma, veternas

Am I an addict? A simple new test may help us get the answer!

January 24th, 2010

Originally posted on Psychology Today:

One of the biggest problems with addiction is that we never know who is truly an addict. Yes, we have tests and notions, interviews and criteria, but all of those are simply tools we’ve used to get around the problem of not knowing. Well, a recent study by a couple of researchers at Florida State University may help us get a little closer (before you get too excited, read the limitations at the end). My take-home message from this post is familiar: Addiction is a disease, not a question of morality.

Am I An addict? Testing for addiction

One of the major reasons for the push to find the ‘alcoholic gene’ was the hope that, once found, it would let us say, with certainty, who is (and who isn’t) an addict. All those people who simply use drugs and other addictions as an excuse for their horrible behavior would be revealed and all those who truly need help could be identified. But it didn’t quite work out that way.

There is no alcoholic gene. There are a whole bunch of genes that are associated with, and most likely contribute to, the risk of someone becoming an addict. But they vary for different drugs, require some pretty serious testing, and contribute very little (individually) to our ability to categorize people. The same genes that are linked to addiction are also linked to ADHD, anxiety disorders, depression, and on and on…

But wouldn’t it be great if we had a conclusive test? Something that worked to really help us tell the difference between addicts and the rest?

Skin response testing

Electrodermal response modulation (ERM; a fancy name for measuring skin conductance) is a measure of how skin conductance changes in response to predictable versus unpredictable stress.

The connection between addiction and skin response might seem a stretch, but hey, dilated pupils are a sign for sexual attraction so… The idea is that the more prepared the overall system is to deal with predictable stress, the better equipped a person is to handle life stressors. Bad responsivity would mean that the person’s system is not adjusting well to stressors that are predictable, producing too much arousal and discomfort to events they should be prepared for.

So for this study, high ERM good, low ERM bad, got it?

To make a long story short, this recent research shows that low ERM was more common among individuals with addiction than among controls (people with no major mental health issues) and even among individuals with personality disorders.

The good news is that this finding is promising in terms of possible future identification of people who are likely to develop addiction problems. But of course, there are some issues.

Limitations of the study

Since the study used people who were already addicted, it’s impossible for us to know if low ERM exists before addiction develops. If it does, we may be able to identify potential addicts before they become addicted, but if not, it would still be useful to have a test to distinguish current addicts from non-addicts.

Of course, at the moment the test only works by comparing addicted to non-addicted groups - we don’t have norms or cutoff points to tell us on an individual basis who is or isn’t an addict. A lot more research will be required before that would be possible.

This is not the first test that has shown promise in terms of a quick identification test for addiction. There is quite a bit of research showing a relationship between a specific brain wave (called P300) and addiction. the problem is that P300 turned out to be pretty generally associated with what are known as externalizing disorders (like illegal activity, high risk sexual behavior, aggression, etc.). I personally believe that as behavioral addictions (like sex addiction that involves high risk sexual behavior) become more commonly understood, many of those externalizing disorders may be reclassified, making P300 possibly more popular as an addiction measure.

The Bottom Line: So can we tell?

It’s too early to know if ERM will turn out to be a really good marker for addiction, but I’m sure people are hard at work trying to figure that out, so let’s give them some time. Years ago I heard a presentation about people with low variability in heart rate which seemed to suggest something very similar, so I’m hopeful. But to me, there’s a more important take home message:

Once again, this study shows that there are physiological factors to addiction that are far beyond anyone’s actual control. I don’t personally know anyone who can change their skin conductance, and so I’m pretty comfortable saying that addiction is an actual medical condition in so far as it has physical symptoms and some promising treatments.

But then again, I am a scientist…

Posted in:  Education Tags: addict, addiction, alcoholic, antisocial personality disorder, drug abuse, erm, genetics, heart rate variability, identification, p300, personality disorder, psychology, science, skin conductance, test, testing

Nicotine addiction and genetics – It’s the little things that matter in smoking addiction

December 24th, 2009

We’ve known for a while that genes play a role in addiction in general and that nicotine is addictive at least in part because it activates receptors for a chemical called Acetylcholine (ACh) that are found all over the brain and body. Nevertheless, finding the specific mechanism for the genetic predisposition has been difficult.

Some recent large-scale studies undertaken at the University of Colorado and other institutions  around the country have made some very exciting discoveries in this area.  It seems that up to now, researchers were focusing on the most common type of ACh receptor, but that several other types play very important roles in determining how people will respond to nicotine the first time they use it, and how much they’ll be likely to use in that early period. It should be pretty obvious that both there factors can play a huge role in nicotine addiction, and indeed, it seems they do.

So here’s a little breakdown of the findings:

• Initially, research examining the influence of ACh receptor proteins on nicotine addiction focused on the α4 and β2 subunits. These are the most common ACh subunit proteins in the brain. Animal and human imaging studies have shown that ACh receptors consisting of two α4 and three β2 subunits are critical for the rewarding effects of nicotine.
• The new studies focused on genes that code for less common ACh receptor proteins. Researchers have implicated the genes for the α3, α5, and β4 proteins in early initiation of smoking, the transition to dependence, and two smoking-related diseases: lung cancer and peripheral arterial disease.
• Investigators also found that whether or not a person becomes dizzy the first time he tries smoking, as well as his or her risk of addiction, depends in part on the genes for the α6 and β3 proteins.

Taken together, the results suggest that genes for several ACh receptor proteins drive different aspects of the multi-step process of nicotine addiction.

The importance of the first time

Interestingly, the findings regarding first smoking experience seem to suggest that the intensity of it, rather than simply how pleasurable it was, are associated with the likelihood of becoming dependent later on, according to Dr. Ehringer, one of the studies’ lead author. For example, the same people that reported feeling extremely dizzy their first time were more likely to report that they became addicted to nicotine. The genetics analysis supported this same finding.

From trying to becoming addicted

Other studies revealed that additional genetic variations, including those in the the gene for the α3 ACh subunit, the β3 subunit, and the α5 subunit seem to code for the likelihood of being able to quit smoking. The α5 protein, which is present in the brain’s reward area, seems to influence the risk of smoking a pack of cigarettes a day as compared with smoking fewer than 5 cigarettes a day.

Conclusions for smoking addiction

I’ve said it before and I’ll say it again and again – no matter how much we try to ignore it, genetics play a huge role in every aspect of our being, including the likelihood that we will become addicted to a substance. By learning more about the role of specific genes and specific types of receptors, researchers can attempt to uncover possible medications that will help us in treating addiction. Still, I think that the bigger take-home message is this: There are reasons behind the development of addiction that are beyond anyone’s control. Thinking of genetic causes and relating them to morality simply makes no sense.

 Citation:

Lori Whitten (2009). Studies Link Family of Genes to Nicotine Addiction – Genes for protein constituents of nicotinic acetylcholine receptors influence early smoking responses and the likelihood of nicotine dependence. NIDA Notes, 22.

Posted in:  Education Tags: acetylcholine, ACH, Brain, cancer, cigarettes, gene, genetics, initiation, nicotine, NIDA, receptor, smoking

It’s in your genes: The connection between addiction and other disorders

December 23rd, 2009

I think it’s common knowledge that children are more likely to develop a psychiatric disorder when one of their parents is diagnosed with one. Just in case it isn’t, as much as 80% of the likelihood that a person will develop a mental health disorder is genetically determined.

The genetics of mental health and addiction

The thing is, some studies have shown that children are more likely to get any disorder, while other have shown that a child is most likely to get a similar disorder to the parents. Granted, for things like anxiety, and depression, knowing which of the two answers is correct may not matter much (though for some parents it does). But when it comes to substance-abuse, parents want to know whether they should take special precautions, which is especially true if addiction runs in the family or if any psychological disorders are common.

A recent study tried to answer that question while focusing on anxiety, conduct disorder, depression, and substance use [1]. The researchers’ reasons for choosing these four disorders had to do with repeated findings about the association between them [2].

The results showed that if both parents displayed generalized anxiety disorder their children were more likely to suffer from anxiety and depressive disorder [1]. It was also revealed that parental substance use was associated with an increased risk of conduct disorders in offspring.

In general, these results indicate that the heritability is not super-specific. However, it seems that while substance abuse and things like depression and anxiety are related, parents transmit disorders in a relatively specific way. So, if you’re worried about your children having substance abuse problems, I’d look more toward family history of those or impulse and attention problem, not depression and anxiety.

Citations:

1. Johnson, J.G., Cohen, P., Kasen, S., & Brook, J. S. (2008) Parental Concordance and Offspring Risk for Anxiety, Conduct, Depressive, and Substance Use Disorder, Psychopathology, 41: 124-128.

2. Merikangas, K.R., Dierker, L. C., & Szatmari, P. (1998) Psychopathology Among Offspring of Parents with Substance Abuse and/or Anxiety Disorder: A High-risk Study, Journal of Child Psychology and Psychiatry, 39: 711-720.

Posted in:  Education, For others, Tips Tags: anxiety, conduct disorder, depression, genetics, heritability

Addiction is a disorder of control, not choice – A response to Heyman’s book

December 5th, 2009

I was working on the first chapter of my book today and the issue of choice plays a prominent part in it. I’m a little pissed at Dr. Heyman, whose name sounds like something a stoner might say, about his book, “Addiction – A disorder of choice”.

The thing is that at its most basic, every action we perform seems like a choice. Whenever you take a step, think a thought, or feel a feeling, you’re “choosing” that specific action rather than an almost endless number of other options.

However, when choices are involuntary, or are made below the level of consciousness, as is often the case not only with addiction but in many other instances in life, than I believe the word choice is being misused. Dr. Heyman knew that his book would cause controversy, but he also knows very well that the mere exposure to substances can cause profound changes in the way animals make choices.

Drugs alter the way the brain works, including the ways choice are made. They affect the internal value given to rewards, they alter the brain’s ability to adjust to new situations, and they change the brain’s basic neurochemistry to cause profound effects on overall function that no doubt alter many more processes.

And I haven’t even touched on the ways that different people are pre-programmed to make choice in different ways because of their genetic make-up. Whether you call it choice or not isn’t the question. Rather, the question is one of control. Addiction is a disorder of control.

Posted in:  Drugs, Education, Opinions Tags: Brain, choice, choosing, control, Drugs, function, gene, genetics, Heyman, programmed

Crystal meth and cocaine, Agassi and Gasquet- The reality of drug use in our society.

November 11th, 2009

After Andre Agassi’s recent confessions in a tell-tale book about his use of crystal meth during his playing days, Richard Gasquet, who recently made it to the Wimbledon semifinals has just tested positive for cocaine.

He says he was contaminated with the drug when he kissed a woman who was using it.  Right. Unless the woman was covered in an inch thick layer of coke, or unless Gasquet drank about a pint of her heavily intoxicated saliva, we all know that’s a lie. I’m pretty sure the committee now deliberating will come to the same conclusion.

Drug use in our society

The bottom line is that drugs are everywhere, including our star athletes, night-club hopping starlets, and big-time business executives. And in case you haven’t figured this out, they’re not going away. The best we can do is to keep researching the problem so that we can:

1. Educate the public (educational and dissemination research).
2. Identify risky users earlier (assessment and genetics research).
3. Figure out the most effective ways to get them into treatment (intervention research).
4. Discover the best methods to treat them (clinical and pharmacological research).
5. Repeat the cycle.

That’s it! That’s all we’ve got. Recreational drug use will most likely continue forever, and I for one think that’s the wrong problem for us to be focusing on.

Interdiction – Our current solution to drug use

Limiting the drug supply, which is a big part of how our government currently deals with the problem, drives up the price of street drugs. This in turn reduces their purity (dealers have to make money) and gets in the way of recreational drug use. So far so good. But guess what?

Addicts don’t care about the cost of drugs.

Trust me, I used to sell them and use. I used to know a lot of other people who did too. Addicts are not making rational decisions based on economic realities. They’ll sell their stuff, lie cheat and steal their way to more drugs. Their brains are no longer depending on rational thinking when it comes to their drug use. That’s pretty much the definition of addiction.

Decriminalization – Our next step

I’m going to write a post soon about the notion of decriminalization. Decriminalization is different from legalization. Making drugs legal is like sanctioning their use – making citizens think the drugs are okay. For the most part, they’re not. But decriminalization would take addicts out of our prisons and give them the treatment they need. I think it’s time we faced the music and dealt with drug use problems at their core, with the people most often negatively affected by them.

Posted in:  Drugs, Education, Opinions, Treatment Tags: addicts, agassi, assessment, cocaine, confession, cost, crystal meth, dealing, decriminalization, economics, economy, education, gasquet, genetics, interdiction, intervention, jail, legalization, lie, Medications, pharmacology, police, prison, recreation