Sooner or later we all ask ourselves this question.
Surprisingly, there are some but no definite answers. This blog entry will discuss some of what is known about risk factors for developing drug
addiction.
First and foremost, do we have evidence that individuals are at risk for specific types of addictions, or is there a general tendency to develop addiction?
The answer is that epidemiological studies looking at comorbidities (i.e., the co-occurrence of different types of disorders) favor the idea that individuals have a general tendency to develop drug addictions(Kessler et al., 1997). In other words, people who are addicted to one type of drug often also admit to having used or had addiction to other types before or at the same time. Thus, it appears that our biology can wires us with a general tendency for developing addiction to substances of abuse. The overlap with other forms of addiction (e.g., gambling, binge eating, sex addiction) is present but not as large.
Second, what are the specific factors that increase your risk to develop addictions?
Family: Before examining specific effects of genes, extensive evidence shows that that addiction clusters in families, i.e. there is a higher chance of developing an addiction if one of your blood relatives also has a problem with addiction(Kendler et al., 1997). The closer the family member who has a problem with addiction, the higher the risk. Obviously, this points to both genetic and environmental influences.
Genes: Heritability, i.e. the degree to which genes determine the risk for developing addictions: most of the genetic and shared environmental risk factors for illicit substance use and substance abuse/dependence are nonspecific, i.e. the researchers could not find evidence for genetic factors that increase risk for individuals to abuse substance A and not also to abuse substances B, C, and D(Kendler et al., 2003).
Psychological factors: Two psychological characteristics have been reported repeatedly to be associated with higher risk for various types of addiction - impulsivity and sensation seeking. High levels of impulsivity, i.e. the inability to control premature or inappropriate action, are clearly related to higher levels of use of various drugs(Verdejo-Garcia et al., 2007). Higher levels of sensation seeking, i.e. the need for high levels of external stimulation combined with the urge to seek such stimulation, has also been related to increased risk for drug use(Kelly et al., 2006). In part, this may be due to these individuals experiencing greater subjective effects associated with drug use: feel the drug, like the drug, and experience a high. Finally, the way you look at risk, i.e. whether you focus on the potential benefits or the potential adverse consequences of a situation with uncertain outcome, is also associated with risk for addiction. Specifically, individuals who have a low risk perception, i.e. tend to not see the bad after-effects, are at increased risk for addiction(Ryb et al., 2006).
Psychiatric conditions: Of the many psychiatric disorders, two are noteworthy, one not so surprising, the other one, more so. First, individuals with attention deficit hyperactivity disorder in general are at higher risk for addictions(Biederman et al., 1998). This is probably not surprising because these individuals are also often highly impulsive. However, this increased risk is reduced if these individuals are properly treated - even if it is with prescription stimulants(Wilens et al., 2003). Second, people with anxiety problems irrespective of the type (whether it is panic, social anxiety or post-traumatic stress disorder) are at increased risk for also developing addictions(Sareen et al., 2006). This may be due to the fact that these individuals use substances to reduce their anxious experiences.
So what can you do? Look at yourself, your family background, your own behavior and your previous experience. Do you get hooked on something easily? Are you impulsive? Do you like to be in a highly stimulating environment? Are you anxious? These are simple questions that may raise or lower your concern about your own personal risk. There are many aspects, though, that are not covered here and that I hope to cover and clarify in future blogs, so stay tuned.
For more info:
Biederman J, Wilens TE, Mick E, Faraone SV,and Spencer T (1998): Does attention-deficit hyperactivity disorder impact the developmental course of drug and alcohol abuse and dependence? Biol.Psychiatry 44: 269-273
Kelly TH, Robbins G, Martin CA, Fillmore MT, Lane SD, Harrington NG,and Rush CR (2006): Individual differences in drug abuse vulnerability: d-amphetamine and sensation-seeking status. Psychopharmacology (Berl) 189: 17-25
Kendler KS, Davis CG,and Kessler RC (1997): The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey: a family history study. Br.J.Psychiatry 170: 541-548
Kendler KS, Jacobson KC, Prescott CA,and Neale MC (2003): Specificity of genetic and environmental risk factors for use and abuse/dependence of cannabis, cocaine, hallucinogens, sedatives, stimulants, and opiates in male twins. Am.J Psychiatry 160: 687-695
Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J,and Anthony JC (1997): Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch.Gen.Psychiatry 54: 313-321
Ryb GE, Dischinger PC, Kufera JA,and Read KM (2006): Risk perception and impulsivity: association with risky behaviors and substance abuse disorders. Accid.Anal.Prev. 38: 567-573
Sareen J, Chartier M, Paulus MP,and Stein MB (2006): Illicit drug use and anxiety disorders: Findings from two community surveys. Psychiatry Res. 142: 11-17
Verdejo-Garcia A, Bechara A, Recknor EC,and Perez-Garcia M (2007): Negative emotion-driven impulsivity predicts substance dependence problems. Drug Alcohol Depend. 91: 213-219
Wilens TE, Faraone SV, Biederman J,and Gunawardene S (2003): Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 111: 179-185
An Addiction Assessment Quiz
I found a site that has a
quiz you can take to see if you have a problem with an
addiction. Check it out!
Quiz
Hi Emily
looks like the link gets you back to the stop addiction website, it would be useful to figure out what the sensitivity and specificity of the questionnaire is, which is what is important to know how good the test really is.
I agree that there are many
I agree that there are many different factors that need to be taken into account when determining the causes for addiction. Depending on the individual, there may be more or less factors affecting the severity and duration of an addiction. However, I do not believe that any individual case of addiction is solely attributed to one factor. Addiction, in my opinion, is an interaction of all of these different factors (psychological, biological, societal, etc.) that combine in different levels depending on the individual. For instance, an individual who is genetically predisposed to drug addiction will not necessarily become an addict—the environment influences the prevalence of the actual disease. On the other hand, the environment alone cannot cause drug addiction either. An individual who has many strong, positive relationships with their peers or family members tend to have higher level of resilience—which may cause them to be less susceptible to their negative environment. In either case, I do not believe that addiction is caused by one factor alone. Instead, addiction must be looked at using various perspectives, taking into account many different factors.
Not just one cause / factor
I could not agree more with you, it is indeed true that there is not one cause for addiction, whether it be biological, psychological, or social. The route to addiction is complex and relies on various factors coming together. Nevertheless, it is useful to think of addiction risks and to examine oneself as to how one rates on several of these risk factors. It seems to me that this is not unlike preparing yourself to bring an umbrella when you know that it may rain today.
As you've already noted,
As you've already noted, there are a variety of risk factors that can make someone more likely to become a drug addict. In addition, I also agree that looking at our own risk factors and examining our own lives can only better prepare us for what may come. However, if you look at your own life and realize you have a few risk factors playing against you (i.e., your father was a drug addict, you are very impulsive, you suffer from an anxiety disorder), what do you do next? As important as it is to recognize risk factors for addiction, I think it is just as important to offer ways to not let those risk factors guide you into the somber world of addiction. I don't think many people would be sure of what to do. Do you make sure to avoid all drugs and alcohol? Do you just keep a close watch on what you do in the future? Should you go see someone for help or counseling? One possibility is that this realization could create even more anxiety - it could be torture walking around knowing you have a high likelihood of becoming a drug addict or alcoholic. It would definitely be beneficial for readers, whether they think they know what to do or not, to have some advice on where to go if you think you may stand a high chance of becoming addicted.
Addiction and Pain Medication
This was a very good topic. Some people suffer from chronic pain and become addicted to their pain medication. Even those with no previos history of addiction to alcohol, illegal drugs or addictive behaviors discover that they are addicted to pain medications. Then they go to rehab for the drugs and feel left with no options to deal with their pain.
They didn't plan on it but they take increasing doses of drugs to deal with their pain and the pain actually gets worse. I found a very interesting book which deals with pain, addiction, and pain medication called "A Day Without Pain" by Dr. Mel Pohl. A very good read by a doctor who lives with pain and understands the links between addiction and pain. Use of alternative therapies like reiki, meditation and host of others seem to help a lot. He runs a rehab clinic in Las Vegas and shares his own story of pain. Many people entering his facility for addiction to pain meds prompted his book and the formation of a drug free pain recovery program. The book is an easy read and addresses a facet of addiction which deserves greater attention.
Daniel
Opiates
Often medications for severe pain are made from opoid plants. These purple-flowered plants produce opium poppies, which are used in the production of opium. Opium is what we in the U.S. call narcotics, as they dull and numb one who ingests what may be made by the opium poppies, as there are several drugs that have been developed from what these plants provide that are narcotics.
Some medications are from natural opium, such as cocaine, or the opiates from the poppy seeds can be used to create semi-synthetic medications, such as Heroin. Heroin was marketed by Bayer Pharmaceuticals for 12 years by telling others that it was a non-addicting form of morphine (pure opiate drug), since there were many soldiers addicted to morphine after the civil war. During that same period of time, Bayer marketed heroin for children who coughed. Of course, Heroin is very addictive, and is no longer available.
While Poppy plants exist and are grown in areas of IndoChina, Afghanistan is the number one producer of poppy plants. The United States is the number one country that consumes what is derived from these plants. Opium-derived medicines once could be bought freely in the U.S. by anyone less than 100 years ago. Yet now, they are classified by the Drug Enforcement Agency as narcotics, and are scheduled by them, according to the danger they potentially could cause another who takes them.
While prescribed to patients for such issues aside from pain on occasion, such as chronic coughing and diarrhea, their greatest benefit is for the relief of pain experienced often by patients is the primary reason doctors prescribe opoid drugs, and they do so often. Vicodin, a mild narcotic, is the most frequently prescribed medication in the U.S. presently.
If patients take opium-derived drugs for long periods of time, tolerance may develop, and the patient may need to take more of the drug to acquire an effect of relief. In addition, the patient may develop a dependence on these types of drugs, which can lead to addiction and possible abuse. This is why overdose of these types of medicine occur- as the reasons for taking these drugs initially become replaced with relief due to addiction in some who take narcotics for a long period of time.
Dan Abshear
Knowledge is power?
Here is another angle: we seem to know much about addiction, but how do most doctors go about treating it? With a pill, unfortunately, and with mixed results at best.
Why can't we develop a set of guidelines that would enable people to re-frame their thinking about the addictive substance?
You are welcome to visit my blog: http://wisdomtoquit.com/blog where I discuss this issue.
Nice article. All people is
Nice article. All people is at risk of addiction whatever forms of addiction it is. The important is awareness to be able to prevent it.
Agreed on Many Factors
I completely agree that there are just so many factors at play when it comes to addiction.
It all gets mixed up i believe when we have psychological impulses and physical urges at the same time so people, even professionals, can confuse the two and end up with a less than stellar view of the real problems.
I think the impulsiveness and lack of control is a major factor but the causes of this can be so complex that it is hard to lay it at a genetic predisposition either.
However that being said i think that learning control can be done for many people so there is hope as long as impulsiveness can be changed.
nice post but why are genes
nice post but why are genes always blamed for bad things? i believe more in psychological factors
The usefulness of knowledge in addiction prevention
Great summary of findings. Of course some of the specifics are a bit more complex (e.g., impulsivity is not necessarily the inability to control inappropriate behavior and can therefore actually be advantageous in some situations), but the overall point still holds: There are many factors that interact to produce one's risk for addiction.
As one of the comments alluded to, there is a big push (Especially by Dr. McLellan, our deputy drug czar) to provide more screening in primary physician offices. Getting that done will go a long way towards getting people treatment before things get out of control.
I think that knowing the determinants can also help us better target our prevention efforts. Programs like DARE have been useless because they've tried the shotgun approach of delivering the same prevention efforts to all children. We need more targeted efforts aimed at kids with a high risk due to environmental, genetic, and neuropsych factors. only then will we see real prevention effects.
That's my opinion at least. Great job!
addiction
this is very insightful and very true
Agriturismo
better not to smoke ... If you already have a cigarette addiction, I recommend a serene environment in contact with nature to combat cigarette. You can relax and succeed in your goal to stop cigarette! You can try a holiday in Italy in agriturismo in the mountains and lakes. Thanks
Tendency for Sexual Addictions?
The article says "psychological characteristics have been reported repeatedly to be associated with higher risk for various types of addiction - impulsivity and sensation seeking..."
This is something I've been trying to find out myself. I know the concept may apply more to drug addictions and alcohol addictions, but I wish there is more clarification on sexual and porn addictions and common factors/denominators present in genes or personalities of sex addicts.
Do people who are addicted to porn have common characteristics? And if so, how can we explain the high number of porn addiction especially among men?
A good resource I recommend is http://www.pushofhope.com and I would welcome other resources to help understand the challenge of pornography addiction.
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