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Are you at risk for addiction?

Could you become an addict?

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

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