Brains Wired for Addiction (No Kidding) and What This Says About "Harm Reduction"
Addiction Is in the news again..
Posted February 28, 2012
Addiction is the news again, a good thing because large numbers of people are drug/alcohol addicted --alcohol is a drug in case anyone has been lulled into thinking it's "different." So when I use the word "drug," know I am also referring to alcohol. Recent research published in Science http://tiny.cc/sy20 reminds us that there's "different brain wiring" in people who are, or who have been addicted to stimulants, along with their siblings -including those who've avoided drug use and therefore addiction.
The role of genetics in addiction is fairly well established. In the early ‘80s, Schuckit (in San Diego) found that son's of alcoholics (who are not yet drinkers themselves) have a different response to alcohol. Going a step further, there's evidence from twin studies, from rodent studies, from molecular genetic studies, that different brain wiring -heritable different wiring-- is implicated in addiction to drugs. And today, the Chronicle of Higher education ran a review by Peter Monaghan, http://tiny.cc/t0791 of Memoirs of an Addicted Brain: A Neuroscientist Examines His Former Life on Drugs http://tiny.cc/hhjx4 by Marc Lewis, a neuroscientist who was himself a "practicing addict" for many years, before cleaning up and going to graduate school. Lewis describes what was going on in his brain subjectively (what he felt) when he was seeking, looking forward to, and consuming drugs, and then explains it from the perspective of a neuroscientist. It's all about dopamine.
None of this is big news for addiction medicine specialists, nor for people in recovery from drug addictions --but it's always a relief to see supportive results from empirical labs, from neuroscientists, and now from a neuroscientist who himself was an addict, or should I say a recovering addict. Addiction, once it gets going, is a "chronic disease" as spelled out by the folk wisdom of 12-step self-help programs, and it doesn't go away, it just goes in remission when the addict stops taking drugs entirely. The study in Science, and Lewis' book are important, given the present influence of the "harm reduction" movement that is quietly at war with proponents of the disease model of addiction, that calls for abstinence.
No one is "born" an addict, unless his or her mother was using drugs while pregnant. But people are born with the particular wiring that involves some kind of vulnerability in the dopamine circuit, likely related to the neurotransmitter receptor sites (as this research demonstrated), rendering someone (and his or her family members) addiction-prone, making a person highly vulnerable to addiction. Not everyone with genetic vulnerability will get addicted --but when the vulnerability is there, falling into repeated drug use is far more likely. Abstinence from drugs is still the best insurance policy for those with addiction problems anywhere in the family, and especially for those who have themselves suffered from addiction to any drug, recently or far in the past. Harm reduction as a goal, is self-defeating.
Adolescents experiment with drugs; that's normal. When teens with vulnerability to addiction start experimenting, they're like anyone else, however, their response to drugs differs. Likewise, when stressed adults are given prescriptions for Ativan or Klonipin or other Valium-related drugs, those without genetic vulnerability may be able to take the drug daily for at least a few months before becoming addicted. Those with high potential for the disease of addiction may be addicted in a week, or in two weeks. They may be calling their physicians for refills after a few weeks, when their prescription was supposed to last for a month. Teens, young adults, ambitious and nervous young men and women dealing with early career problems, middle-aged populations dealing with life-changes, elder adults whose lives are changing yet again, unemployed, underemployed and depressed adolescents and adults across a wide range of socioeconomic and ethnic groups, people with illnesses and people in perfect health --everyone with the genetic vulnerability to addiction is in danger when exposed to addictive substances.
Why are so many clinicians still back in the 1960s, believing that this "predisposition" is psychological in nature and that it's etiology lies buried in some psycho-social-environmental misfortunes in childhood? Why are addicts still automatically labeled, often diagnosed with a "personality disorder," along with addiction? Of course they act screwy when under the influence of drugs, but that's drug effects, not bottom line personality. No doubt professionals who continue to hold old (and disproven) perspectives on addiction are being loyal to their own mentors, superisors, teachers, parents. We generally hold on to false beliefs out of loyalty to the authorities in our lives, past and present. But maybe it's time for a change. George Valiant, in a terrific longitudinal study conducted some years ago, found that when he first interviewed a group of young men, before they became alcoholics, they described fairly normal childhoods. Years later, after they were flagrantly, actively alcoholic, they changed their stories, and suggested that they were somehow traumatized by childhood experiences. This then became the excuse they used, to explain their alcoholism. Maybe this type of rewrite of personal history is what throws clinicians off. Still looking to childhood trauma for the etiology of mental disorders, they settle on these stories, and encourage drug-addicted clients to focus on childhood traumas. Some unfortunately still encourage clients to "discover" hidden childhood traumas not remembered, that probably never happened. Too many psychotherapists are still clinging to childhood trauma, perpetuating what I think we can honestly call "the trauma racket." It's a money-maker.
So lets ask again, why (aside from loyalty) do so many mental health professionals (and the populations they influence) refuse to let go of old, useless (and maybe harmful) theories of addiction, and how does this connect to the popular theory and practice of what's known as "harm reduction." The answer to both questions may also be economics. Similar to what we are seeing right now in our electoral politics, money sometimes exerts a remarkable influence.
When Alcoholics Anonymous was gaining in acceptance in the 1980's, scientists in the addiction field found that funding agencies were disinclined to support and fund abstinent model treatment research. Instead they went for treatments that avoided abstinence, the types that came to be referred to as "harm reduction." There's a huge alcohol and pharmaceutical industry lobby and congress could not buck it. The influence of pharmaceutical companies is formidable. The addiction disease theory is tightly connected to abstinence models of treatment, and abstinence modes of treatment cut into the alcohol and pharmaceutical industry profits. Additionally important -and this may be anecdotal and therefore possibly suspect -I have heard it is speculated that there's a high rate of alcoholism in our official representatives in congress, and the judiciary may be particularly prone to alcohol and pharmaceutical abuse and addiction. So of course there's little support for research on the abstinence model of treatment, and of course harm reduction is considered more attractive. If harm reduction was limited to trying to literally reduce harm, well no one could object. But when harm reduction is focused on finding ways that addicts can continue to use drugs and where addicts are even told that they have to continue to use addictive drugs, because of their personality problems, or even because of their "wiring," that's another story. That's not harm reduction; it's harm extension. It supports the legal and illegal drug industries, at the expense of its victims.
Other reasons clinicians may be part of the problem: Many clinicians are "using." Some may suffer from the disease of addiction, in which case at some point they'll cease being able to function. But more may be free of vulnerability, and therefore they may be successful at "controlled" drug/alcohol use. Personal drug use creates a liberal attitude towards drug use in their clients, even when their clients are young adolescents.
In summary, too many professionals fail to understand that addiction disease IS a disease, and funding agencies, at least in the past, have refused to fund abstinent model treatment research, while money continues to be thrown away in various "wars" on drugs. It's hard to believe that still, in 2012, it's "news" that brains may be wired for addiction. We can only be relieved to see this, and lets hope clinicians begin to get the picture, and stop (inadvertently, they don't mean to do harm, they think they're helping) promoting ongoing addiction. I've been treating addicts for years. Initially, they are often still using, but over time they get abstinent and are able to quickly build wonderful lives. In all of these years, I've never seen a practicing addict who didn't want to stop using, although early in treatment they won't say that. They may insist they want "harm reduction" but only because they don't believe they'll be able to stop using. Later, in recovery, they will tell me about how much they wanted to stop. When clinicians encourage harm reduction, it's received as a resounding: "You don't have the character (or the chemistry) to stop."
Meanwhile, I've long wanted to get honest (anonymous would be fine) data about clinicians' use drugs, legal and illegal, likewise data about our senators and congressmen/women, and data about the judiciary, but this seems to be one of those studies that just doesn't happen.
To read a summary of the Science story, go to:
To read the original research go to http://www.sciencemag.org/content/335/6068/601.abstract
To read the review of Marc Lewis' book go to: http://tiny.cc/t0791