Recovery: The Difficulty with Understanding Addiction

7/29/2014 by Paul Kerrigan

At one time, people didn’t worry much about what addiction was or what caused it. Stagger down Main Street three sheets to the wind once too often and it was off to the asylum for you. Bill Wilson, co-founder of Alcoholics Anonymous, was committed four times in 1933 alone. Back then, addiction was seen as a moral failing requiring removal from society, plain and simple.

Today’s dominant view of addiction, the “disease theory,” is more complex but no less problematic. At its root is the premise that all behaviors—including addiction—have purely physiological causes. But addiction treatment professionals have muddied that definition with other factors that don’t really fit their premise. The result is a mess.

For instance, according to a definition adopted by the American Society of Addiction Medicine (ASAM) in 2011, “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry ... with dysfunction in these circuits” generating addictive behavior. But according to the ASAM, this odd physical disease is also affected by “culture,” “problems in interpersonal relationships” and day-to-day “trauma or stressors.” The ASAM doesn’t identify the link between these non-physical factors and the purely physical brain circuitry disorder they claim addiction to be.

This paradoxical hodge-podge has seeped into popular culture, along with the notion that “addiction can happen to anyone.” (Google that idea and you’ll get about 84,800 results.)

Shortly after ASAM redefined addiction, Science Daily declared the new definition “describes addiction as a primary disease, meaning that it’s not the result of other causes such as emotional or psychiatric problems.” 

Now, I’ve never rooted around in anyone’s “brain circuitry” but my own, but I’d wager a significant body part that addiction almost always stems, at least in part, from preexisting emotional or psychological problems; I’ve known too many unglued tweakers who were plainly unglued before they ever touched the drug—including myself—to believe anything else. Addiction doesn’t just “happen.” It’s not jock itch.

Another approach, the “psychoanalytic theory,” hews closer to common sense. According to a 2010 article in Psychology Today, “Addicts abuse alcohol or other substances to protect themselves against overwhelming anxiety and other painful emotions such as loneliness and depression.” This, however, is a minority view, and it doesn’t take into account clear statistical and genetic links between addicts and their families. 

Clearly, addiction must have both environmental and genetic factors—and science is beginning to bear that out.

In his book The Biology of Belief, cellular biologist Dr. Bruce Lipton explains how emotions can regulate genetic expression. He says, “Each cell membrane has receptors that pick up various environmental signals such as thoughts attitudes and perceptions. Your cells can choose to read or not read specific genes depending on the signals being received from these environmental receptors.”

This means addiction can’t happen to just anyone. A genetic predisposition to addiction is required, but if you never taste alcohol or escape the stress of growing up among addicts, that addiction may never manifest. If it does, successful treatment will  likely require dealing with both physiological impulses and their psychological triggers.