The Fault in Our Genes: Understanding Addiction as a Disease

Food, sex, video games, gambling, alcohol, shopping, hoarding, drugs - what do all of them have in common? All of these can lead a person down the path of addiction.

Before proceeding, it’s important to note what addiction truly is. Simply put, it’s a disease that happens as a result of alteration in your neural pathways. What it certainly isn’t is a weakness of will-power or character or a moral flaw.

Mumbai-based psychiatrist Dr Yusuf Merchant points out that addiction should not be viewed as a weakness in character. “Someone who is an addict is looking for a solution. Why not replace his addiction with a solution? What we do is isolate the person further, making them feel lonelier”, says Dr Merchant.

He adds that addiction is only a symptom of the problem.

Too caught up to read? Listen to the story here:

Addiction: A ‘Brain Disease’

Between 2000-01, about 732 lakh people in India were consuming alcohol and doing drugs, according to a National Survey conducted by United Nations Office on Drugs and Crime (UNODC) and Ministry of Social Justice and Empowerment and published as a report in 2004.

While cannabis was used by 87 lakh people, alcohol was consumed by 625 lakh people and opiates by another 20 lakh. India also recorded 3,647 suicides in the country due to drug abuse and addiction, according to government’s statistics.

According to the National Institute of Drug Abuse (NIDA), USA, addiction is a “brain disease”. It further describes it in the following manner:

Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful consequences, and are preventable and treatable, but if left untreated, can last a lifetime.

Help.org, as part of a collaboration with Harvard Medical School, describes addiction as a “chronic disease” that changes “both brain structure and function”.

Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain. This happens as the brain goes through a series of changes, beginning with recognition of pleasure and ending with a drive toward compulsive behavior.

Help.org

Nature-Nurture and Addiction

While environmental factors are very significant in triggering addiction, biological reasons are given less responsibility than their due when it comes to this.

According to biological psychologists, genetic abnormalities are behind making some people more inclined to addiction, and doctors agree.

Yes, some people are biologically more inclined to addiction. There is role of the prefrontal cortex that is meant to control one’s drives. It’s been seen that people who have attention deficit hyperactivity, conduct problems, impulse dyscontrol, are high on sensation-seeking behaviour/experimentation, prone to anxiety are more likely to develop dependence.  

Dr Sameer Malhotra, Psychiatrist, Max Hospital

Dr Nigel Barber further points out that:

It is possible that some people are more prone to addiction because they obtain less pleasure through natural routes, such as from work, friendships and romantic relationships. That could explain why they are more thrill-seeking, or “stimulus hungry”.

About 40-60 percent of someone’s vulnerability to drugs is due to genetic factors.

Additionally, presence of mental health issues and the adolescent age group is further capable of increasing the risk of addiction.

The reasons why a person becomes addicted to different things differ for everyone. They could be anything from peer pressure, a desire to abuse drugs, to perform better (as is in the case of “study drugs” or substance abuse by athletes) or to feel better (in case of anxiety, depression or stress).

Broadly speaking, there could be two kinds of factors that might lead to addiction:

• Environmental: these include social environment, familial background, peers
• Biological: genetic makeup, age and even gender and ethnicity (Source: NIDA)

Stages of Addiction

Addiction is marked by strong cravings and satiating those cravings in a manner that involves complete dependency on the object. Every interaction with the object of addiction releases dopamine or the ‘feel-good’ hormone. However, over time, the dopamine production ceases in response to any other activity which may have earlier been pleasurable.

As a result, the person becomes completely dependent on their addiction to experience pleasure. If this wasn’t enough, over time, the same amount of the abused substance stops producing the same amount of dopamine as before. This is called tolerance.

Tolerance leads to compulsion or the absolute need to increase the dosage in order to reach the state of happiness and euphoria experienced earlier. Even though the substance’s effect on the person has reduced, the desire to reach the previous levels of pleasure still remains.

Dr Malhotra summarises addiction and says that “in Psychiatry, the term dependence is used and it incorporates the following concept:

• excessive use: over and above the intended use
• lack of control over initiation, amount used
• neglect of other priorities due to its excessive use
• tolerance: same amount not able to bring same pleasure, so one builds its use over time
• use interferes with one’s day to day functioning and biological rhythms including disturbed sleep-wake cycle
• withdrawal: marked distress on non-availability of the substance/object”

What After Addiction?

Even for someone who has overcome their addiction, it’s still easy to go hurtling down the same path. The same cravings which led to it in the first place are still capable of causing a relapse.

This is further aggravated by relational memory and conditioning. For instance any item related to a past of substance abuse - a credit card for someone who has been addicted to shopping, a glass of wine in case of alcohol - can once again cause relapse despite staying clean for years.

Dr Malhotra further points out that all addictions, whether it involves substance abuse or activities like shopping or hoarding, are similar in principle.

There are individual variations and substance related variations in pattern/manifestations, however underlying biological mechanisms are similar.

Dr Malhotra

They need to be approached in a similar manner with appropriate medical treatment.

Addiction therefore should be looked at as a chronic, progressive disease. Chronic because someone who has had a tryst with addiction once will always be susceptible to it and progressive because it will worsen if it’s not treated.

Scientists further add that if someone has been clean for five years, the likelihood of relapse is pushed further down, perhaps to the same level as an average population.

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