Biology, environment, or psychology? Which is most important in addiction?

I get asked this question a lot, both by people who are fully committed to the biological (or brain) model of addiction and ones who thinks it’s crap and that it’s all about psychology, experience, and motivation.

The thing is that it is absolutely impossible to separate the influence of the brain, environment, and psychology since they all intertwine and interact to deliver the final condition… I was reading an article about marketing in the new Internet age yesterday and it included a joke that I thought was relevant, so I’ll steal it. Instead of focusing on addiction, this joke centered on the question of which part of the body is most important? Maybe it’ll do a good job of explaining why asking the question of which of the above is most important is to some extent useless.

So – The brain, blood, lungs, and Legs were all fighting each other on the question of which of them was most important in the human body. Along came the anus and argued for its own place as The King of all that is human. The first four all laughed in its face, thinking the idea that the anus is King a funny joke. In protest, the anus shut down, a little upset at being made fun of. Three days later the rest of the body sent a notice that the anus has won the debate and begged it to get back to business.

You see, the brain runs the body, upon which it relies for everything and together those two interact with the environment in ways that alter them both. Then you place thousands and millions of people together in the environment and they interact to create a psychological reality that affects everything else that’s already there. It’s completely impossible to separate the parts sice they all rely on each other and are affected by the others.

This is why behavioral interventions, medical interventions, and environmental conditions have all been shown to affect the probability of addiction developing and of addiction ceasing. They all contribute so they all have the power to affect it, though the mix is probably different in different people based on their own experiences, biology, etc…

Make sense?

College drinking and frats – A match made in alcohol heaven?

contributing author: Gacia Tachejian

animal-houseIf you asked college students in America what goes on at a Fraternity or Sorority party they would tell you that drinking alcohol is a major component. The movie Animal House made heavy college drinking a well known fact decades ago, and research backs it up.

Studies have consistently shown that the highest rates of heavy alcohol use and alcohol disorders occur in the college-age population. But who’s to blame? Although heavy alcohol use has been documented within Greek organizations, the question of whether the Greek environment fosters substance use or whether heavy substance users chose to be in Greek environments has not been researched until now.

In order to find out whether the Frats/Sororities were the main influence for heavy alcohol use or if individuals joining the Greek organizations were simply heavier alcohol abusers researchers recently collected data from 3,720 pre-college students who were then followed for the 4 years of college they enrolled in (talk about a lot of work).

Of the almost 4000 participants there were students who joined the Greek environment and those who didn’t. Also, there were students who were late joiners and students who joined but withdrew before they graduated. After looking at all the different categories, one thing was apparent:

Students, who at any given period were part of a fraternity or a sorority, drank more alcohol and had more negative, alcohol-related consequences while being a member of a Greek organization. Also, once they deactivated, those participants drank less and had less drinking-related consequences.

The real issue as to why this is so important has to do with the consequences of alcohol use. Problems like drinking and driving (and possible DUI arrests), alcohol abuse, alcohol poisoning, and violence are a serious problem among college students. Apparently, Greek Environments make these consequences more likely.

It’s important to note: If the only finding her was that participants in the Greek system drank more alcohol or were more likely to drink alcohol at all that would be one thing (this findings was also true here by the way), but the fact that they were also more likely to have negative consequences associated with their drinking suggests that interventions might be useful within this college-environment.

Something to think about next time you’re bored on a Thursday night…

Citation:

Park, Aesoon, Sher, J., Kenneth, S., & Krull, L., Jennifer (2008) Risky Drinking in College Changes as Fraternity/Sorority Affiliation Changes: A Person – Environment Perspective. Psychology of Addictive Behaviors, Vol. 22, No. 2, 219-229.

Biology versus Choice: Is a simple explanation of addiction enough?

At the recent Addictions conference, held in D.C. and sponsored by Elsevier, a well known academic publishing house, I got myself into one of those long debates with a fellow addiction researcher. The question we were debating was whether addiction is primarily biological or if it is mostly a matter of personal choice. We ran through research evidence, the notion of stigma, and more, making us late for the afternoon session of talks – but it was worth it.

My take on it was that one can’t separate biology from choice, a point I have made over and over (see my choice Vs. control talk), and that ignoring the biology of addiction is therefore impossible. My opponent across the stage (or lunch table as it were) was Christopher Russell, a graduate student at the University of Strathclyde in the United Kingdom who is a bigger believer in the choice view of addiction, along with people like Dr. Bruce Alexander of Rat Park fame and Dr. Gene Heyman who wrote “Addiction is a disorder of choice.”

I like good debates and at as far as I understand it Christopher and I ended-up agreeing that as usual neither biology, nor choice, do a good enough job of explaining a complex disorder like substance abuse and addiction. I’ve been making that point for a while, so I’m pretty comfortable with the final conclusion – Biology, environment, and choice (cravings) all factor into addiction as I understand it. Without understanding the machinery and how genetics and behavior affect it, I think the rest of the discussion is moot, but it is pretty much as pointless without addressing environmental influences and the role of choice.

I liked debating with Christopher so much that we’re going to be bringing him on a writer on A3. He’ll help us keep on top of the most recent addiction research and news while bringing in another voice on the topic that I think will help move our discussion forward. So please help me welcome Christoper Russell from the U.K., and look ahead for his contribution as well as a likely ongoing debate about the importance of biology versus personal choice.

Is anonymity the final shame frontier in addiction?

I’m a drug addict and a sex addict, and as far as I’m concerned, staying anonymous let’s me remain buried in shame, and a double life, that keeps me always one step ahead of those close to me. Did I say too much? Did I give away my secrets? None of those  questions matter when everyone knows everything there is to know about you. For a disease couched in anxiety, obsessions, and compulsive behavior, there’s very little that can be more triggering.

The difficulty of confessing addiction

Obviously I’m not naive to the consequences of confessing to others, and I’ve had a few very uncomfortable conversations that ended in people losing my number or superiors telling me they didn’t need to know. When it comes to the former, it’s their choice, and it might be a wise one, but having those who stay close to me know my truths keeps me safe by making me accountable and protects others from being hurt. And I can hurt with the best of them. Maybe that’s why when it comes to physician treated addicted physicians, there are no secrets, no anonymity, the family and employers are made part of the process. Some notable addiction providers (like Journey Healing Centers and others) have programs that explicitly involve the family in the treatment process as well. Getting the secrets out works to break away from the shame.

We’re only as sick as our secrets, even together

On an organizational level, I understand the need for anonymity to avoid having any specific member represent the group. But that logic only holds when everyone is told to remain anonymous. Otherwise, the entire group represents itself, which is, if nothing else, truthful. If one person slips, relapses, or goes into a homicidal rampage, it only makes the rest of us look bad if no one knows that millions others are “the rest of us.”

Over and over I hear people talk about the secret of their addiction and the lies they have to tell to cover up their shameful acts. Unfortunately, that only contributes to the stigma of addicts and makes it all the more difficult  to get some perspective on the actual problem: We do things we don’t want to over and over regardless of how much they hurt us or those around us

If you’ve read anything on this site, you know that I believe in many factors that contribute to addiction, including biology, environment, experience, and their interactions. Still, when it comes down to it, the misunderstanding of addiction is often our number one problem. And anonymity does nothing to reduce that misunderstanding.

How we can make a difference

Media portrayals only exacerbate the problem as they show us stories of addicted celebrities who are struggling but then leave the story behind before any recovery occurs. That way we only get to see the carnage but have to look pretty hard to see anything more.

But we can change all this with a small, courageous, action. We can let those around us know that we’re addicts, that we’re doing our best to stop our compulsive behavior and that we want them to hold us accountable. If we slip, we can get back up because we don’t compound the shame of a relapse with lies we tell, and those around us know that even a relapse can be overcome because they’ve seen those examples over and over in all the other “confessed” addicts around.

It’s time to leave the addiction “closet” and start living. We may not be able to change who we are easily, but we can change the way we go about living and make it easier on ourselves and on others. By breaking our anonymity, we can help assuage our own shame and let everyone know that addiction is everywhere and that it can be successfully overcome.

Just a thought…