Consider the stair steps to addiction: 1) use, 2) abuse, 3) dependency, 4) compulsivity and 5) addiction. A person can be dependent on, or compulsively abusing, a chemical/activity but not be addicted. But if a person is addicted, he or she is also doing the steps before that: compulsive use, dependency, abuse and use. The separation between step 4, compulsivity, and step 5, addiction, is significant. Some experts say the brain sort of flips a switch, which means “it” is now an addiction, an irreversible condition of the brain – consistent controlled use will never be possible. If that is true, a person can be using compulsively and not have flipped the switch to addiction, yet. Compulsivity and addiction look a lot alike. There is no test to definitively determine whether a person has an addiction, only assessments that indicate it. For example, if a person meets X number of criteria out of Y, it indicates that he or she has an addiction.
Most of these types of conversations on this topic are irrelevant to the process of working on a compulsion or an addiction. Addiction or compulsion? Genetic brain disease? Biopsychosocial? Mental disorder? What does it matter when it comes to an individual needing help? You’ve got to do the same things to get healthy regardless of the definition you prefer. It doesn’t matter when it comes to changing directions in life toward a whole and healthy life. Abusing substances and/or behaviors is self-destructive and needs to stop, as in abstinence. Unhealthy sexual behavior and unhealthy consumption of food needs to be replaced by their healthy counterparts.
There are more ways than one to define, name and understand all of this. That “invisible line” from abuse-dependence-compulsion to addiction could be a well-worn neuropathway that is always going to be a vulnerability. Let me give you a couple of examples. Regardless of what you name it, addiction, disease, disorder, pleasure or medication neuropathway, or whatever, the two country-boy metaphors below may help us understand how it works. Its early development begins with use, goes to abuse, then to dependence and on to compulsivity, and boom! A person is looking in his or her rearview mirror and suddenly realizes that it has become an addiction without knowing exactly when it crossed that invisible line. The speed at which it happens varies from person to person and from environment to environment.
Either way, once an addiction exists or once the neuropathway exists, it will always be there. Thus, the need to always play good defense with abstinence is vital in my opinion. In recent years, many programs and professionals have been advocating a “harm reduction” approach, which means to control the use of drugs by using less. That’s absurd to me! For example, consider a person who was addicted to alcohol, got into recovery, was sober for a few months to decades, and then decided that he or she would drink a glass of wine one night before bedtime. If truly addicted earlier in life, this definition of addiction says that he or she could not consistently control drink that wine very many times. Instead, in a short period of time, the person would be drinking alcohol at the level at which he or she did before quitting decades earlier. Why play Russian roulette with your life?
On Capstone’s campus, we have a creek that runs through the middle of our property. It begins about two miles from campus at the highest point of a little foothill to the Ozarks. Many decades ago, when a heavy rain poured thousands of gallons of water between our campus and that hilltop, the water was pulled by gravity down the hill along the route of least resistance. As this happened thousands of times over the years, the flowing water eroded the topsoil all the way down to the bedrock and cut out the pathway that we call the creek. Now, rainwater has no hesitation or difficulty finding its way to our creek. It is automatic.
What if I took a bulldozer to the hilltop and damned up the beginning of our creek and dug a little trench that sent the runoff water in a little different direction on the other side of a ridge? Additionally, what if I hauled in thousands of tons of topsoil dirt and filled up our current creek for the entire two miles and then laid Bermuda sod on top of it? Over the next several decades, there would be another pathway for the creek that went somewhere far from Capstone’s campus through a different valley. But then let’s say that 30 years from now, I took that bulldozer back to the hilltop and opened a little-bitty ditch that allowed a small percentage of the water to flow over the old creek’s path. Because of the vulnerability of the topsoil and Bermuda, the water would quickly wash it away until the creek was back to the original main path.
Another example of a well-worn pathway to avoid has to do with an individual’s “arousal template,” defined by Dr. Patrick Carnes as “what an individual experiences as erotic.” In other words, the stimuli that causes a person to become sexually aroused. Here is an all-too-common example. A young man is using pornography, and his choice for his arousal is a woman with dark skin, blond hair, blue eyes and huge curves. The man gets married to a beautiful woman, the love of his life, and she has dark skin, dark brown hair, brown eyes and a Miss Fitness of America athletic-type body. He uses porn for years, and as his tolerance grows to more extreme behaviors, he continues to want the same characteristics in the look of the porn women that he is aroused by. Then he breaks under the heavy shame he is carrying, confesses to his wife and the church, and goes to treatment or therapy. His wife decides to give him and their marriage a chance. They both do their individual therapy work because it takes two healthy individuals to have a chance at a healthy marriage. Yes, she needs it too because she has been betrayed by infidelity, and that is what we call a Big T Trauma. As they are being healed individually, they begin the work of healing their marriage. They grow in their intimacy (depth and quality of their relationship), and he goes for 20 years without looking at any porn. And then …
His job requires him to have a CFO for his company to oversee all the financial transactions. This position is one in which there are several hours per day of one-on-one meetings with just he and the CFO. He puts out an ad for the job position. One of the applicants comes for an interview. She is very beautiful, has blond hair and blue eyes, is very curvaceous, and dresses and acts seductively. I don’t even have to explain my point here. She is a very strong trigger for his “old” arousal template. Of course, he treats this woman with respect, but he also treats himself and his wife with respect and wisdom as well as his company and the team that works there. All those fantasies that included women with the same basic characteristics are in his brain, lying there in wait, and just like that topsoil, his OLD pattern will wash out with a few rains. To not hire her is professionally ethical as well as best for all involved. A part of the “fit” with an organization is that the team consists of people who contribute to a chemistry that prevents future problems.
Most people in the treatment field agree that there is a susceptibility with some people that makes them at risk for developing an addiction. Some groups call that susceptibility a “genetic predisposition.” Other groups call it a “neurobiological vulnerability” that developed because of environmental experiences.
Kevin McCauley, MD, was a keynote presenter at the 13th Annual IITAP Symposium in May 2018. He gave the following example regarding the susceptibility for addiction, but I’m paraphrasing: “You take 10 people and give them a round of Oxycontin. After they’ve used the prescription, four or five will say, ‘Oh no, I didn’t like that; it’s not for me.’ The next four or five will say, “OK, that helped with my pain, gave me some euphoria, but I’m glad it’s over, and no more for me.” Then there’s that one! That person has found something that he or she did not know existed. The drug is so powerful that he or she is seeking it as if it were life itself. The person found something so important that it is worth everything.”
The ratio 1 out of 10 has been used for many decades as the general measurement of the percentage of the general population that has the susceptibility. I think it is higher when you add the numerous activities that fall into the category of “Process Addictions” or “Behavioral Addictions.” These are behaviors that cause the brain to flood the same neurotransmitter sites as substances do: primarily dopamine, which is the reward center for incentive and motivation to “DO THAT AGAIN!”; endorphins, which are the attachment, love, emotional and physical pain relief; and oxytocin, which is a hormone that is the bonding, trust, warm fuzzy feeling, like when a mother nurses her baby.
What’s the deal with the individuals that have the susceptibility?
The Genetic Science Learning Center at the University of Utah discusses the genetic influence in a very clear way on its website: http://learn.genetics.utah.edu/content/addiction/genes/.
Susceptibility Does Not Mean Inevitability
When scientists look for “addiction genes,” what they are really looking for are biological differences that may make someone more or less vulnerable to addiction. It may be harder for people with certain genes to quit once they start. Or they may experience more severe withdrawal symptoms if they try to quit.
Factors that make it harder to become addicted also may be genetic. For example, someone may feel sick from a drug that makes other people feel good. But someone’s genetic makeup will never doom them to inevitably become an addict. Remember, environment makes up a large part of addiction risk.
Dr. Glen Hanson says, “Just because you are prone to addiction doesn’t mean you’re going to become addicted. It just means you’ve got to be careful.” No one is born an addict. Scientists will never find just one single addiction gene. Like most other diseases, addiction vulnerability is a very complex trait. Many factors determine the likelihood that someone will become an addict, including both inherited and environmental factors.
Because addiction is a complex disease, finding addiction genes can be a tricky process. Multiple genes and environmental factors can add up to make an individual susceptible, or they may cancel each other out. Not every addict will carry the same gene, and not everyone who carries an addiction gene will exhibit the trait.
I might add, the lack of susceptibility does not mean you are immune or invulnerable to developing an addiction.
So, what is the bottom line? Everybody agrees that there is some kind of a susceptibility to addiction in the brains of most people who develop an addiction. On one end, some believe this susceptibility in 100 percent genetic. On the other end, others believe that it is 100 percent developed through life experiences that wire the brain to have these neurobiological vulnerabilities: 1) lower-producing dopamine and endorphin system (due to synaptic pruning of receptors in adolescence); 2) an ongoing higher anxiety with the inability to emotionally self-regulate (usually developed in childhood); and 3) a hypervigilant stress response from unhealed trauma. Each of these would make the use of substances or behaviors that activate the flooding of endorphins and dopamine extremely more enticing than to a person without those environmentally created vulnerabilities.
Many professionals agree that the development of an addiction is a result of the interplay between genetics and environmental experiences. So we take this position at Capstone: The people who are fully matured neurobiologically and have an addiction are so because of different combinations of genetics, or the lack thereof, and environmental factors. When there is a genetic component, it is not a single gene but instead a combination of many genes in many different combinations that creates what is commonly called the genetic predisposition. Genetic predisposition does not mean genetic predetermination – on the contrary.
There are people with the genetics who are addicted. There are people with the genetics who are not addicted. There are people without the genetics who have developed addictions. The key is found in life experiences of trauma, neglect, abuse, pain, emptiness, etc. As Dr. Gabor Mate says, “Addiction is always about the pain, pain from trauma or pain from neglect, emptiness.”
I would add another category to that. The American Education Society held a workshop that I attended in the mid-2000s titled “High Risk Youth and Their Overindulging Parents.” The workshop was on the cutting edge of what all of us are so painfully aware of today with the entitlement levels of many millennials and Generation Xers. Many kids today grow up in families that are so overindulgent in materialism, permission, sting-free discipline and protection from natural consequences of bad behavior. This not only teaches them that they are above the rules; it also trains their brains to continue to seek better and faster ways of experiencing novelty and reward euphoria. These loving parents, often children of families that had little, work hard to succeed and give their children all the things they didn’t get. Unfortunately, the children grow up incapable of having the same drive and determination as their parents because their strength was castrated by overindulgence, all done in love.
Which is more powerful in the development and continuation of active addiction? I might respond by asking, “What does it matter?” The more important question is, which is more powerful in its potential for living a whole and healthy life? In other words, which is most changeable or healable? Which can you do the most with to help somebody or yourself to become whole and healthy? Obviously, it is the environmental factors of healing trauma; developing attachment capacity; building core-to-core relationships with God, self, family and friends; discovering and refining gifts and talent; using those gifts in meaningful purpose; and living a healthy lifestyle – physically, spiritually, mentally, emotionally and relationally. These are the expertise areas of Capstone.