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Posted by on in Drug Addiction

Twenty or thirty years ago doctors and therapists suspected that alcohol and drug addiction seemed to be a genetic disease. Using observation, psychologists were able to see a strong link between addicted parents and their children. To put it simply, if a person’s parents were alcoholics or addicts then they had a greater chance of being addicted themselves. However, it is certainly not a guarantee. Plenty of addicted parents have perfectly addiction-free children. The medical profession puzzled over just how much of addiction was genetic. Did things like childhood trauma or emotional neglect have any role in addiction? Are certain families plagued with a predisposition to addiction? In recent decades, technology and medical advancements have allowed researchers to find solid evidence for the genetic role of addiction in families.

Genetic Evidence

Recent discoveries in DNA testing and gene profiling has given us new insights into how addiction runs in families. Using gene markers has allowed scientists to identify at least three gene qualities that are predictive of drug and alcohol problems. These include genes involved in alcohol metabolism as well as in the transmission of nerve cell signals and intensity of nerve cell activity. The research reveals that there is also more to addiction than just our genes. People born with these ‘addiction genes’ do not always become addicts. People born without these ‘addiction genes’ can become addicts. So how much of addiction is based on our family? For both alcohol dependence and drug dependence, considerable evidence suggests that genetic factors influence the risk of these disorders, with heritability estimates of 50 percent and higher (D. Dick 2008). So our genes make up about half of our chances of becoming addicted to drugs and alcohol. Where do the other 50 percent come from then?

Other Influences

Research and case-studies have found that dozens of other factors can contribute to the likelihood of forming an addiction. One of the greatest factors is the age at which the person takes his first drink or drug. Evidence shows that people who begin drinking or smoking before the age of 15 have a significantly larger chance of forming an addiction later in life. Another important factor in developing addiction is our personality. Certain personality traits are very high in the addicted population. Some of these traits include anti-social behaviors, lack of empathy, and low inhibitions. Children who exhibit these qualities at a young age could potentially be at risk for addiction. Lastly, events like trauma and abuse can lead to addiction. Perhaps the best example of this is in groups of soldiers suffering PTSD. Soldiers with this stress disorder appear almost 4 times more likely to acquire an addiction than those who do not have PTSD.

Originally Posted @ Recovery Blog

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Posted by on in Alcoholism

Where’s That Pink Cloud When You Need It? Understanding and Managing Post-Acute Withdrawal

pink cloud

When I was in training, more years ago than I care to count, my mentors warned me not to float away on the “pink cloud” likely to envelop patients in the early stages of  recovery from substance use disorders.  I was told  that   the initial rockiness of stopping alcohol and/or other psychoactive drugs is often followed by feelings of elation and  great expectations for the future.  In this irrationally exuberant state, recovery can feel essentially effortless and treatment activities may seem like an unnecessary  waste of  precious time.  The danger, of course, is that  abandoning these activities leaves one  defenseless when the pink cloud vaporizes.  At some point,  the hard work of sustaining sobriety in the face of the wreckage wrought by addiction  seems daunting if not overwhelming,  and those who are going it alone and who  fail to  anticipate the transience and fragility of the pink cloud experience often take it hard when their mood darkens,  and  are vulnerable to relapse.

Clinical experience has taught me that some people do pass through a pink cloud after negotiating the acute withdrawal phase of recovery,  but I’ve also learned that the  first year(s) of recovery  are a jarring and complex mix of  emotional highs and lows for most people.  And I’ve found that  some people never catch a  glimpse of the pink cloud in the early going.  They  just feel chronically down,  out, scared and  hopeless for months on end.

Today, the treatment and recovery communities offer  more detailed guidance to practitioners, recovering individuals and family members about the array of difficult and highly individual challenges people face during the first months and years of abstinence from alcohol and drugs. And they caution that it can take a good deal of time  for mood, thinking and behavior to improve and stabilize. Terms likes “Protracted Withdrawal” and  “Post-acute Withdrawal Syndrome (PAWS) are used to describe the psychological and physiological phenomena that can destabilize and derail people in recovery  for an extended period after drug and alcohol use end.

For example,  The Substance Abuse and Mental Health Service Administration (SAMSHA) warns thatlow feelings are to be expected for most people in early recovery and that protracted withdrawal may persist for “weeks, months, and sometimes years”.  In a 2010 Advisory SAMSHA explained that:

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Posted by on in Alcoholism


I didn’t really expect the Godfather to figure prominently in any of my blog posts, but I thought that paraphrasing Michael Corleone  here might be a good way to start a discussion about addiction as a disease vs. addiction as a choice.  It is my experience that family members (and addicts themselves) still struggle greatly with the feeling that  excessive drug and alcohol use are essentially moral problems.  So I think it’s always important, in treatment, to look at  the mounting evidence that addiction to substances, as well as certain compulsive activities,  actually change the brain in ways that undermine the ability to make  healthy choices. Learning about the neurological impact of addiction can help everyone affected by it to find compassion for their struggle with a devastating illness.

There is an ever-increasing amount of data, including results  from neuroimaging studies, that support the definition of addiction held by the American Society of Addiction Medicine, which is that,”Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry”.  Today we understand for example, how substance abuse and even activities like gambling, affect the action of dopamine in the brain.  Dopamine is the substance released by  neurons in the reward centers of the brain whenever we do something pleasurable.  The brain has evolved to reward us for doing things useful to the survival of the species–such as  eating and procreating, and a flood of dopamine is the reward we get for participating in these activities.  However, drugs of abuse, gambling, binge-eating  and even excessive internet use can cause the reward centers of the brain to release far more dopamine than we’re used to getting, and if this  happens on a regular basis, the brain remodels itself to defend against the flood of  dopamine it’s receiving.  It begins to produce less of the stuff on its own and it becomes less sensitive to  it as well.  As addicts develop this “tolerance” to their drug or activity of choice, they need more and more of it to achieve the pleasure they’re used to getting from their habit, and the brain’s reluctance to produce dopamine on its own means that they also feel less pleasure from doing the things that used to make them happy. Consequently, drug rewards eventually become more important to addicts than anything else. I believe addicts when they tell me that their need to get high  actually makes them stop thinking about other things, including food and including people, that are otherwise important to them.  I believe them because what they’re saying is completely consistent with changes that technology now allows us to  see in the reward centers of  addicts’ brains.

Other parts of addicts’ brains change too.   In addition to this malfunction of the reward circuitry, there is a weakening of the executive control mechanisms in the pre-frontal cortex.  This is the  part of the brain that  helps people to regulate emotions and impulsive behavior.  So heavy drinking (including intermittent binge drinking) undermines the very functions that are needed to make healthy decisions about future drinking. Moreover,   the brain isn’t so quick to heal once someone abstains from alcohol and other drug use. A recent study of current and former cocaine users for example,  found that even after 4 years of abstinence, there were abnormalities in some brain regions involved with reward processing.

But family members , friends and romantic partners can’t see a broken brain the way they can see a broken leg, and so the addict’s destructive behaviors  feel very  personal to them.  It really  hurts to come in a distant second, time and time again, to opportunities to drink or drug. It hurts to be lied to,  stolen from and blamed for everything that goes wrong in a relationship.  These and other terrible betrayals actually cause a cascade of stress-related changes in the brains of people who love addicts.  Or, to state it a little less clinically, the addict breaks their hearts.


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