Risk Factors For Addiction: Why Do Some People Get Addicted When Others Do Not?
In 2011, the CDC announced that the United States was in the midst of a prescription opioid epidemic. The epidemic persists, and today, over half of all overdose deaths caused by opioid abuse are from patients abusing legitimate prescriptions from their own doctors. Simply stated, some people are at a high-risk for addiction, and a seemingly harmless prescription from a doctor to treat a legitimate ailment, can be a gateway to a life-long problem of substance abuse.
In a recent episode of Straight Talk MD, Dr. Frank Sweeny welcomed Anna Lembke, author of “Drug Dealer, MD”, into the virtual studio, and she explained what the important risk factors are for people who are likely to form a substance use problem.
“Ok so that raises this question – Some people drink a glass of wine a day, forever. No problem. They don’t have any of these symptoms: of the control, the compulsion, or the consequences. There are lots of people with ADHD, taking Adderall or Ritalin for twenty years for a diagnosis of ADHD, but they don’t manifest the symptoms of addiction.
Why does one person take the Adderall and Ritalin and go off the deep end? You described a couple of cases like that, or at least one case of a lady whose life was ruined by it. Why do some people take it compulsively, and other people just say, I’ll take five milligrams of Adderall once a day and that’s fine. Why doesn’t everybody cross that line and develop an addiction with the same drug?”
“Right. So that’s the million dollar question that we don’t really have the answer to, except that we have identified some of the risk factors associated with crossing that line and developing addiction. One of the huge risk factors is actually genetics. If you look at family trees or twins studies, or any other studies that we typically use in the social sciences, to see which diseases are heritable, it turns out that 50- 75% of the risk of developing addiction is related to whether or not you have a parent or a grandparent who has some sort of addictive problem. Which, by the way, is much higher than the heritable risk with something like depression or even schizophrenia, which we think of as a very biological illness.
Genetics is huge. One of the things that doctors should be doing, which they’re not doing, is actually screening people for not just a personal history of addiction, but a family history of addiction. If it’s there, that individual is no doubt at much higher risk to go on to become addicted to the prescription that that that individual is prescribing.
"One of the things that doctors should be doing, which they're not doing, is actually screening people for not just a personal history of addiction, but a family history of addiction..."
“There are other personality traits that have been linked to developing addiction, for example, impulsivity. So what is impulsivity? That means individuals who are less good at delaying gratification for positive rewards, or who tend to act on their thoughts without thinking about the consequences necessarily. Impulsivity is, in fact, a pretty stable genetic trait. We know that kids who rank high on scores of impulsivity are at increased risk to go on and develop addiction.
But I think it’s important to point out that although there are these genetic risk factors and these characterological risk factors, another huge risk factor is actually environmental risk factors. We often forget about this, but, for example, if you are poor, if you are unemployed, if you have a chaotic home and family environment, all of those are risk factors for addiction.
Probably the most important risk factor of all is simple access. If you live in a neighborhood where people are selling drugs on the street corner, you are more likely to develop a substance use problem. If you go to a doctor who freely writes prescriptions for Adderall and opioids, you are more likely to develop a substance use problem. So there’s some point at which the sheer access to a drug tips over, and it kind of becomes the most important risk factor of all. I think that’s the moment that we’ve reached in our history.”