is becoming very complex... to the point it may seem very confusing.
There are valid arguments for genetic, biochemical, personality
(emotional), family, peer, and community/cultural influences, all
affecting the use of drugs and alcohol. Behavior is complex. Moreover,
addictions are often accompanied by other serious disorders. For
instance, about one third of substance addicted persons are also
mentally ill. This is called a dual diagnosis. Looked at another way,
about half of the mentally ill are substance abusers (and more would
be if they could afford it). They are self-medicating. Interestingly,
certain depressed persons consume coffee and cigarettes at a very
high rate (10 to 15 cups per day) and this seems dependent on
specific genes being present.
Other life events are associated with addictive behavior; there was
pain in the early lives of many addicts. Teens living with a single
mother are 30% more likely to use drugs than teens in homes with
two supportive parents. Bad relationships with father markedly
increase the risk of drug use. Perhaps half of substance abusers have
been victimized and about one third are diagnosable as Post Traumatic
Stress Disorder. Likewise, half of all teenaged alcohol abusers have
been physically or sexually abused, suffered the loss of a parent, or
witnessed hostile, violent parents. Moreover, research has shown that
Antisocial Personalities quickly become dependent on drugs, especially
In the area of drug and alcohol use, it is well to keep in mind that
we are a drug using culture (Kuhn, et al, 1998). Indeed, about 95% of
American adults consume some psychoactive substance every week.
Yes, every week! This, of course, includes prescribed and alternative
drugs, coffee, tea, cigarettes, and alcohol as well as illegal recreational
drugs. Nevertheless, if you add in America's other compulsions of
eating, making money, gambling, shopping, materialism, etc., one has
to take seriously Bill Moyer's (Moyers on Addiction, WNET, 3/29/98)
observation that we are a "culture of addiction" that demonizes some
addicts and embraces others.
One way to de-demonize addiction is to believe the addict is a
powerless victim of some drug. Another way is to believe that
addiction is a disease, something physical and totally beyond the
addict's control. There are new books, The Selfish Brain (DuPont,
1997) and The Craving Brain (Ruden, 1997), which seek to prove that
addictions are a brain disease. Their treatment is, of course, more
drugs to affect the dopamine and serotonin levels and/or tough-love
and AA approaches to strip away the addict's denial of a problem.
Other studies have suggested that certain genes increase alcoholism
and that addictions are 50% inherited. These physiological factors
must be acknowledged, but thus far their import is unclear.
There is evidence that men and women differ in their proneness to
addiction, in their preference for a specific addiction, and in how they
respond to treatment. In rats, at least, estrogen enhances the effects
of certain drugs, such as cocaine. Women tend to use cocaine to self-