Addiction Is Genetic Predisposition Plus

Most people who try drugs don’t get addicted, even to opioids or methamphetamine, which suggests that ‌factors other than simply being exposed to a drug can contribute to addiction. ‌The majority of people who do get hooked have other psychiatric disorders, traumatic childhoods or both — only ‌7 percent report no history of mental illness. ‌‌Nearly 75 percent of women with heroin addiction‌‌ were sexually abused as children — and most people with any type of addiction have suffered at least one and often many forms of childhood trauma‌‌.

Chandra Sripada, professor of psychiatry and philosophy at the University of Michigan, argues that distorted thinking is more important in addictive behavior than overwhelming desire, leading to what he calls “unreliable” control over use. . . .  During addiction . . . despairing thoughts about oneself and the future — not just thoughts about how good the drug is — predominate. At the same time, thoughts about negative consequences of use are minimized, as are those about alternative ways of coping. Drugs are overvalued as a way to mitigate distress; everything else is undervalued. The result is an unstable balance, which, more often than not, tips toward getting high.

This theory ‌is helpful for explaining who is most likely to get addicted and what is most likely to generate recovery. Risk factors like poverty, a traumatic childhood and mental illness generate excess stress while tending to produce negative thoughts about oneself. In my case, I was depressed and isolated because of what I later learned was undiagnosed autism spectrum disorder — and hated myself for my inability to connect. The result was a mental climate conducive to relying on drugs, even when they no longer ‌provided relief.

Factors linked to recovery — like social support and employment — can offset distorted thoughts and inflated valuation of drug use. Essentially, people make better choices when they recognize and have access to better options‌. If you are locked in a room with an escape route unknown to you hidden under the carpet, you are just as trapped as if that exit didn’t exist. My recovery began when I saw that there was a bearable way out.

This is why punitive approaches so often backfire: Causing more pain to people who view drugs as their only way to cope drives desire to use even more. Punishment doesn’t teach new skills that can allow better decisions.

From the New York Times. 

The story has many other worthwhile insights, for example, on how addition is neither a total absence of free will nor a totally unfettered free choice.