Thursday, April 25, 2013

Nature, Nurture, and Me


Which came first, the addiction or the trauma?

About a year ago, Jonathan Taylor, a professor at California State University in Fullerton, assigned his students some reading from my book, The Chemical Carousel, for his “Drugs, Politics, and Cultural Change” course. At the same time, the class watched an interview with Dr. Gabor Maté, author of In the Realm of Hungry Ghosts: Close Encounters with Addiction. In a letter written for his readers, Dr. Mate´ insists that addiction “is very close to the core of the human experience. That is why almost anything can become addictive, from seemingly healthy activities such as eating or exercising to abusing drugs intended for healing. The issue is not the external target but our internal relationship to it. Addictions, for the most part, develop in a compulsive attempt to ease one’s pain or distress in the world…. The more we suffer, and the earlier in life we suffer, the more we are prone to become addicted."

I find this perspective interesting, because I agree with so little of it. I do not believe that almost anybody can become involved in an addictive relationship with almost anything—not unless they have the genes for it. I do not believe that the genuine heart of addiction, its true root cause, is childhood abuse—although that is frequently and tragically a component of addiction, for many reasons. Overall, I see addiction as a biochemical disorder with strong behavioral attributes, mostly genetic in origin, influenced by—but not hostage to—environmental impacts, making it not so different from, say, diabetes or depression.

No doubt about it, there is a fair amount of distance between the doctor and your humble science journalist, from the nature/nurture point of view. And, students being students, they picked up on this, and wanted an explanation that would make some sense of these two seemingly opposite positions. Professor Taylor threw the question back to me:

My class was wondering how one would reconcile your and Mate’s views.  Both of you discuss the addicted brain and clearly view addiction as a brain disorder.  The fundamental difference is that Mate disputes the genetic component of addiction, or at least he says there is some genetic component but that the majority of the brain dysfunction and low levels of neurotransmitters found in addicted individuals relates to environmental influences during early childhood (or in the womb), rather than a genetic component…. In the book he discusses studies that indicate that insufficient maternal care, exposure to conflict etc. all lead to improper brain development which leads to increase susceptibility to addiction.  So while you write about “inherited susceptibility,” he seems to favor an “environmental induced susceptibility…. Any elucidation I can share with my students would be helpful.

So. I was well and truly on the hook. I kept my response short, for the obvious reasons, but there is no getting around the fact that it’s a damn good question. Here’s what I ended up telling the class:

-------------------------------------------------------------------------------------------------------------------------
Jon:

"Your students ask, quite rightly, how to reconcile the views expressed in The Chemical Carousel and In the Realm of Hungry Ghosts. Or, nature vs. nurture. Dr. Maté looks to environmental impacts during early childhood as the addiction trigger, while I advocate a view of addiction as a genetic disorder, expressed because of changes in DNA, not bad mothering. (It wasn’t very long ago that schizophrenia was firmly believed to be a result of bad mothering, too!) More to the point, Maté believes, for example, that ALL female heroin addicts were sexually abused as children. That is certainly not an assertion widely agreed upon or well supported by the scientific literature. In the most recent population study of addicts and non-addicted siblings, published in Science (Feb. 3 2012), when the researchers looked at the early lives of sibling pairs, they found all the same risk factors: both the addicts and their siblings had seen roughly equal amounts of trauma in childhood. 'We really looked at their childhoods,' says Karen Ersche, lead author of the study and group leader for human addiction research at the University of Cambridge in England, quoted at Time Healthland. 'There was a lot of domestic violence, there was sexual abuse — but both [groups] had that.'

"So, which came first, the trauma, or the trauma-prone personality? Where Dr. Maté sees childhood trauma, I tend to see behavioral dysregulation. Children born with an addictive propensity also carry with them the potential for various kinds of behavioral problems, impulsivity being a common one. And it is entirely likely that most addicts have had rocky childhoods, since, quite often, they have had alcoholics in the nuclear family, with all the attendant problems, including sexual violence. Or, their own behavioral template leads to problems—angst, worry, fights, trauma. In a sense, we can say that sooner or later, something, or someone, or a series of environmental impacts, will traumatize a child with addictive propensities, in the same way that latent schizophrenia is “switched on” by a traumatic or highly emotional event. Addicts feel like outsiders from an early age, and many of them sense that something is not quite right with them, long before they ever take a drink or a drug.

"Sorting out this chicken-egg problem is a major headache. And we haven’t even discussed the possibility of trauma in the womb. But I am willing to say that none of this is as settled or as straightforward as Dr. Maté would have it. On the matter of nature/nurture, I’m willing to put the odds of that mix at 60/40, which is a good deal less genetically loaded than my estimates used to be. The growing research field of epigenetics has brought the two views closer together by demonstrating that a person’s DNA can in some cases be modified, and genes turned off and on, by environmental impacts.

"Overall, it’s safe to say that Dr. Maté and I do agree on this: One of the best defenses against the scourge of addictive disease is a stable, loving, empathetic family."

Best,
Dirk

Photo Credit: http://lofalexandria.blogspot.com/

6 comments:

Jason Schwartz said...

I have the same reaction to Mate's sociological version of the self-medication hypothesis.

As for trauma, I tend to believe that, for the most part, trauma does not cause addiction. However, it may influence the onset, course, severity and response to treatment.

I also know that childhood trauma is associated with earlier age of first use and earlier age of use is associated with high rates of dependence.

I'm also interested in the idea that PTSD and addiction may share certain mechanisms. For example, I hear a lot of similarities in PTSD survivor descriptions of intrusive and overwhelming multi-sensory memories and addict descriptions of craving.

All the best,

Jason Schwartz

Dirk Hanson said...

Hi Jason, thanks for your thoughts. (Jason is the clinical director of the Dawn Farm addiction treatment center.) I agree that there is something that connects addiction and PTSD but it's still fuzzy in my head.

The trauma business is tough,and another area difficult to sort through from a biopsychological point of view.

Edward L Platt said...

George Vaillant's longitudinal Study of Adult Development is incredibly insightful for the nature/nurture question, at least as it applies to alcoholism.

He found that "Multiproblem families ... produced children who later were afflicted with sociopathy and alcoholism... After 33 years, however, the effect of multiproblem family membership upon most adult outcome variables seemed attenuated" (The Natural History of Alcoholism).

This seems to suggest that childhood trauma may lead to higher rates of substance problems at an early age, but that lifelong addictions are better predicted by other factors, like genetics.

Vaillant also writes " The presence of strengths rather than weaknesses in the childhood environment correlated most highly with adult outcome." So everyone seems to agree that a stable family can be a great defense.

Jerry Simpson said...

I think that it depends on which personality you are. In some cases trauma triggers addiction but in others, addiction leads down the path to trauma...

John Cleveland said...

Why a dicotomy, either/or? Why not a continum of influences; biogenetic on end, environmental on the other, and all points in between. I am reminded of Godwin's Type II or male limited presdisposition with 9 times the rate of addiciton regardless of environment and the Type I or mileu limited with only 2 times the rate expressed because of the socioeconomic status of the adoptive father.

Dirk Hanson said...

Agree with your continuum, Type 1s and Type 2s, sort of representing the ends of the spectrum.

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