Excerpted from The Craving Brain:
It was a family party like any other. The grandfather was sitting in the corner by himself, drinking heavily. I had known him since he was a handsome young man, but now he had a red, enlarged nose, a flushed face, and a protruding stomach. A blank stare suggested some early alcohol-related dementia. His middle-aged daughter was already into her third or fourth martini, and a granddaughter was pouring mixed drinks for a group of friends.
His grandson Jeremy, who was just a few years out of college, walked over to say hello. His older brother had almost died from an accidental overdose of prescription pills and alcohol a few years earlier, but it had not stopped Jeremy from drinking heavily through college. Now he worked at a bank, and his father had told me that he was partying hard on weekends.
Jeremy gestured toward his inebriated family members with a full glass of whiskey in his hand. Half joking, he asked, “Dr. Spickard, you don’t think I’ll end up like them, do you?”
I looked at him in disbelief, wanting to exclaim, “Are you kidding? Your future is staring you in your face.”
Instead, I explained to Jeremy that, with his family history and drinking behavior, he was probably rewiring his brain in ways that could give him an irresistible craving for alcohol. In fact, he might already be in trouble, and he needed to find a doctor who knew how to administer a screening test for addiction.
Somewhat to my surprise, Jeremy followed my advice. After his screening test showed that he was abusing alcohol and at risk for addiction, he significantly changed his drinking. To this day, he drinks only in moderation, modeling for his own children a sober lifestyle. His grandfather was not so fortunate and died of alcohol-related causes just a few months after the party.
If you are drinking heavily or abusing prescription pills or illegal drugs, the answer is yes. These behaviors are universal risk factors for addiction. No personality traits, religious beliefs, life experiences, or education can prevent the injury to the human brain that frequent exposure to addicting chemicals causes.
At the same time, there are personal risk factors that dramatically increase the chances of developing an addiction.
1. The Family Tree
Multiple studies confirm that a family history of addiction is the single most important personal risk factor for developing an uncontrollable craving for alcohol and other drugs. In part, our genes help determine how we metabolize drugs and the intensity of the pleasure that they give us. Genetic influences also affect our levels of dopamine and other mood regulators in the brain. Fewer dopamine receptors may lead to a naturally low-mood state, which in turn creates a heightened risk for addiction.
The risk is so pronounced that I recommend that patients with a family history of addiction—parent, grandparent, aunt, uncle, brother, or sister—give complete abstinence serious consideration.
2. An Early Start
As we have seen, children and teens who begin drinking before age fifteen are at high risk for developing an addiction to alcohol and other drugs. For young people who wait to begin drinking until after they have reached legal age, this risk drops considerably.
3. Change and Crisis
When Manuel retired, his friends encouraged him to liven up his day with a splash of vodka in his morning orange juice. He had never been a drinker, but when I saw him a year later, he was in a wheelchair, drinking a fifth of whiskey every day and nearly dead from cirrhosis of the liver. It was two months before he was able to walk with a cane and enter a treatment program. When he finally returned home, he was able to stay sober until he died more than a decade later.
Divorce, retirement, job loss, illness, and death—no one is immune to the personal crises that increase the risk of addiction. People have many healthy ways to find solace and support, and during difficult times we must consciously commit to avoiding increased use of alcohol or other drugs to medicate our emotional pain.
4. Trauma and Extreme Stress
The formidable Adverse Childhood Experiences (ACE) study has demonstrated that far more people have been exposed to extreme trauma and stress than previously believed, and childhood trauma is a significant risk factor for addiction. These trauma-related risk factors include child abuse, growing up with one or more addicted parents or caretakers, extreme poverty, war and displacement, racism, violent crime, natural disasters, and terrorism. When trauma victims try to medicate their pain with alcohol or other drugs, they place themselves at high risk for developing an addiction. U.S. soldiers, for example, are returning home from war zones addicted in record numbers to pills prescribed for injuries and combat fatigue.
Not surprisingly, sexually abused children, like James, are at high risk for developing an addiction. In one survey at our Vanderbilt treatment program, 70 percent of female patients reported that they were sexually abused as children, and other researchers have reported similar outcomes. Less attention has been paid to the traumatic suffering of sexually abused boys, and more research is needed to create effective, targeted prevention programs.
5. Mental Illness
Many people drink heavily or use other drugs because of the traumatic pain of emotional disorders, like depression, schizophrenia, bipolar, and anxiety disorders. When abuse leads to addiction, the result is a complicated web of physical and emotional problems. Patients with a dual diagnosis—mental illness and addiction—find it harder to get sober, and treating both disorders simultaneously significantly improves their chances of recovery.
My colleague Sara taught me the most about the terrible pain—and peril—of people suffering from both mental illness and addiction. Her story, which follows, haunts me and my colleagues to this day.
6. Cultures at Risk
“There is something horrifying about the look of Navajo drinking in Gallup,” wrote Calvin Trillin. “Something that makes it less like big-city skid-row drinking than like a medieval epidemic.” He was describing a reservation town where drunken adults and youths passed out on the street were almost as common as empty beer bottles.
Perhaps because of a metabolic intolerance for alcohol, indigenous groups, such as Native Americans, the Inuit, and the Maori people of New Zealand, suffer extreme consequences from heavy drinking. But other cultures and countries are also at risk. In the United States, alcohol is the number-one drug problem across virtually all ethnic groups.