This is an age old question and there are no easy answers. People often ask if they had a genetic predisposition to addiction before they became dependent on various chemicals.  The short answer to this is always yes but not in the way one might think.  People tend to expect that as the field of genetic research advances we are going to find “the gene” for various disorders, addictive disorders included.  While this may be true in the case of certain disorders, think Trisome 18 (Edwards Syndrome, or Trisome 21 (Down Syndrome) where we can identify a disorder in a fairly specific location of the human genome, this is not the case for many “somewhat inherited” disorders.

It is more helpful to think of addiction as genetically influenced than to think of it as genetically caused.  At True North We typically explain this to our patients by explaining that the human genome evolved with protective measures in place.  One of those measures was to spread the architecture of the brain out across the genome.  This increases the chances that if there is damage to the genome that occurs during the formation of the genetic code, the damage is less likely to decrease the chances of the birth from becoming viable.

With this thought as the premise, we explain it like the human being is a thermometer.  If the thermometer reaches 100 degrees then the person will have expressed the genetic predisposition for addiction.  So how then do people from the same families, with similar use patterns early end in one sibling becoming disordered in their use while in another siblings life it seems to fade away?  Well, we are all born with different genes.  Even siblings have variation in their genetic code which is why they look different, have varied health problems, etc.  Even siblings can be born at a “different temperature” then one another.  Some individuals are born with a very low temperature, for example, 15 degrees, while others are born with a very high temperature such as 90 degrees.  While people who are related are likely to be born with less disparity in their baseline biological predisposition, this is not always the case.  The genetics of each person are actually very different.

With individuals being born of varied “temperatures” we now come to the environmental side of the equation.  Before anyone, regardless of baseline temperature can become disordered in their drug use, they must be exposed to drugs. Exposure falls into a category we refer to as “risk factors.”  It is the only risk factor that is a must.  People who never use substances do not have disordered use ever.  It is an unassailable fact.  Other risk factors an individual might be exposed to or participate in could be the use of more addictive drugs such as heroin, trauma, grief and loss, socioeconomic pressures, medical problems, learning difficulties, lack of resources, poverty, lower educational attainment, overwhelmingly high exposure to chemicals, lack of boundary support growing up, marital problems, etc.  We could add any human related problem to this list and it would most likely be appropriate to include.

On the other side of the equation, we have what we refer to as “protective factors.”  These are strengths, supports, and traits that make their temperature go down.  This could be a vital mentor such as a coach or a high degree of interest in music or some other hobby. It could be a strongly held faith or belief system that is protective and rooted in strength,  Even simple things like enjoying reading play a part in keeping their temperature down.

We are born with our biological predisposition for disordered use.  As we go through life our risk and protective factors act like a yo-yo causing our temperature to move up and down the thermometer.  At points in the pre-addicted persons life they may be at very high risk and may even appear to be addicted.  Their temperature may be very high.  They may have recently experienced a traumatic experience they are unsure of how to cope with and/or resolve.  Perhaps this person seeks counseling when they are at 95 degrees and they begin to resolve the trauma and the counselor equips them with new skills.  Perhaps they meet a significant other who has a great deal of protective influence over their decisions.  Two years later their temperature is back to a very reasonable 50 degrees of risk.

Our group participants who are taught these concepts typically have a very favorable response to it.  On the one hand, they will often begin to conceptualize the point in their lives when they reached a temperature that was irreversible.  Their genetic predisposition had been expressed much like it is in the case of a diabetic.  The Type II diabetic is usually in a a very similar relationship with their disorder.  Once they reach 100 degrees they are not curable, but their disorder can be managed.  With addiction, the disorder is best managed through abstinence from drugs and alcohol. If this can be maintained the disorder can ultimately lie dormant and the individual can be fairly unaffected in the future.   It is secondarily managed at times by controlled replacement therapies such as methadone and buprenorphine in the case of heroin addiction.  These secondary approaches with reduce the harm being done to the mind, body, and spirit but the disorder remains active within these individuals.

For individuals in private therapy who are unsure of their situation, this can also be a wonderful way to look at their situation.  Be careful to avoid denial (you do not have to be addicted to anything to experience this) as the situation is assessed.  Objective, outside influences are often helpful in getting an accurate read on one’s own “temperature.”  If it seems to be that the temperature is worrisome but not to the point of full genetic expression of the disorder, it may be time to focus on raising protective factors, adding new ones and eliminating or reducing risk factors.

As always, we hope you find this blog useful.  Feel free to share what you find here with others.  True North isn’t a large program that is just in it for the money.  We are owned and run by a recovering clinician that has spent his entire adult like working with addictions in several levels of care and with everyone from homeless families to teen gang members to NFL players and attorneys.  The point of what we do is to help.  We are here to keep it personal and to keep it effective.  We know we have to make a bottom line to keep our doors open but our mantra is a “good clinical decision is a good business decision.”

Kansas Cafferty
Founder, Director
True North Recovery Services
San Diego Intensive Outpatient Treatment Program