Addicts new to recovery typically enter treatment motivated by their current crisis and a desire to escape their actual and potential consequences (rather than a desire to change their behaviors and live differently moving forward). And instead of being focused on the day-to-day solutions that might help them stay sober, they are often more interested in the causes of their addiction. Sometimes they think that if they understand their problem's etiology, it will go away. Other times, they just want someone other than themselves to blame. Either way, addicts nearly always want to know: "How and why did I get this way?"
Whenever I am asked this question, I first state that knowing why you are addicted will not control your addiction. And then I answer the query as best I can, understanding that some folks either can't or won't move forward into healing without some type of practical response.
For the most part, addictions (of any type) arise thanks to a combination of risk factors -- some genetic, others environmental. It is possible for an addict's risk factors to be entirely hereditary or entirely situational, of course, but usually it's a combination of nature and nurture coming together and forming a witch's brew of risk.
Thanks to modern science, genetic risk factors are relatively easy to identify. Consequently, we now know that certain genetic deviations can influence the ways in which addictive substances are processed in the body and brain, thereby raising or lowering the risk for addiction. For example, a genetic variation affecting dopamine receptors in the brain causes the enjoyable effects of alcohol and other addictive substances to intensify, greatly increasing the propensity for addiction. (The release and reception of dopamine in the brain is, generally speaking, what causes us to feel pleasure.)
Conversely, other genetic variations can reduce the risk for addiction. For instance, a genetic mutation that creates a deficiency in the aldehyde dehydrogenase enzyme, which is critical to the metabolism of alcohol, results in classic hangover symptoms (headache, nausea, nerve sensitivity, etc.) almost immediately after alcohol is consumed. This, of course, greatly reduces an individual's propensity toward alcoholism (but not other addictions).
Furthermore, genetics can factor into numerous emotional and psychiatric disorders -- depression and bipolar disorder, to name but a few -- and many of the people living with these issues choose to self-medicate with addictive substances and/or behaviors, in time becoming addicted. In these cases, what is inherited is not a unique genetic response to a potentially addictive substance or behavior, but the propensity for an underlying neurobiological vulnerability that may, over time, lead to addiction. For instance, people with bipolar disorder are much more likely than others to become addicted, but this propensity has nothing whatsoever to do with the ways in which addictive substances and behaviors are experienced in the body. Instead, it's connected to that person's desire to escape the emotional pain of an underlying, genetically driven psychiatric disorder.
That said, genetic predispositions are not entirely to blame for addiction. Environmental factors play an equally significant role. In fact, good genetics can easily be usurped by bad environment (and vice versa). For instance, abused and/or neglected kids are incredibly at risk for addiction, regardless of their genetic makeup. And the more times a kid is traumatized (neglect, emotional/physical/sexual abuse, etc.), the more likely addiction becomes. One study found that kids with four or more significantly traumatic experiences are:
• 1.8 times as likely to smoke cigarettes
• 1.9 times as likely to become obese
• 2.4 times as likely to experience ongoing anxiety
• 3.6 times as likely to be depressed
• 3.6 times as likely to qualify as promiscuous
• 7.2 times as likely to become alcoholic
• 11.1 times as likely to become an intravenous drug user
Thus, we see an undeniable link between childhood trauma and numerous adult-life symptoms and disorders, including addiction.
Another relatively common environmental risk factor is early exposure to an addictive substance or behavior. Put simply, the lower the age of first use, the higher the likelihood of addiction. Of course, the age of first use and familial instability are often intertwined. In such cases, the other environmental risk factors (abuse, neglect, inconsistent parenting, etc.) may be the overarching factor in the development of addiction. Nevertheless, the link between age of first exposure and later-life addiction is undeniable. (Early in the treatment process, trauma-related issues are acknowledged as a way of reducing in-the-moment shame, but they are not the primary focus. In fact, treating trauma issues should not occur until the addict has six months or more of solid sobriety and a strong social support network. Otherwise, the difficult and highly upsetting work of trauma treatment could easily lead to relapse.)
So who and what is to blame for addiction? For most addicts, there are numerous contributing factors -- some nature, some nurture. So addicts should blame whomever and whatever they want. But they should also understand that not every person at risk for addiction becomes addicted. Plenty of people with serious genetic predispositions and/or horrible childhoods don't become addicts. They either don't use at all, or they use responsibly. No matter what, there is always a choice.
Most importantly, as stated in the opening paragraph of this article, knowing why you are addicted is not of primary importance. Such knowledge will not cure or control an addiction. Sure, you might feel better if you've got someone to blame other than yourself, but at the end of the day you need to understand that nobody poured that bottle of vodka down your throat. You chose to drink, or get high, or whatever, so it's you and nobody else who is ultimately at fault. Furthermore, you and you alone are responsible for your recovery.
Robert Weiss LCSW, CSAT-S is senior vice president of clinical development with Elements Behavioral Health. He is the author of numerous books, including Sex Addiction 101. For more information please visit his website.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.