Why Me?

Many people who have diagnosed themselves addicted quickly come to ask themselves, “why me?” Beyond the self-pity, my experience is that getting bogged down in the specifics of what led to the addiction is nearly always a waste of time. Most of the time people who are asking that question have a hidden question that goes something like this:

If I understood what led to my addiction, could I fix that, still drink and have a good time?

The chances are by the time a person comes to read information on this site and seriously deal with the problems and consequences of addiction, they have already tried controlling many parts of their behavior. If understanding were the solution most people would’ve figured out long ago, and be drinking and happy at the same time. Do not be discouraged. If you give up the idea of successfully controlling your alcohol or drug intake is a good bet you’ll be much further on your way toward relief from the problem. With that in mind, let’s look at some of the major components of an addiction.

It really is astonishing that people so tenaciously hang on to the idea that someday they can successfully drink despite a mountain of evidence to the contrary. I’m not including all those who do not classify themselves as addicted, only those who recognize that their behavior is unpredictable when they drink, use, or act in addictive ways. If the painful results of your activities are not enough to convince you that you need to change, my words will have even less of an effect. If you have made your own diagnosis, then this article might be helpful to you.

Nature vs. Nurture

Let’s consider some of the factors that contribute on a statistical basis to the development of substance or behavior addiction. Simply, we can consider nature versus nurture. For nature we obviously include genetics and family history. In the nurture category we have primarily chemical exposure but we should also add social substance and behavior use patterns that a person might observe/participate in while growing up and in early adult development. Finally we’ll talk about factors that reduce the likelihood of substance dependence.

Let’s start with genetics. Just how much of this problem is family related, or genetically linked. Unfortunately we don’t know. The largest data set we have comes from Dr. Mark Shuckit in his genetics of alcoholism studies. It seems to indicate an approximately 40 to 60% relationship of genetics. In other words, you are just as likely to determine whether or not genetics are related in your substance dependence problem if you flip a coin.

It is easy to collect anecdotal evidence from current and recovering addicts who’ll regale you with tales of their own alcoholic mother and father or both. It is just as easy to find people who will report that no one in their immediate direct family had a problem with drinking or drugs. It may be obvious, but it does bear stating that for any person living genetics, as a factor in the development of their substance abuse is virtually irrelevant. You either have a problem or you don’t. It only might matter for purposes of genetic counseling. If two alcoholics are contemplating having children together, they might give some thought to the likelihood of eventually having addicted children. Realistically, they wont, and shouldn’t think too much about it.

Currently there is no analysis to be performed on DNA which indicates with any degree of certainty the tendency to develop or not develop addiction. Of course the insurance companies would love to have a blood test that would tell them chances that their insured will go on to be an alcoholic. Fortunately such test does not exist because there are too many other factors.

Even if there were such a specific DNA tests, there is another layer to consider. The DNA sports small little molecular tags that line the sugar backbone of the genetic molecule. These tags–called methyl groups–are like little switches that regulate whether or not a specific gene will be transcribed into action. Methylation of DNA is a dynamic process and currently we don’t know what controls it. It may be that a person has a gene for addiction but it is not expressed because of the way the tags are placed on the DNA. We don’t know what controls the tags.

Further, behavior as complex as addiction is almost certainly a poly-genetic phenomenon; more than a single gene. Pleasure seeking/pain avoiding behavior is a fundamental in any organism. If there were a set of genes that controlled any specific behavior, like excessive drinking, we would naturally expect each gene to have a partial influence on the other genes and possibly a substantial influence on the final behavior.

Brain Structure

From a narrow anatomic standpoint, brain structures are plastic. Discoveries from brain injury research as well as studies of brain development in children reveal that human brains continue to grow. Even if a self-destructive set of behaviors such as excessive drinking were to develop, the brain can heal and grow out of them. As long as you’re green you’re growing.

One area where genetics might someday be more useful is in the tailoring of specific medications for individuals. In general, this author has been disappointed with what the pharmaceutical industry has produced by way of treatment for addiction. There are some data suggesting antidepressant medication may be useful, but I am suspicious of the entire data set concerning these drugs. Until we have available all of the data from every study including studies that were aborted because of results that didn’t support FDA approval of the drug, we won’t really know the full side effect profile all of these drugs.

With regard to the genetics, however, there may be certain groups of people more responsive to specific drugs. Pharmacogenetics is an exciting new area here. Imagine a medication that was specifically chosen for you that minimized both side effects and was more effective than a one-size-fits-all medication. That would be progress.

A good example of this phenomenon is codeine. Approximately 10% of people receive no pain relief from codeine. Might as well be a sugar pill. The body does not recognize it as a painkiller in these people. Good to know if you’re in that group and the doctor gives you a medicine for your acute pain that isn’t going to work. Someday we may benefit from genetic information with regard to addiction but that is still off in the future.

Queen Amygdala

As with nature, nurture is largely a fait accompli. Don’t be discouraged here either. Even though you may have had some particularly difficult or traumatic events in your youth, you can continue to be nurtured by others and of course yourself.

Just in front of your ear, over by your temple is an area of the brain called the amygdala. The amygdala is the part of the brain most responsible for recognizing, categorizing, and recalling painful or scary events. It is easy to see why this system should be so valuable in animals and human beings. If something scary happens is probably associated with danger, damage and injury. It would be a handy system to have once you escaped the danger or damage if you could remember to avoid the trouble next time. Unfortunately many scary and painful experiences are so memorable that the brain wants to make absolutely sure you’re not exposed to them again. Ironically this system becomes so hyper aroused that fear and anxiety may seem to be spontaneously generated.

The mind is a wonderfully facile at pattern recognition. Human beings are the dominant creatures on earth because of their ability to synthesize data and make patterns. That massive organ of analysis you have on your shoulders is millions of years in the making. In the case of addiction this pattern recognition is turned up to such high levels that patterns are “discovered” which otherwise don’t exist.

For example, if you had been particularly humiliated or made to feel shamed in a social setting, whenever the opportunity arises to be in another social setting the amygdala kicks into gear and replays the movie of that painful experience. The amygdala and the judgment center of the brain, the orbital frontal cortex, have a conversation. The amygdala says, “I was so scared the last time that happened but I want to make sure I stay out of danger.” The cortex responds, “ I know what to do, let’s have a drink.”  Another message is sent to the legs and over to the arm which then walk over and pour drink.

The new social experience is muted and much less scary under the influence of alcohol. A feedback loop is created. Fear – drinking – less fear. The trap is set.

The brain has developed a management strategy for dealing with scary feelings. It is instantaneous, very effective, and in the beginning free from problems usually. Except for the fact that the substance is toxic and that the neurons develop tolerance (and that the amygdala won’t be silenced) the strategy would be a good one. If drinking still worked, I’d still be doing it.

Perhaps you can see why stopping the substance is so difficult. A person not only had relief from an acutely painful situation, but also usually did so several times in a row. The mind becomes fixated on the chemical solution. A desperate reworking of the variables trying to obtain the initial sense of freedom and control is the very essence of chemical dependency. Unfortunately, at that point simply stopping the substance is not adequate.

What persist are the original feelings a person started with. In the example above, if it was fear of social situations, then they haven’t had the experience of growing through them. They are frequent in a socially and emotionally inhibited–with good reason, when they first stop drinking or using.

Drugs change the brain

No, not just the barroom-wisdom that alcohol kills brain cells (it does) but more that the presence of alcohol in the brain changes perception. Think about that for a moment. ‘Alcohol changes perception’ is hardly a revelation. It is, of course, why it is consumed. A person wants to change the way they feel, voila, have a drink. Why are we then befuddled when the feelings under the influence of alcohol lead to a new plan?

Sometimes when the addict plans to stop, she or he is able to stop. At other times, the thought of stopping is erased from the mind by the first drink. As alcoholism progresses, the afflicted gets more of the latter and less of the former. He can’t predict which way it is going to go as time progresses. If the “stopping” is successful, the sense of control grows and drinking is bound to continue the next time. If the drinking episode ends in ruin, the sufferer asks, “why me?”

Not drinking also changes the brain. Dealing with life and its challenges as they are presented strengthens the coping mechanisms of the brain. People are often surprised at how much of their anxiety was caused by the substances (and behaviors) they were relying on to deal with the fear. With the help of trustworthy people, any emotional difficulty can be surmounted. All we need is time and love. Change your brain back and stop asking why me. Don’t you agree?



Category: Neuroscience, You Don't Need Rehab

About the Author: Dr. Jason Giles is certified by the American Board of Addiction Medicine and the American Board of Anesthesiology. He is a physician specializing in the treatment of drug, alcohol, and behavioral addictions. He is the founder of Haywire.

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