Even for alcoholism, the evidence for genetic inheritance is minor. At one point we seemed to hear regular announcements that scientists have discovered a gene that causes alcoholism or addiction. But this idea is no longer proposed the way it was. Sure, people still feel that addiction may be inherited. But no one speaks about a gene for addiction - there's a recognition that addiction is just too complicated to be contained within a simple inherited process. Even if a number of genes (which is now how such thinking runs today) are found to influence addiction, would the same genes cause alcoholism and drug addiction? What about smoking? Would the same genes also cause compulsive gambling and overeating? If so, this would mean that everyone with any of these addictions has this genetic inheritance. Indeed, given the large number of addictive problems we've uncovered, it would seem that half of the population has some form of these addiction genes.
How could an addiction like smoking be genetic? Why are some types of people more likely to smoke than others (about half of waitresses and car salesmen smoke, compared with about a tenth of lawyers and doctors)? And does believing that an addiction like smoking is genetic help the person quit (are all those smokers who quit not "genetically" addicted)? Returning to alcohol, are people really predestined biologically to become alcoholics and thus to become AA members? Think about the rock group Aerosmith: all five members of this group joined AA at once, just as they once all drank and took drugs together. How unlikely a coincidence it is that five unrelated people with the alcoholic/addictive inheritance should run into one another and form a band!
The idea that genes make you become alcoholic cannot possibly help us understand how people develop drinking problems over years, why they choose on so many occasions to go out drinking, how they become members of heavy-drinking groups, and how drinkers are so influenced by the circumstances of their lives. Genes may make a person unusually sensitive to the physiological effects of alcohol; a person can find drinking extremely relaxing or enjoyable; but this says nothing about how the person drinks over the course of a lifetime. After all, some people say, "I never have more than one or two drinks at a time, because alcohol goes straight to my head." And how much more true is this for people taking drugs like crack, which only some groups go in for.Â And why do more younger people become obese all the time, if obesity is inherited?
People are blinded by genetic theories so that they can't take in the facts all around them. Becoming - and remaining - addicted has a lot more to do with the groups people come from and associate with, and from their beliefs and expectations about alcohol or drugs(or other activities), than from their biological makeup. Often, people who become addicted set themselves up by investing a substance or an experience with magical powers to transform their beings ("When I drink I'm really at ease"; "Drinking makes me attractive to people of the opposite sex"; "I only feel good about myself when I am buying clothing"; "Gambling rescues me from my hum-drum existence."). It is simply not within the chemical properties of alcohol or a drug, or the experience of activities like shopping and gambling, to offer people what they want and seek from an addiction.
Addiction is not a "hot spot" in the brain. In the last twenty years, our attention has shifted from genetics to neuroscience, as represented by Nora Volkow, director of the National Institute on Drug Abuse, who has become a media star with the meme, "Addiction is all about the dopamine." This refers to a neurochemical that may be entailed in the pleasure centers of the brain, and which various drugs and activities stimulate.
On the one hand, focusing on dopamine and neurochemistry offers a chance to put a wide variety of addictions in the same bag, since eating, sex, gambling, shopping may all stimulate dopamine. And, so, decades after I wrote Love and Addiction with Archie Brodsky, where we said gambling and non-drug activities can be addictive, comes the American Psychiatric Association's diagnostic manual to recognize gambling, and potentially many other things, as being addictive. Addiction is not due to drugs!
But this simply raises the same old spectres. If everything and anything can be addictive, then what causes someone to become addicted, since we all do one or many of these things? In come deficiency models - perhaps some people don't have enough dopamine production. But, then, why do people largely give up their addictions - like smoking, alcoholism and drug addiction? The neurochemical model is no good for telling us about maturing out, the most common route out of addiction. It tells us primarily that we are (thank you Dr. Volkow) hopeless, unless and until we rely on an addiction doctor, like those in the newly-formed American Board of Addiction Medicine.
Volkow is fond of interviews (like one on 60 Minutes) where she points out the certain places in the brain light up on brain scans when people take cocaine. Right and so what? Why do some people continue to return to this state ad infinitum, some do it occasionally, and some do it intensely for a time, and then quit, or even cut back? Now that we know that similar (or other) parts of our brains light up when we have sex, or eat, or go shopping, or gamble, what stops us all from being permanently addicted? Volkow is fond of showing that, as we have long known, the brains of addicts light up even when not taking the drug from seeing the drug, or even locations where they took it. Yes, and so why did my Uncle Oscar - and many, many people you know, or perhaps you yourself - quit his (in Oscar's case) four-pack-a-day habit in his early forties, after 25 years of smoking, and never smoke again?
People, like you, quit addictions (or some cut back) when they want to, need to, have to, live out more important parts of their lives, and then they cope with urges to return to smoking, or gambling, or drugs, or alcohol. I testified at a murder trial where the defense's position was that the man had killed because his irresistible need for cocaine "made him" kill his dealer (and, while he was at it, his girlfriend) to get his stash. Yet, you haven't killed anyone to go shopping, or to smoke a cigarette, or for a drink. You do exercise some degree of judgment and control, even in the worst throes of your addiction. Likewise, there are places where it is forbidden to smoke, yet addicted smokers cope.
And there are other places and times (think of families and children) where you are unlikely to drink or to use. So, if someone tells you your addiction has hijacked your brain, you know you can take it back, whenever, and for as long as, you find it necessary.
Stanton Peele, Ph.D.