Why Some People Get Addicted and Others Don't: (HINT* It's not what you think!)

Today's video is on what makes people vulnerable to addiction. And I'm going to answer that question in three categories. The first category is genetics, so we'll spend a little time talking about that. The second category is underlying mental health conditions, which is kind of related to genetics. And then the third category is major life events. So let's start with genetics. We've known for a long time that there is some sort of genetic connection for people with substance use disorders. It tends to run in families. That's basically what we know. And now with the science that we have, we can actually not only just understand that we need to ask our clients and people and gather information about whether or not you had a parent or a grandparent or an uncle or a cousin or anyone like that in your family that ever had a substance use problem. But now with the science that we have, we actually can gather even more information than that. Usually in my sessions I'll ask a lot of questions about the person that had a substance use disorder. Because what we can actually gain from that sometimes is we can come closer to making a sort of a educate a guess about what sort of neurochemical genetic makeup that this person might have. So for example, if your grandmother drank and she was very anxious and always high strung and you drink or your son drinks or something like that, and they tend to be pretty high strung even before they started drinking and anxious, then that might tell us that you have a genetic predisposition to having excessive amount of glutamate and not enough GABA to balance that out. So we can help to decrease cravings and give you a better chance at avoiding relapse by addressing that issue. Especially if we know it's not just an imbalance being caused by the substance use. Because you can have sort of an underlying condition that's been present, whether it was genetically passed down or like I'll get to in just a second mental health condition that's going to create some neurochemical imbalances, or you can through substance use, create those neurochemical imbalances. So for me, I always ask a lot of questions anytime someone tells me about themselves or the person with a substance use problem, and they'll describe them as angry or anxious or lazy or whatever it is, then I'll say, have they always been like that? How about before they started using? Because what I'm trying to get at is what behaviorally, psychologically and biologically is present in the person before the substance use? Because that's going to tell me that's an underlying condition, not something that's induced by the substance use itself. Because like the example I gave you before about alcoholism, if your grandmother drank and you drank and she was anxious and high strung and you're anxious and high stroking if you drink and now you're anxious and high strong, which is typical of people that have drinking problems, but you really weren't like that before the drinking, then that tells me that that's probably like what we would call a substance induced anxiety disorder. So the difference is, was it there before or is it substance induced? If it's just substance induced, then once we get the substance out and we get you detoxed and give you a month or so, most of those symptoms really sort of calm down and you get back to base level. If it was always there and present and is a big part of what triggers the substance use, then we're going to need to deal with that more proactively, not just get the substances out, because once we get them out, that's still going to be there and we got to do something about it. So that's really a genetic predisposition, which is very similar and sort of tangled up with whether or not a person has an underlying mental health condition. Depending on the extent of the neurochemical imbalance, it might just be a little bit too much glutamate, not enough GABA or something like that. But if it's a pretty significant imbalance in neurochemicals, then the person's gonna have an underlying mental health disorder. And I'll tell you the really, really common ones that we see that are there before the substance use and that would be add. And ADHD counts in that. So that's one category, ADD and adhd, and the other one is anxiety disorders. So in almost all of my clients, I'll do a lot of history and questioning about symptoms of ADHD and or anxiety adhd, because that is a disease of dopamine regulation. And norepinephrine. Norepinephrine, which is a chemical in your brain imbalance along with some other chemicals, but dopamine being the main one and addiction is a dopamine disease. So both of those are stemming from dopamine lack of consistency, basically. So it would make sense that people that have one are super high risk to have the other. So very commonly people with addictions, we see a lot of it in the office. A lot of the teenagers that we see coming in here or young adults that we see coming into hope for families have underlying ADD and adhd. Sometimes it was diagnosed when they were younger and the family knew about it long before they came. And other times they have never been diagnosed before coming here. But after asking a lot of questions about the history and what the person was like before they came, it's very clear that they actually always had that problem going on, but it just was never officially diagnosed. And that helps us to know how to treat that. Like I said, because if you have someone with ADHD and you get them clean and sober and you don't address the ADHD somehow, then you're really limiting their ability to maintain their sobriety. Because remember, ADHD is difficulty thinking through a situation, organizing time, energy and resources, and a predisposition to impulsivity. All of those things really need to work right for a person to be able to maintain their recovery. So it's important to address that issue if it really, truly is an underlying issue. The other one is anxiety disorders, and this is the other one that I see just a lot with substance use disorders, especially alcohol. A lot of times people that become alcoholics, I would describe them as generally like pretty A type people. And I know that's a generalization, but most of the ones that I see are driven, they're motivated, they can be perfectionistic sometimes they can be overly achievement oriented and they push themselves hard. And that same thing that makes a person really successful and able to sort of be motivated and follow through on things can also be really uncomfortable to live with all the time. And many times the person doesn't know it, but they're sort of medicating that overthinking process through the use of alcohol. Of course, if you watch all the videos in the series, you're going to realize that drinking the alcohol actually is going to make that anxiety a lot worse in the long run, but temporarily, there is a short term relief from that overthinking, anxious type feeling. So those are the two underlying mental health disorders that we see a lot of. Certainly any underlying mental health disorder is gonna make your chances of having a substance use disorder much higher than someone that does not. Schizophrenia, bipolar disorder, and trauma. Particularly people that have trauma, which is actually an anxiety disorder, have a much higher rate of having some sort of substance use disorder. And by trauma, I mean either one single event or a string of events, or a lifetime of events in some cases that were extreme, terrifying, something that's a really bad situation that someone went through. After you have experiences like that, it really sort of reshapes what I call your fight or flight button in your brain, which is your Anxiety management. And you can come out of that with a trauma disorder. And those people are much more likely to have substance use problem. In fact, there's a lot of research now about how trauma actually changes the physical structures of parts of the brain. It makes some parts bigger and some parts smaller. And those parts are sort of directly related to things like anxiety, fight or flight, those sort of things, impulse control, that kind of thing that is also related to substance use disorders. So you can see how that's really interconnected. And then the third thing that makes people vulnerable or some people vulnerable and other people not so much to having an addiction would be life events. And by life events, I mean a lot of times I will be treating someone who maybe they drank for most of their life socially, and it really wasn't problematically, or they smoked marijuana or they used other substances recreationally for a long time. And it really never was problematic. It wasn't. It wouldn't meet the criteria for substance use disorder for sometimes even years. And then all of a sudden the person that wasn't an addict or an alcoholic begins to sort of transition over to someone that's symptomatic of someone that actually has a substance problem, not just a social user of substances. And it's important to remember that it's not really you are or you aren't, it's where am I at on the continuum? So when I say they, I don't really want to say turn into an addict because it's not like that happens overnight. But more and more symptoms can come on and you can have a person that did not have a problem that now does have a problem. Let me give you some examples of some of those life circumstances that have a tendency to trigger that any sort of unwanted loss in your life. So let's think about what that might mean. Like, I lost my job and it was unexpected. That's huge. Or I lost a loved one through death or illness. That's huge. Or something happened that disabled you, something physically impaired you, that's a loss. It can even be loss of dream. Like, I always had it in my head that I was going to be a rock star. And that doesn't work out. And then we call that loss of dream. So it's basically a major disappointment or letdown in your life. And you might be wondering, well, why would that make some people more prone to addiction? The reason is, is because when you're in that state of grief, your brain chemicals are actually different, so they sort of unbalance and your serotonin levels drop and your dopamine levels really drop. And that person that may have been using socially, now when they're using, they probably don't consciously recognize this, although some do, they're actually using to fix that grief or that neurochemical imbalance in their brain. So now I'm not just using socially occasionally because it's fun. Now I'm using our drinking to fix a problem, and that's different. And as you continue to do that over a period of time, then your brain, of course, becomes more and more used to that substance. It makes changes related to what you're using and how frequently you're using. And then you really can shift from being a social drinker or user into a problematic drinker user. The other thing about life circumstances that I'll tell you that can really impact substance use disorders is maybe you have someone who already might qualify for a moderate substance use disorder. Or in old terms, we used to call it substance abuse, but maybe not substance dependence. I would say a person that's in stage three, but not stage four. So you're dealing with someone who has a substance problem already, but it's just not as severe as what most of us think about as being an alcoholic or an addict. If you have that person, the problem's already in play. They're already in stage three, which means they're already having negative life consequences associated with their use. If that person then experiences a major loss in their life or a loss of structure in their life, then pretty often what you're going to see is that that person is going to transition from being a stage three problem into a stage four problem. So maybe before they didn't have to drink or use every day, but when they did, they tended to go overboard. That might be stage three. Stage four is what you probably would think of as chemical dependency. They at this point have used so much that they need the substance to function properly, otherwise they go into some level of withdrawal. And that withdrawal can of course happen on a continuum. So it can be from a little bit irritable and difficulty sleeping into full out life threatening or seizures or something like that. So that's pretty often what takes someone from stage three to a stage four. So some examples of that would be, let's say you have a guy who's alcoholic and he's married with a wife and two kids, and he's been in stage three alcoholism for a while, and his wife is always on this case about, you know, you need to stop drinking or you need to cut it back and then finally one day she has enough of it and she decides, I can't take it anymore, and she leaves. Most often in that situation, the wife was keeping the floodgates on the drinking to some degree because she was around, she was on him. He's probably making promises that he's not going to drink or he's going to cut it back. So he has to keep it under control to some degree. Once that person leaves, then it's just sort of a free for all. Now I can drink anytime I want to. Now I'm really upset because you left me. So I want to all the time. And whereas I used to have to sneak or wait till the weekends or something, now it's just on. And so that can shift very quickly from stage three to stage four, or going out of work for some reason is a big one that'll trigger that. So if you've been going to work every day, but you've been a problematic drinker or substance user of any sort, then likely you have to keep it under some sort of control to be able to function and go to work. If for whatever reason you stop having to go to work every day, like you lose the job, you are out for summer vacation, you have an injury and you have to go out on disability, you don't have that barrier there between you and the substance use. And that is a really high risk time for people to sort of transition from stage three to stage four. So those are the three general things to kind of keep in your mind about what makes some people vulnerable and some people not. Let me tell you just a little bit about some protective factors and look at maybe what makes other people not as vulnerable. Obviously the absence of those things that I just talked about makes those other people be less vulnerable. Those strange people that are like normal in our field, it's almost uncommon. So they're the strange ones. To us, having the right amount of serotonin and oxytocin in your brain actually protect you from developing addiction or substance use disorders because you aren't trying to fix that deficit so much. And serotonin is a chemical that regulates mood, sleep, appetite and that sort of thing. But I learned, and I actually got this off of a TED Talk. I don't know if you watch TED Talks, but I love those that a guy named Simon Sinek did, and he actually talks about leadership, not substance abuse or anything, but he was talking about this brain chemical. Simon Sinek says that serotonin is actually the leadership chemical. I thought, oh, that's interesting, because I Hear a lot about serotonin. I talk a lot about serotonin, but I haven't heard it being talked about that way. He was talking about how serotonin is released in your brain. When you do something that you're proud of, especially in the context of your group. And by your group, I mean your workmates, your family, your AA group, you actually get a little boost of serotonin there. And so you can think about addicts and alcoholics. They're not doing a whole lot that they're super proud of in the context of their social groups that they're involved in. But when people are functioning in life in such a way that they feel good about themselves and they feel like they're contributing members of society, they're less likely to become addicted. And the other really important chemical there is oxytocin. That is the bonding chemical in your brain. And it is released typically from physical touch, skin to skin contact. And so when we have good, proper, healthy relationships happening, and you have people in your life that you trust and that you regularly communicate with, you care about them, they care about you back, you're less likely to develop an addiction. Now, a lot of people develop addictions that have loving families, but it's about whether or not they are feeling connected or they have that sort of neurochemical connection to those other people. If for whatever reason that gets in some sort of deficit or problem, then you are much more set up to having an addiction problem because it basically makes you vulnerable, leaves you open. It's like a crack in your armor. So one of the things that we work heavily on, recovery, is building and rebuilding positive, healthy relationships and doing things that you feel proud of, like service work, like picking up a chip, like helping someone else get clean and sober, because those things elicit serotonin and oxytocin, which are protective factors. So that's a little bit of positive, hopeful news on the other end about what makes you not so vulnerable. And so you can have a little bit of control over those if you're mindful. And those are some of the things that you can do that's going to help yourself or maybe your children or your loved one have less vulnerability for addiction. I hope that helps. I'll see you in the next episode.