(Nineteenth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
DNA sequences for any human is approximately 99.9 percent identical to every other human. That means that only 0.1 percent of our genetic makeup is unique to us. Genes are functional units of DNA that make up the human genome. But don’t be fooled into thinking that 0.1 percent variation is insignificant. It is nearly 3 billion base pairs of DNA which boils down to 3 million differences that determine our physical features like hair and eye color and health risks or protection from diseases such as heart disease, diabetes – and addiction. Genes influence the numbers and types of receptors in peoples’ brains, how quickly their bodies metabolize drugs, and how well they respond to different medications.
The National Institute of Drug Abuse (NIDA) reports that family studies that include identical twins, fraternal twins, adoptees, and siblings suggest that as much as half of a person’s risk of becoming addicted to nicotine, alcohol, or other drugs depends on his or her genetic makeup. Scientists estimate that genes – including the effects environmental factors have on a person’s gene expression, called epigenetics – account for between 40 and 60 percent of a person’s risk of addiction.
Epigenetics – epi meaning “above” – is the study of functional, and sometimes inherited, changes in the regulation of gene activity and expression that are not dependent on gene sequence. This means exposures or choices people make can actually “mark” (remodel) the structure of DNA at the cell level. So epigenetic regulatory systems enable the development of different cell types (e.g., skin, liver, or nerve cells) in response to the environment. These epigenetic marks can affect health and even the expression of the traits passed to children. For example, when a person uses cocaine, it can “mark” the DNA, increasing the production of proteins common in addiction which is believed to correspond with drug-seeking behaviors.
We are a global community – like it or not. We are connected down to the minutia of life, from what we breathe, to what we eat, to what we think, to what infects us. And right now, the world, our world is in a life-or-death struggle with a microscopic enemy that seems to keep gaining the upper hand. The result in just one area is massive unemployment and the subsequent loss of access and funding for public and private support services.
I don’t want to get in to the politics of whether economies should be opened up regardless of Covid-19 and suffer the consequences in lives lost, verses lives ruined by no work and massive personal and societal debt. What I am concerned about are the consequences of what so many millions of people are facing from having lost their means of livelihood, and in particular, those whose lives were already balanced on a knife edge on a daily basis.
It has been said that the opposite of addiction is not sobriety, it is connection – to others, to a community. The Coronavirus pandemic has brought disconnection and magnified loneliness and stress for people the world over due to social isolation, economic instability, reduced access to spiritual communities, and overall national anxiety and fear of the future. “We certainly have data from years of multiple studies showing that social isolation and social stress plays a significant role in relapse…and relapsing to drug use can play a role in overdose.” Dr. Wilson Compton, deputy director NIDA.
The acronym HALT: Hungry, Angry, Lonely, Tired, is used in Alcoholics Anonymous and most recovery programs. It is a simple reminder that when our basic human needs are not met, one is susceptible to toxic thoughts and self-destructive behaviors including relapse and suicide.
A few months ago, John was on a phone call with a physician who was asking his input about a new drug to help with opioid addiction. At the end of the call, as I walked into the room, John told him about our son’s addiction and death and how we hoped that by speaking openly about him and through our book and blog we could help in some small way. His response was something I will never forget. He said “Don’t underestimate advocacy because it is the surest way to change things. Science and medicine take a long time and have limited effectiveness.”
His comment came to mind in the recent weeks as I watched millions of people around the world protesting against racial prejudice that lay at the heart of police brutality to People of Color (POC). They are advocates of racial equality as a basic human right. I thought: how I wish I could be helpful in a practical way to a problem I have watched change very little over the decades of my life. I felt anger and also frustration, wondering if all the sacrifice and effort would actually bring about real, lasting change.
It is the same feeling I have when I see a young person on the streets, homeless and struggling, enslaved to a substance that is stealing their life. Or anyone living with addiction of any sort. And if I feel discouraged and hopeless, how must they feel? What will help bring real, substantive change and hope in all these circumstances?