genetic predisposition – Opiate Nation

The Important 0.1 Percent

(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.

POWER-less or POWER-ful?

Last week I wrote about regrets that John and I deal with – wishing that we had known about some type of long-lasting recovery option for our son, JL – and the SMART recovery approach and how it differs from traditional 12-Step programs such as AA. Continuing on with the concepts about individuals who struggle with life-threatening addictions of any variety, I have a few more thoughts.

With the genetic / disease model of addiction that scientific research has brought to the table, there are many in the recovery world who feel this mindset gives those living with addiction a green light to excuse their responsibility, their power of choice. But I disagree. It is clear that we had nothing to do with our family tree, our genetic inheritance (1). We were “powerless” as far as choosing to be born into our family. Yet, this doesn’t mean we are powerless to overcome the negative Continue reading “POWER-less or POWER-ful?”

MYSTERIOUS WAYS

I love mysteries. From the time I began reading on my own, I gravitated toward mysteries: first Nancy Drew, then Agatha Christie, Edgar Allan Poe, Arthur Conan Doyle. My husband and I continue to read and watch mysteries covering topics from historical to crime to espionage. Maybe my penchant for asking “Why?” is at the root of this affinity. The challenge of figuring out a conundrum and the satisfaction when the mystery is finally solved. Continue reading “MYSTERIOUS WAYS”

STIGMA, Part 1: What and Why

In the Greek and Latin worlds, a stigma was a mark or brand, especially for a slave, identifying the person as “inferior”. When stigma began to be used in English, it meant the kind of mark or stain you can’t actually see. (Merriam-Webster). Social stigmas are based on perceivable characteristics, associated with certain behaviors that distinguish a person from other members of society. They convey disapproval and disgrace. Dis-approval. Non-approval. Dis-grace. Non-grace. Being dissed.

In an article on The Stigma of Addiction from Hazelden Recovery we learn: “The stigma of addiction stems from behavioral symptoms of substance use disorder… impaired judgment or erratic behavior, which can result in negative consequences including legal, occupational and relationship problems. Understandably, these consequences cause embarrassment and shame among those affected. They also create stigmatized attitudes and perceptions among the wider public, a response that perpetuates and exacerbates the private shame associated with drug addiction.For generations, this combination of personal shame and public stigma has produced tremendous obstacles to addressing the problem of alcoholism and addiction. Today, the stigma of addiction is seen as a primary barrier to effective addiction prevention, treatment and recovery efforts at the individual, family, societal levels. Addiction stigma prevents too many people from getting the help they need.” The article goes on to discuss the irony that many of these stigmatizing behaviors diminish and/or disappear when a person is appropriately treated in recovery.

In my family, and in most others, alcohol and drug addiction is considered private, and “is something only whispered about. Even when the symptoms of the disease are obvious to all around, individuals and families avoid seeking help for fear of even acknowledging the problem. This is one reason only one in 10 Americans with a substance use disorder receives professional care.” (ibid.) When talking recently with some of our son’s friends and former addicts, they are unwilling to let their past drug use become public knowledge because of the potential negative repercussions they justifiably fear in their careers and relationships. What does this say about us as individuals, communities, employers, and society in general?

Hazeldon, with almost 60 years experience treating alcohol and addiction, says “the same undercurrent of addiction stigma keeps addiction under-diagnosed, under-treated, under-funded and misunderstood by many, especially as compared to other chronic health conditions such as heart disease, asthma and diabetes.” Why? The individual is seen as having a moral failure instead of a health problem. I have an anecdote I share with people when we discuss addiction. When I have been given oral opiates when leaving the hospital after surgery, I take one or two and then opt for the pain because I hate the way they make me feel: disoriented, unable to sleep deeply, and not myself. My husband recently had surgery that he was warned would be painful for 4-6 weeks following the procedure. That was an understatement. He was given a prescription for 10 days of opiates. We thought that would be unnecessary. We were wrong. When he was taking the pain meds as prescribed, he was his normal, cheerful self – it was like magic. As soon as they wore off, he was cranky. Of course he was in pain, but it was more than that. Why?

For us, it’s not difficult to understand. He has the “addiction” gene, as we call it. There were alcoholics in both of our mothers’ families. He got the gene that I seemed to have dodged. Did he ask to have that gene passed down to him? Did he decide he would feel good taking opiates for pain? Of course not. And neither did our son. Nobody makes the decision on how their brain will react to different substances. It happens. The issue is what a person does once they know that a mind-altering substance spells “pleasure” to them? Do they keep a safe distance from it as John has done or do they play with fire? For parents with addiction in our family trees, prevention is our best and most powerful weapon. Two books to aid parents in prevention are:
The Teen Formula : A Parent’s Guide to Helping Your Child Avoid Substance Abuse By Dr Dave Campbell and Drug-Proof Your Kids by Arteburn and Burns.

Had we known then – when our son was an adolescent – what we know now, we would have made significantly different decisions regarding our attitude towards pain medications, drugs, and alcohol – and especially begun discussing addiction in general and in our family in specific. I believe our son would still be alive if we had.

https://www.hazeldenbettyford.org/recovery-advocacy/stigma-of-addiction

Opioid Euphoria

What do you feel when you take a narcotic/opioid pain pill?

There are usually three reactions people have after having being given them for the first time for pain relief: we are disoriented and uncomfortable, even while our sensation of pain is temporarily deadened; we feel ambivalence combined with gratitude for the pain relief and the willingness to have that relief for the next pain-inducing event; or we feel that we have finally found nirvana.The truth about opioids, pain relief, and addiction has long been unclear and confusing. Sadly, this has been purposefully done by the makers of these drugs with one goal: profits. But these statistics are now becoming well known and will hopefully help reverse the trend of opioid addiction and deaths:

Approximately 25% of people who use an opioid will become addicted after a short period of use, which could be once, 3 days or a week.

The longer you use an opioid, the chances will increase that you will be addicted. This is because almost everyone will build up tolerance to them, which leads to addiction.

Genetics play a very important, but as yet not fully understood, role in what type of reaction each of us have to opioids. What is clear is that those families who have tendencies toward addictions – alcohol, drugs, food, gambling, sex, etc – will be those most likely to be drawn to opioids due to sensing them as pleasurable. There is something in their brain that is wired differently than others.

Our addiction doctor and recovery counselors have explained it to us and this is the essence: There are four areas of the brain that handle the substances and experiences we send it. Very simply put, they are:

Pain center: The PAG, known as the central gray, has cells that produce enkephalin that suppress pain

Emotional center: The amygdala regulates how we process emotions, memories, and rewards

Addiction center: The nuclean accumens, due to neuroplasticity, changes over time and builds up tolerance

Control center: The brain stem, the control center between the brain and the rest of the body, controls basic body functions like breathing, swallowing, heart rate, consciousness, etc.

The first three areas have the ability to build up tolerance, which is what keeps addicts coming back for more – and each time needing more. That is the nature of tolerance. The fourth area, the brain stem, has the least ability to build up tolerance. This is why an overdose – using an amount that is significantly more than what your body has built up a tolerance for – shuts down the respiratory center and you stop breathing.

In our family, and in the families of our son’s friends who are addicts or alcoholics, there are definite genetic predispositions to alcoholism that is traceable back many generations. Other addictions are no so easily identified, but they are there. It is not something anyone initiated or wanted or can change. But what can change is knowing the genetic trait is present and taking preventative steps as early in life as possible.

Talking openly and honestly about our predecessors – and our own – addictions is the first step. Seeking wise informed counsel for what things to avoid, especially while young, may help prevent some of the pitfalls. But for most teens, and especially for those from high risk families, experimentation will be unavoidable. Knowing as soon as possible if your child is moving away from their normal behavior and intervening with proven methods may save them – and you – from the pain that hundreds of thousands parents like my husband and I have now had to live with.