Opioids: Why do some get addicted and others don’t?
Even before I worked in the field of mental health and substance abuse, I often wondered why some people try a drug and get hooked right away, and others with an “I’ll try anything once” sort of attitude skate by without a problem. The outdated moral model’s take on addiction would apply a character defect to the person who gets addicted, but we know differently now. We know that mental illness and chemical dependency are diseases of the brain. In addition to the neurological implications for addiction, scientists are also working on the identification of genetic markers to look at a predisposition for the disease.
According to a recent MedPage article on using genetic markers to identify addicts, genetics account for about 50% of the addiction. The other half is made up of things like environmental exposure to particular drugs, peer pressure, mental illness (this may lead an individual to self-medicate with alcohol or other drugs), or, as is often the case with opioid addiction, chronic pain. The genes that control impulsivity, as in, the decision to try a drug or not, have been isolated as well as the genes that control the opioid receptors in the brain. However, predicting who will and will not become addicted is more complicated and likely involves many more genetic components.
This hasn’t stopped drug testing companies from developing tests that promise to make such predictions, and scientists are warning of the potential dangers of, for example, delivering a test that assures an individual they are at low risk for developing an addiction to opioids when this might not be entirely true. Since genetic testing is considered a Laboratory Developed Test (LDT), they escape any major oversight by the FDA. More regulation by the FDA may be coming as companies are pushing the envelope and bringing tests into the marketplace to sell to physicians, and, in some cases, directly to the public (i.e. 23andMe).
I think these tools can be helpful if we don’t ignore the entire picture. Just as we need to treat the whole person, mind, body and spirit, when we assess a person’s risk for addiction, we need to look at all the factors involved rather than relying solely on one test.