Sunday, February 5, 2012

Is Addiction Inherited?

This past week the media (National Public Radio, BBC World News, for example) picked up a story from Science that addiction might be hereditary, based on a study out of Cambridge, UK, of 50 pairs of siblings, where one sibling had a cocaine addiction and the other did not, yet both had similar changes in the brain (in areas of impulse control). The conclusion that these similar brain changes indicate inherited traits may overlook the discovery that experience changes brain anatomy, chemistry, and function. As such, it might be equally plausible to conclude that siblings were similarly exposed to parents who were unavailable, misattuned, or abusive in ways that caused the brain to develop as seen in the touted study.

In the TBIPS course on Repetitive Painful States, in which a portion of the course is devoted to addiction, we consider the possibility that addictive behavior (whether substance abuse or self injurious such as cutting) is a way to manage untenable beliefs and affects. Having gone unrecognized and misunderstood, or worse, as often is the case, having had one’s reality attacked and one’s spirit nearly extinguished, a child is often without the opportunity to learn to regulate one’s impulses. Does this not affect the developing brain? [This is not to say that the myriad possible ways a child's brain might develop is not constrained by genetics.]

We go even further in class, presupposing that new experience in relationship with the analyst, repeated and protracted, also begins to change brain anatomy and function, encoding experience in such a way that impulse control is gradually developed, not by prohibition of behaviors, but by the shared experience of accepting a patient’s reality, bearing painful affects together, and reconfiguring belief systems about the self and the self with others. Differing with most treatment modalities for addiction, I expect that it would be a further misunderstanding of an analytic patient to base treatment on the contingency of abstinence while the patient has yet to have help with painful affects and untenable beliefs.

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