Is It Possible Not to Be Predisposed to Addiction?

I just finished reading Transcendent Kingdom by Yaa Gyasi. In the book, the protagonist’s brother overdoses after being addicted to opioids for three years. The protagonist goes on to pursue a Ph.D. in neuroscience, and her main experiment is on mice. She gets the mice addicted to Ensure, which they have to press a lever to get, then when the mice go for Ensure, they sometimes get shocked instead.

In the book, there are three groups of mice: the first gives up after a few shocks, the second is more resilient but still gives up eventually, and the final group doesn’t care and keeps enduring the shock. Obviously, addiction is prevalent in the third group.

Somehow, this novel got me thinking about addictive personality and whether such a personality type exists. Surely, the third group of mice was more predisposed to addiction or addictive tendencies but did the mice have addictive personalities? I know this is only a fictional work, but its basis is a real study done in the Deisseroth Lab at Stanford. There are many powerful quotes in this book, and it is evident that addiction is found in the brain, not necessarily the human psyche, but in the brain’s actual physiology. Blaming an addiction on somebody's personality seems to be a long-shot where this book's narrative is concerned. I had to look further into it.

The first article on addictive personalities I found was by Healthline, which opened with this:

Addiction is a complex health issue that can affect anyone, regardless of their personality.

The article argues that addictive personality traits are a myth. A study has shown that it’s hard to prove whether addictive personality traits appeared before or after the addiction caused changes to the brain.

Of course, there are problems with the general idea of addictive personality traits. For example, people may assume that they cannot form an addiction because they don’t have an addictive personality. On the other hand, it may make people with addictions believe they cannot recover because they are inclined to addictions. Finally, it creates a stigma that people with addictions are inherently “bad” because they have the negative traits associated with an addictive personality. Inherent in the idea of an addictive personality is that people without addictions cannot get addicted, and people with them cannot recover.

The supposed traits of an addictive personality are:

• thrill-seeking behaviour
• impulsive or risky behaviour
• selfishness
• low self-esteem
• difficulty with impulse control
• unstable mood
• lack of personal goals
• dishonesty or manipulation of others
• social isolation
• lack of strong relationships

Honestly, it’s hard to imagine that everyone with an addiction (about 21 million Americans in 2017) has all or one of these traits. It’s also painful to think that people blame personality traits for addictions and not the substances themselves for being addictive and available, sometimes readily so. The top three most common addictions in the US are tobacco, alcohol, and marijuana. Two of which are legal and easy to access, with the third being legal in some states and arguably, not hard to access even where it is illegal. The fourth is painkillers.

I want to start by saying there’s no single factor that determines whether or not someone will suffer from an addiction now or in the future. Childhood experiences, biological factors, environmental factors, and mental health concerns are determinants that may affect someone’s risk of addiction, but they don’t mean someone will become addicted to drugs. Studies have found that genes may be responsible for 40 to 60 percent of someone’s risk for addiction, and teenagers and those with mental illnesses are at a higher risk overall. From the day you’re born, no matter what personality traits you exhibit or what you may be exposed to, you might be predisposed to addiction. Both genetic and environmental factors contribute to the likelihood of drug use and, through drug use, drug addiction.

The National Institute on Drug Abuse identifies the following risk factors:

• Aggressive behaviour in childhood
• Lack of parental supervision
• Low peer refusal skills
• Drug experimentation
• Availability of drugs in the environment
• Community poverty

But what about the big question — is it possible to not be predisposed to addiction, and if so, does that mean you cannot form an addiction? Suppose you make up the 40 to 60 percent of the population that isn’t genetically predisposed, and you haven’t been/aren’t in an environment with risk factors. Are you immune to the addictive properties of substances?

It seems like a question that’s impossible to answer. How would researchers form a study to answer the big question? It would be unethical to give a portion of the population a highly addictive substance to see if every person became addicted, or would it? Aren’t millions of Americans prescribed addictive painkillers every year? Prescription painkillers aside, the only way to answer the question (though it may still not be ethical) is animal studies.

As well as discussing the usefulness of animal models of substance abuse, this article reviews various studies. It points out how important risk factors are in determining whether or not substance abuse or addiction will occur. In a controlled study, where all the animals are under the same conditions and given the same amount of the same drug, in situations where the animals' basic needs are and aren’t met, not all the animals become addicted. Just like in the fictional study, some animals are dissuaded with little effort from seeking the substance. Other animals, against all barriers, continue to seek and take the substance.

We know people can take addictive substances without forming addictions. One example is alcohol. Many people drink without abusing alcohol or becoming alcoholics. The same can be said for prescription painkillers. Not everyone who is prescribed narcotics becomes addicted to drugs. It is a complex health issue, as Healthline pointed out. Why some people get addicted, and others do not is a common scientific question.

Is it safe to assume that some people are not predisposed to addiction and, therefore, will not become addicted to anything?

I don’t think it is. I believe that circumstances are a lot to consider in this situation. A person’s circumstances can change often and quickly. In the novel, the protagonist’s brother becomes addicted after a sports injury. An injury could happen to anyone at any time without a person expecting it. An accident or injury could be life-changing, and when prescribed drugs to cope with the pain and trauma, you could form an addiction, couldn’t you?

I also think that predisposition can occur at any time in anyone’s lifespan, including old age. Someone prescribed an opioid painkiller in their 20s may not become addicted, but that doesn’t mean that the same person prescribed the same drug in their 50s won’t. I don’t think that predisposition can only occur in childhood or early adolescence. I also don’t believe that just because you have the genes, they’ll automatically make you suffer an addiction. I think the genes could not affect you in adolescence but afflict you in adulthood or late life.

I don’t think we know enough about genetic or environmental factors, about human behaviour in general, to answer the questions about whether people are immune to drug addiction. We may never know. With access to many addictive substances, such as alcohol, nicotine, marijuana, what do we do with this lack of knowledge around whether or not we could become addicted? Do we try them anyway? Do we brush them off as not that damaging? How much harm could a legal substance do?

All I know is this; we have to stop using the term “addictive personality.” We have to start recognizing that addiction isn’t a choice. It’s genetic or impacted by the environment people have to live in. The risk factors aren’t a choice as much as genes aren’t a choice. We have to stop blaming the people who develop and suffer from addictions and start blaming the substances and lack of drug education or drug intervention at the right time. We have to find out when the right time is. We have to celebrate recovery but recognize that recovery isn’t a cure, and relapse isn’t a choice. Right now, there is no cure. There are only treatments. We have to recognize addiction as an illness someone suffers from, not as something someone is, an addict.