In order to beat addiction, we must study those who don’t suffer

Like millions of others, I placed a bet on Saturday’s Grand National. And yet, like a sizeable portion of that group, I won’t be having another punt until next year’s race. So, why is it that some are able to have an occasional bet, drink socially or smoke a crafty cigarette, while others become addicted?

The concept of an addictive personality has been talked about for years and we can probably all think of someone we know or have met that we would describe in this way; the person that doesn’t know when to stop and always wants more.

I have worked with people in residential drug detox (fortunately many of them managed to give up their drug of choice), and what struck me is how their lives evolved as they recovered from addiction. Whatever they did – whether it was to embrace religion or the twelve-step programme in alcoholics anonymous – it was in a way that appeared to be as all-consuming as their previous addiction.

There was no middle ground; it was all or nothing. While it is undoubtedly healthier to replace cocaine with Christianity, both were approached in such an enthusiastic way it became their identity and consumed daily life.

The science exploring addiction hasn’t settled on whether there is such a thing as an “addictive personality”. Those favouring a biological and genetic explanation come close to endorsing the idea as they point to an inherited predisposition to problems with drugs, such as addiction. The difficulty with this line of thought is that it doesn’t explain how those whose parents had problems with drugs managed to avoid a drug problem themselves.

Another factor that raises questions about the role that genes and biology play, is the impact of social and environmental factors. For example, how much we are influenced by what we experience when growing up, seeing parents use alcohol or other drugs. Drug treatment centres are heavily populated by individuals who have experienced trauma and abuse to an extent that can’t be explained by chance. We know how drugs are relied on to survive trauma, flashbacks and painful memories.

This doesn’t mean that social or environmental explanations of addiction aren’t flawed either. Obvious shortcomings are demonstrated by the fact that many people experience trauma and abuse, but don’t go on to develop problems like addiction.

Navigating all this, the scientific consensus has settled on a blend of biology and sociology, believing addiction is best explained by nature via nurture. In other words, both factors are at play and interact to produce a high risk of an individual developing a problem with drugs.

The idea that addiction is a brain disease has rich and powerful backers – America dominates research funding and scholarly output in this field. The National Institute of Drug Abuse receives millions of dollars annually and is preoccupied with the biology and genetics of addiction. Some view this as benign, as having a disease model of addiction helps reduce stigma by reducing the perception of individuals making bad decisions about drugs. But although that might be the case, it also suggests that it is inevitable for some people, that it is only a matter of time before they develop an addiction. This could potentially rob people of hope and self-determination.

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Instead of being seduced by expensive brain scanners, which show parts of the brain lighting up when using psychoactive drugs, we need a new scientific approach. Decades and millions of dollars spent on biological research have done little to help those who become addicted, and even less when it comes to preventing people developing a problem in the first place.

It may seem counterintuitive, but we need to understand more about people who don’t develop these types of problems. How have they survived significant trauma? What helped them avoid drug use and develop an addiction? What specific factors supported them and enabled the decisions they made?

Understanding this would yield significant and important insights that would have the potential to save lives. In fact, I’d bet on it.

Ian Hamilton is a senior lecturer in addiction and mental health at the University of York