Variables That Influence Addiction and Addictive Behaviors: What
Biology Can tell us About Addiction
Reisa Stefura
Dr. Anil Hira
In light of steady rates of drug use and addiction it would be valuable to reexamine the
way in which drug addiction is understood. By reexamining our understanding of causality of
addiction, policy makers will be better equipped to produce more efficient and effective
policies. About 60% of Americans sample illicit drugs at least once in their life time, and even
after including marijuana, the lifetime prevalence of illicit drug use is about 32%. (Robinson et
all 2003). In addition, stimulates such as cocaine and amphetamines are popular recreational
drugs, which are thought to be used worldwide by least 52 million individuals. However, in spite
of their high liability, not everyone who uses these drugs develops dependence. (Ersche 2013).
Addiction is more than just using drugs; it is understood as “a compulsive pattern of drug
seeking and drug taking behavior that takes place at the expense of most other activities
(Robinson et al 2003).” What causes this “addictive behavior” is presented in three dominant
theories. Firstly, there is an overwhelming amount of literature, which looks to environmental
causes of addiction, such as; childhood trauma and stress as the causes of addiction. Secondly,
new and emerging science looks at addiction as a biological dysfunction of the brain, which
affects decision making, reward gratification and self-control. And lastly, some literature looks
at a combination of environmental, biological, spiritual and structural variables that create
addictive behavior. This paper will examine all three theories to show how addiction can be
understood, not just in an environmental context, but as biological, structural and spiritual. By
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understanding how addiction is developed will allow policy makers to create more universal
and effective policies to battle addiction and addiction relapse.
Environmental Factors of Addiction: Psychiatric Approaches
Addiction isn’t just a self-inflicting disease; it affects all levels of social life and family ties.
Witnesses of addiction also become victims of addiction due to the all-consuming nature in
which it takes control. Environmental factors are major causations of addiction.
Experiences such as childhood trauma and neglect are said to have massive effects on the
personal psyche of a child when either; emotional or physical abuse occurs. (Van Dalen
2001) A new dynamic is experienced when a child become subject to the emotional abuses
from an addicted adult and thus, leads to the possibility of generational addiction. Ersche
describes that “This familial aggregation of drug and alcohol dependence suggests that
genetic factors, a shared family environment, or an interaction of genes and environment
underlie the increased risk for addiction in some people (Ersche et all 2013).”
Environmental addiction is seen in four major areas; childhood trauma, neglect, emotional
abuse, physical abuse and sexual abuse. Figure 1.0 below shows the four major areas in
which environmental experiences can influence addictive behavior. It also demonstrates
which area of the psyche is influenced due to the circumstance.
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Figure 1.0- Shows how environmental factors influence the psyche.
Environment
Physical Abuse and Addiction
Emotional abuse, Neglect and Trauma
Sexual abuse and Addiction
Influence
Lack of control, helplessness, stress,
fear and instability.
Cycle of neglect, PTSD,
Fear, anxiety, depression, insomnia,
obesity,
self-destructive behavior, headaches,
aggression, anger, hostility, poor selfesteem, substance abuse,
suicide attempts, and sexual
maladjustment
Physical Abuse and Addiction:
There are two types of physical abuses that can occur. Firstly, personal physical abuse,
where the child is the one abused and secondly, witnessing physical abuse of a relative by
another relative. Both outcomes are equally harmful for the psyche of a child. Dr. Annaclare
Van Dalen suggests that “Children carry the impact of witnessing family violence deep within
their psyches. When one parent assaults another, powerful emotional forces are initiated both
in the consciousness of the child and within the unconscious where defense mechanisms are
formed and personality is shaped.”(Van Dalen 2001) This lack of control over the situation
leads to anxiety fears or stress. The child may begin to feel that the world is dangerous and they
must fend for themselves (Van Dalen 2001). She further concludes that “Failure to stop the
violence generates feelings of helplessness and guilt. Both feelings are intolerable. Helplessness
challenges the omnipotent fantasy of being able to control the violence that in turn defends against
feelings of terror generated by the violence itself. Guilt leads to self-blame for failure to stop the
assaults and the self-blame is fueled by the fantasy of being able to control the violence.”(Van Dalen
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2001) Stress is a major byproduct of experiencing physical violence. Dr. Gabor Mate suggests
that “stress diminishes the activity of dopamine receptors in the emotional circuits of the
forebrain, particularly in the nucleus accumbens, where the cravings for drugs increase as
dopamine function decreases. Furthermore, Gabor suggests that “The research literature has
identified three factors that universally lead to stress for human being: uncertainty, lack of
information and loss of control.” (Mate 2008 198) In episodes of family violence whether,
personal or witnessed can ingrain feelings of loss of control, stress, uncertainty and many other
negative effects, which has major correlations of drug addiction in adult life.
Sexual Abuse and Addiction:
While all traumatic events cause copious amounts of stress, which can affect the
neurobiological structuring of the brain in children. Sexual abuse adds new dynamics to
that relationship. Debra Rose Wilson, PHD “found that adults who had experienced
childhood sexual abuse were twice as likely to suffer from mental health disorders when
compared to their counterparts who were not abused.”(Wilson 2009) Wilson further
suggests that’ “A history of childhood sexual abuse has been linked to fear, anxiety,
depression, insomnia, obesity, self-destructive behavior, headaches, aggression, anger,
hostility, poor self-esteem, substance abuse, suicide attempts, and sexual maladjustment.”
(Wilson 2009) The way sexual abuse interacts with chemical functions of the brain and
psychiatric disorders is through PTSD. Wilson describes that as “The abuse is associated
with chronic hyper arousal of the stress response and hyper vigilance to the environment,
making survivors more vulnerable to stress. The vulnerability to stress may lead to the
complex disease processes associated with PTSD.”(Wilson 2009) As a result, her conclusion
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indicates that “Numerous psychological and physical disorders recognized as part of the
sequel of childhood sexual abuse have been presented. Survivors are predisposed to
numerous psychiatric and somatic disorders. This population is known to have increased
vulnerability to stress and the subsequent health-deteriorating consequences of lifelong
stress.” (Wilson 2009) While sexual abuse is not a definitive precursor for addiction
behavior (As many persons who experience sexual abuse do not turn out to be addicts);
psychiatric disorders resulting from sexual abuse are often prone to addiction.
Furthermore, the age in which sexual abuse takes place can also affect the seriousness of
the consequences of mental health. Studies show that the earlier sexual abuse is reported,
the more devastating the consequences are (Elliot et al 1995). This is likely due to the
formability of the brain patterns in early childhood development.
Emotional Neglect and Maltreatment:
Childhood experiences of maltreatment and neglect also affect the physical structure of the
brain. Studies show that emotional maltreatment and neglect can happen on a generational
basis. Abuse through the use of drugs and alcohol can create a cycle of neglect and
emotional trauma. Peterson describes that “drug or alcohol dependency was one for the
earliest apparent characteristics validated as increasing the likeliness of child
abuse.”(Peterson et all 1996) In addition, “Substance abuse was found in more than half of
the families where childhood neglect and abuse occurred.”(Peterson 1996) In return, the
child of the addicted parent becomes prone to adult addiction through the cycle of violence
and neglect. This idea is further explored by David Bernstein, who on a ten year research
project discovered that children who reported instances of childhood maltreatment by
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addicted parents, “suffer from a variety of other psychiatric conditions, especially mood
and anxiety disorders, post-traumatic stress disorder (PTSD), and personality disorders
(Bernstein 2008).” Emotional maltreatment and neglect leave an emotional impact in the
early environment of the brain (Mate 2008)
Childhood Trauma and Addiction:
All areas of abuse from physical, sexual, emotional and neglect can be summed up as
traumatic experiences. While some show tougher consequences on later adult life.
Traumatic experiences presented in childhood correlate to negative consequences on the
psyche and structure of the brain and this often times lead to addictive behaviors.
Environmental influences shape the brain through early experiences. While biologic factors
create the brain, the environment in which a child is subject: molds it.. Mate describes that
“The three dominant brain systems of addiction-the opiate attachment-reward system, the
dopamine based incentive motivation apparatus and the self-regulation areas of the
prefrontal cortex- are all fined tuned by the environment. To various degrees, in all
addicted persons, these systems are out of kilter.” (Mate 2008) The basis of the above
literature looks at how environmental influences can affect the brain as it begins to develop
in early childhood years. This would suggest that addictive tendencies develop after
genetics has already taken effect and before the first drug is taken. It would be important to
look at this phase and more specifically, at children who have reported residency with
substance addicted parents to practice intervention models to combat potentially adverse
consequences of trauma.
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Part 2:
Biological Factors of Addiction: The Neurochemistry Approach
There is much literature on the study of addiction as a biological dysfunction of the brain.
Through advancements of neuroimaging technology; new and better theories have been
able to materialize about the neurological functions and how it relates to addictive
behavior.(Lingford-Hughes et all 2013) The neurochemistry of addiction, particularly
involving dopamine, serotonin, opiate and GABA, has been studied with PET and SPECT
and similarities between all drugs of abuse have been found[sic] such as reduced
dopaminergic markers.( Lingford-Hughes et all 2013)All authors, whether they examine
psychiatric theories on addiction or neurological theories agree that once a drug is taken it
ultimately changes the structure and function of the brain. Drugs are chemicals that react
with our biological chemicals to disrupt the natural pathways; however, where scientists
contend is whether the structural dysfunction precedes drug intake. If there are structural
dysfunctions of the brain before drugs are taken, this would place an argument that there
are biological dysfunctions that predispose persons to addiction. Figure 1.1 below charts
the areas of the brain that are major contributors to addictive behavior.
Figure 1.1 What areas are most prevalent to addiction and what(if known) are there
functions in addictive behavior
Brain Region
Reaction
White and Grey fiber matter located at the
Prefrontal Cortex
Serotonin and Dopamine markers
Self-control and decision making
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Gratification and positive response benefits
GABA-benzodiazepine receptor complex
Tolerance levels
Pre Frontal Cortex and Grey and White Matter:
Self-control is said to be a contributor of addictive behavior. One area of the brain that
determines self-control is the prefrontal cortex and more specifically, the fractional
anisotropy in frontal white matter of the brain fibers. (Ersche 2013) The figure below locates the
area of white matter that affects self-control and impulse decision making. It also shows the
relationship of addicted patients compared to their non-addicted siblings and another set of
healthy individuals. The aim of this study was to determine whether the addicted and nonaddicted siblings would have the same levels of self-control and decision making processes
compared to the healthy sample. It would also examine where in the brain these reactions were
located to possibly determine what part of the brain affects impulsive decision making.
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Figure 1.3- Shows the Deficits of motor inhibitory control and white matter organization in
stimulant-dependent individuals and their non-dependent siblings.
Source: Karen D Ersche- Neurobiological Correlates of the Familial Risk for Stimulant Drug
Dependence
(a)Stop-signal reaction time (SSRT) differed significantly between the three groups (F2,141¼9.9,
Po0.001). SSRT was significantly prolonged in both the stimulant-dependent individuals and
their siblings compared with unrelated healthy volunteers (Bonferroni Pp0.005, for both
comparisons). (b) The skeleton of group differences in mean fractional anisotropy (FA) is
colored in blue (F2,141¼26.3, Po0.001); on the basis of prior literature, regions of interest were
selected within the blue skeleton, which included the inferior frontal gyrus and the presupplementary motor area (colored in orange)
Ersche suggests that “abnormalities in brain systems underlying the clinical symptoms of
stimulant dependence may not only be observed in individuals who are dependent on
stimulant drugs, but also in their non-dependent first-degree relatives. Key symptoms of
stimulant dependence, such as the inability to stop using the drug and the loss of control
over drug intake, may be underpinned by a general lack of self-control, which may have
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predated drug-taking.”(Ersche 2013) This relationship suggests that there is some form of
biological connection to genes and addiction. Her conclusions suggest that “We identified
significant impairments in inhibitory control abilities and abnormally high levels of
impulsive and compulsive personality traits in the sibling pairs compared with the
unrelated healthy volunteers. The sibling pairs also shared abnormalities in brain regions
that have previously been associated with stimulant dependence, such as the inferior
frontal gyrus, the amygdale, and the putamen.”(Ersche 2013) New theories regarding
addiction as a biological precursors are becoming more prevalent in scientific theory as
new neuroimaging techniques are allowing more scientific evidence to be
represented.(Lingford-Hughes et all 2013) The results show how genetics are able to
influence our ability to make impulsive decisions which can associated with addictive
behavior.
GABA-benzodiazepine receptor complex:
A new area that has gained focus in addiction theory is the function of the GABA-receptor.
Researchers have vast amounts of evidence of GABA-benzodiazepine receptors affecting
chemical functions in alcoholics. Studies show that GABA receptors, which are
compromised in alcoholics, affect levels of tolerance. Lingford-Hughs suggests that “The
GABA-benzodiazepine receptor complex (GBzR) has been an intense focus of interest since
many of alcohol’s central effects are mediated through its agonist action at the GBzR and
benzodiazepines which alleviate alcohol withdrawal symptoms. It has been proposed that
reduced GABA function is associated with vulnerability to alcoholism. Reduced levels of the
GBzRs, particularly in the frontal lobes, have been reported in imaging studies of alcohol
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dependence.”(Lingford-Hughs, 2003) Lingford-Hughs further suggests that “One study
excluded grey matter atrophy as a significant contributor to this reduction. It is not known
whether the reduced levels of GBzR preceded alcohol abuse. These findings may reflect an
alteration in the subunit profile of the GBzR that is seen in animal models as a means of
reducing sensitivity to alcohol (i.e. tolerance).”(Lingford=Hughs 2003) The GABA Receptors
may be a separate part of the brain that has been studied in addiction, but it is not
independent in the way it functions. All functions work interdependently of the other. And
in the case of one dysfunction ie) the GABA receptors, it can delay and affect other areas of
the brain such as dopamine receptors. Carlton Erikson, an expert of neurological addiction
writes “Of course, nerve cells in the brain have many interconnections with other nerve
cells. Thus, any brain pathway for something like pleasure will have contained in it
different nerve cells that release dopamine, serotonin, endorphins, glutamate, GABA,
acetylcholine, endorphins, and many more. This means that ultimately, many different
addictive drugs may exert their effects through several neurotransmitter systems.”
(Erikson 2008) Ultimately, all areas of the brain need to be functioning at capacity, and
with drug intake or genetic defects, one area will affects function in other areas of the brain.
This will affect many other areas of the brain that are needed to regulate mood and over all
“functionality” of the human brain and human action.
Serotonin and Dopamine Markers:
There is an overall consensus that the majority of addictive behavior is caused by lack of
dopamine and serotonin in the brain. This exists as either a naturally occurring low dose of
dopamine or a blockage in dopamine receptors that affect the markers of when dopamine
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is released into the brain. In addition, dopamine has shown as a contributor to relapse and
the transition from drug use to addiction. Dopamine is essentially, a feel good hormone that
is released in pleasurable experiences. It is described as one of the most important
influences of addiction. Gabor Mate describes how important dopamine receptors are in
drug addictions. This is demonstrated by a study conducted on mice that had been trained
to drink alcohol He describes that “they were given an infusion of dopamine receptors right
into the nucleus accumbens. Before the infusion these rodents had fewer than normal
dopamine receptors. The receptors were incorporated into a harmless virus and entered
the animals brain cells so that, temporarily, a normal range of receptor activity was
achieved. As long as the artificial supply of dopamine was available; the mice reduced their
alcohol intake considerably, but they gradually became boozers again, when their intake
was decreased.” (Mate 2008) The reduced amounts of dopamine can be attributed to
genetics. Erikson suggests that “We can reasonably assume that addicts who become
dependent early in life and/or with little drug exposure are the most heavily genetically
predisposed to the disease. These individuals may have more severe defects in one gene,
perhaps having little ability to produce normal amounts of brain dopamine. Alternatively,
these persons may have more modest genetic defects in several genes. Here, the person
may produce abnormally low amounts of dopamine but also break down dopamine too
efficiently. Together, this would lead to severe reductions in brain dopamine levels. For
these people, a single exposure to cocaine may be life-changing because of cocaine’s ability
to dramatically increase levels of dopamine.” (Erikson 2008)This is seen in many stories
and trials of drug addicts who describe that once the drug was taken a feeling of “normal”
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occurred (Mate 2008). This can be partially explained by possibly low occurring natural
levels in the brain, which are leveled out with drug use.
Furthermore, dopamine function can explain the transition to addiction. After, the drug is
taken; the effects of dopamine can either create a substantial withdrawal or in cases where
extensive drug use is preformed, reduce the overall levels of dopamine that are created
naturally (Robinson et all 2003) The withdrawal period for those who have naturally
occurring low levels of dopamine are said to feel withdrawal symptoms to at more extreme
levels, which may cause transition from drug taker to addict.(Robinson et all 2003)
This view essentially describes that once the drug is taken, the withdrawal phase from
normal to “un-normal” feelings of pleasure are in the transition from drug intake to
addiction.
Structural and Spiritual Theories:
The last theory that deserves exploration looks at structural causations of addiction. While
this theory is the most underrepresented, it should not be discredited on those grounds. It
provides some additional insight to the causes of addiction. The first theory rests on
displacement. While most work based on this theory isn’t overly academic, there is some
academic work that looks into structural displacement as a larger concept of addictive
behavior. Professor Bruce Alexander from Simon Fraser University describes addiction as a
displacement. He suggests that “"Addiction in the modern world can be best understood as
a compulsive lifestyle that people adopt when they are isolated from the myriad intimate
ties between people and groups - from the family to the spirit and community – that are
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essential for every person in every type of society(Alexander cited by Luntz, 2003).” This
idea focuses around the structural solitude of modern day living. Luntz describes that
“Central to Alexander's theory is the belief that some historical cultures were immune to
addiction: "Although alcohol consumption and drunkenness on festive occasions was
widespread in Europe during the Middle Ages. Mass alcoholism was not a problem".
Likewise, he claims that intact indigenous communities in North America were not
troubled by addiction, even though drug use existed (Alexander cited by Luntz 2003).” This
idea is further explored as Alexander asserts that “widespread addiction to alcohol, tobacco
or opiates began when large numbers of people lost the connection to a local community
that gave them a sense of place.” (Alexander cited by Luntz 2003) While there are many
holes in this theory as the only causation, movement and dislocation could be examined as
a traumatic experience that potentially could change the functioning of the brain, especially
in the event of separation from family.
The structural theory is also describes by Mate who touches on it a little bit in his book, In
the Realm of Hungry Ghosts”. He describes that “incompleteness is the base line for
addiction.” (Mate 2008) What he generally means by this is that things in life need balance.
This idea also encompasses the idea of self-fulfillment, acceptance of one’s self and
understanding the why behind motivation. Gabor Mate makes little distinction against
workaholic addiction, and the drug addicted junkie in the downtown Eastside of
Vancouver. While one is obviously more destructive and harmful than the other, the basis
of their existence stems from the same place. He adds the spiritual component into his book
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because it provides a more complete analysis of drug addiction and all other addictive
tendencies.
Analysis of Policies:
In all the above literature, all authors, whether advocates for environmental causes or
biological causes, coincide that one concept doesn’t exist without the other. However, in the
current context, policies to combat drug addiction exist mainly in the environmental realm and
in some cases neither. There are essentially two methods that the Government of Canada
utilizes to treat/prevent addiction. One is through enforcement and the other is through
treatment facilities; mainly detox. Enforcement is described on the Government of Canada’s
Website:
“The Enforcement Action Plan bolsters law enforcement efforts to investigate and
prosecute drug crimes. It will increase law enforcement’s capacity to combat marihuana
grow operations and synthetic drug production and distribution operations.
The Enforcement Action Plan will:
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provide funding to the RCMP so they can expand their dedicated anti-drug teams to
help locate, investigate and shut down organizations involved in the production and
distribution of illicit drugs;
provide resources to the Public Prosecution Service of Canada to provide legal
advice to law enforcement at the investigative stage and to effectively prosecute
those involved with the production and distribution of illicit drugs;
increase the number of Health Canada inspectors and investigators to ensure
accurate and timely analysis of suspected illicit drugs seized by law enforcement
agencies;
help law enforcement agencies stop the flow of money that organized crime makes
from the illicit drug trade;
improve the ability of Canadian law enforcement agencies to conduct joint
investigations with their United States counterparts; and
ensure that strong penalties are in place for serious drug crimes;
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The Government of Canada has committed approximately $102 million in new funding over
five years to implement the Enforcement Action Plan. This funding will bolster existing law
enforcement efforts.” (http://www.nationalantidrugstrategy.gc.ca/enf-app.html
In addition, the government plans on investing in treatment of addicts by “Promoting
collaboration among governments and support agencies to increase access to drug
treatment services (mainly detox), enhance treatment and support for First Nations and
Inuit, provide treatment programs for young offenders with drug-related problems, enable
the RCMP to refer youth with drug-related problems to treatment programs; and support
research on new treatment models(http://www.nationalantidrugstrategy.gc.ca/enfapp.html) The Government has allocated “approximately $100 million in new funding over
the five years to implement the Treatment Action Plan. This funding will bolster existing
treatment efforts”( http://www.nationalantidrugstrategy.gc.ca/enf-app.html)
The inability of the government and policies makers to recognize addiction as a medical
problem that is caused through environmental structuring of the brain and chemical
reactions has created Canada’s current ineffective policies.
This is counterproductive the majority of the literature that exists, which points at
addiction as a biological and chemical dysfunction(in both environmental and biological
theories) More specifically, enforcement seems counterproductive to prevention, as the act
of criminalization doesn’t provide any treatment options, other than maybe abstinence,
which cannot be verified within jails. More efficient and effective policies would be to
examine the chemical impacts in efforts to possibly prevent the spiraling effect of addiction.
In addition, by examining generational addiction as a preventative strategy would be
beneficial due to studies on how addiction creates addiction. This is important because it
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would target and possibly prevent future occurrences of addictive behavior. Most literature
shows the negative side effects that childhood abuse and trauma cause on the psyche of the
child. More programs that would provide a combinational approach to these at risk youth
would be worth researching. Ersche suggests in the conclusion of her article, to possibly
work on self-control of as risk addicts through scientific techniques(Ersche 2013).
Furthermore, investing in these areas at an early stage might provide future research on
the success of preventative measure of addiction. Either way, the focus should incorporate
a combinational model, as opposed to treating addiction as a criminal social ill. Addiction as
shown by the literature is a serious health concern that affects the structuring of the brain
and policies that are directed at it would benefit from focusing on those models.
Conclusion:
In the current context, policies to treat and prevent addiction are counterproductive to
biological models of the brain. This is plainly visible in a bus ride to the Down Town East
Side and by simply viewing addiction rates in Canada. After many attempts of treating
addiction as a social ill (through criminalization) and increasing incarceration there been
no reported decrease in drug use. When examining drug addiction, it is important to look at
all the variables that contribute to it. While previous studies of environmental impacts have
been demonstrated, new and emerging technologies that focuses on neuro brain imaging is
focused on examining the neurological side of addiction. By combining previous literature
of environmental l influences with new and emerging science of chemical dysfunctions and
spiritual/structural theories will produce more efficient and effective policies to combat
addiction in the future.
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