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Why do some people have addictive personalities and others seem immune?

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Fear is an iron-clad protective cloak. Why are some people saved from addiction by it? 

I had the pleasure of reading Jason’s Smith’s book “The Bitter Taste of Dying” pre-publication. I even hope to think in giving the manuscript a critical read that I helped him hone in on the title — he had many symbolic phrases that stuck in my mind — but I think he chose the best (or his Publisher did). But maybe he didn’t read that email.

The point is, his book is, in his words, “about trying to understand why addicts do what they do“, even when it seem unfathomable to those on the outside. As a reader, I stepped into his life for a moment and marked up 20 points in the book where I got a deeper understanding of what actually happens. 

I came away from the book — a quick night’s read because it was so engrossing — with a new found understanding of addiction. I had a gained empathy for addicts.

I became curious about the causes of addiction. Why do some people have addictive personalities and others seem immune? Current research seems to suggest it is 50% genetic and 50% down to how individuals cope with life, i.e. make themselves emotionally more or less vulnerable.

Soon after finishing Jason’s book, I spent the day with a friend I rarely see. While our kids enjoyed racing around at the wildlife park, we talked. Near the end of a day full of lovely conversations spent catching up on life, she suddenly brought up a far deeper subject. 

She was worried for her son. He was 16 and had been so unhappy in younger years she admitted he almost tore their family apart. Today, watching him, he was the epitome of quiet, shy politeness and I couldn’t quite imagine what she was relating to me. 

She faced yet more tough time ahead. She was agonizing over whether to give him drugs.

Her son had recently come home and admitted a friend had given him a Ritalin (methylphenidate).

He said it cleared his mind. It made him focus at school, the utter bane of his existence. He showed her and her husband a report he researched the day he popped the pill. He argued it was the best writing he’d ever been able to do.

She was torn.

Ritalin is considered to be a potential drug of abuse under the Controlled Substances Act. Its manufacture is regulated. Ironically, it is given to children to counteract ADHD. She has grounds for concern.

She wanted her son to succeed. She wanted to help him be happy in any way possible. She just didn’t want him dependent on any substance to do so.

She herself had a phobic fear of flying. She developed it as an adult just before a family holiday. She couldn’t imagine canceling the trip to Egypt so she allowed her doctor to prescribe her tranquilizers. The second time she flew, she used half a pill. She would rather forego pills, but can’t. She’s not only phobic of flying but of addiction. With respect to the risk of addiction, she is incredibly admirable, reasonable, lucky and brave all in one.

Fear is her iron-clad protective cloak.

Is this the main factor that stops those given potentially addicting drugs from risking addiction?

So, what would her son do? He was begging to be diagnosed and prescribed Ritalin. Her doctor advised that she should give it to him — he warned that if he wanted it enough he would find a way. No matter how she protested he would find a way. Would he be safe?

The appointment was two weeks away.

I told her about Jason’s story. I told her addiction is 50% genetic and 50% how we cope. Her son could be fine. This could be a miracle drug. Given his response it might fix his confidence.

The point is no one knew.

I’m like my grandmother. She would throw away prescription painkillers as soon as she could bear the pain. She is just like a wonderful friend I have now. At 70 she had a hip replaced and was completely off meds by day two. She had to fight the doctors and nurses tooth and nail to do so, but she won and she is beautifully mobile only a month later.

I too have given up painkillers as soon as I possible could. After having teeth pulled and after childbirth and for the same logic. I know I have an addictive personality. I love clove cigarettes but never let myself have a second one exactly because I knew where that would lead. Luckily, I’ve never had an urge to lose control or escape myself through drugs or alcohol. 

Or so, I thought.

Standing empathizing with my friend, thinking about Jason’s book and thinking about how I feel about drugs, I remembered being given a powerful anesthetic before surgery. My entire lower body relaxed into one of the most enjoyable feelings I have ever experienced. I felt warm and perfect. The world felt right.

I never related it to something I would want to experience again. I never wanted to need surgery again.

Talking with my friend, and thinking about how much her pills helped her and how her son craved Ritalin, I gained a new perspective.

I realized that if I were given the choice to have that feeling again I would chose to feel that way every day.

Suddenly, I had an even more personal understanding of addiction.

No one would deny me pain relief. Surgery without it would have been barbaric.

Living with chronic pain is also unbearable. Anyone would wish suitable painkillers for sufferers.

They exist, except some people fall into addiction.

If Ritalin clears the mind of a kid who has always hated school and makes him want to excel, who would deny him it?

When it comes to drugs like the prescription pain-killer OxyContin, a drug Jason Smith has experience with, he has pointed out in follow up articles that it can make some people suicidal. Yet, to others, it is a miracle drug that eases extreme pain and does not drive one to the depths of dependency.

It seems to be a huge part of going forward on drug addiction problems is sorting out who is vulnerable and who is not. How can we take out the guesswork? 

Wouldn’t it be nice if our ‘sensitivity’ to addictions of various forms could be read from our DNA? There is some work towards this goal. 

The era of Precision Medicine, backed by Obama’s Million Genomes project, is a step towards matching medical treatments to individuals at the DNA level. One prescription drug might cure you, but not me.

How far will this understanding of individuals’ biological responses extend to addiction?

Whether we will get there, the point is that the way people respond to prescription “pleasurable substances” is not a black and white matter. It’s stratified. People respond differently. Those, like my friend, who fights any risk of addiction like the plague, are quite safe in the long-term with state-change-inducing drugs. Those who want to escape, or who perhaps have different metabolisms, may be more prone to succumb to over-use.

This is something we should accept about human biology and psychology and work towards understanding. If patterns can be identified it would benefit everyone — those who can use such drugs without risk, potential addicts, existing addicts, their families and society at large.

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