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Spotting The Potential Addict
- By News Services
- Published 03/4/2008
- Understanding Why People Do Drugs , Understanding Addiction
- Unrated
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By WILLIAM HATHAWAY, The Hartford Courant
Ray B., now in his 30s, lives in suburban Hartford. In accordance with the principles of Alcoholics Anonymous, he prefers not to be identified.
This is the story he does tell:
Ray began smoking pot and sneaking drinks from his parents by the time he was 9, and by 14 he was a daily drinker and drug user. His father was a drunk, and two of his siblings were addicts. By the time he reached his early 30s, Ray had been arrested a dozen times, was dealing drugs and was living in a van in California with his wife and two children.
He gave as much thought to picking up a drink or a drug as he would to breathing. "It's like going to a shopping center and you throw a bag of Doritos into the cart," he said.
Ray's history is not unusual, but new tools are offering new answers to the question of why someone like him becomes an addict.
Combining a new understanding of the genetic origins of substance abuse with brain scans that can track neurological changes, researchers can do something they've not been able to do before: spot potential alcoholics and addicts before it's too late.
And as their understanding of addiction increases, so does the urgency researchers feel about preventing drug abuse at the youngest possible age.
"We are turning adversity into opportunity," said B.J. Casey, director of the Sackler Institute for Developmental Psychobiology at Weill Medical College of Cornell University. "It has nothing to do with stigma. 'Just say no' is just not working."
Risk Factors
Central to this new approach is a growing understanding of how many people are born with at least one foot planted on addiction's slope — and that the earlier they begin abusing drugs or alcohol the more momentum they gain along their path to misery.
Ray B., for example, has a host of the risk factors that clinicians, parents and counselors should be looking for, researchers say.
He's the child of an alcoholic, making the risk of becoming an addict four times more likely. Even if the children of alcoholics are raised by non-alcoholics, their risk is still higher.
Ray also started drinking before the age of 13, which ups the risk by a factor of eight. By contrast, children of alcoholics who don't start drinking until they are 21 or older have only a slightly greater lifetime risk of addiction.
Add stress and you have a recipe for big and intractable lifelong problems.
In addition to a better understanding of just how much these issues influence behavior, researchers are using imaging technology to understand what's happening inside the brains of youngsters at risk of abusing substances.
Brain Differences
Studying colored images of brain activity in youths, researchers have viewed differences in brain function between those at risk of addiction and their peers.
In addition to differences in how pleasure, or its anticipation, is processed in the brain's reward centers, the frontal cortex — the area of the brain that helps control impulses and governs rational behavior — is slow to develop in those at risk of addiction.
That area of the brain develops last in all teenagers — a subject that has received a good deal of attention over the past several years.
But in those prone to drug abuse, the ability to govern rational behavior is a particularly late bloomer. These adolescents tend to engage in all sorts of risky behavior, whether sexual adventures, gambling, driving fast — or substance abuse.
Imaging studies, moreover, show that when these children drink or do drugs, it can further impair these key brain areas. And later, after extended use, drinking or using drugs becomes habitual — as automatic as Ray B.'s grabbing a bag of chips at the supermarket.
"There is a feedback loop," said Dr. John Krystal, professor of psychiatry at Yale University and head of alcohol research center at VA Connecticut Health Care System in West Haven.
"Once they drink, their ability to assess long-term benefits of putting down the drink never develops. The impaired judgment can become ingrained."
"In the heat of the moment, they don't have control," Casey agreed. Not only do these youths fail to perceive dangers of drinking and doing drugs, they tend not to be able to value positive goals such as work or school that require sustained effort.
"They have a problem in sustaining motivational sense," Krystal said. "They work for a period of time, but if it is too long and frustrating, they lose track of the work they are trying to do."
Instead, they crave only the immediate reward of the drug or drink.
When you add stress, it becomes even more unlikely an adolescent can assess negative consequences of his or her behavior. Essentially, stress jams a wedge between rational centers of the brain and the more impulsive "fight or flight" response.
Because of their genes, they are more sensitive to the pleasurable allure of drugs and alcohol and even more prone to the risky behavior, a hallmark of the teen years anyway. And areas of the brain that can moderate their behavior develop late or not at all if damaged at an early age by drugs and alcohol.
These young addicts in training "face a triple whammy," Casey said.
Identify And Intervene
That's why, experts say, parents and schools need to work to identify the Ray B.'s of the world early in life. The new understanding of just how vulnerable certain children are underscores the need for early identification and intervention.
If there is a family history of alcoholism and drug abuse, if a child faces many stresses in his or her life, and if the child is found experimenting with drugs at an early age, then adults need to act quickly to try to stop the behavior before the descent into addiction gains too much momentum.
"Simply put, you don't want people drinking before they are able to assess the impact of their drinking," Krystal said.
However, predisposition is not fate and every adolescent is different, Casey stressed.
"The last thing I want to do is stereotype people," Casey said. "Any psychotherapy should be individualized treatment based on their history and genetic factors."
And even after decades of addiction, the hijacking of neurological pathways, the sheer perpetual habit of substance abuse, recovery sometimes happens.
After a decade of misery, Ray B. followed the example of his father and a brother, and sought treatment for alcoholism. Three years ago, he began to go to AA meetings. He recently obtained his high school diploma and is even thinking of junior college.
"Three years ago, I never thought I would be here," he said.
Copyright © 2008, The Hartford Courant March 3, 2008
Ray B., now in his 30s, lives in suburban Hartford. In accordance with the principles of Alcoholics Anonymous, he prefers not to be identified.
This is the story he does tell:
Ray began smoking pot and sneaking drinks from his parents by the time he was 9, and by 14 he was a daily drinker and drug user. His father was a drunk, and two of his siblings were addicts. By the time he reached his early 30s, Ray had been arrested a dozen times, was dealing drugs and was living in a van in California with his wife and two children.
He gave as much thought to picking up a drink or a drug as he would to breathing. "It's like going to a shopping center and you throw a bag of Doritos into the cart," he said.
Ray's history is not unusual, but new tools are offering new answers to the question of why someone like him becomes an addict.
Combining a new understanding of the genetic origins of substance abuse with brain scans that can track neurological changes, researchers can do something they've not been able to do before: spot potential alcoholics and addicts before it's too late.
And as their understanding of addiction increases, so does the urgency researchers feel about preventing drug abuse at the youngest possible age."We are turning adversity into opportunity," said B.J. Casey, director of the Sackler Institute for Developmental Psychobiology at Weill Medical College of Cornell University. "It has nothing to do with stigma. 'Just say no' is just not working."
Risk Factors
Central to this new approach is a growing understanding of how many people are born with at least one foot planted on addiction's slope — and that the earlier they begin abusing drugs or alcohol the more momentum they gain along their path to misery.
Ray B., for example, has a host of the risk factors that clinicians, parents and counselors should be looking for, researchers say.
He's the child of an alcoholic, making the risk of becoming an addict four times more likely. Even if the children of alcoholics are raised by non-alcoholics, their risk is still higher.
Ray also started drinking before the age of 13, which ups the risk by a factor of eight. By contrast, children of alcoholics who don't start drinking until they are 21 or older have only a slightly greater lifetime risk of addiction.
Add stress and you have a recipe for big and intractable lifelong problems.
In addition to a better understanding of just how much these issues influence behavior, researchers are using imaging technology to understand what's happening inside the brains of youngsters at risk of abusing substances.
Brain Differences
Studying colored images of brain activity in youths, researchers have viewed differences in brain function between those at risk of addiction and their peers.
In addition to differences in how pleasure, or its anticipation, is processed in the brain's reward centers, the frontal cortex — the area of the brain that helps control impulses and governs rational behavior — is slow to develop in those at risk of addiction.
That area of the brain develops last in all teenagers — a subject that has received a good deal of attention over the past several years.
But in those prone to drug abuse, the ability to govern rational behavior is a particularly late bloomer. These adolescents tend to engage in all sorts of risky behavior, whether sexual adventures, gambling, driving fast — or substance abuse.
Imaging studies, moreover, show that when these children drink or do drugs, it can further impair these key brain areas. And later, after extended use, drinking or using drugs becomes habitual — as automatic as Ray B.'s grabbing a bag of chips at the supermarket.
"There is a feedback loop," said Dr. John Krystal, professor of psychiatry at Yale University and head of alcohol research center at VA Connecticut Health Care System in West Haven.
"Once they drink, their ability to assess long-term benefits of putting down the drink never develops. The impaired judgment can become ingrained."
"In the heat of the moment, they don't have control," Casey agreed. Not only do these youths fail to perceive dangers of drinking and doing drugs, they tend not to be able to value positive goals such as work or school that require sustained effort.
"They have a problem in sustaining motivational sense," Krystal said. "They work for a period of time, but if it is too long and frustrating, they lose track of the work they are trying to do."
Instead, they crave only the immediate reward of the drug or drink.
When you add stress, it becomes even more unlikely an adolescent can assess negative consequences of his or her behavior. Essentially, stress jams a wedge between rational centers of the brain and the more impulsive "fight or flight" response.
Because of their genes, they are more sensitive to the pleasurable allure of drugs and alcohol and even more prone to the risky behavior, a hallmark of the teen years anyway. And areas of the brain that can moderate their behavior develop late or not at all if damaged at an early age by drugs and alcohol.
These young addicts in training "face a triple whammy," Casey said.
Identify And Intervene
That's why, experts say, parents and schools need to work to identify the Ray B.'s of the world early in life. The new understanding of just how vulnerable certain children are underscores the need for early identification and intervention.
If there is a family history of alcoholism and drug abuse, if a child faces many stresses in his or her life, and if the child is found experimenting with drugs at an early age, then adults need to act quickly to try to stop the behavior before the descent into addiction gains too much momentum.
"Simply put, you don't want people drinking before they are able to assess the impact of their drinking," Krystal said.
However, predisposition is not fate and every adolescent is different, Casey stressed.
"The last thing I want to do is stereotype people," Casey said. "Any psychotherapy should be individualized treatment based on their history and genetic factors."
And even after decades of addiction, the hijacking of neurological pathways, the sheer perpetual habit of substance abuse, recovery sometimes happens.
After a decade of misery, Ray B. followed the example of his father and a brother, and sought treatment for alcoholism. Three years ago, he began to go to AA meetings. He recently obtained his high school diploma and is even thinking of junior college.
"Three years ago, I never thought I would be here," he said.
Copyright © 2008, The Hartford Courant March 3, 2008
