Maybe he's born with it—maybe it's childhood trauma

Genetic risk isn't the same as genetic certainty, but that doesn't mean we always have control over our substance use.

Many years ago, I found my alcoholic (now ex) boyfriend’s birth father’s family. That’s when I truly realized that alcoholism is a genetic problem, and not a character flaw or weakness. I learned that his birth father died at 39 yo from cirrhosis of the liver because he was an alcoholic. Some of his birth uncles had medical problems from heavy drinking most of their lives. Is the research community looking at this? If we can identify the ‘alcohol-abuse’ gene, couldn’t we help people to avoid the dangers of alcohol?

-DH

Hi DH,

Thank you for being the first person to send a question to Ask a Sober Lady! 

To answer your first question, yes, the research community is looking into the genetic realities of addiction and learning more about them all the time. Like your ex, both sides of my family have a history of addiction, which sometimes makes me feel like my alcoholism was a kind of genetic destiny. But the reality is a bit more complicated. 

There’s no doubt that genetics often play a role in substance use and addiction. But instead of a single alcoholism or “addiction gene” that someone either has or doesn’t, research suggests there are multiple genetic variations at play. Think of it like the development of a bad day. Instead of one big thing that sets the whole day on a downward spiral, a bunch of smaller but upsetting things happen, each one increasing the likelihood you’ll end up crying in the bathroom. 

Different combinations of these genetic variations result in different risks. Some are associated with specific substance use disorders (a clinical term for what people often call drug abuse and drug addiction); other variations are associated with a general increase in addiction risk. Certain combinations may confer larger increased risks than others, but it’s one of the many parts of the human genome we’re still learning about. 

So, what do these variations do? Many affect how the brain regulates dopamine—a neurotransmitter central to the brain’s “reward system.” People sometimes call dopamine a “feel good” neurotransmitter because it’s associated with experiencing pleasure, but it plays many roles in the brain and body. 

From a substance use standpoint, dopamine significantly influences mood, motivation, attention, memory, and motor control. Alcohol and other drugs can also affect dopamine in the brain. For example, alcohol use initially increases dopamine levels in the brain; most people respond to that surge with—this is nice; I am relaxed and happy! In a person genetically predisposed to wonky dopamine regulation, that initial influx of dopamine might trigger a more extreme—amazing; I want to feel this way forever—response. Those initial reactions are likely to play a role in how each person uses substances in the future.

(The cruel kicker is that chronic alcohol use depletes dopamine levels, leading to more alcohol use and, thus, more dopamine depletion.) Dopamine isn’t the only neurotransmitter system involved in substance use and addiction, but it’s pretty central to the process. 

All of this research is important in understanding substance use and addiction and may well help us come up with better treatments. Certainly, the more educated the general public is about substance use disorders, the more people can make informed choices and reduce stigma. 

It’s important to remember that genetic risk isn’t the same as genetic certainty. It’s totally possible to have a high genetic risk of addiction and never develop the disorder. Conversely, someone with no increased genetic risk of addiction could end up with alcohol-associated liver disease. It might sound wishy-washy, but it’s common in medicine. A person who is genetically high risk for lung cancer may never develop it, while someone with no genetic predisposition may end up having a lung removed. 

I understand why the genetic component of addiction is so compelling, especially for loved ones of someone who is struggling. It makes it feel like there is this concrete, medical, indelible thing responsible for behavior that can otherwise be baffling and infuriating. As someone who grew up loving a family member with a substance use disorder, it was too easy to believe that selfishness, irresponsibility, or weakness was at the core of the person’s use. 

Truthfully, however, environmental factors or childhood trauma can play just as big a role in propelling someone’s substance use as their genetics—sometimes more. Other factors include cultural and socioeconomic realities, mental health disorders, and physical ailments. All of these can affect the brain and how a person uses substances, and substance use can have its own damaging effects on the brain. It’s the merry-go-round from hell.

Yours is an important question because—despite all we’ve learned about addiction—societally, we’re still pretty ready to chalk it up to character flaws. Or maybe we think if there’s not a genetic basis, substance use disorders boil down to personal weakness. But our experiences and circumstances have tremendous influence over how our brain works, and how our brain works affects our behavior in very complex, and sometimes mysterious ways.

Advice posts will initially go up every other week, but if I get enough questions, I’d love to make this weekly.

Please send questions and feedback to askasoberlady@gmail.com. By sending a question, you agree to let me reprint it in the newsletter with your name redacted or changed. Emails may be edited for length or clarity.

I’m not a doctor or mental health professional, so my advice shouldn’t be construed as medical or therapeutic advice. You are free to take or leave it.

Studies cited:

Deak, J. D., & Johnson, E. C. (2021). Genetics of substance use disorders: A review. Psychological Medicine, 51(13), 2189-2200. https://doi.org/10.1017/S0033291721000969

AS Hatoum, et al. Multivariate genome-wide association meta-analysis of over 1 million subjects identifies loci underlying multiple substance use disorders. Nature Mental Health. DOI: 10.1038/s44220-023-00034-y (2023)