What leads to drug addiction? Is addiction a form of insanity?
There is a popular saying in 12-step recovery groups. In fact, the saying is a quote, attributed to Albert Einstein. You may have seen it somewhere on social media, as you scroll through Instagram, Facebook, or Twitter. Or, if you attend meetings, you have probably heard it repeated by group members.
The quote goes something like this: “Insanity is repeating the same thing over and over, expecting to get different results.” I have no idea if Einstein actually said anything like this, but, of course, any quote is more impressive when attributed to one of the most brilliant scientists who ever lived.
The reason this quote is used in addiction recovery meetings is to imply that using drugs and going back to use drugs again after quitting is insane. If a 12-step member looks you in the eye and recites the insanity quote with intensity and sincerity, it seems to be deeply profound.
Of course, it is insane, doing the same thing and expecting different results. Or is it?
Is this truly the definition of insanity? According to the dictionary, the word, “insanity,” refers to being mentally ill or foolish. But is repeating the same action over and over, expecting the outcome to be different at some point, foolish? Does it point to mental illness?
When children learn how to walk, do we call them insane for getting up and falling down, over and over again? What did they think was going to happen when they tried to take a step?
What about when a person who quit drugs and relapsed many times wants to quit drugs again? Are they insane? Should they just give up and keep using drugs?
How about when someone shows up at the doors of a residential rehab program, wanting to check in for the tenth time to try to quit drugs or alcohol? Does the staff turn them away? Is it insane to go back to rehab over and over again without trying a different way?
As you can see, boiling recovery down to a handful of quotes, catchphrases, and slogans that do not stand up to scrutiny can confuse a person trying to recover and make sense of their addiction. Where does addiction come from?
What are the main causes of drug abuse?
Is it the drugs that cause addiction or is addiction something that only happens to certain people who use drugs? Is addiction genetic or is it learned behavior?
Or, could it be when a certain type of person is exposed to a certain type of drug under certain circumstances, drugs provide an effect that is desirable enough that the person wants to repeat the experience. With repeated use and getting a desired result, a powerful habit is formed in the reward center of the brain.
As it turns out, the causes of addiction are complex and poorly understood. Even today, with extensive brain research and experience in treating addiction, experts still disagree and argue over the causes of drug addiction.
When it comes to alcohol addiction, the initial cause seems to be more clear. People who have alcoholism in their families tend to have a higher risk of alcoholism. If they drink regularly, they risk becoming addicted to alcohol, more so than someone who does not have a family history of alcohol use disorder.
While the same is not true of drug addiction in general, maybe we are not looking at the problem in the right way. Why is it that when we consider alcohol addiction, we focus on the one drug, alcohol, but with drug addiction, we group all other drugs together?
Could it be that there are people with a genetic predisposition for opioid addiction?
Could there be another type of genetic pattern related to stimulants, such as cocaine or methamphetamine? Maybe there are even finer, more granular distinctions to be made, within these classes of drugs.
It is well known that most people who experience drug addiction have a “drug of choice.” While they may use other drugs for the experience of getting high, one way or another, they will always gravitate to, given the chance, the one drug that they prefer.
The mechanisms involved in how genes are expressed and their influence on how a person interacts with the outside world are complex. To complicate things further, separating learned behavior from genetic predispositions is a difficult task.
While scientists and philosophers ponder the origins and nature of addiction, it might be reasonable for us to take the position that it does not matter. Understanding how to help guide future children away from addictions is a good goal for addiction researchers.
Yet, if you are working to overcome your own addiction, the origin story of your addiction is not necessarily relevant to what you need to do to move forward. Did you inherit it or learn it from your friends or family members? Or, was it a combination of a variety of factors? Most addiction treatments do not rely on analyzing the origins of your addiction.
The doctor says I am addicted and have a substance use disorder. Is addiction a disease?
Imagine going to a doctor to get help with a drug addiction. You started using drugs for a specific purpose. Maybe it was to feel better about yourself in social situations. Or maybe it was because of physical or emotional pain. It could have even been because of intense boredom.
At some point, your drug use got out of control. You discovered that you were obsessed and could not stop, even if you wanted to. Then, people around you got involved in pressuring you to stop using drugs.
During your doctor visit, the doctor asks you questions and takes notes. Depending on your particular addiction, you may or may not get a prescription for medication. The doctor may recommend therapy and group meetings.
When you leave the exam room, you may be concerned when you see a diagnosis code circled on the paperwork that goes to the front desk. Is addiction a disease? Why do they have disease codes for addiction?
Is being tall a disease?
What would it be like to be seven or eight feet tall in the Middle Ages? What would people say about you? Would they accept you as you are, or would they call you names, assigning unpleasant labels to you because of how tall you are.
Being so tall could even get you killed. What if you lived in a village that was under attack? Everyone runs and hides from the attackers. But, you stand out as an easy target. It is harder to hide and blend in with crowd when you are the tallest person in the village.
People might call you a giant. They might make fun of you, throw stones at you, treat you as if you are cursed. Your family might even take you to a “healer” to undergo treatment for your “condition.”
Can a disease be a super power?
If you are very tall in today’s world, you have an advantage over people not as tall as you. Sports, such as basketball, are easier for you. CEOs of large corporations tend to be taller people.
In the modern world, excess height is viewed as a natural advantage. It could almost be considered a sort of super power.
It is interesting to consider that a trait that a person is born with and has no control over could be considered a disease in one era and an attractive, powerful quality in another.
Addiction is a similar condition, that in our time, is considered to be, by the medical community, a disease. Why is addiction a disease? One reason is that there is medical treatment that is effective for certain types of addiction. In the world of modern medicine, if there is a treatment, there must also be a corresponding disease code to accompany the doctor’s diagnosis.
Is it possible that, if the world were a different place, people who are predisposed to addiction might have the advantage in many areas over people who are not at risk for addiction? What if addiction, when the drugs are taken out of the equation, was a super power?
What if intelligence was a disease?
In the medical television drama, “House, M.D.,” there was an episode where a man with a very high IQ took a drug on a regular basis to lower his intelligence. The reason why he did this was so that he could relate better to his wife. At the end of the show, if I remember correctly, he chose to return to his life of self-medicating to lower his innate mental abilities.
People with high intelligence levels do tend to have some unique problems in life that are not as common to people of average intelligence. The same goes for creativity, which could be thought of as a more difficult to measure form of intelligence.
High IQ people and talented artists tend to be more depressed and anxious. They may have a higher incidence of mental illness, and even addiction.
What drug did the man take to lower his intelligence in the show? Was he addicted?
The drug that the man was using in that episode of House was dextromethorphan, also known on the streets as DXM. This drug is a drug of abuse for some people, but use is not thought to be widespread. While it is not a highly addictive drug, it could very well be a gateway drug for some people, leading to eventual full-blown addiction.
DXM happens to be the active ingredient in the cough syrup, Robitussin, and some other over-the-counter cough syrups and capsules. One reason that young people abuse the drug is not because the effects are desirable, but because it is easily accessible. Anyone can walk into a pharmacy, supermarket, or gas station convenience store, and buy a bottle of Robitussin.
Why would a teenager or college-age young adult abuse DXM? Possibly, simply because of boredom. People have a tendency to want to change their consciousness and see the world around them differently, especially intelligent and creative people.
Once a person is used to taking a drug and getting high, they are going to be open to the idea of using other drugs. This is why any drug can be a gateway drug. Marijuana is another common gateway drug, and it will be more accessible going forward, thanks to the legalization movements in many states.
Is boredom the most common cause of addiction?
There may be a short list of common reasons for drug addiction. Boredom in the world of intelligent, creative young people whose minds are not adequately engaged is likely a major cause. I see this as a contributing factor for most, if not all, of my patients.
Other causes include childhood trauma and abuse. While a serious trauma, such as being raped or assaulted, can certainly lead to an addiction, there are other, more subtle forms of abuse.
When a parent ignores their child, possibly as a result of their own addiction, or even intentionally, this is abuse. This kind of emotional abuse is far more widespread than other, more physical, kinds of abuse. People with addictions who generally believe that their childhood was uneventful and not too bad, might look closer, with the help of a therapist, and uncover a personal history of emotional abuse.
Drug use might start as a way to cover up the pain of trauma and abuse, or it could be a way to get attention in a family setting of emotional abuse. Because of the lasting effects of emotional pain, which is not so different from chronic physical pain, an abuse victim might be more likely to take opioids or alcohol over stimulants.
Does everyone who takes drugs or alcohol to cover up the pain of trauma, or to deal with boredom get addicted?
This is an excellent question! A wise teacher in my medical training once said to me that all families are dysfunctional. It was such an important insight to him, he stopped, looked at me, and repeated it to me again.
If all families are dysfunctional, and at least one child is emotionally abused in every family, and alcohol and drug use are so widespread, why are there not more people addicted? Does this mean that not everyone who takes drugs or drinks alcohol gets addicted? Yes, addiction is a fairly uncommon phenomenon.
Most people who try drugs will eventually put them down and move on with their lives without ever becoming addicted. This is true even of the highly addictive drugs, such as methamphetamine, cocaine, heroin, and fentanyl. Some people will just not like them or tire of them after a while.
There are often college kids who drink heavily while in college, and then they finally get sick of waking up with a hangover. They simply make a decision to quit drinking and that is the end of it. After quitting, they might still have an occasional beer or glass of wine, but without drinking to excess, so they can avoid the sickly feeling of getting drunk and having a bad headache the next day.
What qualities lead a person to get hooked, unable to stop taking drugs?
If a person takes a drug and finds the effects highly enjoyable, pleasurable, or very effective in relieving emotional pain, their brain’s reward center will respond by becoming reprogrammed over time to find the drug to be a necessity of life. As addiction progresses, the brain will see the drug as being just as important as food, water, and air.
Are you addicted to air?
Hold your breath for a few seconds, and you will agree that you at least have a significant dependency on the air that you breathe. That is how it feels to be addicted. When the drug is not available, the addicted person can think of nothing else other than where the next dose will come from.
Even when faced with self-harm or harming others, they will continue to seek out their drug and use it. It is not so different from gasping for air. If you were trapped in a room filled with toxic gas and you could not get out, you can only hold your breath for so long.
Of course, if a person is kept away from their drug of choice for a period of time, they realize, logically, at the level of their prefrontal cortex, that they do not need drugs to survive. Many people find that, when they cannot get their drug of choice after a while, that their addiction starts to fade away, and they can overcome it without help.
The issue for other people, highly intelligent and creative people in particular, is that the effects of addiction are much more difficult to overcome. Addiction tends to hijack the higher decision-making processes in the brain. It somehow acts as a puppet master, pulling the strings to cause addiction-related thoughts and feelings to bubble up into conscious awareness.
If you are smart, creative, and addicted, these thoughts and feelings, also known as cravings, will be very intense and hard to ignore. Your addiction will use your intellectual powers against you, coming up with very convincing arguments for you to continue with your addictive behavior.
So, is addiction inherited or learned behavior? What causes drug abuse in the first place?
Now, after looking at some things that lead a person to try drugs and what might trap a person in a long-term addiction, do we have a better understanding of addiction being learned or inherited? Is it nature or nurture? Genetic or learned?
If intelligence and creativity are risk factors, these qualities have a significant genetic component. Just like height is a genetic quality, inherited from your parents, your level of intelligence is also inherited. While these qualities can be influenced to a small degree by environment, they are mostly inherited.
Other personal qualities may also be risk factors, such as anxiety and empathy. These characteristics are likely related to a mix of inherited and environmental factors.
So, when a person who has qualities that may predispose them to try drugs and then get hooked by a long-term addiction, and they are exposed to drugs, there is a significant risk that they will develop an addiction. Of the people who become addicted, some will continue long-term with functional use of their drug of choice, denying the existence of an addiction problem.
Many people caught in active addiction are functional and in denial.
Do you know anyone who you think might be addicted to drugs or alcohol, but they get by in life, going to work and taking care of their home life? You might be surprised how many people are out there, living their lives with an active addiction, but without any intention of doing anything about it.
When a person with a drug addiction is exposed to a highly addictive drug, the progression of their addiction can be greatly accelerated. The alcoholic might move from wine or beer to hard liquor. The person who takes pain pills tries heroin or street fentanyl. Or, the cocaine addict tries smoking crack cocaine.
While the drug itself does not turn a person into an “addict,” the interaction of certain drugs with people who are predisposed to addiction and already with a habit of using drugs or alcohol are at high risk when exposed to certain drugs that stimulate the reward centers in the brain more intensely than other drugs.
How likely is it for a person to become addicted?
The incidence of induced addiction is difficult to measure. Experts disagree on how likely it is that a person takes an addictive drug and becomes addicted.
At the low end are the false claims made by the Purdue drug reps at the dinner lectures they held for local doctors to teach them how safe Oxycontin was. They claimed that only a tiny fraction of one percent of patients might become addicted.
I was at one of these lectures, and I don’t remember the exact number they put up on the screen, but I do remember a decimal with multiple zeros to the right. They made it seem almost impossible for someone to become addicted to Oxycontin, which we know today is not exactly true.
More realistically, the number might be between 1% and 15%, depending on the population of people exposed to a drug and the type of drug involved. Let us assume that the chance of becoming addicted to drugs is 1%. This seems fairly low.
Addiction is not common, but it can overwhelm the public health system.
Yet, we must think of the large populations of our communities, states, and our country. One percent of 300 million people is three million people. That is a lot of people addicted to drugs, and a costly public health issue to address.
The risk of death in surgery is also about 1%. And, in recent times, we are all aware that the risk of death from COVID-19 is about 1%. So, depending on how you view the issue, 1% can be a relatively high number. Not everyone goes in for surgery, but millions of people may be exposed to COVID-19, and millions of people are exposed to drugs or alcohol.
As COVID-19 math has taught us, a small increase in risk can lead to much more serious problems. Our healthcare system has limits and cannot handle large percentages of the population getting sick all at once. When addiction rates go up, rehabs and detox centers get overwhelmed.
Our local county detox and rehab program often has a waiting list to get in. The current level of addiction in the community, particularly opioid addiction, is high enough to outpace the public health system’s capacity in many communities.
Toxic contamination of the street heroin supply with imported fentanyl analogs has lead to the current opioid epidemic.
Because of the introduction of highly addictive and deadly fentanyl on to US streets, imported through the US Postal Service from China, the level of opioid addiction has created a crisis that has overwhelmed healthcare and addiction treatment services in many communities. This is why we have an opioid epidemic in the US. It is not so different from the global COVID-19 pandemic in the way that seemingly small percentages can cause a big problem when they occur on a large scale.
While it is true that if you are currently addicted to drugs or alcohol and you want to quit, it may not be critical to examine your past and figure out why you became addicted in the first place. Such examination will be speculative and possibly not helpful in formulating an effective treatment plan.
On the other hand, understanding what makes people susceptible to addiction and how certain drugs lead to further behavior that causes addiction to spiral out of control is important. At the level of public health for cities, states, and countries, small changes can make big differences.
The best time to overcome addiction is before it even gets started.
There is definitely a need for further research and discussion in the addiction treatment community. We also must take care in allowing drugs that may serve as gateways to be overly available. For example, psuedoephedrine, which has no abuse potential by itself, unless chemically altered in a clandestine lab, is kept safely behind the pharmacy counter. However, dextromethorphan, and other abusable OTC drugs and products, are available on the shelves of many stores and accessible to anyone.
Marijuana is another drug that we must consider carefully. Legalizing a drug often leads to children believing that the drug is safe and socially acceptable. An alternative is to decriminalize, so that the drug is not legal, but the consequences of being caught with it are minimal.
There is effective medical treatment for the most dangerous forms of drug addiction.
For people who are already affected by opioid addiction, there are effective medical treatments that can give the addicted brain a chance to heal. These medication-assisted treatments, using medications such as Suboxone, methadone, or naltrexone, are highly effective. Making these treatments more available will help more people to overcome opioid addiction.
Similarly, naltrexone, when prescribed properly, is effective in treating alcohol addiction. Whether it is provided in the form of the Vivitrol monthly injection, or using The Sinclair Method with naltrexone tablets, this medication does work to help people reduce or quit drinking alcohol. It is also highly effective early on, before alcoholism progresses to a more dangerous stage.
Addiction podcasts, books, and articles can be good sources for the latest information on addiction treatment and recovery.
For more information on the topic of what causes drug addiction, you might be interested in tuning in to an addiction podcast to learn more about what leads people to become addicted. Podcast content ranges from the very specific opiate recovery podcasts, to more general addiction recovery and addiction treatment podcasts.
Additionally, there are a variety of books and journal articles that can be helpful in learning more about the topic. If you have found this article to be informative, I encourage you to read more of our blog articles and follow this website’s social media channels for future updates.