What the Addiction Counselor Needs to Know About Genetics

Transcription

1 What the Addiction Counselor Needs to Know About Genetics Instructor: Don Cleveland

2 Presenter: Donald Cleveland: Don Cleveland has been working with substance abusers for the past 15 years both as a senior pastor and counselor. He earned a Bachelor of Arts degree in psychology from the University of South Florida and is currently working on a Master of Arts degree in counselor education. Don is also working towards becoming a Licensed Mental Health Counselor at Rehab After Work in Brandon, Florida; it is here that he s able to practice his passion of living in the moment with clients, and writes about person-centered and cognitive behavioral interventions. Course Description: This course will provide the substance abuse counselor with the basic information necessary to understand hereditary factors involved between a client s genetic background and their addiction. The critical interplay of the environment and the Durand and Barlow (2010) Integrative Model will also be addressed in assessing causes of substance dependence. Course Objectives To help the counselor understand the role both genetics and environmental factors play within substance dependence. Course Outline I. Understanding the genetics of addiction and their limited role II. Understanding how genetics, environment, and the Durand and Barlow (2010) Integrative Model play interrelated roles within substance dependence III. The Case of Marissa Doomsday IV. Closing Considerations What the Addiction Counselor Needs to Know About Genetics This course will provide a review of the primary terms and concepts involving the way a substance dependent client s genetics and environment contribute to the disease of addiction. The disease paradigm is in reference to the American Medical Association s acceptance of alcoholism as a disease in 1956, and is the theory of choice when considering substance dependence and genetic influences. Many clients and family members concerned about the genetics of substance dependence, act as if addiction is some predetermined fate they were destined to suffer. Like the substance abuser who takes all the blame and responsibility for his recovery, the addict who focuses on an addictive personality or genetics, can take the opposite approach by blaming faulty genes. Both extremes could not be further from the truth. The reality is that we cannot talk about genetics without discussing the environment a substance dependent individual grew up in and now participates in. To build a basic overview of the multiple core causes of substance abuse, we will first review the Integrative Model as envisioned by Durand and Barlow (2010). This will serve as the foundational understanding when communicating with clients about the primary causes of substance abuse and how genetics is just one of many factors contributing to dependence. We will review the terms necessary to construct a working knowledge in this area; it will assist us in an overview of how genetics and personality enhance our work with substances abusers concerned with these issues. The Integrative Model Durand and Barlow (2010) take an integrative approach with regard to all major mental health disorders. Substance dependence is particularly relevant given the tight relationship between it and the factors found in the Integrative Model: social, psychological and biological influences, and as described in the chart below. As referenced in the Durand and Barlow (2010) Integrative Model for Substance Abuse: Social Exposure from media, parents and peers Psychological stressors Psychological Positive and negative reinforcement Cognitive Biological Sensitivity, metabolism and arousal Mood disorders and anxiety

3 Social Causes Stress is the theme of social causes related to substance dependence. The stress of anxiety which media portrays, combined with the pressure from peers as well as parents and other leaders who serve as poor role models, are just a few of the clues related to the social factors promoting substance dependence (Durand and Barlow, 2010). Psychological Causes As the psychological factors are all too numerous for an extensive listing here, we will explore the primary behavioral concern, reinforcement. The reinforcement of feelings of euphoria achieved from drug use is powerful from both a positive and negative reinforcement standpoint (Durand and Barlow, 2010). An example of positive reinforcement is the temporary sense of well-being and happiness. One of the most truthful statements I ever heard was from a person struggling with substance dependence who said, I do it to feel good. This simple fact is often denied due to the shame associated with the moral model of substance abuse treatment. It is simply another denial added to the pile of lies told to oneself and to others. Examples of negative reinforcement revolve around the goal of escaping a situation or consequence. These possibilities include using drugs to numb emotional pain, avoiding highpressure situations, or to escape any other concern troubling the abuser. Cognitive factors include mental events, representations, beliefs, or intentions that facilitate a dependence on drugs. One example of this is the phenomenon of expectation. Our thoughts are constantly predicting and anticipating the future in a way that organizes much of our life. Our expectation for the effects of a drug has shown to be a primary motivator, and regardless of whether or not a chemical contains an active ingredient. Placebos used in health care clinical trials are a powerful example of the impact inactive drugs can have on the body and especially when a person is expecting a specific result. Our brain s natural biochemical factory combined with its executive function, anticipates outcomes that can produce expected results without the actual drug being absorbed into the body. Biological Causes Genetic and biological influences on substance dependent individuals include inheriting a more sensitive reaction to drugs which metabolizes rates faster than normal, leading to higher doses and a host of other mental health disorders. All contribute to substance dependence problems that can predispose a person to develop an addiction (Durand and Barlow, 2010). Neuroplasticity, the way brains adapt in response to changing conditions, is also affected by drug use through increased efforts the user performs to maintain a drug induced state. At the same time, life s natural reinforcements such as sex, food, love and accomplishments are hijacked in favor of the quicker, more intense experience of drug use. Although drugs produce desired feelings much faster than the natural reinforcements referenced above, these gains are short term and do not last. Rather, it s these reinforcement issues that keep a dependent individual chasing that first high which ultimately requires increased dosages. The Limited Role of Genetics Before we launch into a discussion about how to alleviate a client s concern about being doomed to a life of substance dependence due to their genes, let s review the terms necessary for a basic understanding of this phenomenon as referenced in the Dictionary by Apple Inc. (2012). Environment The conditions outside of person that effect the way the person acts and reacts to a variety of stimuli. Gene A unit of heredity transferred to offspring from parents that determines a characteristic of the offspring through coded proteins. Predestination A preordained event that cannot be avoided due to either divine intervention or biological determinants. Predisposition A tendency to be susceptible to a specific condition.

4 While Durand and Barlow (2010) paint a broad picture of substance dependent causes, Doweiko (2012) hones in on the idea that genetic predispositions are not predestinations meaning a one-way ticket to substance dependence. Instead, genetic influences are a possibility still being researched as a contributing factor when combined with the environment inhabited by the substance dependent client. The term predisposition, more accurately describes science s loose hold on how genes can act to help produce dependence for a substance dependent individual. We can confidently tell our clients that there is no specific gene for alcohol addiction or any other type of drug abuse. Doweiko (2010) does make allowances for the research that has been done with alcohol and advises that there is indirect evidence of a genetic predisposition toward the alcohol use disorders. This is a far cry from the idea many clients bring, advocating that they have the incurable and unavoidable disease of addiction. The term predestination describes the attitude of an individual that believes they have a fixed destiny. In the case of substance dependence and to the drug user or concerned family member, predestination can become a fatalistic way to minimize responsibilities associated with recovery and relapse by blaming genetics. Consider the case study below when asked to address this issue in future sessions. The Case of Marissa Doomsday Marissa has come to Morgan for help with her anxiety and substance dependence issues. It is their third session and they are about to uncover one of the key reasons Marissa has never traveled very far in her recovery journey. Morgan: Do you think the main reason you have used alcohol in the past is to calm your fears or is there another reason? Marissa: It definitely takes the edge off, especially in social situations. My parents are alcoholics so you know Morgan: What do you mean? Marissa: Well, being a lush in my genes you know. The reality is I m stuck with this thing and we can do little about it here except hope for the hopeless. Further probing reveals not only a magical belief in an untenable genetic inheritance for alcoholism, but also Marissa s profound fear that there is nothing she can do to change her situation. Morgan: What if I told you there is no alcoholic gene. That the best science can tell us is that the environment a person chooses to live in is just as important, if not more important than a person s genes? Marissa: I d say I wish I could believe that. You don t understand. We all act the same way and when we meet up with aunts, uncles and cousins it s the same scene. As the black sheep of the family, I m just not able to handle my liquor like they can. Overcoming the Magical Beliefs of Genetics Marissa is a classic case of a person demonstrating many of the principle causes of drug abuse but focuses all her energy on a variable she cannot change. For her, this explains the inability to quit drinking which keeps her feeling anxious and out of control. In recovery, this type of thinking halts progress because Marissa is allowing herself to deal with the belief that she cannot change an inheritance for drinking. Morgan s intervention must first begin to help her understand that scientific beliefs are a fantasy. He then needs to address her intuition, informed by previous experiences, which would make her believe that she is just like her family. The chart below highlights the points Morgan needs to help Marissa discover about the cause of her alcohol dependence. Marissa s substance dependence causes based on the Durand and Barlow (2010) Integrative Model for Substance Social Parents poor role modeling Stressors to drink and fit into family Psychological Positive reinforcement by escaping family problems and relationships Negative reinforcment by escaping anxiety Biological Possible lower ability to metabolize alcohol Mood Disorder: Anxiety

5 What is striking about this assessment is that these basic issues only scratch the surface of the deep hurts and anxieties Marissa has yet to deal with in her recovery. However, this dysfunctional belief in a genetics-only cause keeps her from moving forward. Therefore, she must successfully resolve this dilemma and deal with other issues related to her dependence on alcohol. Closing Considerations A substance dependent client s belief system should always be well understood by the counselor. Their beliefs serve as motivators resulting in both positive and regressive movements in recovery. When the issue is an insistence on genetics as a predestined fate for addiction, clinical research is emphatic in its insistence that the environment plays a more decisive role than genetics. This belief comes as a remnant of the excitement associated with the Human Genome Project completed in The 20,000 to 25,000 genes mapped alongside their three billion chemical base pairs have been declared finished. However, the analysis of the Human Genome Project is expected to be ongoing for years to come. Goldman, Oroszi, and Ducci (2005) sound a hopeful note in their review of future genetic modeling as an answer for substance dependence. Scientists are no longer searching for a single gene as a culprit but rather a combination of genes acting together as a predisposition toward substance dependence. While their belief is that genetic models are needed to assist current ineffective treatments for substance dependence, they conclude, It is a sobering reality that genetic findings have so far not led to the creation or targeting of addiction treatment or prevention. The clinician will not find it surprising that overcoming the dysfunctional belief of genetics, as causation for substance dependence, is yet another challenge to the overall theme of breaking down the walls of denial and magical thinking. By discussing some form of the Durand and Barlow (2010) Integrative Model and the scientific realities of genetics, you can broaden your clients thinking about why they are addicted. In addition, you are able to lay the groundwork for more a more productive intervention.

6 Quiz 1. The difference between the terms predestination and predisposition is that: a. There is no difference as these terms mean basically the same thing. b. Predestination describes the genetic likelihood that a substance abuser will become dependent while predisposition describes the possibility a substance abuser will become dependent. c. Predestination describes the genetic possibility that a substance abuser will become dependent while predisposition describes the certainty a substance abuser will become dependent. d. Predestination describes the genetic certainty that a substance abuser will become dependent while predisposition describes the tendency a substance abuser will become dependent. 2. The following are the primary causes of substance abuse and dependence as envisioned by the Durand and Barlow 2010 Integrative Model: a. Psychological causes, social stressors, and inheritance b. Psychological causes, social stressors, and biological issues c. Psychogenic causes, social stressors, and inheritance d. Psychological causes, social ambitions, and inheritance 3. Cognitive factors fall under the psychological domain of the Durand and Barlow (2010) Integrative Model and involve mental events, representations, beliefs, and intentions. 4. Research into genetic models as a cause for substance dependence is: a. Still in its infancy b. Can only be considered in association with the environment a person lives in c. Will soon be the most successful way to treat substance dependence d. Both a and b 5. Marissa s successful recovery from alcohol dependence will: a. Have little to do with resolving her belief that she has inherited her condition from her parents b. Begin with her acceptance that she is not predestined to fail because her genes are faulty c. Not be possible unless her medical doctor determines her condition is not due to genetics d. Begin with her acceptance that she does not have a predisposition to fail because her genes are faulty References Dictionary, (2011). Apple Inc. (2.2.1). Software Application. Doweiko, H. E. (2012). Concepts of chemical dependency (8th). Belmont, CA: Brooks/Cole Cengage Learning. Durand, V. M., & Barlow, D. H. (2010). Essentials of abnormal psychology (4th). Belmont, CA: Wadsworth Cengage Learning. Goldman, D., Oroszi, G. A., & Ducci, F. (2005). The genetics of addictions: uncovering the genes. Natures Reviews Genetics, 6(7), doi: /nrg1635