What Comes First – the Disease of Addiction or Addictive Behaviors?

Here’s a chicken or egg question. Which comes first? Does the disease of addiction lead to habitual behaviors (such as drug use), or do habitual behaviors (like drug use) cause addiction?

Addiction is largely genetic, according to author Howard Wetsman of Questions and Answers On Addiction. He says that “something on the order of 70% of the variance of who becomes an addict is explained by their genetic makeup.” A family history of addiction may predispose you to habitual behavior. In a sense, it creates a brain condition in which you feel better when using a substance. The biology of addiction is in the brain, not the body, although the symptoms are expressed in the body.

In what way is addiction a brain disease? The brain functions differently in people with an addiction.
• There are many ways that the brain is affected, but dopamine is a primary factor. Dopamine creates the feeling of pleasure. Drugs take control of this system, causing large amounts of dopamine to flood the system. This flood of dopamine is what causes the “high” with drug use. With repeated drug use, the brain starts to adjust to the surges of dopamine. Neurons may begin to reduce the number of dopamine receptors or simply make less dopamine. Because some drugs are toxic, some neurons may also die. As a result, the ability to feel any pleasure is reduced. Now the person needs drugs just to bring dopamine levels up to normal.
• With drug use, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it.
• Addiction increases the brain’s reaction to stress. Brain circuits become overactive, making people feel very stressed when they aren’t using drugs causing “cravings.”
• Additionally, addiction weakens the prefrontal cortex. The prefrontal cortex powers the ability to think, plan, solve problems, make decisions, and exert self-control over impulses. This is also the last part of the brain to mature, making teens most vulnerable.

Wetsman would say the remaining 30% of people who become addicted to a substance do so through repetitious drug use. They may not be genetically predisposed but enjoy recreational drug use that spiraled out of control. Or others may have become dependent on a substance unwittingly as through a medical prescription.

If it is true that addiction is a disease and predates habitual behavior, it would explain why some people would describe themselves as having an “addictive personality.” They have a tendency toward habitual behaviors that may be expressed through alcohol, drugs, food, gambling, sex, etc. The disease of addiction also explains why many people switch their preferred addiction after recovery. Hypothetically, some people may stop cocaine use and start gambling. Recovery is not simply the absence of drugs or alcohol. Ceasing the substance is only the beginning, or they may fall prey to switching the addiction.

So, in your experience of people with addictions, which came first, the chicken or the egg?