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Addiction: The problem, or the solution?

September 23, 2013
by Dennis Grantham, Editor-in-Chief
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Physician/researcher suggests that adverse childhood experiences, not substance characterists, are at the root of treatment-resistant addiction problems

For as long as people have struggled against the bonds of addiction, there's been a theory that a major basis of addiction is the chemical properties of the substance being used.  Opiates, we might say, are highly addictive because that's how opiates are.  The same is true for methamphetamine, alcohol, or tobacco. It's all about the chemical properties of these substances and how they bind to various neurobiological connections in the body, many pharmacological experts would say.

But what if an extremely large study advanced a different agenda for the cause of addiction?  What if such a study stated plainly that what we see as the problem of addiction isn't really the problem at all, but a manifestation of a deeper pain caused by a damaging incident within the life history of an individual?  What would this understanding of the cause of addiction mean for its diagnosis and treatment?  What would it mean for the process that we call detoxification?  Could it change the industry's history high levels of treatment failures and relapses?

Not all of the answers are clear yet, but a powerful Sunday Behavioral Healthcare Leadership presentation by Vincent Felitti, MD certainly suggested that traditional theories about the origins of addictive behavior and the so-called "addictive personality" could be more than a little off the mark.

In "The origins of addiction:  Evidence from the Adverse Childhood Experiences (ACE) Study," Felitti, a co-author of the landmark study, gave Summit attendees something very interesting to think about.

He suggested that signs of addiction that might be seen as "obvious," such as obesity, frequent smoking or drinking, or abusive use of illicit or prescription medications "aren't the essence of the problem." Instead, he suggested, the ACE study offers evidence that such obvious addiction is "actually an individual's flawed solution to the real problem, which is the lingering and often nearly forgotten impact of a series of adverse incidents that happened in childhood, sometimes decades before.  

He cited the example of a woman whose obesity presented a major health problem, a problem that was to kill her at age 42.  After successfully losing more than 200 lbs on a medically managed fast, a weight loss that eliminated her need for supplemental oxygen therapy (she never smoked, but suffered from scarring of the lungs), the woman inexplicably put on 37 pounds in just two weeks.  

Further investigation showed that the woman's weight gain began at age 11.  But what caused it?  The woman's answer shocked Felitti and other obesity experts. The woman gained weight as a protective mechanism, she admitted, a means of making herself less  attractive to a sexual molester - her grandfather - who began abusing her, and continued to abuse her, before the age of 11. 

After similar inquiries with other patients, "we stumbled into all sorts of child abuse and markedly dysfunctional households," said Felitti. "The ACE study was developed to see if what we discovered in weight loss programs had any relevance in the general population."

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Childhood experience and/or stress are, indeed, often at the root of an addiction. Trauma, as well. But I'd be interested to know more about the behavior of compulsive action: when does it begin and under what conditions? Are there common patterns of thinking that can be identified and pre-empted in addicts?

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