Is addiction based on the environment that you are raised in, or does it come down to the genetics that you are born with? The Daily Beast http://www.thedailybeast.com/articles/2016/10/16/can-a-dna-test-really-predict-opiate-addiction.html reports that “…genetics account for roughly half the risk, leaving the rest to environment.” The testing that currently exists costs around $1,000 and is 93 percent accurate.
Apparently there are scientists who have developed a test that incorporates DNA, genetics, family history, and other factors that can predict with 93 percent accuracy if someone has addictive potential or not in terms of opiate based drugs. Now while the Genetic Literacy Project https://www.geneticliteracyproject.org/2016/10/20/doctors-use-dna-tests-screen-opiate-addiction/ says that you “cannot take these new studies seriously until they are peer reviewed,” having this predictive power could come in handy when screening people, for example, at their annual physical each year.
Imagine a future in which you get a very comprehensive report when you get your first physical exam as a young teenager, and they tell you things that you may be predisposed to, such as addiction. You have to wonder if such information would be useful in changing people’s behavior, or if it might even backfire and become a self fulfilling prophecy of sorts.
Which really begs the question: Should we be using this technology to screen for addiction potential at all? Is it right to do so, and could it actually be more harmful in the long run than it is useful?
In order to answer that question we would need to measure the effect of prevention and how it affects genetic predisposition. In other words, if you make a great deal of prevention efforts with someone who is already genetically predisposed to opiate addiction, are those prevention efforts going to help, or will they be overcome by genetics? Which is more powerful?
Eventually it is likely that we will have that sort of data, and we will know more clearly if our efforts are better spent on prevention or on rehabilitation. In the meantime, because of the spiraling and wide reaching effects of addiction on an individual, on their family, and on society, it probably makes sense to do everything we can in order to head off an addiction.
In other words, we should probably use every tool at our disposal in order to help people to avoid what can potentially become a lifetime of addiction. If you can prevent one person from a lifetime of suffering with drug addiction, you may actually prevent several generations to follow them from the same outcome. Again, we don’t really know how much of it is learned behavior from our environment versus the genes that we are born with.
In my own personal case I have to believe that it could be a mix of both. I had a strong and healthy environment during my childhood but I also had a bit of family history that would suggest potential for addiction. There is also the question of whether or not there is a difference between a predisposition to opiate addiction versus having a predisposition to alcoholism, and whether or not they are the same thing or not. It is very possible that the potential for addictive behavior is very generic, and that a specific drug or substance simply wins out over any others due to variables that are beyond our ability to decipher. In other words, personal preference might dictate what your drug of choice becomes, but the predisposition for addictive potential could still be a very generic thing.
As medical technology and genetics improves over the next few years, we are probably going to be facing more and more ethical questions along these lines. Whether or not we should be testing people at all is the foremost question, but there are also issues that go far beyond that when it comes to coaching people who receive such test results. For example, do you tell people to avoid pain medication at all costs just because their genetics suggest they might be prone to addiction? Is that a fair instruction when weighed against their potential pain and suffering? How is such a line determined, and who is fit to determine such a line? Even medical doctors do not have access to your exact level of subjective pain at any given moment, and can only attempt to measure it objectively using various tests.
One of the answers in all of this advancing technology, hopefully, will be the advent of new opiate medications that do not carry any euphoric side effects, thus negating any chance of addictive behavior. Such medications have been shown to be effective in lab animals, and human testing is right around the corner. So in just a few short years we may be at a point where the ethical question of genetic addictive predisposition becomes pretty much moot, because the new painkillers that we develop will not be addictive at all. While that may sound like science fiction, such pain relievers already exist and are now undergoing testing, so the reality might be here sooner than we realize.
Similar genetic testing may soon follow that predicts alcoholism when a child is first born, advising the parents that their newborn will grow up to be a potential alcoholic. Could it be possible that one day we may have to tailor our prevention efforts to people who already know that they may have a problem, even if they have never abused drugs or alcohol yet? That would be quite a shift in prevention efforts, and quite a unique message to give to people.
Ultimately it is still going to come down to rehabilitation for many people, and the same old principles that have led to successful recovery are still going to prevail. While medical technology will continue to advance, human beings will always have the potential for self destructive behavior, and therefore we need to be careful when we are assessing how much faith we are going to put into a medical breakthrough such as this. In the end, addiction is a simple, almost primal drive in people, and it is possible that it cannot be deconstructed and conquered using medical advancement in the way that we are hoping for. Nevertheless, it is our responsibility to continue to make medical advancements in the search for an addiction or alcoholism cure, or at the very least, to try to help those who are afflicted by it.