A recent study from the NIH has taken yet another step towards mapping out the full influence of genetics on the causes and consequences of addiction. This particular study was focused on a group of nicotine receptors that, when present in their “high-risk” form, seem to make it harder for patients to quit smoking. The upside is that patients with “high-risk” receptor genes are also much more likely to be helped by nicotine replacement therapies and other drug-based treatments.
The results of this study don’t surprise me, and I don’t think they surprise you very much either. The genetic component to addiction has been recognized and researched for a very long time. While the exact contributions of genetics and environment are still under debate, and are probably different for every patient, no one doubts that genetics play a strong role in whether or not addiction is even a possibility in a particular person’s life.
One of my favorite topics on this blog is the moral side of addiction — or, at least, the moralities that have been attached to it over the years. Addiction carries a stigma along with it. Sufferers get called “lazy”, “weak”, “selfish”, and all sorts of other things. Symptoms of their disease are interpreted as a lack of willpower, empathy, or moral strength. It’s been my mission to fight this stigma by revealing addiction for what it really is — a biological disease, that has nothing more to do with a person’s character than diabetes or high blood pressure.
One thing I haven’t discussed is how this moral/biological debate looks in the light of genetics. Can we blame someone for having trouble when they try to quit smoking, if they are proven to have genes that put it beyond their control? Is it fair to ask them to try to quit by willpower alone when the wiring of their brain will make this much more difficult for them than for others? This isn’t just about addiction; as genetic science becomes more refined, and more able to detect the hereditary underpinnings of well-known diseases, more and more fields of medicine are having to deal with how these findings impact treatment, blame, and personal responsibility.
Obesity is another good example. It has many of the same stigmas attached to it — weakness, laziness — and a similar relation to genetic conditions beyond any individual’s control. (I will address the popular concept of “food addiction” in a future post, so for now we don’t need to draw the comparison that strongly.) As more and more genetic and socioeconomic factors are discovered to cause and influence obesity, how can we continue to shame people who are diagnosed with it, telling them that they could “get better” if they just wanted it enough? How can rehab centers and counselors tell someone with high-risk nicotinic receptors that they just have to want to quit?
It’s clear to me, and I hope it’s clear to you as well, that rehab centers and other unscientific treatment providers can’t keep telling patients these stories about willpower and wanting. It makes no scientific sense, and the result is baffled, frustrated, self-loathing patients who are shamed out of seeking treatment that could help them because they think they shouldn’t need it.
On the other hand, of course, we can’t entirely abandon personal responsibility in medicine. Any course of treatment requires some action that the patient is responsible for, even if it’s as simple as taking their medication correctly. Genetic studies can go a long way towards freeing us from placing improper blame on patients, but it cannot absolve patients of all the consequences of their decisions.
This is a difficult, emerging problem in the study of medicine and bioethics; there is no clear-cut answer, and as more genetic studies are published, I am certain that the labyrinth of physician-patient responsibility will only get more complicated. I suspect, however, that the best answer — the one we will eventually settle on as a field, and use to guide our treatment of individuals — will look very like what we already do for diabetes and certain cancers. Management of addiction will hopefully involve screening and preventative therapy for high-risk groups, and individualized treatment that combines medication and counseling at the discretion of a trained, experienced physician. Until we work out such a system, I will be fighting for it, using evidence like this NIH study to combat the misinformed, harmful patient-blaming that still goes on today.