Why it’s time to stop believing the ‘addictive personality’ myth

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Watch Painkiller, the Netflix series about the USA’s opioid crisis, and it’s not just the 300,000 deaths from opioid-related overdoses that’s shocking. It’s how easily the drug company Purdue convinced doctors that Oxycontin, the opioid painkiller that became responsible for many of those deaths, was non-addictive.

“The company used the concept of an ‘addictive personality’ to claim their product was essentially safe for most people, and that it was only those with this trait who were at risk of becoming addicted,” says Professor Dan Lubman, Director of Turning Point, Australia’s leading national addiction treatment, research and education centre based in Melbourne.

Taylor Kitsch plays Glen Kryger, a mechanic who becomes addicted to OxyContin after injuring his back, in Netflix series Painkiller. 

Yet the addictive personality theory has been debunked as far as science is concerned – a relic from early last century when addiction was put down to personal failings.

“The idea persists because of stigma. It makes it easy to blame people for their circumstances,” he says, adding that it’s still around in the “drink responsibly” or “gamble responsibly” messages from the alcohol and gambling industries. These are words that imply the products are safe, the industries blameless – and it’s being “irresponsible” that brings trouble.

While genes or temperament can raise our addiction risk, they don’t add up to a single addictive personality – or make addiction inevitable. Instead, there are multiple influences that can nudge us towards addiction. Being a risk-taker or being impulsive, being anxious or depressed, even being a high achiever can all raise the risk, for example – yet we all know people like this who don’t have a problem.

“A common thread linking these traits is difficulty regulating emotions – and drugs and alcohol are a way of managing emotions,” says Professor Nicole Lee of the National Drug Research Institute in Melbourne.

“Good emotional control depends on two parts of our brains working in harmony – one is the seat of our emotions, the limbic system; the other is the logical, thinking part of our brain, the prefrontal cortex,” Lee explains. “When everything is working well, this rational part of the brain can calm things down if the limbic system whips up emotions. But sometimes these two systems are out of balance.

According to Lee, people who have low emotional control, whether it be from ADHD or an experience with trauma, may be at risk of problems with alcohol and other drugs.

“With ADHD, the rational part of the brain is less active than average, so it has more difficulty keeping big emotions in check,” says Lee. “Trauma is different – it primes the limbic system to overreact so much that the rational part of the brain is no match for the intensity of emotion.”

If you have ADHD, stimulants like amphetamines can help the brain feel normal because they increase activity in the prefrontal cortex. And if you have experienced trauma, drugs and alcohol can mute intense emotions.

“A common thread linking these traits is difficulty regulating emotions – and drugs and alcohol are a way of managing emotions.”

This may help explain why cognitive behaviour therapy (CBT) can help people beat addiction.

“We don’t know exactly how CBT works for addiction – but my personal belief is that it helps activate the prefrontal cortex by helping us be deliberately more mindful of our thoughts,” Lee says.

Around one in four of us grapples with alcohol, drugs or gambling at some time in our lives. Family history ups the risk, though how much of this is genetic and how much is learnt isn’t clear. But inheriting a gene variant that helps your body process alcohol slowly can increase the risk because you’re less likely to have adverse effects from alcohol.

“But it’s not inevitable,” says Lee. “It can take more than a higher risk alone to create dependence. You can be vulnerable to addiction because of genetics, for example, but it only becomes a problem when some stressor in your life activates that vulnerability.”

Still, if there’s a family history of alcohol dependence, her advice is to be mindful of your drinking habits and if you do develop a problem, a period of abstinence, rather than moderation, is best.

As for the belief that “once an addict, always an addict” – that’s another myth whose time is up, according to experts. It’s not the reality, Lee says, with some research suggesting that 75 per cent of people either quit or moderate their habit.

Like the addictive personality myth, this concept discourages people from getting help because it perpetuates the stigma that clings to addiction, and implies there’s little hope of overcoming it, says Lubman.

“We know that the average time from developing a problem with alcohol to getting help is about 18 years. If that were the case with cancer, there’d be an outcry. If we want people to get help earlier, we need to stop blaming them and treat addiction like any other health condition.”

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