Dr. Nora Volkow was decisive when a physician at the emergency room who was evaluating her for a foot fracture suggested she take prescription analgesics to ease the pain: “No thank you,” she told the…
Dr. Nora Volkow was decisive when a physician at the emergency room who was evaluating her for a foot fracture suggested she take prescription analgesics to ease the pain: “No thank you,” she told the doctor.
“I’ll manage the pain,” Volkow says she told the physician during the December 2017 encounter. “The pain was not severe enough for me to take the risk. I managed the pain by avoiding putting pressure on the foot.” Volkow, the director of the National Institute on Drug Abuse, had an uncle and grandfather who were both alcoholics, she says. That family history puts her at greater risk of developing a substance use disorder if she were to take powerful opioid painkillers, she says.
There’s wide consensus among substance use disorder clinicians that genetics predisposes some people to alcoholism and addiction. Given that, if you have family members who have a problem with drugs or alcohol, you should do everything possible to protect yourself from developing substance use disorder as well, says Deni Carise, chief scientific officer at Recovery Centers of America. That’s because research strongly suggests that there’s a genetic component to substance misuse disorder, says Carise, who’s based in Philadelphia. “The science is clear: (genetics) play a very real role in the development of alcohol or drug disorders,” she says. “If you have any family members who currently have or have had alcohol or drug problems, you are likely to be at higher risk (for addiction). Additionally, some genes may make it more difficult for someone to quit once he or she starts using a drug.”
As with all genetic disorders, the closer the relationship, the higher the risk, says Dr. Bradford Bobrin, who is board-certified in psychiatry, addiction medicine and pain medicine, and is the medical director for addiction services at AtlantiCare in Atlantic City, New Jersey. AtlantiCare is the largest health care system in southeastern New Jersey. “However, any family member (who has substance use disorder), no matter the closeness, indicates a genetic risk, so uncles and cousins shouldn’t be ignored,” Bobrin says.
The stakes for avoiding substance use disorder — involving either illicit drugs or alcoholic beverages — have never been higher, considering the lethal opioid epidemic raging throughout the country and the even higher number of deaths linked to alcohol abuse. More than 72,000 people are estimated to have died of drug overdoses in the U.S. in 2017, according to preliminary statistics from the Centers for Disease Control and Prevention. More than 49,000 of those deaths — about 81 percent — involved opioids, which include illicit drugs like heroin and prescription medications like hydrocodone, morphine, codeine and fentanyl. Though it gets far less attention in the press, alcohol abuse continues to exact an even larger toll. About 88,000 people in the U.S. die annually from alcohol-related causes like drunk-driving accidents, liver disease, cancer and heart disease, according to the National Institute on Alcohol Abuse and Alcoholism.
While you can’t do anything about your genetic background, you can take steps to safeguard your health if substance use disorder is part of your family history. Experts recommend these five strategies:
1. Research your family history. Ask your parents and other relatives whether alcoholism or addiction runs in your family, says Dr. Marvin Seppala, chief medical officer of the Minnesota-based Hazelden Betty Ford Foundation. Some people, particularly older individuals, may be reluctant to share such information. Let your relatives know you’re trying to gather the information to safeguard your health and, if you’re a parent, the well-being of your children. “Family history is the major risk factor associated with addiction,” says Seppala, who is in his 43rd year in recovery from alcoholism and drug addiction.
2.Only drink at celebrations. Limiting your intake of alcohol to special occasions can help mitigate your risk of developing alcoholism, Bobrin says. While some health organizations say that nonrisky drinking equates to one drink per day for women and two for men, people who have a genetic predisposition for substance use disorder should consume less than that, Bobrin says. “Creating boundaries surrounding the amount and frequency of alcohol intake allows those with a family history of substance use disorder to take control of their lives and set limits that work for them,” Bobrin says. “Of course, the best action is to not begin drinking alcohol at all.”
3. Notify your health care providers about your family history. It’s a good idea to notify your health care providers about your family history of substance use disorder, says Howard Samuels, owner and chief executive officer of The Hills Treatment Center, an alcohol and drug treatment facility in Los Angeles. Samuels has been in recovery from heroin addiction for more than 30 years. Your health care provider can suggest options to deal with pain other than potentially addicting opioids, he says. There will be times when such prescription drugs are necessary, like when you undergo surgery. If you are in recovery from substance use disorder, you should give the painkilling drugs to a trusted relative or friend to distribute to you, Samuels says. “If you don’t have a personal history of addiction or alcoholism, I think that you are OK managing the pills yourself,” Samuels says. “But you have to be aware that there’s a risk (of addiction) since it’s already in your DNA. You have to tread very carefully.”
4. If you’re a parent, educate your kids about their potential genetic risks. If you have a history of addiction or alcoholism in your family, it’s a good idea to inform your children, Seppala says. Letting your kids know about their genetic predisposition can help them make better, informed choices about whether to drink or try recreational drugs, he says. Around age 10 is a good time to have such a discussion, when kids are old enough to process the concept of genetic risks, Seppala says. Waiting to have such a discussion until the child is in high school may be too late, since many kids are exposed to alcohol and drugs in middle school. “Let your children know of the risks as you would with any potentially fatal disease,” Seppala says.
5. Disclose your family history to a potential partner. You don’t have to discuss a history of alcoholism or addiction in your family on a first, second or even third date, says Anita Gadhia-Smith, a psychotherapist who practices in the District of Columbia and suburban Maryland, and the author of “From Addiction to Recovery: A Therapist’s Personal Journey.” While you don’t need to bring up the subject in the early dating phase, it’s probably a good idea to talk about your family’s history with substance use disorder if your relationship becomes serious. “To withhold such important information too long could become damaging to an intimate relationship and prevent the formation of trust,” Gadhia-Smith says. “If you have entered into a new romantic relationship and you know that it is getting serious, share your history with your partner. Your partner deserves to know who you really are, and will accept you if you are truly a fit with one another.”