Be Mentally Well Series

Is there an addictive personality?
A conversation with Dr. Lisa Fortuna

There is still widespread debate about whether some people have an addictive personality – about whether and to what extent someone’s genetic code is a principal culprit in substance abuse issues that typically begin in adolescence for the unfortunate millions who suffer with them.

Dr. Lisa Fortuna of the Department of Psychiatry at the University of Massachusetts Medical School (UMMS) is among those who accept that a biological vulnerability for the development of addictions likely exists. But she also is careful to point out that there is much more to the story.

Science and medicine understand the risk for addictions as a “constellation of issues,” among them stress, impulsivity, trauma, anti-social tendencies, and genetics, to name just a few. And, Fortuna adds, the best hope for recovery lies not in singling out genes or any single factor, but rather in more fully understanding the intersection of biology, environment and social circumstances that place youth at risk.

Fortuna, MD, MPH, is a board certified child and adolescent psychiatrist, assistant professor of psychiatry and director of Child and Adolescent Multicultural Health Research at UMMS. Her research interests include Post Traumatic Stress Disorder (PTSD), adolescent substance abuse and co-occurring disorders in adolescence. She completed a K23 Patient Oriented Career Development Award from the National Institute of Drug Abuse which focused on a therapy development study for adolescents with co-occurring PTSD and substance use disorders. She is also involved in translational research, and in adapting evidence based interventions for community and mental health interventions with youth, including those at risk of getting involved in gang activity or juvenile detention. Her research interests also include Latino and immigrant mental health services.

On Oct. 10, 2012, in a program titled “Adolescents at Risk: The Challenge of Substance Abuse,” Fortuna will discuss the concept of addictive personality as part of the Be Mentally Well (BMW) Lecture Series. She recently talked about her research as a preview to her BMW presentation.

Q. So can someone say: ‘I was just born this way? It’s not my fault. I have an addictive personality.’

A. We can’t really say that. It’s not that simple. There is the possibility of familial and genetic vulnerability, yes. That doesn’t mean that you can’t do something about it. I would not want to use a label or say to someone, ‘you have an addictive personality.’ I’d want to talk about the whole constellation of behaviors and issues that relate to the addiction and what choices they can make to change things.”

Q. What do you talk about in the clinical process, with clients?

A. I talk about vulnerabilities vs. labels; about the genesis of the addiction, such as whether a mood disorder is also present – about personality disorders, ADHD, trauma; or whether someone is involved in drug or alcohol use because they are self-medicating.

Q. So you have to look much deeper in treatment.

A. You have to manage specific symptoms and understand the psycho-social context. A parent component (involvement) is key, and understanding things like school dynamics.

Q. Is there evidence that addiction is a behavioral thing, something you learn, say, in the home?

A. There might be a concurrent biological predisposition for personality disorders and alcohol dependence in the family for instance – risk factors that “travel together” and create circumstances that place youth at risk for addictions themselves. One trait that’s definitely been linked to addiction is impulsivity. Those adolescents who have this are at a higher risk of developing substance abuse issues…There’s a little bit of the chicken and egg piece to all of this. Drug and alcohol use can increase impulsivity and behavioral problems, which in turn perpetuate the addictive cycle. With young people with addiction addressing things from a biopsychosocial model and family intervention model can be very helpful.