Adolescent psychiatrist talks about addictive personalities

Be Mentally Well—Adolescents at Risk: The Challenge of Substance Abuse coming Oct. 10

By Dennis Nealon	October 3, 2012
Department of Psychiatry Communications

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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.

Lisa Fortuna, MD, MPH, assistant professor of psychiatry, 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 that the risk for addictions is a “constellation of issues,” among them stress, impulsivity, trauma, anti-social tendencies and genetics, to name just a few—and that 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.

On Wednesday, Oct. 10, Dr. Fortuna will discuss the concept of addictive personality as part of the Be Mentally Well Lecture Series in a program titled “Adolescents at Risk: The Challenge of Substance Abuse.” [See sidebar for more details.]

Fortuna recently talked about her research as a preview to next week’s Be Mentally Well program.

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 bio-psychosocial model and family intervention model can be very helpful.

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