Do I Have an Addictive Personality?

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No, You Don’t. That Phrase Has No Medical or Scientific Meaning

We thought we’d clear that question up right away:

There is no such thing as an addictive personality.

In fact, one addiction professional is so certain of this, and feels so strongly about the phrase, that she wrote an article in 2015 called The Addictive Personality. The author, Dr. Maryann Amodeo, opened the piece, published in The Journal of Substance Use and Misuse, with these two sentences:

“The term addictive personality needs to be retired permanently from use by the alcohol and drug (AOD) treatment field. The term engenders confusion and misunderstanding and undermines our ability to help individuals with alcohol and drug problems.”

She goes on to discuss the reasons the phrase and the ideas that keep it alive in our public consciousness often lead to negative consequences for people with alcohol and/or substance use disorders (AUD/SUD), impair treatment effectiveness, and perpetuate stigma around addiction and addiction treatment.

We’ll talk about her important and insightful paper in a moment, because Dr. Amodeo does an excellent job explaining why the phrase addictive personality can cause harm. However, when we put the idea in its modern context, we see the contemporary paradigm of addiction by itself should be enough to put the idea to bed without additional commentary from Dr. Amodeo or anyone.

What is the contemporary paradigm of addiction?

It’s called the medical model of addiction. Here’s the definition, as presented by the American Society of Addiction Medicine (ASAM):

“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.”

Let’s talk about that definition.

A New Era of Addiction Treatment

That’s what we’re in: a new era of addiction treatment. Although the medical model of addiction has been around since the 1990s, and has been endorsed by every relevant medical and public health organization or government agency since the early 2000s, the vestiges of the old 20th century concept of addiction persist in subtle ways throughout our society.

The phrase addictive personality is one of those subtle – but impactful – ways of thinking about addiction that perpetuate the stigma addiction professionals have worked for decades to eliminate. Let’s start with the beginning of the definition:

Addiction is a treatable, chronic medical disease…

Other chronic, treatable diseases include:

  • Arthritis
  • Asthma
  • Cancer
  • Chronic Obstructive Pulmonary Disease
  • Crohn’s Disease
  • Ulcerative Colitis
  • Irritable Bowel Syndrome
  • Cystic Fibrosis
  • Diabetes
  • Heart Disease
  • Obesity
  • Osteoporosis

Now ask yourself a question. If you felt pain in your knee, went to the doctor and got a diagnosis of arthritis, would you sit in the car after the appointment and ask yourself:

Do I have an arthritic personality?

Of course not.

And if your eight-year-old child has trouble breathing when doing sports and their pediatrician diagnoses them with asthma, do you ask yourself:

Does my child have an asthmatic personality?

Of course not. Because personality has nothing to do with asthma. Personality has nothing to do with arthritis, either. And no one has a cancerous, diabetic, or obese personality

This brings us to an important point. There are behaviors an individual may engage in that increase risk of developing specific medical diagnoses – including alcohol/substance use disorder (AUD/SUD). There are also genetic factors – i.e., what an individual is born with – and environmental factors – i.e., things that happen during life – that increase the risk of developing specific medical diagnoses – including AUD/SUD.

But personality has nothing to do with any of that.

People are More Than Diagnoses

That may seem obvious. But many of us are still confused about this. The persistence of the phrase addictive personality reveals the latent beliefs left over from our old ideas about addiction. Not long ago, people thought addiction was the result of a personality defect, a character flaw, or a lack of responsible moral or ethical decision-making skills.

People who develop an alcohol or substance use disorder often ask themselves:

Is this just who I am? Is this just how I am? Maybe it’s something I did?

No, no, and no.

Dr. Amodeo lists three false assumptions the idea behind the question “is this just who I am” can lead to. We’ll list these now, along with her refutations of these assumptions.

The Addictive Personality Myth: Refuting Three Assumptions

Assumption 1:

Individuals who develop AUD or SUD have a specific personality type that “precedes and propels” the development of the disordered use of substances.

Refutation:

This assumption has no basis in scientific research. There is no evidence for the existence of an addictive personality.

Assumption 2:

A person with an addictive personality has predictable patterns of thought and behavior that include preoccupation with drugs, compulsive drug use, and choosing drugs despite negative consequences

Refutation:

The personality characteristics described above do not predict the development of AUD/SUD, but rather, are often the result of AUD/SUD.

Assumption 3:

During or after treatment for AUD or SUD, a person will relapse – i.e. return to alcohol or drug use – or initiate the use of other drugs of misuse because of their personality characteristics.

Refutation:

People with AUD or SUD relapse for many reasons. There are a host of triggers that lead to relapse. However, the primary reason a person may relapse after treatment or initiate the use of other drugs during treatment is because of incomplete treatment, incomplete education on the nature of AUD/SUD, inadequate coping mechanisms, and/or a failure to address “co-occurring psychiatric or medical problems which may have fueled the addiction.”

There’s one last thing we want to address here, and it’s important.

You can’t use your personality as an excuse to justify behavior.

With that said, there are things you can learn about yourself that may have affected the development of an addiction disorder. And if you address these things, they can help you enter treatment, achieve sobriety, long-term recovery, and/or sustained abstinence.

We’ll talk about those things now.

Addiction Disorders: Genetics, Environment, and Behavior

We’ll repeat it again: your personality does not cause you to develop an addiction disorder. Current scientific knowledge indicates that a combination of genetics, behavior, and environment combine to contribute to the development of AUD/SUD. This knowledge also both eclipses and includes the nature v. nurture debate vis a vis addiction. Therefore, in answer to the question “is addiction an innate behavior or something you learn” the answer is “yes.”

Because it’s both.

Genes and Addiction

We’ll explain why, beginning with the genetic component. A Genome-Wide Association Study (GWAS) performed in Sweden 2014 included the health and genetic records of more than a million people, and used pairs of twins to determine the role of genetics in addiction. They identified the following overall contribution of genetics to substance use disorder:

  • In men, the hereditability (the genetic component) of SUD was 55%
  • In women, the hereditability of SUD was 73%

What that means is that in 55 percent of cases of SUD in males and in 73 percent of cases of SUD in females, they identified genes known to be associated with SUD. Now we’ll look at what we know about the contribution of genetics to the disordered use of alcohol and marijuana.

Alcohol Use:

  • Heavy Drinking. Data showed 13 genetic variations associated with heavy alcohol consumption.
  • Alcohol Use Disorder. Data showed 10 genetic variations associated with AUD. Seven of these had not been identified before the study.
  • AUD and Heavy Drinking. Data showed five variations associated with AUD and heavy drinking.

Marijuana:

  • Researchers identified a specific genetic mutation present in all the people with cannabis use disorder (CUD, a.k.a. marijuana addiction), and absent in the people without CUD.

Now we’ll look at the second component known to contribute to the development of AUD and SUD: environmental factors.

Adverse Childhood Experiences (ACEs) and Addiction

We’ll start with the concept of adverse childhood experiences, since their relationship to addiction has a broader evidence base than the concept of early life adversity. Close to twenty-five years ago, the Centers for Disease Control (CDC) and Kaiser Health Systems launched the ACE Study, which examined the relationship between events people experience during childhood and adolescence with their long-term behavioral, emotional, and physical health. The study, and the conclusions drawn from it, marked a sea-change in how we think about overall health and wellness. The ACE study is responsible, in large part, for what we know of today as trauma-informed care.

The study identified the following events as ACEs:

  • Physical abuse
  • Emotional abuse
  • Sexual abuse
  • Physical neglect
  • Emotional neglect
  • Living with a family member with AUD or SUD
  • Witnessing or experiencing domestic violence
  • Living with a family member with a mental health disorder
  • Living with a family member who becomes incarcerated
  • Experiencing racism and/or bullying
  • Living in foster homes
  • Living in an unsafe neighborhood
  • Witnessing community violence

The CDC, the Kaiser researchers, and the Substance Abuse and Mental Health Services Administration (SAMHSA), concur that individuals who experience ACEs are at increased risk of:

That’s how environment – i.e. the external circumstances of childhood – affects the development of AUD or SUD later in life. It’s important to note that the experiences in the first bullet list increase risk of developing the list of disorders or negative outcomes in the second bullet list: we italicize increase risk because that’s what they do. Every person who reports ACEs does not go on to develop everything in the second list. They are, however, at increased risk of those negative consequences.

Early Life Adversity (ELA) and Addiction

The concept of early life adversity (ELA) is similar to the concept of adverse childhood experiences. Whereas the term ACE was initially used to describe experiences and events that happen after infancy and toddlerhood – i.e. during school-age years and adolescence – the phrase ELA appeared around 2012 to describe a wider set of experiences and encompass events that occur in utero, around the time of birth, and during infancy/toddlerhood as well as the negative events an individual might experience during later childhood and adolescence.

A paper published in 2021 called “Neurobiological Mechanisms of Early Adverse Experience, Blunted Stress Reactivity and Risk for Addiction” opens with the following warning:

“Exposure to adverse circumstances during childhood and adolescence may lead to poor health outcomes in adulthood. In the behavioral realm, ELA is associated with future maladaptive behaviors including abuse of alcohol and other substances (SUD), compulsive gambling, and risk-taking behaviors.”

Here’s how ELAs can lead to greater risk of developing addiction:

  • An individual experiences one or more of the following adversities early in life:
    • Lack of nurturing
    • Physical abuse
    • Sexual abuse
    • Low socioeconomic status
    • Significant family disruption
  • The stress associated with these experiences leads to physiological changes in the brain, in areas related to:
    • Impulse control
    • Threat recognition
    • Risk appraisal
    • Pleasure
    • Reward
    • Emotional regulation
    • Attention
    • Social cognition
  • The brain areas affected by these physiological changes tell the story. Compared to people without ELAs, researchers observed:
    • Attenuated development in the areas related to control, inhibition, and rational decision-making
    • Enhanced reactivity in the areas related to reward and pleasure
    • Fewer connections between the brain areas related to control, inhibition, and rational decision-making and the brain areas related to reward and pleasure.

It’s crucial to note that “…in the context of early life adversity, such alterations may be an adaptive survival response to external conditions that are out of the individual’s control and cannot be escaped.” What this means is that early in life, an individual may experience events that change their brains is such a way that increases their risk of developing a host of behaviors associated with addiction, including addiction itself.

However, the phrase cannot be escaped refers to initial experiences that increase risk of addiction, the same way they increase risk of diabetes, cancer, and heart problems. It does not mean an individual with a history of ELAs has an addictive personality and will develop addiction any more than it means a person with a history of ELAs has a cancerous or diabetic personality and cannot escape developing cancer or diabetes.

Behaving Your Way to Wellness

If you’re in recovery from an alcohol or substance use disorder, and you engage in any kind of treatment program, whether it’s residential, partial hospitalization, intensive outpatient, or outpatient, you’ve probably heard this:

You can’t think your way to sobriety or recovery,
you have to act your way to sobriety and recovery.

What that means is that recovery depends on what you do, not what you say. It depends on the actions you take – supported by the thoughts you think – but cannot happen through thinking alone. You behaved your way into addiction, which means there are behavioral choices you made that resulted in the development of an alcohol or substance use disorder, the same way behavioral choices can lead to obesity or diabetes. However, once addiction takes hold, your choices change: you can’t go back for a do-over, but you can choose treatment and recovery.

You may have a long list of ACEs and ELAs in your history. But those events are not determinative. They increase risk, yes. But that’s not the same thing as having an addictive personality. If you think – hold that – if you’re one hundred percent sure you have an addictive personality, try this one thing for us. Try saying to yourself “there may be events in my past that changed my brain and increased my vulnerability to addiction, but those changes do not define me or my personality.”

Making that simple change in self-talk can make a big difference. It can get you out of a psychological space that keeps you from seeking support, and put you in a psychological space that allows you to choose recovery.

When you choose treatment and recovery, you learn exactly what we say above: you learn a new set of behaviors and actions that result in sobriety, abstinence, and/or recovery, depending on your treatment program and your overall health and wellness goals.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.