NURTURE, NOT NATURE:

Some Gene Research Just Isn't Worth the Money (KEITH HUMPHREYS and SALLY SATEL, 1/18/05, NY Times)

No one can dispute addiction's high cost. But is genetic research the best way to reduce it? Probably not.

Environmental approaches may not be as sexy as high-tech gene-based solutions, but they work. In the past 20 years, California has reduced smoking to 16 percent of adults from 26 percent through higher cigarette taxes, closer monitoring of sales outlets, restrictions of smoking in public places, endorsement of antismoking attitudes in the general public and better decisions about health by current and prospective smokers. [...]

In its defense, genetic research may one day improve addiction treatment. In response to Dr. Merikangas and Dr. Risch, addiction genetics researchers noted that therapeutic response of alcoholic patients to the medication naltrexone, an agent first developed for heroin users, might be associated with a variant of a gene that codes for a specific brain receptor. If replicated, this finding might allow clinicians to use genetic information to decide whether to offer naltrexone to a particular patient.

But future improvements in treatment from genetics research are unlikely to have much effect because, research shows, most addicts who recover do so without formal treatment. A survey by the National Institute of Alcohol Abuse and Alcoholism, for example, found that three-quarters of adults who had once been alcohol-dependent but no longer have alcohol problems never received treatment.

As Dr. Merikangas and Dr. Risch emphasize, addiction is malleable under the right circumstances. Only 12 percent of American soldiers addicted to heroin in Vietnam maintained the heroin habit after returning home. That is a striking example of a physiological process (drug dependence) interrupted by psychological and environmental processes - less need to manage the anxiety or boredom of a war zone, reduced availability of inexpensive heroin and increased recognition of the personal cost of continued drug use. Less startling examples of environments' changing addictive behavior abound: when is the last time you saw a heavy smoker light up at a religious service?

Our wish that various pathologies were beyond our control does not make it so.

Posted by Orrin Judd at January 17, 2005 9:02 PM