The Pyramid of Addiction

                                       By Dave Marley, Pharm.D., Former Executive Director North Carolina P.R.N.

The disease of addiction can be described as a pyramid of risk factors which include heredity, environment, and the use of psychoactive drugs. The specific combination of all three in a given individual can lead to addiction, if a person reaches their individual threshold of all three risk factors.

Of the three risk factors involved, heredity is something we have no control over. However, just having the “compulsivity gene,” does not mean that one will always become an addict. You also need a level of environmental stress, and the use of psychoactive drugs.

Environmental stress varies from person to person. Being exposed to environmental stress such as child abuse, incest, or domestic violence, especially at a young age, can change brain chemistry, and make a person more likely to use drugs. Certain professions such as pharmacy and others are considered high stress jobs, thereby increasing a given individual’s chances of reaching their addiction threshold.

Heredity and stress are meaningless unless the individual actually uses drugs. Therefore, looking at addiction as a pyramid of risk factors, you can have a number of scenarios in which addiction can occur.

For example, a person could have extremely low genetic susceptibility, high stress, a minimal drug use (even from a valid prescription), and become addicted if they have crossed their addiction threshold.

Conversely, an individual with high genetic risk, low stress, and minimal drug use can also become addicted. Finally, someone with little genetic risk, low stress, but uses large amounts of drugs can also become an addict.

These risk factors are important, especially for health care professionals. While heredity is a constant in the equation of addiction, environmental stress is not, and according to almost every health care trade journal in publication, job stress is on the rise. Combine high stress with ready access to drugs, and you have the perfect incubator for addiction.

Dr. Doug Talbott, MD has been quoted as saying “addiction is as much an occupational hazard to health care workers, as black lung is to coal miners.” When you consider the environmental stress and access to drugs, one can truly appreciate Dr. Talbott’s statement.

The implications are for the development of more “non-traditional” addicts. People who, because of unmanageable stress levels, start self medicating later in life. We are however, not without solutions to this problem. The professions have responded with Impaired Practitioner Peer Review Organizations. The various state and national professional associations are also taking a good hard look at quality of workplace issues.

As an individual, you can assess your family history and consider your current stress level. If you are feeling overwhelmed, contact a counselor before you feel the need to start treating your situation with the use of drugs. Pharmacists instead of being immune to addiction, are actually at much higher risk for developing this deadly disease.