Diagnosing Addiction Among Young Adults Discussion Paper

Research has shown that nature and nurture significantly influence one’s health (LeTendre and Reed, 2017). The dynamic interactions between the environment and genes determine individuals’ health. For instance, both lifestyle factors, such as physical activity, diet, and stress, and genetics increase or protect against the risk of addiction disorder (Giménez-Meseguer, Tortosa-Martínez, and Cortell-Tormo, 2020). Substance dependence disorders are chronic relapsing issues that have adverse societal consequences. Studies on family members related by blood, especially twins, have indicated that there are critical environmental and genetic factors in the inheritance of addiction disorders (Baratta et al., 2021). Modern advances in addiction diagnoses use genetics to identify certain variants that normally predispose a person to these substance dependence disorders. However, there is no specific gene for a certain addiction like alcoholism. Instead, there are multiple genes, each with a small effect, that interact with each other as well as with their external and biologic environments to make a person less or more susceptible to the development of substance addiction (Lin et al., 2022). This paper will seek to answer the question; in what ways are environmental and genetic factors considered when diagnosing substance and alcohol addiction in young adults?

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Diagnosing substance addiction is often challenging because the onset of this disorder is rarely sudden. In most cases, substance dependence is preceded by an increase in risk-related behavior. The trajectory of the behavior typically originates from childhood (LeTendre and Reed, 2017). For instance, adolescence is a significant stage for the initiation and experimentation with substance abuse. Diagnosing Addiction Among Young Adults Discussion Paper The use of illicit drugs and alcohol misuse in adolescence is an empirically proven risk factor that exacerbates the development of later substance use disorders. Recognizing the early trajectories and risk factors that make young adults susceptible to substance addiction is crucial in developing effective diagnosis, treatment, and prevention strategies (Castillo-Carniglia et al., 2019). Substance dependence among young adults is a serious public health concern. Youths who engage in drug abuse and alcoholism are more likely to experience adverse social, legal, and academic problems. Additionally, drug addiction and excessive alcohol misuse are associated with neurologic damage, liver disease, cardiovascular disease, and cancer, as well as mental health issues such as anxiety and depression. The economic and societal costs of substance dependence disorder are also substantial.

Cannabis is a commonly used illegal drug among young adults. Research shows that around 14 percent of adolescent-onset marijuana users develop cannabis addiction, a rate almost twice that of adult-onset abusers (Zehra et al., 2018). This trend informs the biologic and environmental mechanisms involved in the development of substance dependence. For instance, cannabis contains cannabinoids whose receptor belongs to the Gi/Go protein-coupled receptor family. In a mammalian brain, this receptor is densely found in regions engaged during higher cognitive functions, emotional inputs, the rewarding stimuli, and habit formation (Volkow and Boyle, 2018). This is consistent with existing literature that reported that individuals who tried substance use or alcohol misuse in adolescence were four times more likely to develop substance dependence than those who first tried them in emerging adulthood or later (Castillo-Carniglia et al., 2019). Also, those who start alcohol misuse before the age of 15 are more likely to develop other forms of addiction, like drug abuse disorders. Addiction in young adulthood may be exacerbated by the likelihood of substance and alcohol use in adolescence, altering the course of teenage development.

Those who begin to use alcohol in adolescence are more likely to become drug addicts during young adulthood since it increases the chances of the adolescent being affiliated with deviant peers or decreases the likelihood of their association with peers who model or reinforce prosocial behavior. Other than the environmental effects, early use of illicit substances and alcohol can affect the biologic development of an adolescent brain. According to Castillo-Carniglia et al. (2019), excessive alcohol indulgence during adolescence increases the risk of neurocognitive changes that could result in subsequent misuse of illicit substances and alcohol in emerging adulthood. Additionally, early substance use and subsequent dependence in adulthood are manifestations of the inheritance of a disinhibitory psychopathology liability. Studies involving twins have suggested that early use of substances is heritable, and thus, the association of dependence risk in young adulthood is mediated primarily by genetic factors (Baratta et al., 2021). Additionally, alcoholism before the age of 15 is associated with abuse of other drugs, which culminates in addiction during young adulthood (Volkow and Boyle, 2018). In diagnosing substance addiction, health practitioners should look out for early alcohol use, which could indicate an inherited risk behavior that may disrupt the normal course of human development in adolescence.

It is widely claimed that alcoholism stems from the family. This is because of the genetics that is transmitted and the familial environment. The heritability of drug addictions varies across substances, age, population, and gender. Studies exploring heritability among dizygotic and monozygotic twins have shown that the heritability of every addictive drug range from 40 to 60 percent, especially the heritabilities of illegal addictive drugs (Lin et al., 2022). Drug and alcohol issues among youths demonstrate that dependence behavior is a manifestation of risk to a multitude of externalizing disorders. Longitudinal research has shown risky behavior development characterized by dramatic changes moderated by environmental and genetic influences (Zehra et al., 2018). The genetic effects are important in diagnosis because their prediction of substance use takes a dramatic trajectory in young adulthood and adolescence. According to Meyers and Dick (2013), genetic factors account for 50 percent of the variance in substance use patterns for early use at 18 years and one-third for 16-year-olds. This pattern was consistent for both sexes. This indicates that the importance of genes as a risk factor increase with age. However, the importance of environmental factors decreases significantly with development from adolescence to adulthood (Volkow and Boyle, 2018). These factors account for 70 percent of the development variance at 15 years and around 15 percent at 18 years. This has implication in the diagnosis because the practitioners since they understand that as substance use patterns develop, varies, and stabilize across young adulthood, genetic factors’ importance to the dependence increases.

However, environmental factors are also crucial because early use of some substances, such as alcohol, appears to be primarily influenced by neighborhood, school, and family. Accordingly, familial and other social environmental factors influence early initiation and use patterns more than genetic ones (LeTendre and Reed, 2017). However, later dependence on those substances is more influenced by biologic inheritance. Familial and social environments are considered when diagnosing addiction because they strongly influence adolescent development, directly predicting risky behavior. This is because, in the early stages, it is difficult for teenagers to manifest their genetic predisposition since most of their decisions and behaviors are influenced by people in their social environments who have authority over them. As they transition from adolescence to adulthood, the influence of the figures of authority diminishes as they move out of the social structures of their adolescence. Therefore, young adults have more liberty to manifest their genetic predisposition. They can freely choose their activities and associates. However, certain environmental influences are deeply ingrained and evident among young adults who no longer live with their parents. Health practitioners working with young adults struggling with addiction should identify the personal values that the community or family has instilled in the addict. Diagnosing Addiction Among Young Adults Discussion Paper

Another aspect of genetic factors and addiction explored during diagnosis is the interaction between childhood behavior issues and later addiction disorders. In the genetic influence, the conduct disorder in substance-dependent fathers is closely linked with later substance disorders. Specifically, certain genes that seem to influence adult substance addiction are associated with conduct disorders in childhood and adolescence instead of early drug dependence (Lin et al., 2022). This further suggests that childhood conduct problems could be an early expression of an underlying genetic predisposition to subsequent substance use problems. The linkage between genetic predisposition and behavioral problems emerges earlier in an individual’s development since genetic factors are more apparent in conduct disorders before their influences on patterns of substance dependency (LeTendre and Reed, 2017). Early behavior problems are considered in diagnosis because they could have been a manifestation of genetic factors that influence substance abuse and dependency among emerging adults.

Practitioners also understand that individuals typically abuse more than one substance. The polysubstance approach is adopted in diagnosis, given the high prevalence of dependence across different drug classes. Moreover, individuals struggling with addiction also exhibit symptoms of other mental health disorders, including antisocial personality disorder and severe mood swings. Genetic predisposition increases the susceptibility to various forms of substance addiction as well as other psychopathologies. Research continues to suggest that genetic factors that influence one’s susceptibility to drug and alcohol addiction are the same genetics associated with childhood behavior disorders and adult antisocial tendencies (LeTendre and Reed, 2017). Therefore, there are common genetic factors for externalizing psychopathologies and substance dependence. Alcohol addiction and illicit substance dependence have shown similar genetic influences specific to each disorder. Specifically, 64 percent and 69 percent of total genetic variance on illegal drug addiction and alcohol dependence respectively, result from genetic predisposition evident across a specific externalizing psychopathology (Meyers and Dick, 2013). Consequently, genetic factors that influence drug or alcohol addiction are not specific to that dependence disorder. To this end, practitioners do not consider each disorder separately because addiction is a manifestation of risk to a multitude of externalizing problems, including antisocial personality disorder and conduct disorder. Diagnosis of conduct disorder or antisocial personality is crucial in diagnosing addiction among young adults because those externalizing disorders could be a manifestation of the risk of alcohol and drug dependence.

Both environmental and genetic factors are considered during diagnosis because of their interaction. Certain environmental factors have been shown to moderate the importance of genetic influences on drug abuse and addiction, as well as externalizing disorders. Some of the environmental moderators explored during diagnosis include childhood stressors such as sexual, physical, and emotional abuse, prosocial and antisocial behavior of peer-group, access to alcohol and illicit drugs, parental monitoring, religiosity, and parental attitudes toward alcohol and substances (LeTendre and Reed, 2017). Genetic factors strongly influence substance use and addiction among young adults without a religious upbringing. Additionally, genetic predisposition play a major role in substance dependence among individuals with a history of minimal parental monitoring. This is because individuals engage in early use in adolescence since the lower parental monitoring gives them more opportunity to manifest genetic predisposition (LeTendre and Reed, 2017). Furthermore, young adults who associate with deviant peer groups in adolescence have a conducive environment to express their genetic influences. The moderating effects of environmental factors on the effects of genetic factors are crucial in diagnosing addiction among young adults.

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The paper has demonstrated how environmental and genetic factors are considered when diagnosing substance and alcohol addiction in young adults. Those who start alcohol misuse before the age of 15 are more likely to develop other forms of addiction, like drug abuse disorders. Practitioners explore adolescent behavior because addiction in young adulthood may be exacerbated by the likelihood of substance and alcohol use in adolescence, altering the course of teenage development. Also, early use of illicit substances and alcohol can affect the biologic development of an adolescent brain. In diagnosis, the polysubstance approach is adopted, given the high prevalence of dependence across different drug classes and the exhibition of symptoms of psychiatric disorders. Early behavior problems are considered in diagnosis because they could have been a manifestation of genetic factors that influence substance abuse and dependency among emerging adults. Certain genes that seem to influence adult substance addiction are associated with conduct disorders in childhood and adolescence. Both environmental and genetic factors are considered during diagnosis because of their interaction since specific environmental factors have been shown to moderate the importance of genetic influences on drug abuse and addiction.

References

Baratta, A. M., Rathod, R. S., Plasil, S. L., Seth, A., & Homanics, G. E. (2021). Exposure to drugs of abuse induce effects that persist across generations. In International review of neurobiology (Vol. 156, pp. 217-277). Academic Press.

Castillo-Carniglia, A., Keyes, K. M., Hasin, D. S., & Cerdá, M. (2019). Psychiatric comorbidities in alcohol use disorder. The Lancet Psychiatry, 6(12), 1068-1080.

Giménez-Meseguer, J., Tortosa-Martínez, J., & Cortell-Tormo, J. M. (2020). The benefits of physical exercise on mental disorders and quality of life in substance use disorders patients. Systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(10), 3680.

LeTendre, M. L., & Reed, M. B. (2017). The effect of adverse childhood experience on clinical diagnosis of a substance use disorder: Results of a nationally representative study. Substance use & misuse, 52(6), 689-697.

Lin, L. A., Powell, V. D., Macleod, C., Bohnert, A. S., & Lagisetty, P. (2022). Factors associated with clinician treatment recommendations for patients with a new diagnosis of opioid use disorder. Journal of Substance Abuse Treatment, 141, 108827.

Meyers, J. L., & Dick, D. M. (2013). Genetic and environmental risk factors for adolescent-onset substance use disorders. Child and Adolescent Psychiatric Clinics, 19(3), 465-477.

Volkow, N. D., & Boyle, M. (2018). Neuroscience of addiction: relevance to prevention and treatment. American Journal of Psychiatry, 175(8), 729-740.

Zehra, A., Burns, J., Liu, C. K., Manza, P., Wiers, C. E., Volkow, N. D., & Wang, G. J. (2018). Cannabis addiction and the brain: a review. Journal of Neuroimmune Pharmacology .Diagnosing Addiction Among Young Adults Discussion Paper