Dr. Howard Wetsman has always known he was half Irish and half Jewish. But after undergoing genome testing, he was shocked to learn he also had African Ancestry. The test revealed he had a liver enzyme that is African.
That enzyme also impacts the way his body metabolizes certain drugs.This is an important discovery for Dr. Wetsman as he is involved in research looking at how genetics impacts addiction and how pharmacogenetics can lead to more personalized addiction treatment.
His story was featured in our blog article, Genetics of Being Black in Addiction.
- The US Surgeon General has called addiction a public health crisis
- Only one in ten people with addiction are actually getting treatment
- Addiction is considered to be, on average, heritable about 50 percent of the time, according to the journal Clinical Pharmacology & Therapeutics
- Genetics and environmental factors are thought to play equal roles in the onset of addiction, the National Council on Alcoholism and Drug Dependence (NCADD) states.
- In 2015, more than 27 million people in US were current users of illicit drugs or misused prescription drugs
- Drug overdose is the leading cause of accidental death in the US
Listen to Dr. Wetsman’s full interview below.
Dr. Wetsman answers your questions about addiction below:
Can you become addicted to sugar?
I see addiction the same way the American Society of Addiction Medicine has defined it, and that means that addiction is one illness regardless of the substance or behavior involved. And the answer is yes, you can have addiction involving sugar.
In fact, studies on other mammals shows that sugar affects the same receptors in the brain as opioids. At our American Addiction Centers clinics in Louisiana we have treated people with primary addiction involving sugar, and treatment works.
What about sex addiction? Is it in my genetics as well? How can I break the cycle?
Regardless of the reward, whether substance or behavior, involved in addiction, what causes addiction is rarely just genetics or environment. Most often its a combination of both. Some of the biology and the interaction between genetics and environment is described in a recent Youtube video I did.
As to addiction involving sex, breaking the cycle is the same as addiction involving anything else; reach out for help. No one does this alone. There are treatment centers that address addiction no matter where you are in the country, and there are mutual help organizations such as Alcoholics Anonymous, Overeaters Anonymous, Sex and Love Addicts Anonymous, etc., available both in your area and on line.
How does the doctor’s theory explain the rising number of Whites addicted to heroin? Was there a government intervention regarding African-Americans?
No matter what population you look at, regardless of country, ethnicity, economic status, educational status, religion, or other factor, you’ll see the same 10-20% of that population has addiction. What’s most important to understand about opioids is that people in the addiction treatment field have seen this coming from a long time ago. Unfortunately, it’s only seemed to become important enough to have a national conversation about since people with more access to politicians have started to die in greater numbers.
Before this opioid epidemic, addiction was killing more Americans than anything else. After this opioid epidemic, that will still be the case. What changes from time to time is what substances or behaviors are involved in addiction, but addiction hasn’t really changed. It is true that some substances can kill you faster than others, or more certainly than others, but it’s important to remember that this is the 3rd American Opioid Epidemic. The other two ended and so will this one, but what’s important is that we don’t stop talking about addiction when this one’s over they way we did after the last two.
What do Irish genetics say?
Again, I’d say that I haven’t seen any study showing that addiction, as a unified illness, happens less or more in one population than another. You’ll see lot’s of non-scholarly and scholarly works about the preference of one nationality or another for a particular substance, and I imagine the popular notion about the Irish and alcohol is what motivates the question.
But these kinds of things aren’t core to addiction, they are just imposed by the happenstance of access, economics or cultural rules of the time. You will see some genetics that make some drugs less likely to be involved in addiction in some populations, but this doesn’t affect the percentage of the population that has addiction.
It just involves other rewards. For instance in the Japanese, it is quite common to have a problem metabolizing alcohol so that it’s harder to use the substance. Consequently addiction involving alcohol may be comparatively less common in Japanese, but addiction isn’t.
Is gambling part of genetic addiction?
Addiction is both genetically and environmentally determined, but yes, if you have genetics leading to addiction, gambling may still be a reward involved in the illness.
I’ve been clean and sober for 6+ years, when do the dreams of getting high stop?
This is a most important question, because there’s a lot of stories in the recovering community about “drug dreams.” The science is, as best as I can tell, that dreams are random. They don’t mean a lot. Dreams about getting high don’t mean you want to get high or that your recovery isn’t good.
It’s best to look at them as if two random brain cells accidentally interacted. Just wake up and say, “Well, that happened, and now it’s over.” Call someone, go to a meeting, read some recovery literature, but don’t take it personally. As to when this stops? I know people with decades in recovery who still have them.
So what Dr. Wetsman is basically saying that the enzymes in the liver process the drug at such a high rate that it will increase a person’s dependency on it? What if that drug never enters their system?
The enzymes in our liver aren’t really there for medications or drugs. They are there for environmental toxins, and that’s how the liver sees anything we put in our bodies, as a toxin. So even a medication your doctor gives you to help you, your liver will see as a toxin to be gotten rid of.
The mutation I mentioned really has nothing to do with dependence, it has to do with the liver’s clearance of the medication. So for patients who need the medication for treatment of addiction, those with the mutation may need higher dosages. Their asking for the higher dose was initially seen as “drug-seeking” when in fact it was just their real experience brought about by their genetics.
Does the addiction gene affect all potentially addictive behavior? (e.g. food, gambling, etc.)
Well there’s no addiction gene, but rather many that can contribute, and yes, addiction involving any behavior or substance can be just as genetic as addiction involving alcohol, opioids, or anything else.
As an RN with a Masters degree and soon a doctorate, I’m completely disturbed by the doctor’s statements. I would suggest asking for specific research studies that support his theory, when the studies occurred, and the population studied.
This type of nonsense confuses people and is consistent with the type of discriminatory studies of minorities throughout history. I’m surprised this is the basis of his “education” today. I’m not saying it’s not true, but I’m asking for research support that confirms his statements so that I can look at it from an “African genetic” perspective and get less offended…..I hope.
I’m not sure what you heard me say that is so disturbing, so let me, hopefully, clarify it. Addiction is no more likely in a minority population than a majority population, regardless of what country you look at. There is no group that is genetically more likely to have addiction than any other. By not looking at the genetics however, we are more likely to ascribe to cultural differences things that are just biological, and that has served to increase prejudice, not decrease it.
I was referring to the several studies that opined that patients with addiction involving heroin were less able to be treated than patients with addiction involving opioid pills when buprenorphine first came out. There were subtle biases in these and hidden prejudices. It was clear from the demographics that the heroin-using groups were more urban and more African-American than the opioid pill using groups.
These studies ascribed these differences to the “heroin culture,” and made it sound like certain patients had poorer outcomes than others. In fact, I hear from colleagues weekly that still believe that buprenorphine treatment for addiction involving opioids doesn’t work for “some people.”
They completely ignored that some patients, depending on genetics, needed higher doses for good treatment. I hope I’m making it clear that prejudice should be eliminated and that each patient’s care be individualized. As I said, we have to stop looking at what people look like on the outside and start looking at the inside. We’re all different and all deserve individualized care.
How well researched is this genetics theory? Does this theory have anything to do with the melanin that darker people have? What implications does this theory have for AOD treatment and
Not sure what genetic theory you’re referring to. I was talking about a liver enzyme that affected the metabolism of a medication we use to treat addiction. If you mean how well researched is the genetic cause of addiction, I’d say very well. You can find dozens of studies that all say a minimum of 50% of the variance is genetic, and those are conservative.
For example, imagine a person growing up with a father with addiction involving alcohol. The son hates that his father drinks and swears he’ll never touch a drop. At age 40 he’s in a study about alcoholism and he’s marked down as a person who is the biological child of an alcoholic but doesn’t drink.
He counts against the genetics in this study. But they never asked him if he had addiction involving anything else and don’t count his addiction involving opioids. If you define addiction as one disease, the genetics will account for more than 50%.
I don’t have any information on melanin or skin pigment. In fact, my best guess from the literature is that it has nothing to do with it, because addiction is pretty much the same no matter what your skin color.
Implications for addiction treatment are huge. Professional treatment organizations such as AAC understand that each patient needs individualized care both at a biologic and psychosocial level. The older models of treatment are, perhaps, more cookie cutter in their approach, but this is changing rapidly.
I‘m an African-American female. Who’s been on buprenorphine 4 yrs. Now I’m on a maintenance dose. I feel that I’m a success story. My only issue is that my doctor hasn’t talked about me weaning off and I’m ready. What can I do?
I get this question a lot from a lot of different directions so I have several answers. My political answer is why do we talk about the need to get people off of buprenorphine when we’d never talk about the need to get patients with diabetes off of insulin? My recovery answer is why would we want to change something that’s working? But you aren’t asking a political or recovery question. So let me give you a personal answer. If you want to get off, the best thing to do is talk to your doctor. Don’t try it by yourself.
Let me add something of what we’ve learned getting hundreds of people both on and off buprenorphine. Not everyone who is on buprenorphine needs to stay on it, but some do. Some who don’t will need something else to stabilize their midbrain dopamine tone in the absence of buprenorphine.
Remember, if you see addiction as a primary illness, there’s no “normal” to go back to, just the illness that started the use in the first place. So what we’ve learned from the genetics is that there are people who can’t get off buprenorphine without getting on something else, sometimes something as simple as a prescription vitamin, that can replace the function that buprenorphine is patching up.
Thanks for asking, and thanks for being sober.
Does addiction skip a generation?
That’s a commonly referred to idea, that addiction skips a generation. There are technical reasons why it can, but most commonly it doesn’t. What does skip a generation is the drug involved. This is most common because the person growing up with addiction sees what his parent is using, blames the drug, and decides he’ll never use it.
In his life addiction doesn’t involve that drug, but rather another reward that is more acceptable to him (perhaps work, money, overeating, etc). His children, who never see him use Granddad’s drug have no problem with it. They try it, and it works. So if you define “addiction to” something, it would appear to skip a generation, but in the families with addiction I’ve seen, I don’t see the skip, just a change in most effective reward.