These days most of us are willing to believe that drug addiction—including alcoholism—is a disease. Still, we harbor a sneaking suspicion that it’s really a disease of the weak-willed, the spiritually unfit, or people who are not quite like us. The comedian Mitch Hedberg understood this when he riffed:
Alcoholism is a disease, but it’s the only one you can get yelled at for having.
“Goddamn it, Otto, you’re an alcoholic!”
“Goddamn it, Otto, you have lupus!”
One of those two doesn’t sound right.
Whatever our prejudices, the truth is, given the right circumstances (which can include factors like high stress, early drug exposure or childhood abuse, poor social support, or genetic predisposition), anyone can become a drug addict. Addiction is not just a disease of weak-willed losers.
Indeed, many of our most important historical figures have been drug addicts—not only the creative, arty types like Charles Baudelaire (hashish and opium) and Aldous Huxley (alcohol, mescaline, LSD), but also scientists like Sigmund Freud (cocaine) and hard-charging military leaders and heads of state from Alexander the Great (a massive alcoholic) to Prince Otto von Bismarck (who typically drank two bottles of wine with lunch and topped it off with a little morphine in the evening).
From studies comparing identical and fraternal twins it is estimated that 40 to 60% of the variation in the risk for addiction is contributed by genetic factors. That said, we are only in the early stages of understanding genetic contributions to addiction. There is no single “addiction gene,” and it is likely that a large number of genes are involved in this complex trait.