Addiction and the factors that fuel it

Addiction doesn’t happen in a vacuum.

As Department of Psychiatry associate professor Sheila Specker, M.D., has seen time and again, it’s often accompanied by depression, bipolar disorder, an eating disorder, or another mental health problem. Sometimes it’s one thread in a tangle of issues; often it’s tough to tease out which problem came first.

Two decades ago, when Specker was running an outpatient treatment program she’d developed for women battling addiction and eating disorders, she learned that in many cases, depression had often preceded both.

“And we were surprised at the high rates of sexual and physical abuse” in patients’ histories, Specker says. “We were also surprised at the high rates of suicide attempts, and of compulsive behaviors like shoplifting—and just the severity of other mental health problems.”

Those patterns informed the big-picture approach she would take—and continues to take—in her work. Aiming to improve both the prevention and treatment of addiction, Specker studies the complex interplay of different factors that keeps some people in the grips of alcohol or drug dependence.

Currently, she’s a lead investigator in a five-year study through the University’s Center for Women’s Health and the National Institute of Drug Addiction examining differences between men and women in impulsivity and addiction.

She’s also partnered with the Hazelden Foundation to explore the role of impulsivity in young adults addicted to cocaine and other stimulants. “We used brain imaging to look at connections in the brain in those who relapsed versus those who didn’t. It does appear there’s a difference,” Specker says.

Specker spends about a third of her time in the clinic, often treating health professionals with addiction. And recovery rates are markedly higher among health care providers, she says. “There’s a lot at stake: reputation, livelihood. They tend to have more of a support system. They tend to have better access to effective treatment options. Especially for physicians, the resources available are better.”

As a consultant to Tapestry, a women’s residential treatment program in St. Paul, Specker continually sees how unemployment, homelessness, and “psychosocial instability” undermine patients’ efforts to break free.

Across all demographics, a few things have become clear to Specker over time. “The genes are most critical,” she says, when it comes to addiction—and, therefore, so is the role of early counseling for youth who have it in their family history.

Perhaps most important, “People who have ongoing support from others in recovery, and those who do ongoing treatment activities, do better.”