Hello. Dr. Brensilver here again.
In a certain sense, you could say we’re all scientists. Even if we don’t make our living from science, we all try to understand causes and effects in our lives and in our world – and the attempt to understand cause-effect relationships lies at the heart of scientific investigation.
In terms of substance abuse, many of us who realized that we were addicted attempted to understand the reasons for our addiction. In explaining the reasons for one’s own addiction, people often make reference to difficult feelings, traumatic experiences, the desire for pleasure or peer influences. Are the reasons that people give correct? Do the reasons that are given correctly identify the causes of an individual’s addiction?
This is a difficult question to answer, but we can get some clues from a brilliant study of depression recently published by Kendler and colleagues. I’ll explain how Kendler tried to answer our question – it’s a little subtle, but really interesting. From a larger study on psychiatric genetics, the authors identified 630 people with a history of depression. All 630 participants provided rich details about their lives when they experienced depression. Kendler then determined the level of understandability of the episode of depression. So, for example, if a person had faced really difficult experience (i.e. one’s child being diagnosed with a serious disease and the accompanying financial stress) their depression would be rated as ‘completely understandable.’ If, on the other hand, everything in the person’s life seemed to be going well and there were no major stresses or conflicts and the depression came “out of the blue,” their depression would be rated ‘not understandable.’ Level of understandability was rated from one to five. Here’s how their reasoning went: If the person’s depression was very understandable and their reasoning process was valid, you would expect that person to have fewer risk factors for depression than the people whose depression was ‘out of the blue’. The ‘out of the blue’ group should, for example, have more anxiety, be more neurotic, have a family history of depression and be more likely to get depressed in the future than the ‘completely understandable’ people. But, this is not what Kendler found. Instead, those with understandable depression had the same level of risk as those with depression that was not understandable. The authors conclude that the reasons people give for their depression do not represent the actual causes of their depression.
The study was about depression, but my guess is that the findings would be similar for addiction. The reasons that an individual gives for their addiction may not always be the causes of their addiction.
So, what’s the upshot of all this? First, mental health professionals should not be hesitant to treat depression or addiction, even when people give good reasons for being depressed or addicted. Second, simply because we’re not great scientists in understanding our own depression or addiction, it doesn’t mean we should stop trying to understand. There is evidence that the stories we tell about our problems can be adaptive and help us deal with the challenges of our life more effectively. Expressive writing and some forms of counseling are ways of telling stories, and this kind of story-telling can be truly helpful. Third, the study doesn’t mean that all causes of depression are genetic – environmental factors certainly play a role in the genesis of depression or addiction. Rather, it means that sometimes the causes are opaque to us. We’re reminded to be humble as we go about trying to understand the causes of our difficulties.
Link to study: http://www.ncbi.nlm.nih.gov/pubmed/21383746
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