ADDICTION IS A DISEASE, BUT THE ADDICT IS STILL RESPONSIBLE

“Oh, no, you’re not going to tell me that it’s all just hereditary and he’s not responsible for what he does.” That was from a high school friend of ours talking about her pending divorce from an alcoholic, drug-addicted husband.

And she’s not alone. Many people refuse to accept that alcoholism and drug addiction are diseases. Such notable “experts” as Rush Limbaugh have made similar claims, protesting that calling addiction a disease is just an excuse that allows people to avoid responsibility.

But why should calling something a disease imply that people don’t have to be responsible for their actions? Shouldn’t people who have a hereditary disease still be held responsible for the decision to get treatment?

And scientific evidence clearly shows that alcoholism is a hereditary disease.

Studies of twins are a good way to learn if something is hereditary. Identical twins are formed from the same egg, and have twice as many genes in common as fraternal twins, who are formed from two different eggs. If alcoholism were caused by growing up in a crazy home or just plain willfulness, the number of genes wouldn’t matter. Fraternal twins would have the problem in common just as often as identical twins.

But they don’t. If one twin is alcoholic, the odds that an identical twin is also alcoholic is twice as high as for fraternal twins. The number of genes in common does matter, and that’s evidence that alcoholism is a hereditary disease.

Adoption studies are even better. What happens when siblings are separated at birth and grow up in different homes, say rural vs. urban, religious vs. secular, or with alcoholic vs. non-alcoholic parents? Some things will be very different. Others won’t. For example, children separated at birth are just as likely to have the same eye color as siblings who grow up together. That’s because eye color is hereditary.

A lot of research has been done on sons of alcoholic parents, including the ones separated at birth. Researchers have found the boys whose biologic parents are alcoholic are four times as likely to become alcoholic themselves, and it doesn’t matter where or how they grew up. Kids with alcoholic genes who are adopted at birth and grow up in healthy, loving and non-alcoholic homes have the same rate of alcoholism as anyone else born to alcoholic parents.

People who become alcoholics do so because of an inborn, hereditary predisposition. They don’t choose to become alcoholic and it isn’t just willfulness. They are not responsible for having the disease.

But they are most certainly responsible for what they do about it, the same as with any other hereditary illness.

Diabetes, for example, is partly genetic. We don’t blame people for being diabetic. But we expect them to see a doctor, watch their diet, take their insulin and do whatever else is necessary to take care of themselves.

If a diabetic is hospitalized for not taking his insulin, we wouldn’t say, “It’s not your fault; you have a disease.”

No, we’d say, “Start taking your insulin before you kill yourself.”

Epilepsy is also an illness, so we don’t blame people for having it. But if someone with a treatable form of epilepsy kept having seizures day after day we wouldn’t say, “Oh, you poor thing. You’re not responsible for this.”

No, we’d say, “Why don’t you see a doctor and get on some medicine before you get hurt.”

And we wouldn’t blame family members for finally throwing up their hands and having nothing to do with a diabetic or epileptic who keeps landing in the hospital because he refuses to take his medicine. If someone is so irresponsible as to not get help for a chronic illness, should his family be expected to continually support and protect him?

Addiction is no different. Researchers are certain that alcoholism is a hereditary disease and drug addiction probably is, too. But these are treatable diseases and people who have these diseases are responsible for getting treatment.

Our high school friend is right to divorce her husband. Not because he is a moral misfit and a willful drug abuser. But because he refused to get help for a treatable disease that has ruined their marriage. His alcoholism and drug addiction are hereditary diseases, and he is responsible for what he does about them.

Jim Gogek is an editorial writer and columnist for the San Diego Union-Tribune. Ed Gogek, M.D. is a psychiatrist at the Meadows, an addiction treatment facility near Phoenix, AZ.