“My name is Mo, and I am an alcoholic and a drug addict” are words that I never thought I would need, or want, to string together. I am also a physician, a son, a brother, a friend, a dog-owner and an active participant in several communities. I have an amazing family, wonderful friends, a passport with extra pages full of stamps and degrees from top universities. Despite this, I found myself homeless, destitute and with very little will to live. 

In the long-form definition of addiction published by the American Society of Addiction Medicine, we learn that “about half of the likelihood that an individual will develop addiction” is genetically predetermined. Genetics, alone, are not enough to produce an addict or an alcoholic. The other half of the formula has to do with environmental factors and how these factors dance with an individual’s genetic predisposition. 

Much to our misfortune, genetics are far less modifiable than environmental factors. 

Any cardiologist would tell a child of a parent with a history of premature death due to coronary disease to quit smoking, eat healthy and exercise. The genetics are unquestionably there. Optimization of environmental risk factors as related to coronary artery disease, in addition to treatment of co-morbid conditions and preventative medication as indicated, is paramount in this patient population to best protect individuals from their unique genetic predisposition.

As non-researchers in the field of addiction and members of society at-large, these environmental factors are where our attention should be.

“Environmental factors” is not a euphemism for “access to drugs or alcohol.” 

While drugs and alcohol are at the core of the destruction and incomprehensible demoralization that addicts and alcoholics so profoundly experience, they are not the problem. In fact, drugs and alcohol were the solution to my problem. They numbed the pain and flattened the fears I experienced from my perceived inability to live authentically. 

My main goal in my lifelong journey of recovery is to live authentically. Wray Herbert, an award-winning journalist and writer on the psychological sciences, writes, “authenticity [is] acting in accordance with one’s thoughts, desires, and needs. This commitment is essential for self-regulation, and violating this commitment leads to feelings of inauthenticity, which taint one’s moral self-concept and lead to emotional disregulation. In short, being an imposter to oneself leads to moral and psychological distress.” 

On September 30, 2017, The New York Times’ Editorial Board published an opinion piece titled “America’s 8-Step Program for Opioid Addiction” suggesting steps to be taken on a large-scale to address the current and growing pandemic. 

On a far smaller, and perhaps more impactful and meaningful scale, let’s work to reduce the prevalence of addiction and alcoholism together by fostering safe environments for all members of our society to live authentically without fear or shame, such that an individual’s genetic predisposition matters less.

This would also help anyone without the genetic predisposition to addiction and alcoholism who may struggle with the ability to be authentic, and therefore happy.