On April 5. 2012 my colleague Pat Olsen revealed in this blog that Dr. Kenneth Blum, PhD had chosen Malibu Beach Recovery Center as one of 10 U.S. treatment centers to participate in the first clinical study of a Genetic Addiction Risk Score (GARS) he has developed. Funded by Dominion Diagnostics, GARS was patented in 2005 (Blum patented an earlier version in the 1990s). GARS is designed to test 9 genes and 17 alleles (genetic variants) in men, 18 in women. Using a simple saliva test, GARS can show predisposition to all reward deficiency syndromes from alcohol and drugs to smoking, sugar craving, high-risk sex, gambling, and ADHD. It was Dr. Blum who in 1990, with Dr. Ernest Noble, first discovered the link between genetics and addiction.
One of the first at MBRC to volunteer to take the GARS test was Counselor Elisabeth (“Liz”) Winchell. The results of the tests are confidential, but as soon as they became available Liz asked Dr. Blum for hers. She found the results so interesting that she allowed Dr. Blum to publish them. The paper about Liz and her genetic predisposition to addiction will appear in an upcoming special Issue of the OMICS-Addiction Research & Therapy Journal. The article is entitled: “Neurogenetic Impairments of Brain Reward Circuitry Links to Reward Deficiency Syndrome (RDS) as evidenced by Genetic Addiction Risk Score (GARS): A Case Study.”
Joan: Liz, how long have you been sober?
Liz: I celebrated 17 years of consecutive sobriety last May 5th.
Joan: Briefly describe your history with drugs and alcohol
Liz: My first use was at age 13; I drank a wine punch and became violently ill. I did not drink again for several years. But I was diagnosed that year with bleeding ulcers and prescribed a barbiturate medication called Donnatal. Over the next 18 months five members of my immediate family (everyone except my mother, who completely lost her mind) died and I quickly found that taking handfuls of Donnatal helped me to forget.
From age 14-15 I used LSD and began stealing Tuinal and Seconal from my mother. I also tried Cocaine intranasally. From 16 -18 I used Quaaludes and other sedatives and was hospitalized multiple times from overdoses. I also began using prescription stimulants intravenously and had multiple police encounters. My mother sent me to treatment at Saint John's Hospital in Santa Monica but I ran away. (I was a chronic runaway)
At 18 I moved back to NYC and began shooting heroin and cocaine. Heroin made me violently ill, but it made me emotionally invulnerable like no other drug I had tried. Vomiting for hours when on it, and for days when I did not have it was a small price to pay for being able to 'function' without feeling a thing. (I was a singer in punk rock bands and working in music clubs, so this lifestyle was the norm in the late 70s and early 80s) I would drink alcohol every so often, but there was no question that I was literally allergic to it, even on small amounts I would experience alcohol poisoning type symptoms.
In my 20s I began trying to stop using on my own. I did many methadone detoxes and fell into a pattern of being able to stop all drugs (except alcohol) for several months at a time. Invariably, I would go back to using. I began seeing Dr. Harvey Karkus, a celebrity psychiatrist in New York who ran a methadone clinic (my fellow patients were the guys from Aerosmith, among other big bands at the time). Dr. Karkus saved my life. He took me under his wing. Doing therapy with him, as well as having a professional 'friendship' with he and his wife made a huge difference in my ability to imagine a life without alcohol and drugs. I was kept on a low dose (35 milligrams) of methadone, and although I periodically 'slipped' by using pills and cocaine I started going to AA meetings.
Although I did not stay sober until my 30s (with several AMAs from treatment at Hazelden, Cedar Sinai, etc) I did modify my using pattern. I relapsed 3 times at 3 years sober (each relapse lasting only a few days), but was finally able to maintain abstinence.
Joan: Briefly describe what the GARS test revealed.
Liz: The test revealed that I have a genetic sensitivity (what AA would call, "an allergy") to heroin and alcohol. It also showed a marker for hyperactivity, with the possibility of ADHD, and impulsivity.
Joan: What made you volunteer to take the GARS test?
Liz: I know that science will one day confirm the hypotheses of 12 Step recovery: That there are biological differences in people who become addicts. I was very excited to participate in this study.
Joan: Did you think the results would show you were genetically predisposed to addiction?
Liz: Absolutely. The correlations with the specific drugs themselves are unmistakable. But, even more interesting is the identification of the hyperactivity that explains my preference for, and paradoxical reaction to, stimulant drugs. It also explains my pattern of relapse, which was predominately without plan or conscious intention. More than anything, I think this piece of information will help others to build a recovery plan contingent upon impulse control.
Joan: If you had received this information before you starting drinking and using drugs, would it have prevented you from becoming an addict?
Liz: I know that telling my daughter repeatedly as she was growing up that she has a strong family history of addiction on both sides had an impact on her desire to try drugs. She has not used anything except marijuana (in college) and is a social drinker. However, she manifested the addiction with overeating. Her eating disorder almost killed her, and she now works a strong 12 Step program.
So, yes, in general, having this information could impact the conscious decision to use drugs. However, if further research is done on cultures who do not have exposure to drugs and alcohol (Mormons, for example), it may be that the genetic compulsion might manifest in other obsessive behaviors.
Joan: At what stage of recovery do you see this information being useful.
Liz: I believe that knowing these things in early recovery, or even in treatment, could be useful. It could engage the addict and give him a scientific imperative of why he cannot continue to drink and use. It is helpful at any stage of recovery to explain, in hindsight, what history already shows. But it is somewhat anti-climatic. If I had known this in my very early recovery I am sure it would have made a difference. (as long as it was paired with therapy to address the deep-seated reasons I was using).
Joan: Would you want your daughter to be tested?
Liz: Absolutely. I would also like another assessment technique added that screened for other behaviors, like disordered eating, gambling, or sex addiction.
Joan: When you look back at your parents and grandparents, from whom you inherited these genes, what do you see?
Liz: I am positive that the results of my genetic testing indicate a pattern in my family going back several generations.
I have done several genograms to map my family patterns, and Dr. Blum's research just confirms what drug and alcohol treatment professionals have always suspected: I have inherited a genetic predisposition to compulsive behaviors.
Although I did not know my father Hyatt von Dehn well, he did tell me that he was an alcoholic in recovery. His driven personality was evident in his career as a hotelier (he founded the Hyatt Hotel chain). Hyatt had two sons from a different marriage, and the strain of addiction affected both as well as their families for several generations. One of my half brothers did not drink to excess or use drugs, but he died from complications related to overeating. It may be interesting to note that my father was married seven times, which suggests compulsivity in itself.
My mother Eileen Jean "Walda" Winchell did not drink to excess or take narcotics, but she was chronically ill. She was overprescribed opioid pain medications and become dependent on them.
My maternal grandfather was columnist and media personality Walter Winchell. He did not abuse alcohol at all, nor did he touch drugs of any kind. He was a workaholic though. I am sure that I inherited my intense energy from him. My grandfather was full of energy. This was manifested in a brilliant mind, pressured speech (which became his trademark), and a great passion for the injustices in the world, as well as those he perceived were done to him. Walter's father was an alcoholic and womanizer who brought shame to the family. The Winchell family came from a long line of Rabbis and published poets and scholars in the Ukraine. Although there is no addiction noted in that lineage, there were definitely problems with melancholia.
My maternal grandmother was the daughter of an alcoholic, although she did not grow up with her father. She rarely drank, but like my mother had many serious health problems and used prescription pain killers and sedatives to excess. Both my mother and her mother also were invested in staying very slim, and in my mother's case this bordered on disordered eating.
Finding out the results of my genetic testing has given me peace of mind, and helped me to begin a deeper acceptance of my own drug use. As a recovering addict/alcoholic I consider myself completely responsible for my choice to drink and use, but I now know absolutely that I must never drink and use again because of my genetic makeup. The genetic test results provided me the information about my impulsivity that I can now utilize to continue to build a strong foundation for long-term relapse prevention.
Photo: Elisabeth ("Liz") Winchell