Addiction Medicine: Closing the Gap between Science and Practice

25.4

33.0

37.7

38.7

43.5

Predisposition/Genetics/

Family History

Lack of Willpower/Self-Control

Stress/Anxiety

Easy Availability

Inability To Resist Peer Pressure

P E R C E N T

Figure 2.A

Perceived Causes of Addiction ....................................................................................

Involving Tobacco/Nicotine

Source: CASA Columbia National Addiction Belief and Attitude

Survey(NABAS), 2008.

Note 1: Respondents could choose two or three answers.

Note 2: Other research finds that genetics account for up to 75% of

the risk of nicotine dependence.

However, as a sign of increasing acceptance of
addiction as a disease, this same survey found
that the majority (78 percent) regard addiction
involving drugs other than nicotine or alcohol as
a chronic disease.^203 Another 2009 nationally
representative survey of adults ages 18 and older
also found that the majority of the respondents
believe that addiction is a health condition that
requires ongoing attention and support (83
percent).^204

Perceived Causes of Addiction

For decades, public misconceptions about the

origins of addiction have led to negative
attitudes and discrimination against those
afflicted with the disease and hindered progress
not only in understanding it, but also in
developing and providing effective treatments
for it.^205 In 2008, CASA Columbia probed these
perspectives with a nationally representative
survey of American attitudes toward substance
use and addiction--the National Addiction Belief
and Attitude Survey (NABAS). Although public
attitudes increasingly appear to be reflective of
the science of addiction, people still often hold
conflicting views about the causes of addiction,
many of which are inconsistent with the growing
body of evidence.

CASA Columbia’s NABAS found, for example,
that while many people understand that factors
such as genetics, family history, other health
problems and availability of addictive
substances play a role in the development of
addiction and that loss of control is a defining
characteristic of the disease, a significant
proportion of Americans cite “lack of will power
or self-control” as a primary causal factor.
Surprisingly, respondents who had a personal
experience with addiction--either that of a
family member or friend or their own--did not
differ much from the general public in these
perceptions of the key contributors to addiction.
Respondents also had different views on the
causes of addiction depending on the substance
involved.^206

Tobacco/Nicotine. Despite the fact that

genetics account for up to 75 percent of the risk

for addiction involving nicotine,^207 the NABAS

found that only one in four respondents (25.4

percent) cited “a predisposition to addiction, due

to genetics or family history” as a primary

causal factor when given a list of potential

causes of addiction involving tobacco/nicotine.

Respondents were most likely to cite an

“inability to resist peer pressure” (43.5 percent);

“easy availability of tobacco among youth”

(38.7 percent); “stress or anxiety about work,

family or other problems” (37.7 percent); and

“lack of willpower or self-control” (33.0

percent) as primary causal factors.^208

(Figure 2.A)

Alcohol. Public attitudes are more aligned with

the science regarding the role of genetics in

addiction involving alcohol. Genetics account

for 48 to 66 percent of the risk that someone

who drinks alcohol will become addicted^209 and

nearly half (47.6 percent) of respondents to the

NABAS cite “a predisposition to addiction, due

to genetics or family history” as a primary

causal factor. Other perceived primary causes of

addiction involving alcohol include “stress or

anxiety about work, family or other problems”

(44.9 percent); “emotional disorders or mental

illness, such as depression or anxiety” (35.3

percent); “lack of willpower or self-control”