Category Archives: Drug use
Over the weekend I went to the cinema with my oldest son to watch Mad Max: Fury Road. The reason I mention this is because King Immortan Joe in the film (who live in a world where water is a scarce commodity) tells his thirsty subjects “Do not become addicted to water, it will take hold of you”. As soon as I got home after the film, I was straight onto Google and Google Scholar to see whether there had been anything written on ‘water addiction’. Unsurprisingly, there were lots of newspaper reports of individuals being ‘addicted’ to water but little in the academic literature. For instance, one American online article told the story of Sasha Kennedy:
“[Sasha] is addicted to water, drinking 25 liters of the stuff a day, far exceeding the USDA Recommended Daily Water Intake of 2.7 liters…What surprised me most was that the condition had a name: Psychogenic polydipsia. It is ‘an uncommon clinical disorder characterized by excessive water-drinking in the absence of a physiologic stimulus to drink’ and is typically found among mental patients on phenothiazine medications. Kennedy appears to be completely sane, although she does experience the dry mouth sensation characteristic of the condition…You’d think drinking so much water would do something to her health, but medical experts confirmed that there is nothing wrong with her. She doesn’t even have hypoatremia, where cells swell due to too much water in the blood. She’s perfectly healthy and her blood isn’t diluted. Then again, her habit started when she was two years old, so maybe her body acclimatized. Her lifestyle, however, is drastically affected by her addiction. She has to go to the toilet 40 times a day and can only get about an hour of sleep every night before having to wake up to drink some water or go to the loo. She carries large bottles of water with her everywhere she goes, and once quit her job because the tap water quality wasn’t up to par”.
Another case was reported by the UK’s Daily Mail who recounted the story of 22-year old “aquaholic” Sarah Schapira who (at the time the article was written) drank seven litres of water every day, and like Sasha above spent a lot of time in the toilet. Schapira stated:
“My argument has always been that water is good for you and helps you to detox. We’ve all been told about the benefits of water, so I drink lots and lots of it, from the minute I wake up to the minute I go to bed. If I don’t have my bottle of water I feel paranoid. And if I try not to drink for an hour, I start to feel dehydrated and I get throbbing headaches. But it has got to the stage where I don’t know how to give it up. It used to make me feel really good and healthy but not any more. I know I ought to cut down but I’m not sure how I can”.
Polydipsia (which in practical terms means drinking more than three litres of water a day) often goes hand-in-hand with hyponatraemia (i.e., low sodium concentration in the blood) and in extreme cases can lead to excessive water drinkers slipping into a coma. The low levels of sodium causes the brain to swell which in turn constricts the blood supply to the brain when the brain compresses against the skull’s inner surface. Another person interviewed for the Daily Mail story was 26-year-old Rachel Bennett, a marketing agent from North London who drank also drank seven litres of water a day which led to headaches and dizziness. She said:
“My friends used to tease me about the amount I drank, but I dismissed their fears because I always thought it was so good for me. It got to the stage where I felt I couldn’t function without it. If I woke without a bottle of water by my bed, I would feel really paranoid. I couldn’t drink tap water – that tasted awful – instead I drank Evian by the gallon. It’s expensive, too – I could spend over £30 a week on water – but I had got to the stage where I got a huge buzz from drinking so much”.
In researching this article, I was surprised to find dozens and dozens of academic papers on psychogenic polydipsia (PPD). For instance, a paper by Dr. Brian Dundas and colleagues in a 2007 issue of Current Psychiatry Reports noted that PPD is a clinical syndrome characterized by polyuria (constantly going to the toilet) and polydipsia (constantly drinking too much water), and is common among individuals with psychiatric disorders. They also noted that:
“The underlying pathophysiology of this syndrome is unclear, and multiple factors have been implicated, including a hypothalamic defect and adverse medication effects. Hyponatremia in PPD can progress to water intoxication and is characterized by symptoms of confusion, lethargy, and psychosis, and seizures or death. Evaluation of psychiatric patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria, hyponatremia”.
A 2000 study in European Psychiatry by Dr. E. Mercier-Guidez and Dr. G. Loas examined water intoxication in 353 French psychiatric inpatients. They reported that water intoxication can lead to irreversible brain damage and that around one-fifth of deaths among schizophrenics below the age of 53 years are caused this way. The study reported that 38 of the psychiatric patients (11%) suffered from polydipsia with one-third of them at risk of water intoxication. They also reported that being polydipsic was significantly associated with being male, a cigarette smoker and celibate. Those with polydipsia were highly prevalent among those with schizophrenia, mental retardation, pervasive developmental disorders and somatic disorders.
A comprehensive review by Dr. Victor Vieweg and Dr. Robert Leadbetter in the journal CNS Drugs examined the polydipsia-hyponatraemia syndrome (PHS). They reported that PHS occurs in approximately 5%-10% of institutionalised, chronically psychotic patients, of which four-fifths have schizophrenia. Major clinical features are polydipsia and dilutional hyponatraemia. Patents with PHS can experience delirium, generalised seizures, coma and death. The main ways to treat such individuals are fluid restriction, daily bodyweight monitoring, behavioural approaches, and supplemental oral sodium chloride administration. However, these interventions can be expensive as they require experienced and dedicated multidisciplinary staff. They also report that:
“A number of pharmacological treatments have been assessed for PHS including the combination of lithium and phenytoin, demeclocycline, propranolol, ACE inhibitors, selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors, typical antipsychotic drugs, clozapine and risperidone. Of these agents, the most promising are the combination of lithium and phenytoin, and clozapine…Long term strategies include behavioural interventions and the combination of lithium and phenytoin, and clozapine”.
Unsurprisingly, I found almost nothing on being addicted to water. A 2010 review article on PPD by Dr. D. Hutcheon and Dr. M. Bevilacqua in the Annals of the American Psychotherapy Association claimed:
“One way to assess a patient’s ability to limit polydipsia is to examine their objective reasons why polydipsia is so important in their lives. This can be initiated during psychosocial rehabilitation group meetings held semi-weekly (e.g., two 15-minute sessions per week). In these meetings, many patients have described a euphoric quality associated with polydipsia, although others have admitted to increased irritability. Most patients have noted a desire for stimulation, similar to other substances of abuse such as alcohol or street drugs. Developing an understanding of what influences a patient to develop an addiction for polydipsia can improve management of this dysregulation of fluid intake…During the treatment period in a structured inpatient setting, many patients diagnosed with psychogenic polydipsia, whether falling in the range of mild, moderate, or severe addiction, are unable to sustain a comfortable discharge to an open ward…psychogenic polydipsia can become an addiction with no demonstrable cure if left untreated… Due to the nature of the addiction and potential for self-injurious behavior, treatment requires a milieu that balances maximizing the patients’ dignity with their safety, which demands close scrutiny by the multidisciplinary team”.
I also found an old case study from a 1973 issue of the British Journal of Addiction on ‘water dependence’. This paper reported that the excessive drinking of water can dilute electrolytes in an individual’s brain and cause intoxication. A couple of papers by Dr. Bennett Foddy and Dr. Julian Savulescu have cited this case study in their own writings on addiction. In a 2010 issue of Philosophy, Psychiatry and Psychology, they noted:
“Of course, it can be claimed that a person who is addicted to sugar or water is diseased, and that their brain has changed in such a way as to make their sugar- or water-seeking behavior involuntary. Yet we know how sugar interacts with the brain to form a sensitization effect, and it is identical to how drugs – and sugar – interact with the brain of a non-addicted person. If addictions are formed through a pharmacological process, it is the exact same process that forms a person’s likes and dislikes of any pleasurable stimulus. Terms like ‘addiction’ and ‘dependence’ can reasonably be employed when a person’s likes become particularly strong, but it should be understood that these terms denote a difference in degree, not a difference in kind…The only relevant difference between drugs and sugar is that drugs produce a higher level of brain reward relative to the volume of the dose. It is easier to get addicted to heroin than to sugar, because you can do it by taking a quarter gram at a time. It is very hard to get addicted to water, because you must force down liters of it every day”.
This interesting extract argues that it is theoretically possible for someone to become addicted to water and that there is no real difference to drug addictions in terms of conceptualization and mechanism – just that the sheer amount of water that needs to be drunk to have a negative effect is large and highly unlikely.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Daily Mail (2005). Aquaholics: Addicted to drinking water. May 16. Located at: http://www.dailymail.co.uk/health/article-348917/Aquaholics-Addicted-drinking-water.html
de Leon, J., Verghese, C., Tracy, J. I., Josiassen, R. C., & Simpson, G. M. (1994). Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. Biological Psychiatry, 35(6), 408-419.
Dundas, B., Harris, M., & Narasimhan, M. (2007). Psychogenic polydipsia review: etiology, differential, and treatment. Current Psychiatry Reports, 9(3), 236-241.
Edelstein, E.L. (1973). A case of water dependence. British Journal of Addiction to Alcohol and Other Drugs, 68, 365–367.
Foddy, B., & Savulescu, J. (2007). Addiction is not an affliction: Addictive desires are merely pleasure-oriented desires. American Journal of Bioethics, 7(1), 29-32
Foddy, B., & Savulescu, J. (2010). A liberal account of addiction. Philosophy, Psychiatry, and Psychology, 17(1), 1-22.
Hutcheon, D., & Bevilacqua, M. (2010). Psychogenic polydipsia: A review of past and current interventions for treating psychiatric inpatients diagnosed with psychogenic polydipsia (PPD). Annals of the American Psychotherapy Association, 13(1). Located at: http://www.biomedsearch.com/article/Psychogenic-polydipsia-review-past-current/222558218.html
Teoh, S.Y. (2012). Woman addicted to water drinks 100 glasses a day. The Mary Sue, July 12. Located at: http://www.themarysue.com/woman-addicted-to-water/#geekosystem
Vieweg, W.V.R., & Leadbetter, R.A. (1997). Polydipsia-Hyponatraemia Syndrome. CNS Drugs, 7(2), 121-138.
Verghese, C., de Leon, J., & Josiassen, R. C. (1996). Problems and progress in the diagnosis and treatment of polydipsia and hyponatremia. Schizophrenia Bulletin, 22(3), 455-464.
A few weeks ago, three independent things happened that has led me to writing this article. Firstly, I received an email from one of my blog readers who wrote:
“I’m a recovering addict. I still find that hard to admit even after time in therapy and the support of my loved ones, but to say it out loud can sometimes be a help. One part of my therapy, which really did strike a chord was something called ‘Chaos Addiction’. It was suggested to me that my addictive behaviors were fueled by a need to constantly have things in my life that were ‘in flux’ – to experience the ‘predictably unpredictable’. Looking back over my life, it hit home…I’d love it if you might think about sharing this with your site’s readership”.
Secondly, a couple of days later I was given a CD-R by one of my friends that included the song ‘Addicted to Chaos’ by the group Megadeth (from their 1994 album Youthanasia). Thirdly, a couple of days after that I was watching the film Chasing Lanes where the lead character in the film Doyle Gipson (played by Samuel L Jackson) is told by his Alcoholics Anonymous sponsor (played by William Hurt) that he was ‘addicted to chaos’ rather than alcohol.
I have never come across the term ‘chaos addiction’ prior to the email I was sent. As far as I am aware, there has never been any empirical research on the topic although Dr. Keith Lee did write a 2007 book (Addicted to chaos: The journey from extreme to serene) of his own experiences on the topic. Using case studies, the book examines individuals that have become “addicted to intensity out of the chaos and toward mind/body harmony, higher consciousness, and a deeply spiritual transformation”. More specifically:
“In a culture where the ‘extreme theme’ has become the norm, people are increasingly seduced into believing that intensity equals being alive. When that happens, the mind becomes wired for drama and the soul is starved of meaningful purpose. This type of life may produce heart-pounding excitement, but the absence of this addictive energy can bring about withdrawal, fear, and restlessness that is unbearable”.
In researching this article I came across a number of online articles dealing with ‘addiction to chaos’. The term has been applied to the actress Lindsay Lohan following a television interview with Oprah Winfrey (and the many articles that followed that honed in on her ‘addiction to chaos).
A short piece in Business Week by Clate Mask claimed that it is entrepreneurs that are frequently addicted to chaos (based on his “experiences and observations working with thousands and thousands of entrepreneurs over the years” along with his top three signs he sees as being addicted to chaos: (i) their business life revolves around the in-box, (ii) they can’t step away from the business, (ii) they are strangely proud they have so little free time. Clate then goes on to claim that:
“If you find yourself experiencing these symptoms, you are probably addicted to chaos. Get help. Business ownership should bring you more time, money, and control. If you’re not getting that, make some changes to your mindset and your business systems so you can find the freedom you were looking for when you started your business in the first place”.
An online article by Silvia Mordini discussed about her personal experiences and how she now uses yoga to provide grounding and stability in her life. (In fact, there are quite a few papers on treating addictions with yoga including a recent systematic review of randomized control trials by Paul Posadski and his colleagues in the journal Focus on Alternative and Complementary Therapies – see ‘Further reading’ below). As Mordini confessed:
“My past addiction to chaos simply hurt me too much. I got sick of the constant mental tug-o-war with myself. I’m not interested in feeling impatient with one thought and having to pull or push at the next one. Impatience promotes chaos and doesn’t feel good. The antidote to this is patience. Patience feels good. It feels like a return to mental stability no matter the chaos around us or what other people are thinking or doing…[The grounding that yoga brings] serves us as a simplifying force in order to stabilize our minds. When grounded, we plug back into our best selves and become fully present and balanced. Our energy stabilizes. Once centered, we are able to clearly see the circumstances of our lives. We no longer over-respond or over-worry because the static noise of chaos doesn’t pull us apart”.
She then goes on to provide her readers with five practical ways to promote stability and overcome addiction to chaos: (i) practice yoga, (ii) meditate, (iii) use a mantra (she suggests “I will let go of the need to be needed/I will let go of the need to be accepted/I will let go of the need to be accomplished), unplug from technology, and (v) get your hands and feet dirty (do some gardening, go for a walk on the beach, etc.). Obviously there is no clinical research confirming that these strategies would help overcome ‘chaos addiction’ but engaging in them certainly won’t do anyone any harm.
Another online article (‘Addicted to Chaos’) by addiction counselor Rita Barsky notes that many addicts grew up within dysfunctional families and noted:
“We never felt safe in our family of origin and the only thing we knew for sure was that nothing was for sure. Life was totally unpredictable and we became conditioned to living in chaos. When I talk about chaos in our lives, it was often not the kind that can be seen. In fact, many alcoholic/addict mothers were also super controllers and on the surface, our lives appeared to be perfect. The unsafe and chaotic living conditions of our lives were not visible or obvious to the outside world. Despite the appearance of everything being under control, we experienced continued chaos, developed a tolerance for chaos and I believe became addicted to chaos. I think it is important to say I have never done a scientific experiment to investigate this theory. It is based on observation of numerous alcoholic/addicts and their behavior”.
This was clearly written from experience and appears to have some face validity. Interestingly, Barsky then goes on to say:
“During the recovery process life becomes more manageable and less chaotic. The alcoholic/addict begins to feel a sense of autonomy and safety. A feeling of calm settles over their life. The paradox for the alcoholic/addict is that feeling calm is so unfamiliar it induces anxiety. There is a sense of waiting for the other shoe to drop. When there is a crisis, whether real or perceived, we actually experience a physical exhilaration and it feels remarkably like being active. From there it can be a very short distance to a relapse. Even if we don’t pick up we are not in a sober frame of mind. Addiction to chaos can be very damaging. Once engaged in someone else’s crisis we abandon ourselves and often develop resentments, especially if it is someone we love or are close to. Family chaos is the ‘best’ because it’s so familiar and we can really get off on it. When there is a crisis with family or friends we feel compelled to listen to every sordid detail and/or take action. We are unable to let go, we need to be in the mix even though it is painful and upsetting. It requires tremendous effort to detach and not jump in with both feet to the detriment to our well being”.
I find this account compelling because it’s written by someone that appears to have gone through this herself, and has now applied her therapeutic expertise retrospectively to understand the underlying psychology of what was occurring at the height of the addiction. Another compelling account is at Molly Field’s Yoga Blog.
“My object of desire is Chaos. My therapist told me at the end of my first session ever that I have a Chaos addiction…I’m not kidding: this stuff’s insidious. If it weren’t for my awareness of my ability to lose my temper over little-seeming things (aka scars from my past), I’d never know about the Addiction to Chaos. It’s because I grew up with it, was surrounded by it and trained by some of the world’s finest Chaos foments that I became one myself…My relationship with Chaos had become so much a part of my fabric of being that if I didn’t sense it, I would make it”.
Finally, I’ll leave you with the only tool that I have come across that claims to provide a diagnostic indication of whether someone is addicted to chaos. I need to point out that this came from the website of former psychologist Phil McGraw, the US television host of Dr. Phil. I have reproduced everything below verbatim (so when it says that “you are addicted to chaos” if you endorsed five or more of the ten items, that is the view of Dr. Phil – whenever I have co-developed a scale, I at least add the words “You may have a problem” rather than “You have got a problem”).
“While most people try to avoid drama, research shows that others have figured out how to trigger the body’s stress response, just for the rush. Take the test and find out if you’re creating chaos in your everyday life!
Directions: Answer the following questions ‘True’ or ‘False’
- Do you usually yell and scream to make your point?
- Do you ramp things up to win every argument?
- If you get sick, do you feel that EVERYONE should know about it?
- When you argue, do you ever break things or knock them over?
- Does being calm or bored sound like the worst thing to you?
- Do you ever yell at strangers if you feel that they are in your way?
- Do you hate it when you are not the center of attention?
- Is there usually a crisis to solve in your life?
- Do you break up or threaten a break up with a mate often?
- Are you usually the one who starts fights?
Results: If you answered ‘True’ to five or more of the questions above, you are addicted to chaos”
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Barsky, R. (2007). Addicted to Chaos. A Sober Mind, December 2. Located at: http://asobermind.blogspot.co.uk/2007/12/addicted-to-chaos.html
Field, M. (2012). Recovering from an addiction to chaos. The Yoga Blog, April 7. Located at: http://www.theyogablog.com/recovering-from-addiction/
Griffiths, M.D. (2005). Workaholism is still a useful construct Addiction Research and Theory, 13, 97-100.
Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.
Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.
Jakub, L. Addicted to chaos: Oprah’s interview with Lindsay Lohan. Hello Giggles, August 19. Located at: http://hellogiggles.com/addicted-to-chaos-oprahs-interview-with-lindsay-lohan
Kramer, L. (2015). Are you addicted to chaos? Recovery.org, January, 15. Located at: http://www.recovery.org/pro/articles/are-you-addicted-to-chaos/
Lee, J.K. (2007). Addicted to chaos: The journey from extreme to serene. Transformational Life Coaching and Consultancy.
Mask, C. (2011). Three signs you’re addicted to chaos. Business Week, March 18. Located at: http://www.businessweek.com/smallbiz/tips/archives/2011/03/three_signs_you_are_addicted_to_chaos.html
Posadzki, P., Choi, J., Lee, M. S., & Ernst, E. (2014). Yoga for addictions: a systematic review of randomised clinical trials. Focus on Alternative and Complementary Therapies, 19(1), 1-8.
Mordini, S. (2013). Are you addicted to chaos and drama? Mind Body Green, January 15. Located at: http://www.mindbodygreen.com/0-7395/are-you-addicted-to-chaos-and-drama.html
I have just come back from a two-week holiday in Portugal and managed to catch up with reading a lot of non-academic books. Two of the books I took with me were Paul Trynka’s biography of Iggy Pop (Open Up and Bleed ) and Brett Callwood’s biography of The Stooges, the band in which Iggy Pop first made his name (The Stooges: A Journey Through the Michigan Underworld ). Just before I left to go on holiday I also read Dave Thompson’s book Your Pretty Face is Going to Hell: The Dangerous Glitter of David Bowie, Iggy Pop, and Lou Reed (2009). This engrossing reading has been accompanied by me listening to The Stooges almost non-stop for the last month – not just their five studio albums (The Stooges , Fun House , Raw Power , The Weirdness , and Ready To Die ) but loads of official and non-official bootlegs from the 1970-1974 period. In short, it’s my latest music obsession.
Although I say it myself, I have been a bit of an Iggy Pop aficionado for many years. It was through my musical appreciation of both David Bowie and Lou Reed that I found myself enthralled by the music of Iggy Pop. Back in my early 20s, I bought three Iggy Pop albums purely because they were produced by David Bowie (The Idiot , Lust For Life , and Blah Blah Blah ). Thankfully, the albums were great and over time I acquired every studio LP that Iggy has released as a solo artist (and a lot more aside – I hate to think how much money I have spent on the three artists and their respective bands over the years). Unusually, I didn’t get into The Stooges until around 2007 after reading an in-depth article about them in Mojo magazine. Since then I’ve added them to my list of musical obsessions where I have to own every last note they have ever recorded (official and unofficial). When it comes to music I am all-or-nothing. Maybe I’m not that far removed from my musical heroes in that sense. I’m sure my partner would disagree. She says I’m no different to a trainspotter who ticks off lists of numbers.
One thing that connects Pop, Reed and Bowie (in addition to the fact they are all talented egotistical songwriters and performers who got to know each other well in the early 1970s) is their addictions to various drugs (heroin in the case of Pop and Reed, and cocaine in the case of Bowie – although they’ve all had other addictions such as Iggy’s dependence on Quaaludes). This is perhaps not altogether unexpected. As I noted in one of my previous blogs on whether celebrities are more prone to addiction than the general public, I wrote:
“Firstly, when I think about celebrities that have ‘gone off the rails’ and admitted to having addiction problems (Charlie Sheen, Robert Downey Jr, Alec Baldwin) and those that have died from their addiction (Whitney Houston, Jim Morrison, Amy Winehouse) I would argue that these types of high profile celebrity have the financial means to afford a drug habit like cocaine or heroin. For many in the entertainment business such as being the lead singer in a famous rock band, taking drugs may also be viewed as one of the defining behaviours of the stereotypical ‘rock ‘n’ roll’ lifestyle. In short, it’s almost expected”.
Nowhere is this more exemplified than by Iggy Pop. Not only would Iggy take almost every known drug to excess, it seemed to carry over into every part of his lifestyle. For instance, reading about Iggy’s sexual exploits, there appears to be a lot of evidence that he may have also been addicted to sex (although that’s speculation on my part with the only evidence I have is all the alleged stories in the various biographies of him). Another thing that amazes me about Iggy Pop was that he decided to give up taking drugs in the autumn of 1983 and pretty much stuck to it (again mirroring Lou Reed who also decided to clean up his act and go cold turkey on willpower alone). Spontaneous remission after very heavy drug addictions is rare but Iggy appears to have done it. Maybe Iggy gave up his negative addictions for a more positive addiction – in his case playing live. David Bowie went as far as to say that playing live was an “obsessive” for Iggy. As noted in Paul Trynka’s biography:
“[His touring] was simultaneously impressive and inexplicable. David Bowie used the word’ obsessive’ about Iggy’s compulsion to tour – but there was an internal logic. Jim knew he’d made his best music in the first ten years of his career, and he also believed he’d blown it…but he knew his own excesses or simple lack of psychic stamina were a key reason why the Stooges crashed and burned. Now he had to still prove his stamina, to make up for those weaknesses of three decades ago”.
Iggy Pop is (of course) a stage name. Iggy was born James Newell Osterberg (April 21, 1947). The ‘Iggy’ moniker came from one of the early bands he drummed in (The Iguanas). I mention this because another facet of Iggy Pop’s life that I find psychologically interesting is the many references to ‘Iggy Pop’ being a character created by Jim Osterberg (in much the same way that Bowie created the persona ‘Ziggy Stardust’ – ironically a character that many say is at least partly modeled on Iggy Pop!). Many people that have got to know Jim Osterberg describe him as intelligent, witty, talkative, well read, and excellent social company. Many people that have been in the company of Iggy Pop describe him as sex-crazed, hedonistic, outrageous, a party animal, and a junkie (at least from the late 1960s to the early to mid-1990s). It’s almost as if a real living character was created in which Jim Osterberg could live out an alternative life that he could never do as the person he had become growing up. Iggy Pop became a persona that Jim Osterberg could escape into. When things went horribly wrong (and they often did), it was Iggy’s doing not Osterberg’s. It’s almost as if Osterberg had a kind of multiple personality disorder (now called ‘dissociative identity disorder’ [DID]). One definition notes:
“[Dissociative identity disorder] is a mental disorder on the dissociative spectrum characterized by at least two distinct and relatively enduring identities or dissociated personality states that alternately control a person’s behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness…Diagnosis is often difficult as there is considerable comorbidity with other mental disorders”.
I don’t for one minute believe ‘Jim/Iggy’ suffers from DID but a case could possibly made based on the definition above. Some of the things he did on stage in the name of ‘entertainment’ included gross acts of self-mutilation such as stubbing cigarettes out on his naked body, flagellating himself, cutting his chest open with knives and broken glass bottles. He was a sexual exhibitionist and appeared to love showing his penis to the watching audience. On one infamous occasion, he even dry-humped a large teddy bear live on a British children’s television show. (Maybe Iggy is a secret plushophile? Check out the clip on here on YouTube).
In 1975, Iggy was admitted to the Los Angeles Neuropsychiatric Institute (NPI) and underwent treatment (including psychoanalysis) under the care of American psychiatrist Dr. Murray Zucker. After he had completely detoxed all the drugs in his body, Iggy was diagnosed with hypomania (a mental affliction also affecting another of my musical heroes, Adam Ant). This condition was described by Iggy’s biographer Paul Trynka:
“Bipolar disorder [is] characterised by episodes of euphoric or overexcited and irrational behaviour, succeeded by depression. Hypomanics are often described as euphoric, charismatic, energetic, prone to grandiosity, hypersexual, and unrealistic in their ambitions – all of which sounded like a checklist of Iggy’s character traits”.
Dr. Zucker later told Paul Trynka that hypomania tends to get worse with age and it hadn’t with Iggy and therefore the diagnosis of a bipolar disorder may have been wrong. Dr. Zucker now wonders whether “the talent, intensity, perceptiveness, and behavioural extremes” of Iggy were who he truly was “and not a disease…that Jim’s behaviour was simply him enjoying the range of his brain, playing with it, exploring different personae, until it got to the point of not knowing what was up and what was down’. In short, Dr. Zucker (who maintained professional contact with Iggy during the 1980s) claimed Iggy was perhaps “someone who went to the brink of madness just to see what it was like”. Dr. Zucker also claimed that Iggy (like many in the entertainment industry) was a narcissist (“excessive for the average individual” but “unsurprising in a singer…this unending emotional neediness for attention, that’s never enough”). In fact, Iggy went on to write the song ‘I Need More‘ (and was also the title of his autobiography) which pretty much sums him up many of his pychological motivations (at least when he was younger).
It’s clear that Iggy has been drug-free and fit for many years now although many would say that all of his best musical work came about when he was jumping from one addiction to another – particularly during the decade from 1968 to 1978. This raises the question as to whether musicians and songwriters are more creative under the influences of psychoactive substances (but I will leave that for another blog – I’ve just begun some research on creativity and substance abuse with some of my Hungarian research colleagues). I’ll leave the last word with Dr. Zucker (who unlike me) had Iggy as a patient:
“I always got the feeling [Iggy] enjoyed his brain so much he would play with it to the point of himself not knowing what was up and what was down. At times, he seemed to have complete control of turning this on and that on, playing with different personas, out-Bowie-ing David Bowie, as a display of the range of his brain. But then at other times you get the feeling he wasn’t in control – he was just bouncing around with it. It wasn’t just lack of discipline, it wasn’t necessarily bipolar, it was God knows what”.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Ambrose, J. (2008). Gimme Danger: The Story of Iggy Pop. London: Omnibus Press.
Callwood, B. (2008). The Stooges: A Journey Through the Michigan Underworld. London: Independent Music Press.
Pop, I. & Wehrer, A, (1982). I Need More. New York: Karz-Cohl Publishing.
Thompson, D. (2009). Your Pretty Face is Going to Hell: The Dangerous Glitter of David Bowie, Iggy Pop, and Lou Reed. London: Backbeat Books.
Trynka, P. (2007). Open Up and Bleed. London: Sphere.
Wikipedia (2014). Iggy Pop. Located at: http://en.wikipedia.org/wiki/Iggy_Pop
Like many others around the world, last week I was genuinely shocked when I heard about the death of Oscar-winning actor Philip Seymour Hoffman on February 2 (2014). One of my regular blog readers emailed me a couple of days ago asking if I would be writing a blog on him because of all his well publicized past drug and alcohol addiction. As the Wikipedia entry on his personal life noted:
“In a 2006 interview, Hoffman revealed he had suffered from drug and alcohol abuse and that after graduating from college at age 22, he went to rehab for drug and alcohol addiction. He said he had abused ‘anything I could get my hands on. I liked it all’. Hoffman relapsed more than 20 years later with heroin and addiction to prescription medications. He subsequently checked himself into a drug rehab for about ten days in May 2013”.
I had already decided I would do a belated tribute to Seymour Hoffman but not in relation to his chemical addictions – but in relation to his portrayal of gambling addiction in the 2003 film Owning Mahowny. Although my all-time favourite gambling film is the 1974 movie The Gambler starring James Caan (a film on which I’ve written academically – see ‘Further Reading’ below), Owning Mahowny runs a close second. One of the key strengths of Owning Mahowny was that it was based on a real person. Seymour Hoffman played ‘Dan Mahowny’ (whereas the real life person was Brian Molony).
Brian Malony worked as a Toronto-based bank clerk at the Canadian Imperial Bank of Commerce (CIBC). Over a one-and-a-half year period – and to fund his gambling addiction – Molony embezzled over $10million from the bank. His story was later the subject of a best-selling book by Gary Ross (called Stung: The Incredible Obsession of Brian Molony, and on which the screenplay to Owning Mahowny was based). Ross wrote his book following 4-5 hours of interviewing Molony every day for a month. Ross was asked what made Molony’s story so interesting:
“I was senior editor at ‘Saturday Night’ magazine at the time the fraud was discovered, right across the street from the Bay and Richmond (Toronto) branch of the CIBC. I assumed it was some sophisticated computer scam – how else could you liberate $10.2-million from a big bank? [I] was intrigued to learn from Eddie Greenspan, Brian Molony’s lawyer, that Molony was a compulsive gambler and that the frauds had been acts of improvised desperation rather than an elegant criminal scheme…Gambling addiction can be every bit as devastating, and as hard to treat, as a drug or alcohol dependency. It’s all the more insidious for being invisible, and it’s far more widespread than most people understand. A lot of social security checks, pay checks, and even liquidated homes end up on the casino’s bottom line”.
Additionally, and according to Molony’s Wikipedia entry:
“Molony, who had developed a passion for the race-track and gambling from the age of ten years, and acted as a bookie for his school-mates, graduated from the University of Western Ontario in London with a degree in journalism. Initially planning to be a financial writer, he did so well in a Canadian Imperial Bank of Commerce aptitude test that he was put in their management-training program and hired right out of university. Molony spent a few weeks as a teller before working in savings, current accounts, foreign exchange and loan accounting, then ‘floating’ among some of the Bank’s huge network of some 1,600 branches, which gave him a further broad exposure to the bank’s highly regimented workings and familiarity with its systems and internal weaknesses. On a modest annual salary of about $10,000, Molony led an unassuming lifestyle in Toronto, wearing inexpensive, ill-fitting clothes and leaving carefully calculated seven per cent tips in restaurants, at the same time he was embezzling $10.2 million from CIBC to feed his gambling habit, writing loans in the names of both real and fictitious companies. Molony was then able to transfer millions of dollars out of the bank through a company called California Clearing Corp., a wholly owned subsidiary of Desert Palace, a Las Vegas casino. This corporation’s only purpose was to let people deposit sums of money into the casino without detection”.
After 18 months of spending his employer’s money (including $4,732,000 lost at Caesars between February 7, 1981 to April 23, 1982), Molony lost half a million dollars at the Caesars casino playing table games in Atlantic City (AC). Molony had led the life of a ‘high roller, and was being heavily ‘comped’ with free luxury hotel rooms and access to a Lear jet to fly between AC and Vegas. Molony was eventually arrested (April 27, 1982), the day after he lost the money at Caesars. Later in the year (November 1983), Molony admitted during his trial that he had embezzled all the money from CICB and served 30 months in jail. One of his activities since leaving prison has been to lecture publicly on gambling addiction. At the same time that Molony went to jail, CIBC filed a federal lawsuit claiming that Caesars’ staff members should have realized that the money Molony was gambling with was not his own. The case was eventually settled out of court with the terms of the settlement remaining private.
Seymour Hoffman’s portrayal of Molony was excellent and provides true insight into life as a problem gambler. Obviously there is some artistic license in the dramatization of Molony’s life but all the key elements in the film were true. The film is noteworthy because (like The Gambler) the story concerns the effects of gambling addiction on the gambler and those around him rather than the glitz and glamour of gambling in Vegas and AC. Gary Ross, author of Stung was asked whether Seymour Hoffman’s portrayal bore similarity with Brian Molony. He replied:
“Remarkably so. They have the same stocky build, bushy moustache, glasses, slightly unkempt look, and earnestness. And Philip somehow managed to assimilate the psychic essence of Molony – a yawning emptiness that nothing except gambling was able to fill…It’s remarkably faithful to what actually happened. I assumed a great many liberties would be taken in the transition from page to screen, and I’m pleased that the changes were minor and inconsequential. The pathos and grimness of what happened is there in the movie”.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Griffiths, M. (2004). An empirical analysis of the film ‘The Gambler’. International Journal of Mental Health and Addiction, 1(2), 39-43.
Ross, G. (1987). Stung: The Incredible Obsession of Brian Molony. London: Stoddart.
Wikipedia (2014). Brian Molony. Located at: http://en.wikipedia.org/wiki/Brian_Molony
Wikipedia (2014). Owning Mahowny. Located at: http://en.wikipedia.org/wiki/Owning_Mahowny
Wikipedia (2014). Philip Seymour Hoffman. Located at: http://en.wikipedia.org/wiki/Philip_Seymour_Hoffman
Back in 1996, I published a paper on behavioural addictions in the Journal of Workplace Learning. One of my introductory paragraphs in that paper noted:
“There is now a growing movement (e.g. Miller, 1980; Orford, 1985) which views a number of behaviours as potentially addictive, including many behaviours which do not involve the ingestion of a drug. These include behaviours diverse as gambling (Griffiths, 1995), overeating (Orford, 1985), sex (Carnes, 1983), exercise (Glasser, 1976), computer game playing (Griffiths, 1993a), pair bonding (Peele and Brodsky, 1975), wealth acquisition (Slater, 1980) and even Rubik’s Cube (Alexander, 1981)! Such diversity has led to new all encompassing definitions of what constitutes addictive behaviour”.
The reason I mention this is that I was recently asked to comment on a story about ‘wealth addiction’ and I vaguely remembered that I had mentioned (in passing) Philip Slater’s 1980 book (also entitled Wealth Addiction). Slater’s book was written from a sociological standpoint and was both controversial and provocative. Slater claimed on the book cover that: ““Money is America’s most powerful drug. Here’s how it weakens us and how we can free ourselves”. I also came across an interesting 2012 article by journalist Scott Burns (on ‘wealth addiction revisited’) who noted that:
“One of the hallmarks of wealth addiction is very simple: more possessions but less use. We become so interested in possessing the thing that we lose the experience it provides. This can be as vast as owning homes all around the world, as some of the very rich do, as simple as Bernie Madoff’s shoe collection, or as obsessive as a collection of rare watches. Whatever it is, the wealth addict confuses possession with experience”.
Slater argued that our increasing reliance on money and all of the things that it can buy has the potential to become an obsession that can destroy individual lives. According to short article by Dr. Paul Hokemeyer, wealth addiction has three key characteristics:
- Tolerance: More and more money is needed to attain a baseline level of satisfaction.
- Withdrawal: The thought of losing money or not making it fills a person with fear, anxiety and stress.
- Negative consequences: In their pursuit of money, the person forgoes emotional fulfillment, intimate relationships and peace of mind.
These are actually three of the six criteria that I personally believe comprise genuine addictive behaviour (although I use the word ‘conflict’ rather than ‘negative consequences’; the other three criteria are salience, mood modification and relapse – see my previous blog on behavioural addiction for further details).
The reason why wealth addiction has made a re-appearance over the last month is because of an article published in the New York Times by Sam Polk, a former hedge fund trader that worked on Wall Street (and who since the article has been published has been compared to Jordan Belfort, the person that Leonardo DiCaprio portrayed in the true story film The Wolf of Wall Street).
Polk’s article is an interesting read (whether you think wealth addiction exists or not) and I thought I would pick out some of the text and relate it to my own views about what constitutes addictive behaviour.
- Extract 1: “In my last year on Wall Street my bonus was $3.6 million – and I was angry because it wasn’t big enough. I was 30 years old, had no children to raise, no debts to pay, no philanthropic goal in mind. I wanted more money for exactly the same reason an alcoholic needs another drink: I was addicted”
Here, Polk refers to his work bonuses becoming bigger and bigger and that they were never enough. To me, this sounds like some kind of tolerance effect with more and more money needed to achieve the desired (presumably mood modifying effect). Polk also claims – after the fact – that he had become addicted.
- Extract 2: “I was also a daily drinker and pot smoker and a regular user of cocaine, Ritalin and ecstasy. I had a propensity for self-destruction that had resulted in my getting suspended from Columbia for burglary, arrested twice and fired from an Internet company for fist fighting”.
Polk openly discusses his previous use of potentially addictive substances and made the comparisons himself between his self-confessed behavioural (wealth) addiction and his previous self-destructive chemical abuse. Some readers may jump to the conclusion that Polk had (or has) an ‘addictive personality’ but this is not something that I personally believe in. To me, Polk is displaying ‘reciprocity’ (swapping one potential addiction with another) rather than being a function of an underlying personality trait. Giving up one addiction often leaves a large void and sometimes the only way to fill it is by engaging in other behaviours that provide similar feelings and sensations.
- Extract 3: “My counselor didn’t share my elation [at earning more and more money]. She said I might be using money the same way I’d used drugs and alcohol – to make myself feel powerful — and that maybe it would benefit me to stop focusing on accumulating more and instead focus on healing my inner wound”.
Here, Polk’s therapist appears to hit the nail on the head in relation to what money represented for Polk. I would describe the feeling that Polk gained from both drugs and money was omnipotence (something that I have also written about in relation to my research on gambling).
- Extract 4: “I was terrified of running out of money and of forgoing future bonuses. More than anything, I was afraid that five or 10 years down the road, I’d feel like an idiot for walking away from my one chance to be really important. What made it harder was that people thought I was crazy for thinking about leaving. In 2010, in a final paroxysm of my withering addiction, I demanded $8 million instead of $3.6 million. My bosses said they’d raise my bonus if I agreed to stay several more years. Instead, I walked away”.
Polk’s language here is very much rooted in what addicts say about their drug or behaviour of choice (“terrified” of being without the thing they love doing). The weighing up of the costs clearly led to a decision for Polk to quit his “withering addiction” and there are obviously signs both here (and the rest of the article if you read it) that leaving behind the wealth left him with some feelings of regret.
- Extract 7: “The first year was really hard. I went through what I can only describe as withdrawal — waking up at nights panicked about running out of money, scouring the headlines to see which of my old co-workers had gotten promoted. Over time it got easier — I started to realize that I had enough money, and if I needed to make more, I could. But my wealth addiction still hasn’t gone completely away. Sometimes I still buy lottery tickets”.
Here, Polk uses addictive terminology (i.e., withdrawal) to describe giving up the activity that led to him gaining wealth. Again, the fear of running out of money appears psychologically similar to the fear that other more traditional addicts have about running out of their drug of choice. It could also be argued that he has given up one form of gambling (financial trading) with partially doing another (buying lottery tickets).
- Extract 8: “I was lucky. My experience with drugs and alcohol allowed me to recognize my pursuit of wealth as an addiction. The years of work I did with my counselor helped me heal the parts of myself that felt damaged and inadequate, so that I had enough of a core sense of self to walk away”
Polk uses his experiences in giving up drugs with the help of his therapist as a way of helping him give up wealth acquisition. Knowing you have managed to give up one addiction shows that you have the mental strength to give up another.
Obviously I have never met Polk and I can only go on how he described his experiences during his time on Wall Street, However, the insights shared do seem to suggest that some of the wealth acquisition behaviour had addictive elements and that there was at least some evidence that Polk – at least on some occasions – experienced salience, tolerance, withdrawal, conflict and mood modification. Whether he was genuinely addicted to money in the same way as drug addicts are addicted to psychoactive substances is debatable. However, theoretically, I can see how someone might be become addicted to wealth. There are also interesting questions as to whether wealth acquisition may be an underlying motivation for those addicted to work.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Alexander, R. (1981). A cube popular in all circles. New York Times, 21 July, p. C6.
Burns, S. (2012). Beyond envy: Wealth addiction revisited. Dallas News, December 15: Located at: http://www.dallasnews.com/business/columnists/scott-burns/20121215-beyond-envy-wealth-addiction-revisited.ece?nclick_check=1
Carnes, P. (1983). Out of the Shadows: Understanding Sexual Addiction. CompCare, New York, NY.
Glasser, W. (1976). Positive Addictions. Harper & Row, New York, NY.
Griffiths, M.D. (1993). Are computer games bad for children? The Psychologist: Bulletin of the British Psychological Society, 6, 401-407.
Griffiths, M.D. (1995). Adolescent Gambling, Routledge: London.
Orford, J. (1985). Excessive Appetites: A Psychological View of the Addictions. Wiley: Chichester.
Peele, S. and Brodsky, A. (1975). Love and Addiction. Taplinger: New York, NY.
Polk, S. (2013). For the love of money. New York Times, January 29. Located at: http://www.nytimes.com/2014/01/19/opinion/sunday/for-the-love-of-money.html?_r=1
Slater, P. (1980). Wealth Addiction. E.P. Dutton: New York, NY.
In 1984, Dr. Milton Burglass and Dr. Howard Shaffer published a paper in the journal Addictive Behaviors and claimed that arguably the important questions in the addiction field are ‘why do people become addicted to some things and not others?’ and ‘why some people become addicted and not others?’ Answers to these questions have been hindered by two common misconceptions about addiction, which to some extent have underpinned the ‘hard core’ disease concept of addiction. These are that addiction somehow resides within: (i) particular types of people or (ii) particular substances, and/or particular kinds of activity. That is, either some people are already ‘diseased,’ or else some substances/ activities cause this disease, or both.
There is a belief that some people are destined to become addicted. Typically this is explained in one (or both) of two ways. That some people (i.e., ‘addicts’) have an addictive personality, and that there is a genetic basis for addiction. The evidence for ‘addictive personality’ rests to a certain extent upon one’s faith in the validity of psychometric testing. Setting aside this major hurdle, the evidence in this area (as I argued with my colleagues Dr. Michael Larkin and Dr. Richard Wood in a 2006 issue of Addiction Research and Theory [ART]) is still inconclusive and contradictory.
First, psychologists have yet to determine which particular personality traits are linked to addiction. Studies have claimed that ‘the addictive personality’ may be characterized by a wide range of factors (e.g., sensation-seeking, novelty-seeking, extroversion, locus-of-control preferences, major traumatic life events, learned behaviours, etc.). The extent of this range stretches not only the notion of an ‘addictive personality’ but also the concept of ‘personality’ itself. Inevitably, much of this work relies on correlation analysis, and so the interpretation of results is not easily framed in terms of cause and effect. The approach is overly simplistic and is underpinned by a simple proposition that if we can divide people up into the right groups, then the explanation will emerge. However, addiction is far more complex than this. Of course, the relationship between individual bodies, minds, contexts, and life histories is complex and important – but it requires that we approach the matter from a more sophisticated and integrative position.
The search for a genetic basis for addiction rests upon the notion that some types of individuals are somehow ‘biologically wired’ to become addicts. In our 2006 ART paper, we argued that we must set aside any doubts about the limited conceptualization of ‘the environment’ that often typifies this kind of research, and its combination with epidemiological designs that are largely descriptive. Meta-analytic reviews have concluded that the heritability of addictive behaviour is likely to be controlled by many genes each contributing a small fraction of the overall risk. Furthermore, some of these same genes appear to be risk factors for other problems, some of them conceptually unrelated to addiction. We argued that the main point here is that while these findings do contribute something to our understanding of ‘why some people and not others,’ they do not adequately or independently explain the range of variation. Therefore the most we can say is that some people are more likely to develop problems under certain conditions, and that given the right conditions most people could probably develop an addiction. Emphasis needs to be placed on identifying those ‘conditions,’ rather than on searching for the narrowest of reductionist explanations.
We also argued in our 2006 ART paper that substances and activities cannot be described as intrinsically addictive in themselves (unless one chooses to define ‘addictive’ in terms of a substance or behaviour’s ability to produce tolerance and/or withdrawal, and to ignore the range of human experience that is excluded by this). Biologists may be able to tell us very valuable things about the psychopharmacological nature of the rewards that particular substances and behaviours provide, and the different kinds of neuroadaptation that they may or may not produce in order to effect tolerance and/or withdrawal. But we argue that this on its own, is not an adequate explanation for addiction. In 1975, Dr. Lee Robins’ classic study (in the Archives of General Psychiatry) of heroin-users returning from the Vietnam war is one example of the evidence that refutes this oversimplification. This study clearly highlighted the importance of context (i.e., that in a war zone environment individuals were addicted to heroin but on return to civilian life the addiction ceased to exist), and the framework provided by such contexts for making sense of addiction. In a hostile and threatening environment, opiates clearly provided something not usually required by most people; and given a cultural environment in which opiate use is a commonplace, and opiates are available, then opiate use ‘makes sense’. This study provides support for the assertion that some people are more likely to become addicted under some conditions, and that given the right conditions perhaps many people could understand what it means to be an addict.
So, with regard to the question, ‘why some individuals/addictions and not others?’ the rewards associated with various activities may be qualitatively very different, and may not necessarily be inherent or unique to a particular activity or substance, either. Many rewarding activities are rewarding because they present individuals with opportunities to ‘shift’ their own subjective experience of themselves (for example, see the research on Ecstasy use and bungee jumping that I published with Dr. Michael Larkin in a 2004 issue of the Journal of Community and Applied Social Psychology).
Frequently, a range of such opportunities is offered to the experienced user. Dr. Howard Shaffer (in a 1996 paper in the Journal of Gambling Studies) has pointed out that those activities that can be most relied upon to shift self-experience in a robust manner are likely to be the most popular – and (as a consequence) to be the most frequent basis of problems. So, obviously, our understanding of the available resources for mood modification must play a major part in understanding addiction. However, we must make a careful distinction between describing some substances as being more ‘robust shifters of experience’ than others (as we advocated in our 2006 ART paper) and describing some substances as ‘more addictive’ than others (which we argued against).
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Burglass, M.E. & Shaffer, H.J. (1984). Diagnosis in the addictions I: Conceptual problems. Addictive Behaviors, 3, 19-34.
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Transgressive Culture, 1(1), 7-28.
Griffiths, M.D. & Larkin, M. (2004). Conceptualizing addiction: The case for a ‘complex systems’ account. Addiction Research and Theory, 12, 99-102.
Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.
Orford, J. (2001). Excessive Appetites: A Psychological View of the Addictions (Second Edition). Chichester: Wiley.
Robins, L.N, Helzer, J.E, & Davis, D.H (1975) Narcotic use in Southeast Asia and afterward. Archives of General Psychiatry, 32, 955-961.
Shaffer, H. J. (1996). Understanding the means and objects of addiction: Technology, the Internet, and gambling. Journal of Gambling Studies, 12, 461–469.
Tyndale, R.F. (2003). Genetics of alcohol use and tobacco use in humans. Annals of Medicine, 35(2), 94–121.
Walters, G. D. (2002). The heritability of alcohol use and dependence: A meta-analysis of behavior genetic research. American Journal of Drug and Alcohol Abuse, 28, 557–584.