COBE researchers are developing a program that focuses less on student drinking, and more on the underlying factors that lead people to drink. Read more here!
According to a recent national survey conducted by the Substance Abuse and Mental Health Services Administration, 7.5 million (10.5%) children younger than the age of 18 in the United States live with a parent who had an alcohol use disorder in the past year. This is concerning, because research shows that kids who have parents with alcohol problems are also more likely to have alcohol and related problems.
Why do alcohol problems run in families? Research shows that alcohol use disorders are about 50% heritable. This means that about 50% of the reason for why people are different in their alcohol use behaviors lies in their genes. So it is not surprising that kids who inherit genetic risk toward alcohol problems from their parents are more likely to engage in risky drinking. However, the environments where the children grow up also play an important role. In a recent study, my collaborators and I explored whether and how parenting behaviors play a role in the transmission of alcohol problems from parents to children.
It turns out that parental alcohol problems increase adolescents’ risk for alcohol and conduct problems, in part, by disrupting positive parenting behaviors in the family. That is, parents who suffer alcohol dependence symptoms are less likely to be involved in their adolescents’ daily activities, less warm and loving, and have poorer communication with their adolescents. This, in term, may lead adolescents to engage in risky drinking and conduct problems. In other words, having an alcohol use disorder makes it harder for parents to be good, involved parents.
Alcohol problems consume parents’ psychosocial and financial resources, which can get in the way of parents’ ability to create good home environments and to provide positive parenting behaviors to their offspring.
Interestingly, it appears that fathers’ alcohol problems are particularly influential. When considered simultaneously, fathers’, but not mothers’ alcohol problems, were found to be more disruptive to the parenting behaviors of both fathers and mothers in the family.
Perhaps fathers’ alcohol problems create high levels of strain and emotional tension in the family. It is also likely that when the father has alcohol problems, the mother may need to compensate by increasing her responsibilities and duties (e.g., taking over some activities from the father), which may add additional stress and time involvement that could potentially undermine mothers’ positive parenting. In contrast, given that most mothers have primary caregiving roles in the family, mothers may be more likely to maintain positive parenting behaviors such as involvement and communication with their adolescents, even when the mother suffers from alcohol problems herself.
Disrupted parenting behaviors are just one way by which parental alcohol problems may increase their adolescents’ risk for alcohol and conduct problems. We continue to explore other pathways of risk, with the hope to inform prevention and intervention efforts that break the intergenerational transmission of alcohol problems.
Dr. Su is a COBE postdoctoral fellow whose research focuses on the mechanisms (e.g., parenting, intermediate phenotypes) through which genetic predispositions influence substance use and related outcomes, and how genetic predispositions interact with culturally-relevant risk and protective to influence substance use and related outcomes among racial/ethnic minority populations.
Spit for Science Collaborator Assistance Clinics
Longitudinal data is complex and the Spit for Science data is no exception, with over 3,000 variables and nearly 12,000 cases across 5 cohorts! Collaborators and/or their trainees and staff who are using (or interested in) the Spit for Science data are welcome to attend new monthly help sessions for an individualized overview of the Spit for Science codebook and data.
This semester, sessions will be from noon-3pm on Aug 24, Sept 21, Oct 19, and Nov 16.
If you plan to attend, please complete this form in advance, so we will be prepared to address your needs. The sessions are held in 8 N Harrison. If you have questions, or would like to reserve an alternative time, please contact our Project Coordinator (email@example.com).
Dr. Jinni Su presents about her Spit for Science spinoff project studying the affects of microaggressions, racial socialization and other aspects of racial identity on substance use for African-Americans at the December COBE Connect lunch lecture.
To learn more about COBE Connect, visit the COBE Events page.
Whenever I walk into an exam, I practice my breathing. It’s a little bit of an unnatural exercise. But, even six months after I first learned about it, I still use the technique to help myself calm down.
Try it: inhale for 4 seconds, hold for 7 and exhale for 8, no more than 4 times.
If you are looking for specifics, the deep breathing stimulates your parasympathetic nervous system, as opposed to short breaths, which stimulate my fight or flight response.
But, to be honest, I’m not always thinking about neurotransmitters when I’m stressed out. As a slightly-skeptical biochemist, however, I was definitely thinking about them when we were first taught the technique in my Science of Happiness Class last semester.
As a second semester junior in the thick of my biochemistry degree, I registered for the course a year ago thinking it would be fun, something I wouldn’t have to think too hard about while I was calculating dilutions and learning the TCA Cycle. Although I was right about the fun part, the course ended up being one of, if not the most impactful course I’ve taken, both on my future career and myself as an individual.
One of the best aspects of the class is its emphasis on action. Not only do we have experts from their respective fields coming in to talk to us every week, we are immediately given ways to act on this science and incorporate it into our daily lives. It was never presented as, oh, if you’re sad, you should just think happy thoughts and it will be better! Instead, we discussed the negativity bias and its impact on our thought patterns, and were given scientifically backed strategies to help break out of it. That is the kind of learning, in my opinion, that makes the most impact in one’s life.
The course is also designed to help address the problem of lack of engagement, something I’ve personally experienced in more traditional classroom set ups. In the Science of Happiness, we were never racing to cover material for a test. Instead, we were given assignment that helped us integrate theory into our lives, and were allowed time and discuss it with our peers.
We also had a final project that allowed us to take our insights into the community. My group was particularly interested in the impact of acts of kindness on happiness, so we designed a way to see if the positive effects of in-person acts could be simulated by doing acts of gratitude online. The process of formulating our own question kept us interested, and this interest was reflected in the community, when we asked people to participate. In the end, we had people from New York to Tennessee taking part in our online acts of kindness.
My experience with SOH was a positive one, and fortunately, COBE made it possible for me to continue pursuing my interests. I attended the Spit for Science Bootcamp over the summer, where I was taught to manipulate the Spit for Science dataset the same way many of our presenters did. Armed with the confidence and tools COBE has given me, I am now in the process of conducting my own research project, once again based on my own interests, this time in depression among minority groups.
The most important thing I’ve gotten out of my experience with the Science of Happiness and COBE is that research isn’t something removed from real life, but rather, it’s constantly inspired from it. My group were interested in acts of kindness, were often on our phones, and found a way to connect the two. My research project now is based on conversations I’ve had with my friends and patterns I’ve seen in my life. I can say with confidence that my experiences have made me more curious and more active in shaping the world around me, both as a student and as a person.
So, if you’re on the fence about registering for the Science of Happiness or trying your hand at undergraduate research, I say take a deep 4-7-8 breath and take the plunge!
Would you believe me if I told you the majority of VCU students read about substance use and mental health research on a monthly basis?
It is true. Thousands of students read about mental health, substance use and other kinds of health and wellness research at VCU because of the Stall Seat Journal (SSJ), a monthly publication created by The Wellness Resource Center.
The SSJ is posted in over 1,200 bathrooms throughout campus and translates research from Spit for Science and other sources to teach students about health and wellness norms on campus.
But even if students are reading, how does reading a poster every month make students healthier?
A new study led by COBE researcher Dr. Jinni Su explores how learning about social norms in the Stall Seat Journal impacts student health.
The study found that over 90% of students had seen the SSJ and over half of them read half or more of the SSJ multiple times. This is important because the mission of the SSJ is to explore what students actually do versus the perceptions of what they do, a concept encapsulated in social norms theory.
Social norms theory looks at the gap between perception and real life and studies how this misperception impacts the choices people make.
In the case of alcohol use for example, prior research shows that when students falsely believe their peers drink more and more often than they actually do, they are more likely to drink more and more often because they think it is normal.
One of the biggest problems on campus is binge drinking, so researchers aimed to address that first with frequent recurring messaging teaching students about the risk associated with drinking a large amount of alcohol at one time and showing that most students do not binge drink.
The study found that the SSJ impacts students’ perception of peer drinking levels as expected, meaning that they had more accurate perceptions of peer drinking levels after reading. This in turn lowered binge drinking levels, and thus also lowered the number of students blacking out.
Seniors have the most accurate perceptions of their peers’ drinking, supporting the notion that exposure to social norms information over a long period of time increases the effectiveness of the messaging and promotes better health outcomes.
But curbing binge drinking is just one example of how the Stall Seat Journal uses social norms to improve health and wellness at VCU. To check out this month’s Stall Seat Journal as well as old issues, visit The Well’s website here.
Learn how the Center for Human-Animal Interaction puts research into action to promote student health and wellness at VCU with Dogs on Call and Paws for Stress!
Growing up, Savannah Bekkers never loved sports but always cared about her health and wellness. Without the usual outlets for physical activity, she started practicing yoga in elementary school.
“I didn’t know what meditation was or anything like that,” Bekkers said. “I just liked yoga because I thought it was cool.”
As time went by, she found running as a second coping tool. Together, yoga and running gave her mind “time to unwind” from the stress of high school life. Without realizing it, Bekkers was using research backed techniques to support her mental and physical health. So naturally when she arrived at Virginia Commonwealth University, she wanted to learn more about staying healthy, which led her to sign up for THRIVE.
In the Fall of 2016, COBE launched THRIVE, a living-learning community that brought together a hallway of around 40 students to learn more about research on health and wellness in the classroom and in real life. Joining THRIVE includes enrollment in the Science of Happiness, a course that explores mental and physical health and positive psychology co-taught by a team of COBE researchers, and additional health and wellness programming developed by RA’s and COBE collaborators.
For Bekkers, the most important part of her experience in the THRIVE community was taking the Science of Happiness course in the fall. Her interest in yoga and running led her to especially appreciate learning about research on mindfulness and meditation.
“Mindfulness wasn’t something I knew about before the Science of Happiness, and now I see it all the time,” Bekkers said. “It was an epiphany like that every week for me.”
Bekkers also said the class was a welcome change from many of her other introductory classes both in size and in the depth of discussion about each topic.
“Freshman year is mostly big lecture classes, but the Science of Happiness never felt that way,” Bekkers said “I got to ask a lot of questions and further my learning. You don’t really get that opportunity in a lot of bigger classes.”
When she started college, Bekkers was in a perfect position to take her existing interest in health and wellness, apply the language to what she was doing and learn new ways to stay healthy. But as time passed, she saw many of her peers struggling with stress and other difficulties that arise in young adulthood.
“I wanted to communicate what I had learned to other people so that they wouldn’t make the same mistakes that I made Freshman year,” Bekkers said. “I wanted to help create a community that was truly invested in exploring health and wellness together.” With those goals in mind she applied to be an RA with THRIVE.
“For many people, especially when you first get to college, wellness isn’t a priority whatsoever,” Bekkers said. “I know when I moved in I was scared that everyone was going to be super fit or that there’d be requirements about how often you had to go to the gym and stuff like that. But it wasn’t like that at all.”
In her second year with THRIVE, Bekkers works with COBE Administrative Director Marcie Walsh and VCU RecSports Wellness Coordinator Carrie Baines to create monthly programming for her hallmates. One of their first activities was taking a group trip to the gym and then to Belle Isle so they would know their way around campus.
“It’s important just to know where to go and how to access different things on campus,” Bekkers said. “It was really great hearing a few weeks later that most of my students had been back to the gym or Belle Isle multiple times since our first trip.”
Later in the semester her hall took a classes together at the gym to get to know each other better. Bekkers has also hosted scavenger hunts, presentations by VCU researchers and other activities. Beyond learning specific skills or promoting certain practices, Bekkers says that the most valuable part of THRIVE is its focus on translating research into real life applications.
“Joining THRIVE and taking the Science of Happiness is not a band-aid or a painkiller; it’s a set of preventative skills,” Bekkers said. “You don’t have to focus on feeling overwhelmed when you can see stress coming and know what to do.”
Early in her career, Jo Robins, an advanced practice nurse in primary care, treated a series of patients who were obviously unwell but did not meet a specific diagnosis. Traditional medicine wasn’t helping their chronic pain, and she didn’t know what to do.
“I had been taught to diagnose and treat,” Robins said. “When I found out that the majority of the people that I was interacting with didn’t fit the way I had been taught, I got very interested in what was then called alternative medicine.”
That’s when Dr. Robins’ journey with Tai Chi and meditation research began.
Over the past twenty years, she has worked with people in treatment for HIV and breast cancer as well as families in underserved communities using mindfulness and meditation as a form of free and accessible healthcare.
“What I realized was that everybody has the capacity to become more mindful, and it doesn’t cost anything to do that,” Robins said.
Watch the video of Dr. Robin’s presentation at the November COBE Connect lunch to learn more about the evolution of her research at VCU and her contributions to the COBE Contemplative Science research core.
When you ask someone about their heart health, they will often discuss their diet and exercise routines as well as their family history of heart disease. But did you know that meditation can improve heart health too?
At the November COBE Connect lunch, Dr. Jo Robins presented findings from three different studies that examined how mindfulness, specifically Tai Chi and meditation, impacts physical and mental health. Her findings show that in many situations, Tai Chi and meditation improve mental and physical well being, including decreasing your risk of heart disease.
Hear more about her research in the video above and visit the COBE Contemplative Science research core website to learn more about mindfulness studies at VCU.
During the interview Dr. Dick discussed Spit for Science, exploring research on the genetics of substance use and mental health and ways that her research is used in prevention and intervention programming at VCU and beyond.
To listen to her interview, visit the Science Studio website here.
What makes a great leader? And how does having a great leader impact the culture of your workplace?
Dr. Chris Reina, a researcher who studies business and psychology at Virginia Commonwealth University, explored these topics and more during a presentation at the November COBE Connect lunch.
Dr. Reina began by explaining his newest study on leader mindfulness and its impact on job satisfaction, motivation and well being for employees. He then discussed a recently published popular press book chapter on last year’s presidential election and a study on mindfulness, productivity and technology use with undergraduates at VCU.
To learn more about his work, watch the video above and visit the Contemplative Science research core website.
Over the past twenty years, an epidemic has spread across college campuses from coast to coast: stress.
Stress culture has taken over higher learning, straining mental health support systems at schools across the country. As students report higher levels of stress and anxiety than ever before, researchers seek novel alternatives to traditional mental health treatments including meditation and other forms of mindfulness.
At the November COBE Connect lunch Dr. Patricia Kinser of the School of Nursing at VCU discussed two of her studies that look at stress and health outcomes for pregnant women and healthcare providers. While both studies found positive correlations betwen mindfulness interventions and improved health outcomes for each group, mindfulness can help anyone cope with stress more effectively. Learn more about how mindful physical activity and resilience training can help strengthen your ability to cope with stress in the video of her presentation above.
What do pregnant women, healthcare providers and college students have in common?
Stress, and no easy way to get rid of it.
But what you may not know is anyone can learn skills to raise their resilience and cope more effectively with stress. For many, that answer is yoga and other forms of mindfulness.
Dr. Patricia Kinser of the VCU School of Nursing presented at the November COBE Connect lunch about two studies focusing on physical meditation and mindful resilience training and their impact on perceptions of stress and overall mental health. Learn more about her work in the video above and visit the COBE Contemplative Science research core website to learn more about mindfulness research at VCU.
When you look back on freshman year in college, do you remember meeting people, joining clubs or playing sports? Or do you think more fondly of going to your first party and drinking with your friends?
While these may seem like innocent rites of passage that all young adults experience, early adolescent behaviors and habits are formative for lifetime alcohol use. And it’s not just how much you or your child drinks.
In a study entitled “The Role of Social, Familial, and Individual-Level Factors on Multiple Alcohol Use Outcomes During the First Year of University,” doctoral student Megan Cooke and a team of COBE researchers looked at Spit for Science data to learn more about predictors of first year alcohol use across a wide range of alcohol use behavior.
Accord to SAMHSA, college students consume more alcohol and engage in riskier drinking behaviors than their non–college-attending peers. Because of this increased use, it is important for researchers to look at what factors lead people to start drinking as well as those that promote resistance to greater use and problems.
Cooke’s study looked at both normative and problematic alcohol use, in addition to addiction resistance (experiencing less problems and negative outcomes than expected given a person’s consumption levels), in Spit for Science, a longitudinal sample of around 10,000 college students.
The study found that different familial and demographic factors, as well as individual experiences and personality traits, were associated with each stage of progression from starting to drink to alcohol problems or addiction resistance.
For example, extraversion, being outgoing and social, and introversion, being shy and anxious, were associated with increased risk, but in very different ways.
Extraversion was associated with increased likelihood to start drinking, drink more and have problems associated with alcohol, potentially related to drinking motives or expectancies.
Individuals who reported higher anxiety and said they drink to cope did not consume more than their peers, but experienced more negative outcomes and therefore their addiction resistance was lower .
Some factors influence alcohol use behavior before freshman even arrive on campus, with two of biggest influences being peers and parents.
Across all outcomes, the study found that high school antisocial behavior and deviant peer groups were strongly associated with poorer alcohol use outcomes (earlier initiation, greater consumption, greater problems), even after a person goes to college.
Higher levels of conscientiousness were associated with lower levels of alcohol problems. In addition, living with one’s parents during college may provide a buffer against peer group influences, but has no impact on addiction resistance once someone starts drinking.
Some factors had different impacts based on what stage of alcohol use was studied.
For example, when people said alcohol negatively affected their self-perception, they were less likely than their peers to start drinking and if they did they tended to drink less. But those same people showed higher levels of alcohol problems and lower addiction resistance as well.
Additionally, people who said they felt alcohol would help them relieve tension had an increased likelihood of drinking but experience less problems and a higher level of addiction resistance.
As researchers learn more about these traits, they use this information in collaboration with other professionals to create tailored prevention and intervention programming at VCU that promotes healthy behaviors like Love ‘n Liquor and the Stall Seat Journal.
The important thing to remember is there are a variety of factors that influence substance use outcomes, and those factors interact in complex ways to inform whether a person moves from use to misuse to addiction. Freshman year of college is a particular moment where these factors are important, but these predictors stretch from youth across adolescence into early adulthood.
Everyone’s has a different risk profile based on their personality and background, but risk does not guarantee having to face a problem: one can take steps to mitigate risk with healthy choices.
So next time you talk to your children about navigating freshman year and alcohol use, you can reflect on your own experiences and learn a little bit more about yourself and others than you expected!
When life throws a series of curveballs your way, it can be hard to persevere alone. Just as everyone experiences hardship, everyone has moments where they rely on support from friends or a romantic partners to bounce back.
Through conflict and strife, the value of a strong support network becomes clear, bolstering physical and emotional well being when self-care might seem out of reach due to stress or anxiety. Without that support, one might turn to destructive habits like substance use to cope with stress and anxiety.
While experiencing hardship is a universal part of life, how exactly does support from romantic relationships and peers impact alcohol use in particular? And is that impact felt differently by men and women?
A new study by VCU researcher Peter Barr published in the Journal on Studies of Alcohol and Drugs examined whether involvement in committed relationships or social support impact heavy drinking during young adulthood.
Addiction genetics research shows that the causes of excessive alcohol use include a person’s genes, environment and the interactions between the two. Earlier findings on adolescent alcohol use also show that genetic influences are greater when social control is reduced (i.e. having parents that do not actively monitor their children) or social opportunity is high (i.e. having deviant peers that encourage a young adult to drink) because these environments provide individuals more opportunity to express any genetic predisposition. Those findings also show that individuals who are more socially integrated, such as those who are involved in romantic relationships or who have wider peer networks, engage in risky drinking less often in part because they are subject to more social control and monitoring.
Building on this knowledge using data from the Finnish Twin Study, Barr and his colleagues found that involvement in a romantic partnership reduced genetic liability for excessive alcohol use, meaning that if one is genetically predisposed to substance use friends and romantic partners can mediate this increased risk. The study also found that men experience slightly more benefit from this effect than women.
More noticeable differences between men and women emerged for social support: increased social support, in the form of greater number of reported support providers, was associated with increased genetic influence for females and reduced genetic influence for males. This means that among women who report greater numbers of support providers, genetic influences matter more relative to environmental influences, while men experience the opposite effect.
One explanation offered for this pattern is the different expectations for men and women within support networks. Because women are often responsible for providing emotional support, this may create increased strain and exacerbate any underlying risk. In contrast men tend to reap the rewards from social and emotional support while having little expectation to reciprocate.
At the core these findings demonstrate that social relationships are important moderators of genetic influences on young adult alcohol use. Additionally, while some relationships limit genetic liability equally, others, such as extensive social networks, may operate differently across sex.
So the scientific jury is in – there is clear evidence that a strong support network including friends and romantic partners helps you live a better, more healthy life. This is another reminder that genetic risk does not mean you are destined to develop a specific problem; you have the power to make informed decisions to shift the odds in your favor like seeking support from friends and partners when you need it most!
This article was written in collaboration with Dr. Nathan Gillespie, an international researcher of addiction genetics at the Virginia Institute for Psychiatric and Behavioral Genetics.
Opioid overdose deaths have quadrupled since 1999; now 91 Americans die each day due to an opioid overdose according to the CDC. As many as 1 in 4 people who receive a long term opioid prescription not related to cancer struggle with addiction.
While opioids are the most visible example of prescription drug misuse, national data does not tell the full story of the opioid crisis and its impact on adolescents.
In contrast to the growing crisis of adult opioid use, over the past 5 years opioid misuse in high school seniors has dropped 45 percent, from 8.7 to 4.8 percent according to the Monitoring the Future survey administered by the National Institute on Drug Abuse. While the drop is a promising step in the right direction, there is more to the story of prescription drug misuse than just opioids.
Opioids are not the only prescription drugs used recreationally by adolescents. These drugs range from painkillers to stimulants prescribed for ADHD or depressants used to treat anxiety and panic disorders. Many of these drugs have little in common besides the fact that they come from a doctor, but they interestingly share many similarities when it comes to who uses them and who is at risk of developing problems.
Recreational use of prescription drugs is highly correlated with licit and illicit drug use including cannabis, nicotine, and cocaine, as well as various types of party drugs. And research also shows that the risk factors for use and misuse are shared across all prescription drugs regardless of the differences between the drugs.
As we unveil a clearer picture of addiction in adolescents, behavioral geneticists continue their studies using data from twins. Why twins, you ask?
By their nature, twins are perfect for exploring genetic and environmental risk. Identical twins share 100% of their genetic variation while fraternal twins share 50%, just like ordinary siblings. In twin studies, researchers send surveys to hundreds of twin pairs to learn more about their demographics, lived experiences and substance use. After analyzing the data, the different degrees of genetic relatedness allow researchers to estimate the contribution of genetic versus environmental influences.
In the case of non-medical use of prescription drugs, the shared genetic risks include personality traits like impulsivity, sensation-seeking, not coping well with stress.
So what can you do to mitigate risk if you are an impulsive or anxious person?
While there are risk factors for substance use, there are also protective factors too. One protective factor for adolescents is parental monitoring: how much your parents know about where you are, who you are with and what you are doing.
Surprisingly, the impact of parental monitoring doesn’t end when a teenager leaves their home. Spit for Science studies show that the impact of high parental monitoring follows an adolescent from home to college and throughout their lifespan.
In addition to parental monitoring, there are many other ways that environments mitigate genetic risk. For example, if you don’t have access to prescription opioids, then you are less likely to initiate use than someone who readily has access to them. So it is important to remember that just because a person is genetically at risk, that does not mean they are destined to develop a substance use disorder.
Using this knowledge Spit for Science researchers are focusing their future efforts on ways to improve prevention programs for adolescents so that they do not develop problems with prescription drugs in the first place.
Currently, researchers are analyzing the sex and ethnic differences across recreational prescription drug use in Spit for Science data to learn more about how universities can tailor prevention and intervention programming to the specific needs of students. Researchers also plan to link this research to retention and GPA data to create a full picture of where and how students need support and how that impacts their overall success at VCU.
While the opioid crisis is still one of the most pressing public health concerns facing our nation, each day scientists learn more about the risk and preventative factors that underlie substance use disorders and use this information to help those in recovery as well as those who are at risk of developing problems in the future.
If you want to be a part of discovering solutions to the Opioid Crisis through research, visit the Spit for Science website or view this interactive infographic on ways you can include our work in your college experience.
This article was written in collaboration between COBE and Dr. Nathan Gillespie, an addiction genetics researcher at the Virginia Institute of Psychiatric and Behavioral Genetics.
In the not too distant future, most people will likely have their genome sequenced and available to them on a thumb drive or a smartphone app. Along with that information, one would answer a series of questions related to their behavior and background. Using statistical models and formulas built off of years of substance use studies, the app would compile the data and inform a person about their risk profile for different health outcomes.
But this isn’t a conversation about destiny or dystopia. This is the future of personalized substance use prevention programs and similar interventions for other disorders powered by genetics research.
So where did this all begin? And where do we stand with this research currently? Let’s start with a few basic questions.
Are you similar to your siblings because you have the same parents or because you grew up in the same environments? Do your genes and your environments interact with one another to influence who you become as an adult?
Behavioral genetics exists at the intersection of psychology and genetics to study how genes and environments interact and influence the similarities and differences between people. Of the many things studied in addiction genetics, the branch of behavioral genetics that focuses on substance use disorders, some of the core questions include:
“To what degree is a given behavior influenced by genes and environment?”
“Do multiple behaviors, disorders and diagnoses share a common cause or set of risk factors?”
“What specific genes influence a given behavior or disorder?”
To answer these questions, researchers often focus on twins. An investigator will typically start with a large population-based sample of twins (500 or more twin pairs, distributed between identical and fraternal twins). Then the rest of these study follows a traditional, survey-based format.
Researchers begin each survey by asking questions you’d see in any standard psychology questionnaire: demographics, family history, behavioral measures, personality traits, etc. After gaining background knowledge questions will shift in focus to psychiatric criteria from the DSM related to substance use disorders. During this part of the survey, researchers ask when someone first used a given substance, when they started using the most, if they stopped, when they stopped and if they ever experienced withdrawal or cravings.
If a large enough population of twins provide that data, then a scientists can use complex mathematical equations and statistics to estimate how much of a given criteria, syndrome or disorder is due to genes or environments.
Based on these studies, behavioral geneticists learned that across all licit and illicit substances, genes appear to explain anywhere between 40 and 70% of individual differences between people. Which means that on average genes account for half of the variation in both risk of initiating and risk of progressing through use to abuse and dependence.
Beyond genes, the majority of the other half of a person’s overall risk is explained by aspects of the environment that are unshared between individuals, meaning random things that happen to you and not to other members of your family. Cultural environmental factors shared within families like where you grew up, your schooling, etc. account for up to 10% of one’s risk of initiating substance use, but have a non-significant effect on one’s risk of progressing from use to abuse.
So how can people use this information to benefit themselves and others?
It would be revolutionary for everyone to know about their ancestral, genetic and environmental background and have that accessible to them before they decide to smoke their first cigarette or drink their first drink. But this kind of prevention programming will only work if the end users are educated. At this stage, if you were to give every individual in the US their risk profile, most wouldn’t know what to do with it. Many would assume, “I have a particular gene on a particular chromosome. Therefore, I’m going to get disorder X or disorder Y.” Often that is not the case.
In most instances, geneticists study complex traits or outcomes which are highly polygenic, meaning a person must have a number of different genes in order to manifest a given problem. Everyone’s genes are different, so everyone has a different mixed bag of risk profiles that interact with one another and influence their health outcomes. So when we discuss genetics and substance use, we should always be careful to talk in probabilities and promote overall literacy in science through genetic counseling and translating research into accessible forms of media.
As researchers and advocates we believe that knowledge is power, and the future of substance use research will open up a great wealth of personalized data about how genes and the environment influence health. But knowledge by itself is not enough: we must all actively promote scientific literacy to apply this new wealth of information to support the common good.
In this article Dr. Danielle Dick, a leading international researcher on the genetics of addiction and the Director of COBE, talks about the key things we know about the genetics of addiction from her 20 years of research in the field.
Whether you’re a celebrity like Prince, Philip Seymour Hoffman and Heath Ledger or one of the 19 people a week who overdose in Richmond, the opioid crisis invades communities across America without prejudice.
President Trump just declared the opioid crisis a public health emergency, but substance use problems have been a major source of concern for decades. So before we look at the outcomes related to opiates in particular, it is important to know what underlying influences have led us to this point.
Researchers have been working for decades to understand the risk factors that contribute to the development of substance use disorders, but what have we learned from these efforts?
According to Dr. Danielle Dick, a leading addiction researcher at Virginia Commonwealth University and the director of COBE, there are five key things to know about genes, environments and addiction:
Genes are important, and we are not all equally at risk.
Health outcomes are a product of our predispositions, our environments and how they relate to one another. We are all at risk for different things, so we all start from a different place in terms of how much risk we carry relating to substance use.
Scientists have found that the heritability of substance use disorders is somewhere around 50 to 70 percent, so genes play a significant role on substance use.
But heritability estimates are often misunderstood. For example, 50% heritability doesn’t mean that if I have alcohol problems, 50% of the reason is because of my genes and the other 50% is because of my environment. The genetic 50% refers to the differences between all of us. So the difference between how much everyone drinks is about half due to differences in our genes and half due to differences in our environments.
There is no gene “for” addiction; in fact, most genetic risk factors are not specific to any particular substance.
There is no single gene the impacts your risk for alcohol or opioid dependence. Similarly there is no single gene that increases risk of experiencing depression, ADHD or any other complex behavioral health outcome. There are likely thousands of genetic variants that impact risk, and your risk for developing addiction is a combination of all of them!
Further, these genes aren’t specific to any particular form of addiction. Scientists have found that the majority of the genetic predisposition toward substance use is shared across all drugs of abuse. That means that only a little bit of your risk has to do with how your body physiologically responds to any given drug.
Temperamental factors like how much you enjoy trying new things or how well you cope with stress actually have a much larger influence over substance use disorders. People carry predispositions that influence problem use of all kinds of substances and other complex life outcomes.
Genetic risk factors can change as a function of the environment.
When we talk about genes and substance use, we know that dispositions are important but they are not destiny. You are not destined to develop problems. In fact, environments can change the likelihood that you will develop problems even if you are at risk.
For example, we know that access to a drug can change the likelihood that you’ll develop a substance use disorder. So imagine a neighborhood or city where there is no availability of alcohol. It doesn’t matter what your genetic predisposition to alcohol use is because alcohol is not available for you to try. We would all still carry different versions of genes and thus have different levels of risk, but the environment would completely “trump” genetic risk and be the most important factor in how much everyone was drinking (or not) in that environment.
This example may be extreme, but there are all kinds of environments that can alter risk in a more subtle or nuanced ways.
In addition, we know that if you’re in a stressful environment and you’re already at risk regarding substance use, the environment will make it more likely that you develop substance use problems. We also know that kids who are genetically at higher risk of developing substance use disorders but have parents who monitor them closely have a lower likelihood of developing those disorders.
There are many different pathways of risk. People develop substance use disorder for very different reasons.
Some people are at risk due to externalizing behaviors, like how impulsive you are or much you are motivated by reward-seeking. Externalizing behaviors are problem behaviors directed towards the environment like being physically aggressive or disobeying rules. Others are at risk because of internalizing behaviors like how much a person struggles with anxiety or stress. Internalizing behaviors are problem behaviors that focus negative energy towards the self like eating disorders or depression.
Physiological differences in how our bodies respond to drugs also have an impact on our outcomes too. These differences in responses are another pathway of risk.
We all carry combinations of these risk factors that come together to make us more or less at risk.
Risk factors show up at an early age, but they are not universally bad for you.
You don’t have to wait until someone starts drinking to know if they are at risk. Kids will exhibit signs of impulsiveness or shyness or anxiety at a young age. By being aware of risk factors that show up early in development, this information can be used to help prevent the development of substance use problems.
It is also important to note that these personality traits are not universally negative qualities. A little bit of anxiety is good; that’s what makes you study for your exams. And risk-taking by itself isn’t necessarily bad: entrepreneurs are risk takers; fighter pilots are risk-takers. But, being too impulsive or anxious can be challenging. That’s why it is valuable to know where you stand with these risk factors so that once they tip past a certain point, you can think about seeking support.
In summary, we know that substance use is influenced by genes, and we are not all equally at risk. Environments play a role in how genetic risk is expressed, and risk factors are generally not related to any one substance. There are many different pathways of risk, and these start to reveal themselves long before people start using substances.
Though we have come a long way in our understanding of substance use, there are still many things that we don’t know. Here are a couple of the big ones:
We haven’t found all of the genes that predispose people to risk.
We haven’t found them, but we are working on it. There are thought to be thousands of genes involved in altering risk, so it takes a large number of research participants in each study to find them. That’s one of the reasons that we run Spit for Science, which pools data from over 10,000 students to learn more about the genetic and environmental influences on substance use and related behavioral and emotional health outcomes. Anyone can be a part of helping discover the underlying biology of addiction by being a part of research.
Most research on the genetics of substance use disorders focuses on individuals of European descent.
This is an area where we still have much more work to do when trying to understand what are the important genetic variants, environments, and how environments interact with genetic predispositions. Because of the different ancestral histories of people from different ethnic/racial backgrounds, there could be different genetic variants of importance across different groups, and we want to make sure all groups benefit equally from medical advances in genetics. Further, we know that individuals from different ethnic/racial backgrounds can be exposed to different environmental stressors, and we want to make sure we understand the pathways of risk and resilience in all groups, to develop the most effective prevention programs for all children.
While addiction genetics as a field has evolved from a fringe study to become a core part of any conversation on substance use disorders and behavioral health, there is still much to learn about how genes and environments impact risk. Understanding the pathways of risk and resilience can help scientists develop more effective and tailored prevention and intervention programs, so that we can reduce the dramatic costs associated with addiction.
Lauryn Saxe Walker, M.P.H., is a Ph.D. student in the Department of Health Behavior and Policy at VCU. In this article she discusses how her research impacts statewide health care policy surrounding opioid use.
Before I came to VCU, I worked in a medical intensive care unit in Baltimore. I frequently saw overdoses, withdrawl, alcoholic cirrhosis and infectious diseases from sharing syringes for injection drug use. Addiction was so clearly evident in daily medical practice, even a driving force behind many medical problems, but it was rarely addressed as a major health concern.
This is the perspective that drives my work now as a health policy researcher.
Addiction does not stop at the pill, drink or injection. There are a multitude of medical and social consequences and causes of substance use disorders that must be acknowledged if quality of care is to be improved and cost reduced.
The non-medical use of prescriptions drugs is not new. However, over the last decade, opioid prescribing practices increased for a variety of reasons. There was a genuine belief by many providers that opioids were not very addictive, there was a push to treat pain more aggressively, and there were some inadvertent financial incentives. Opioids became commonly prescribed by primary care providers, emergency physicians, dentists and a variety of specialists.
Unfortunately, daily opioid use can lead to dependence in as little as 8 days.
Eventually tolerance increases and more of the drug is needed to maintain sufficient pain control and/or avoid withdrawal symptoms. As people progress from dependence to addiction, they may move to heroin or synthetic opioids, such as Fentanyl. These stronger opioids have resulted in an increase in overdose casualties.
As of 2015, overdoses are now the leading cause of death for people under 50 in Virginia and the country at large, overtaking both gun-related deaths and car accidents nationwide. Virginia had more than 1,100 deaths and nearly 9,000 ED visits related to opioid overdoses in 2016.
As a health policy researcher, it is my job to study the issues that policy makers need to or are trying to address. Our department recently contracted with the state to evaluate the Medicaid Addiction and Recovery Treatment Services (ARTS) program. Through this evaluation, we are working with the Virginia Department of Medical Assistance Services (DMAS) which oversees the Medicaid program to identify implementation timelines, process barriers and data availability.
As a doctoral student, this has provided me with opportunities to work directly with state government officials as well as substance use disorder providers that are participating in the Medicaid program. The collaborative process is critical to producing relevant and accurate research. While we may see the data, providers and state officials can help us understand what may be missing from the numbers or what else needs to be investigated. Additionally, our findings must be presented in a way that is actionable for policy makers.
For instance, we have placed emphasis on identifying regional variation in treatment services. This allows officials to see where remaining problems may exist and what resources specific local areas may require. Our first report to the legislature can be found here.
Although targeted at a narrow population, the Medicaid ARTS program we are currently evaluating is a policy that acknowledges the growing need for attention to substance use disorders and integration into general care. Preliminary findings suggest that more people are in fact receiving treatment for their opioid or alcohol use disorder. Over the next 5 years, we will continue to monitor the effectiveness of these services and the program as a whole.
When people ask about “solving” the crisis, I would offer 2 points:
First, our current healthcare system is divided between physical health and mental health. Substance use disorders fall somewhere in between, so we need to bridge that gap to promote effective treatment. While people frequently present to the healthcare system with physical symptoms, places like emergency departments are often ill-equipped to deal with addiction-related issues. Delivery systems that can address the full-spectrum of health problems may be able to help reduce the opioid use disorder crisis.
Secondly, it is still difficult getting patients into effective treatment. This is in part because there is currently little consensus on what is “effective treatment” in the recovery community. Although there are some treatment guidelines, they are inconsistently practiced. Solving the current crisis will require practitioners from a variety of backgrounds, which historically have been very separate, to work together to reduce the number of people that fall through the cracks of the system.
For those of us in research, we also have a role to play. We have the tools to examine why a program, policy or treatment is or isn’t working. However, with that comes the responsibility to make sure information is shared beyond journals and conference to reach policy makers, providers and anyone that may translate our research into practice.
Research is how I’m contributing to the solution. However, there is plenty of room for all of us as students, clinicians, and community members to do our part.
If you are interested in being a part of research on substance use, mental health and student success at VCU, learn more about Spit for Science undergraduate and graduate research opportunities in a new interactive infographic.
Over the last 20 years, researchers have made huge steps in understanding the relationship between genes, environment and complex traits. While these advances are heralded as leading to a future of improved health outcomes, individuals of minority descent are underrepresented in genetic research and thus are unlikely to benefit equally from advances in genetics.
In an article published by the American Journal on Addictions, COBE Director Dr. Danielle Dick explores the limitations of existing data sets used in genetic research, the importance of diversity within those data sets and possible reasons for underrepresentation of minority populations in research.
“In general, most non-white populations have been underrepresented in genetic research,” Dr. Dick said. “Some of the concerns we reviewed are applicable more broadly to underrepresented groups, while other considerations pertain to African American populations specifically.”
Genetic analysis pertaining to alcohol often begins by studying twins. With twins, researchers can figure out how much of the variation in an outcome is due to genetic influences and/or environmental influences.
Twin studies generally use data from national population registries, such as those in Sweden and Finland. While Scandinavian countries happen to be the ones with registries, their populations are very homogeneous. Thus their registries are very homogeneous as well.
The limited number of studies that have included African American twins found both similarities and differences compared to their European counterparts. Environmental influences in particular vary widely based on experiences of socio-economic status, employment opportunities and other lived experiences tied to race.
Efforts have been made to create African American specific twin registries to counteract the imbalance of current data sets, but there is still a lot of work to be done to improve the diversity of twin registries.
And it’s not just twin studies either. Individuals of African descent have also been underrepresented in gene identification efforts.
“Discussions about race and genetics are further complicated by confusion about how best to reconcile the concept of race as a social construct with the biological differences that are discussed in genetics across racial groups,” Dick said. “Socially-defined racial categories do not necessarily reflect human genetic variation; however, racial categories may be correlated with differences in ancestral history, which can lead to genetic variation across groups.”
For example, people of African descent have greater genetic diversity than Europeans based on their ancestral history. So in addition to not serving minority populations when they are not adequately represented in research, failure to include African Americans in particular could lead to important genetic variants being missed.
While it is obvious that efforts need to be made to close the research gap, they must include awareness of the history of abuses of minorities in medical research and the ethical, legal and social implications of genetic research as a whole.
“Involving individuals of diverse ancestry in discussions about genetic research will be critical to ensure that all populations benefit equally from genetic advances,” Dick said. “The best way this can be accomplished is through interdisciplinary and collaborative work with persons of diverse ancestry.”
On Tuesday, Oct. 3rd, VIPBG researcher Dr. Nathan Gillespie presented at the COBE Connect lunch lecture about the genetic and environmental risk factors in cannabis use/misuse and how they relate to income over the lifespan.
The College Behavioral and Emotional Health Institute hosts COBE Connect the first Tuesday each month at Virginia Commonwealth University in Richmond, Va.
Join us on Tuesday, November 3rd for the next event entitled, “Contemplative Science Research at VCU: Highlights from Four Faculty Members’ Recent Studies,” featuring presentations by Jo Robins, Patricia Kinser and Chris Reina.
Why Science is a podcast about behavioral and emotional health research at Virginia Commonwealth University. During each episode we welcome a new guest from VCU to discuss their work ranging from substance use to stress, mindfulness to empathy and everything in between.
Why Science is produced in partnership with the National Institute for Alcohol Abuse and Alcoholism, the ALT Lab at VCU and WVCW Student Radio. Each episode is hosted, recorded and edited by COBE media specialist Craig Zirpolo.
COBE Administrative Director Marcie Walsh presented on COBE Research in Action: Thrive, Fit and the Science of Happiness at the September COBE Connect lunch lecture.
During her presentation Walsh explored how COBE collaborates with researchers at VCU to translate work on mental health, substance use and a variety of other topics into coursework, programming and policy that improves behavioral and emotional health for people on and off campus.
While there are many examples of research translation from COBE, Walsh specifically cited the Thrive and Fit living-learning communities and the Science of Happiness as two main examples of the work she oversees as administrative director.
The Science of Happiness course examines the state of college student mental health and wellness on a personal and systemic level. Students look at how individuals can create positive change by reinterpreting their goals and identifying steps towards having a successful experience in college and beyond. The course was created by COBE researchers from around the university and is co-taught by those researchers as a way of connecting students directly with experts in different fields.
Thrive and Fit are a partnership between COBE, VCU RecSports and VCU Residential Life and Housing that provide a select group of freshmen with a living-learning experience focused on well-being. Thrive and Fit help students learn how to make the most out of their college years and lead healthy, prosperous lives through coursework, programming and events that connect students to researchers across campus and promote general health and wellness.
At the end of the presentation, former Science of Happiness student Muneera Hassan discussed her experience with the class and how it changed her perspective on research.
“I found out that I really liked research through the Science of Happiness class,” Hassan said. “For me, COBE really put research back into real life.”
Hassan continued studying with COBE collaborators in the Spit for Science Research Bootcamp this summer and now runs her own spin-off research project as an intern with the EDGE Lab.
“I learned research isn’t this thing where there are people in white coats who talk to people in suits and we don’t apply anything to real life for five or ten years,” Hassan said. “It is informed by real life, and your experiences are what inspire us.”