Understanding Implications of Genetic Attributions for Addiction

Addictive disorders are increasingly conceptualized as biomedical diseases with genetic roots. While conventional wisdom has suggested that attributing addictions to genetics should have many benefits, there is reason to suspect that it could have some unintended, negative consequences. In particular, genetic explanations for addictive disorders could lead to the perception that people with addictions lack agency or self-efficacy to overcome their symptoms and to the belief that non-biomedical treatments, such as psychotherapy, are unlikely to be effective. If these effects were to occur among people with addictions and the clinicians who treat them, meaningful negative clinical consequences--with potentially significant ethical, social, and policy implications--could result. This K99/R00 proposal is for a five-year sequence of research, training, and career development activities focused on studying the implications of genetic explanations for addiction and preparing the candidate to transition into a career as an independent ELSI researcher. These activities will take place at the New York State Psychiatric Institute, which is the primary location of research and educational activities for Columbia Universitys Department of Psychiatry. The specific aims of the proposed research are: (1) to investigate the implications of genetic attributions for addiction among people with a substance addiction (alcohol use disorder) and people with a behavioral addiction (gambling disorder), by quantitatively analyzing the relationships between their endorsement of genetic explanations for their addictions and their levels of self-blame, expectancies about treatment effectiveness, and beliefs about their own agency and self-efficacy; (2) to examine the effects of genetic attributions for addiction among clinicians who treat addiction, by experimentally testing how a genetic explanation for addiction affects their ascriptions of blame to patients, their expectancies about treatment effectiveness, and their beliefs about patients agency, and (3) to explore the implications of genetic attributions for addiction in further depth, using qualitative interviews among people with addictions and clinicians who treat addictions. The candidates career goal is to conduct rigorous interdisciplinary research that contributes to a comprehensive understanding of the ways in which genetic and other biological explanations for behavior, identity, and health outcomes affect socially and clinically consequential beliefs and attitudes, as well as the ethical, societal, and policy implications of such effects. The proposed training in qualitative methods, genomic sciences, bioethics, and public policy will allow him to conduct research that informs clinical practice, public education campaigns, and social policy, and to help move the field toward an understanding of how best to facilitate accurate understandings of the genome-- and its role in health, including mental health--among patients, clinicians, and members of the general public, without engendering or exacerbating negative or harmful beliefs and attitudes.