There have been quite a few studies over the years demonstrating the difference between children who later display the behaviors associated with addiction and children who do not have addictive disease. One of my long-quoted favorites is the sociologic work of Shedler and Block at UC Berkeley, who demonstrated that substance use is a symptom of an underlying process, that of addictive disease itself. Sociology won't convince everyone, however, and with apologies to sociologists, we need a better construct if we are to prove, finally, that addictive disease is present prior to the addictive behavior.

If we look at diabetes, we know that the disease is in process long before symptoms are evident. The genetic code and environmental insult have added up to an autoimmune response attacking islet cells. If one has an autoimmune response where islet cells are rapidly dropping in number, one has diabetes whether or not blood sugar, thirst, or urinary frequency have increased. Similarly in addiction, if the brain abnormality is already present and the only thing missing is the marker of substance use (or the addictive behavior of your choice), the patient has addictive illness. Our problem has been in the identification of these patients. That's the holy grail of addiction treatment: finding the patients BEFORE they ever begin their addictive behaviors.

Squeglia, Pulido, and others have written an article published this week in the Journal of Studies on Alcohol and Drugs. The article, titled "Brain Response to Working Memory over Three Years of Adolescence: Influence of Initiating Heavy Drinking," examines a neuroimaging study in youth who were identified as being at risk for substance use disorders. Put plainly, kids were examined with an MRI prior to their ever drinking alcohol. Naturally, the researchers found evidence of brain alteration secondary to heavy alcohol use which followed. We've known that for some time now. What we didn't know, though have long suspected, is that the brains of those who would later drink heavily differed from those who would not drink in this manner.

Alcohol-naive children who showed less activation in certain areas of the brain were at greater risk for becoming heavy drinkers in the three years that followed than were children who did not have such findings.

The lead author of the study, Lindsay Squeglia, PhD, said in a press release, "It's interesting because it suggests there might be some pre-existing vulnerability." We have known and recognized that clinically for decades, but this represents a very clear neurophysiologic correlate that once again underscores that addiction is a brain disease for which addictive behavior is a mere marker. The press release, interestingly, noted that the study doesn't mean teens should all start having MRI scans to see which ones might have addiction, but it is certainly my hope that the study means such a pre-addictive-behavior test may well be forthcoming. Imagine if we could test all children and determine prior to the first sign of addictive behavior which ones have addictive disease.

Preventing addictive disease is not likely to be achieved in the short term, but preventing addictive behavior through early identification of addictive disease is a far more reasonable and likely achievement.