UNDERSTANDING IMPLICATIONS OF GENETIC ATTRIBUTIONS FOR ADDICTION

成瘾障碍越来越多地被概念化为具有遗传根源的生物医学疾病。而当 传统观点认为，将成瘾归因于基因应该有很多好处，确实有 有理由怀疑这可能会产生一些意想不到的负面后果。尤其是，基因 对成瘾障碍的解释可能会导致人们认为成瘾者缺乏代理或 自我效能来克服他们的症状，并相信非生物医学治疗，如 心理疗法，不太可能奏效。如果这些影响发生在有毒瘾的人和 治疗他们的临床医生，有意义的负面临床后果-潜在的重大伦理问题， 可能导致的社会和政策影响。这份K99/R00提案是一项为期五年的研究序列， 培训和职业发展活动的重点是研究遗传解释对 并为候选人过渡到作为一名独立的ELSI研究人员的职业生涯做准备。这些 活动将在纽约州精神病研究所进行，这是研究的主要地点 以及哥伦比亚大学精神病学系的教育活动。《公约》的具体目标 建议的研究是：(1)调查遗传归因对人们成瘾的影响 有物质成瘾(酒精使用障碍)和行为成瘾(赌博障碍)的人， 通过定量分析他们对其基因解释的认可之间的关系 成瘾与他们的自责程度、对治疗效果的期望以及对他们的信念 自我代理和自我效能感；(2)考察临床医生对成瘾的遗传归因的影响 他们通过实验测试成瘾的基因解释如何影响他们的归因 对患者的责备，他们对治疗效果的期望，以及他们对患者机构的信念， 以及(3)进一步深入探讨遗传归因对成瘾的影响，使用定性的 对上瘾患者和治疗上瘾的临床医生的采访。候选人的职业目标是 进行严谨的跨学科研究，有助于全面了解 哪些对行为、身份和健康结果的遗传和其他生物学解释会影响社会和 临床结果的信仰和态度，以及这种信仰和态度的伦理、社会和政策影响 效果。拟议的定性方法、基因组科学、生物伦理学和公共政策方面的培训将使 进行研究，为临床实践、公众教育活动和社会政策提供信息，并 帮助推动该领域对如何最好地促进对基因组的准确理解- 以及它在包括精神健康在内的健康方面的作用--在患者、临床医生和普通公众中， 而不会产生或加剧负面或有害的信念和态度。

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 University’s 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 candidate’s 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.