Substance Use (Not Abuse) Disorder

In this episode, Dr. Nzinga Harrison explains substance use disorder and how medical treatment along with harm-reduction practices can lead to better community outcomes.

“Substance abuse”… carries the stigma that we put on people who are suffering with substance use disorders, or people who use drugs. Abuse is a crime. Abuse comes with negative implications and judgement about choices and morality. And so we try to be very intentional about our language to move from substance abuse to substance use disorder.

Dr. Nzinga Harrison is a well-respected physician and educator, and the Co-Founder and Chief Medical Officer of Eleanor Health, an innovative company building mental health medical homes for individuals affected by opioid and other substance use disorders. She is also the Co-Founder and Vice-Chair of the Board for the non-profit Physicians for Criminal Justice Reform, where she leads advocacy at the intersection of health and criminal justice.

She earned her bachelor’s degree from Howard University, completed medical school at the University of Pennsylvania, and completed General Psychiatry Residency at Emory University. She is Board-Certified in both Adult General Psychiatry and Addiction Medicine and has spent her career treating individuals with Serious Persistent Mental Illness and Addictive Diseases and advocating for stigma reduction, justice and equity in healthcare. Currently, she holds adjunct faculty appointments at the Morehouse School of Medicine Department of Psychiatry and is Campaign Psychiatrist for Let’s Get Mentally Fit, a public education and stigma-reduction campaign.

I asked Dr. Nzinga, is there such thing as an “addictive personality”?

Yes and all humans have it. The addictive personality is the one that continues to engage in behaviors that bring positive benefit even though they have negative consequences. That is all of us! That is neurobiologically how the brain functions.

I think what people mean to say when they say “addictive personality”, what they are actually talking about, is the biological, psychological, social-cultural predisposition to develop an addiction. If we look at addiction as a chronic medical condition, which it is, like diabetes, high blood pressure, or asthma, there’s this concept of a heritability coefficient. That means, what percent of your risk is coded in your DNA the day you are born.

If you look at the heritability coefficient for addiction, it’s between 40–60%. High blood pressure? Between 40–60%. Diabetes Type 2? Between 50–70%? Asthma? Between 35–50%. So addiction has the same genetic risk. So if you have a person lay on top of that risk, psychosocial variables that drive addiction (…abuse, neglect, instability, poverty, losing a parent to the legal system…), then what you have is a person who is more vulnerable to get addicted to whatever series of behaviors or substances they are exposed to. People call it “addictive personality” which puts the onus on that person… when it’s actually genetic vulnerability and psychosocial impact driving the risk for developing addiction.spo

Topics we cover in this episode:

  • The definition of addiction, and examples of behavioral addictions
  • The truth about “addictive personalities”
  • Why substance use disorder treatment is so ineffective
  • Leading with compassion, autonomy, evidence, and data
  • Using value-based care to deliver whole-person, compassionate harm-reduction


Trying to make a difference.