Addiction can develop without a clear or singular cause; it is often a result of a variety of factors, including biological, psychological, and environmental factors. As such, addiction development is typically viewed within a biopsychosocial model, which takes all these factors into account. Understanding this model can help reduce personal and societal stigma and judgment and can help inform prevention and treatment approaches.
- Many risk factors contribute to the development of addiction, including biological, environmental, and psychological factors.
- Exposure and access to substances, along with these risk factors, can lead to substance use and addiction development.
- Preventing or reducing the harm of addiction can be possible at any stage of development with the right intervention strategies and support network.
How addiction develops
Addiction develops as a result of many different factors, which vary and occur uniquely for each person. Many different risk factors increase a person’s likelihood of using substances. This vulnerability, combined with exposure and access to substances, can result in harmful substance use. [1]
Over time and with repeated use, changes begin to take place in the brain, further reinforcing substance use and impairing executive functions like impulse control, judgement, and decision-making. For example, addictive drugs impact the brain’s dopamine production. The drug triggers a flood of dopamine, serving as both a reward and a signal to repeat this behavior.
The person then repeatedly uses the drug in an attempt to experience the same “high” or pleasure sensation, although this sensation ultimately reduces due to an increase in tolerance. This leads to increased frequency and amounts of use, withdrawal symptoms and cravings when the drug is not used, and the development of addiction, or substance use disorder (SUD). [2]
As executive functioning declines, a person also becomes less able to regulate strong impulses and urges, think through the consequences of their actions, and make good choices. These changes in reward circuitry and executive functioning illustrate how, over time, drugs and alcohol can rewire the brain in ways that make it harder to stop using.
Why addiction is complex
The development of SUD is very complex, and there are many contributing factors. Because of this, the biopsychosocial model is often used to help understand each individual’s experience and SUD development.
The biopsychosocial model incorporates: [1]
- Biological factors: Including genetics, brain development, and neurobiological differences affect how a person responds to a drug and how sensitive or susceptible they are to developing an addiction.
- Psychological factors: Including mental health symptoms, personality traits, and childhood trauma. Many people with addiction also struggle with mental health conditions, and may use drugs or alcohol to self-medicate or cope.
- Social or environmental factors: Including exposure to addiction in the home, socioeconomic factors, and peer pressure can also impact addiction. Often, high levels of stress, social isolation, and high availability of drugs contribute to ongoing substance use and addiction.
Often, a combination of factors precedes the development of SUD. Many factors overlap and impact one another, accumulating to create this risk.
Also, it is worth noting that not all people who experience one or more of these factors develop an SUD. Risk factors and protective factors can vary significantly from person to person.
Biological factors that contribute to addiction
Biological factors are believed to contribute to 40-60% of an individual’s risk of developing addiction. [3]
Genetic and family history
Various studies have been conducted to investigate the genetic factors of addiction development, many of which indicate a significant heritable influence. While initial and early stages of drug use may be more influenced by environmental factors, research suggests that the development of dependence and SUD is greatly linked to genetic heritability. [4]
Brain chemistry and dopamine
Drug use changes brain chemistry with frequent and prolonged use. Once dopaminergic changes have occurred, dependence develops, and without continued use, cravings and withdrawal symptoms emerge. [2] While these changes often begin to reverse themselves when a person stops using, they can make it much more challenging to stop or cut back.
By this time, the individual is likely to experience less enjoyment or euphoria from the use of substances. Instead, the body relies on substance use to feel “normal”, leading to uncontrolled and compulsive use, regardless of consequences. [2]
Brain development and early substance use
Substance use in adolescence can be a particular risk factor for SUD development, as the brain has not yet fully developed. Areas involving impulse control, decision-making, and risk analysis are not complete, which can make people of this age group particularly vulnerable to substance use, along with a heightened vulnerability to dopamine effects. [5]
These areas of the brain can become impaired by drug use, affecting brain development. Because of this, childhood or adolescence drug use is a significant risk factor in the development of SUD later in life. [3]
Psychological factors
Psychological factors can play a huge role in the development and continuation of SUD, as well as in a person’s recovery process. Many of these factors overlap or occur concurrently.
Mental health disorders
Mental health symptoms and SUDs often occur concurrently, and their impacts are likely bidirectional; each affects the other. For example, people with conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD) may be more likely to use substances than those without. Likewise, people with SUDs are more likely to experience conditions such as these. [1]
It is common for people with mental health disorders to use substances as a coping mechanism, to mask, numb, or avoid difficult emotions. As such, these conditions may increase the risk of addiction in some people. [1][3]
Trauma and adverse childhood experiences (ACEs)
Research indicates that people who have experienced traumatic experiences in childhood, such as physical and sexual abuse, are at a greater risk of substance use and SUDs later in life than those who have not. People with these experiences can be more likely to use substances as a means of coping with negative emotions. [1][6]
Personality traits
Certain personality characteristics have been associated with an increased likelihood of substance use disorders, although none independently causes addiction. These include: [1][7]
- Sensation seeking
- Low risk aversion
- High emotional expression or mood instability
- Impulsivity
- Social withdrawal
- Neuroticism
Environmental and social factors
Environmental and social factors can increase a person’s vulnerability to substance use and SUDs.
Family environment
The risk of SUD is higher among those with parents with an SUD. This can be influenced by genetic, psychological, and environmental factors, which often overlap, making it difficult to identify the contribution of each factor to increased vulnerability. [3][4]
Children of parents with addictive behaviors may be more likely to use substances and develop SUDs later in life due to their parents’ modeling of substance use and increased exposure and access to substances in childhood. [1][3]
Peer, partner, and community influence
Similarly, people may be influenced by their peers and members of their community if they are exposed to attitudes and behaviors that promote or normalize substance use. Young people in particular (though this can occur at any age) can be heavily influenced by others. They might feel they need to replicate others’ behavior to socialize or participate in groups. [3][4]
This influence also occurs among adults within intimate relationships. Having a partner who uses a certain substance increases the likelihood of the other partner using that substance. [1]
Socioeconomic, ethnicity, and cultural factors
Specific population groups are found to have higher rates of substance use and SUDs than others. SUDs commonly occur at higher rates among the following population groups: [8]
- Lower socioeconomic status
- Unemployment
- Lower education level
- Neighborhoods with high crime rates
- Minority groups
Discrimination, poor service access and availability, cultural alienation, and other stressors or traumas can increase the risk of SUDs among these groups. High-prevalence communities might also result in increased accessibility to substances, further increasing risks among these populations. [8]
Protective factors that can reduce addiction risk
Protective factors that can reduce addiction risk include: [3][9]
- Healthy communication and bonding within the family.
- Strong support networks, including trusted family and friends.
- Community involvement, such as local groups, sports, or religious communities.
- Mentors and strong role models for children and adolescents, whether inside the family or within the community.
- Personality and behavioral traits, including self-esteem, problem-solving skills, self-belief, and impulse control.
- Healthy coping skills and resilience to stress.
The path from experimentation to addiction
The timeline of addiction development can vary significantly from person to person depending on their own risk factors and circumstances. However, it is common for addiction development to follow a similar path:
- Experimenting or infrequent use: Someone uses a drug for the first time or infrequently.
- More regular use: If they don’t experience negative consequences, they might use it more frequently, developing a habit.
- Change in usage habits: Individuals may begin developing a dependence on a substance to cope with stress or difficult emotions, or they may begin using a substance alone instead of using socially
- Increased tolerance: Over time, physiological changes occur, and the drug no longer has the same effect, meaning that tolerance has increased and larger or more frequent doses are used to create the same effect.
- Dependence and withdrawal: The body becomes dependent on the substance to function and to avoid physical and psychological withdrawal symptoms. By this time, the person is using the substance continuously or at frequent intervals.
- Addiction: The person experiences negative consequences of their substance use, such as impaired functioning, loss of employment, and affected relationships, but continues to use the substance regardless. The individual no longer has control over their thought and behavior patterns, with their primary focus on obtaining and using the substance.
Can addiction be prevented?
It is possible to prevent addiction development. The above timeline can take place over many months or years, meaning that there are opportunities for intervention before addiction develops.
However, effectively preventing addiction during this timeframe may not be simple; the individual’s mental state, environment, or neurobiology might impact their ability to implement or accept intervention. Often, a strong support network and professional help can be crucial in implementing early intervention strategies. [2][10]
When to seek help
Recognizing warning signs can make it easier to know when to seek help before significant physiological and psychological changes have occurred. These can include:
- Spending more time thinking about and using substances.
- Using more or more often than intended.
- Using in situations where it’s inappropriate or unsafe.
- Unsuccessful efforts or unkept promises to cut back or stop.
- Noticing changes in mood and behavior.
- Other people have commented or expressed concern about the substance use.
- Noticing changes in physical well-being.
- Financial responsibilities become impacted because money is being used on substances instead.
- Losing interest in hobbies.
- Starting to neglect responsibilities.
Treatment options
Treatment is available to support people at any stage of addiction development. Early intervention strategies can significantly reduce the risk of addiction in high-risk groups, including adolescents. These treatment options can be available in schools, local clinics and hospitals, and mental health services, and can help reduce the harm of or prevent further substance use. [10]
People with an active addiction can utilize substance use disorder treatment options, which often include psychological or behavioral therapies, detoxification and withdrawal support, rehabilitative services, and sometimes medications. [2]
The most effective treatment options aim to identify and manage all aspects of the individual’s substance use, recognizing the complexity of addiction development.
A primary care provider can help identify the types of services required and make necessary referrals.
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