Understanding Substance Abuse
Addiction is a complex condition that cannot be limited to one simple causal explanation. A person's genetics, environment, past experiences, and mental health all influence the development of addiction.1
Learn more about causes of addiction, including:
What Is Addiction?
Addiction is characterized by problematic substance use that significantly impairs everyday functioning.
Common characteristics of people addicted to drugs and alcohol include:2
Negative feelings - Drugs and alcohol serve a purpose for users who are often looking to minimize pain and maximize pleasure. Users who become addicted often start because of negative feelings such as sadness, loneliness, discomfort, and restlessness.
Preoccupation with using - Addiction involves spending a great amount of time thinking about, acquiring, and/or recovering from drugs and alcohol. People who are abusing drugs or alcohol may feel intense cravings for their drug of choice and find it difficult to suppress their urges.
Temporary and short-lived fulfillment - Once an addicted person uses drugs or alcohol, a temporary feeling of satisfaction follows . However, satisfaction is often short-lived and followed by urges to use more. In some cases, heavy use of certain drugs, such as alcohol and opioids, can lead to withdrawal symptoms with cessation of use.
Feeling out of control - As addiction progresses, users may feel as though they are losing control over their thoughts and behaviors. Those with an addiction often report feeling unable to refrain from engaging in drug use.
Using despite negative consequences - A key feature of addiction is also the continued use of drugs and alcohol despite negative consequences, such as health, financial, and legal problems. People may feel unable to stop despite addiction's negative impact on several areas of their lives.
Reasons for Addiction
Addiction is often the result of a complex interplay of numerous factors, including a person's genetics and environmental influences. 3 Two people may be addicted to the same drug, yet have vastly different reasons for using.
Genes and Substance Abuse
Heredity is the process of parents passing on traits to their children at birth.4 Children receive 46 chromosomes containing thousands of genes from their parents. Genes determine the specific traits that a child will have, such as:5
Physical traits: determine a person's outer appearance, such as eye and hair color.
Behavioral traits: influence the way a person acts, such as how shy or outgoing a person is.
Predisposition to medical conditions: can also be impacted by traits and may increase a person's risk of getting a disease, such as cancer.
Although genes play a role in defining a person's traits, environmental factors can also impact traits.5 Environmental influences can even alter a trait.5
Addiction is considered moderately to highly heritable, meaning that genetics play a significant role in addiction. 6 In other words, people who have relatives with addiction problems have an increased risk of developing an addiction themselves.
The influence of genetics on addiction varies from drug to drug. Below is the breakdown of heritability of dependence on or abuse of specific drugs.6
Cocaine: .72 heritability or 72%
Opiates: .70 heritability or 70%
Alcohol: .55 heritability or 55%
Sedatives: .50 heritability or 50%
Marijuana or cannabis: .41 heritability or 41%
Hallucinogens: .39 heritability of 39%
Specific genes that have been linked to addiction include:7
The A1 allele of the dopamine receptor gene DRD2 is associated with alcohol and cocaine addiction.
The lack of Htr1b gene is associated with cocaine and alcohol self-administration in mice.
Lower levels of neuropeptide Y in mice is related to consuming larger amounts of alcohol.
A defective Per2 gene in mice is related to greater alcohol use.
Having two copies of the ALDH*2 gene variation is linked to a lower likelihood of alcohol addiction.
Environmental Factors of Addiction
A person's environment, or the people, places, and things that he or she is exposed to, can also influence whether or not an addiction develops. Aspects of a person's environment that may play a role in causing addiction include:3
Peer pressure: Friends are significant in adolescents' lives. Peers may expose adolescents to drugs and influence their beliefs on what is right and wrong.
Poor parental supervision: Children of parents who fail to monitor their behavior and provide discipline and structure are at risk of addiction.
Parental drug use and criminal activity: Children of parents who use drugs and alcohol and are involved in criminal activity are at risk of abusing substances. Parents may introduce children to drugs, model negative behaviors, and create environments that increase stress.
Presence of drugs at home and/or school: Exposure to drugs and alcohol can provide additional opportunities for children to experiment and possibly go on to develop an addiction.
Living in a poor community: Neighborhood poverty is linked to addiction. This may be due to the stress that poverty causes and the limited opportunities for change.
Although environmental factors can put children at risk of addiction, protective factors can minimize the risk of addiction.8 Children who grow up with good parental support, positive relationships, a sense of community, and anti-drug policies at school, and are able to develop self-control may be protected from some of the risk factors for addiction.3
Childhood experiences, both positive and negative, can have a significant impact on a person's physical and emotional health. Adverse childhood experiences can be stressful, traumatic events that may lead to physical and emotional difficulties.9
Examples of adverse childhood experiences include:10
- Physical abuse.
- Sexual abuse.
- Verbal abuse.
- Physical or emotional neglect.
- Witnessing violence.
- Having a family member with a mental illness.
- Having an incarcerated family member.
- Having a family member who is addicted to drugs or alcohol.
- Parental separation or divorce.
In some cases, trauma can lead to post-traumatic stress disorder (PTSD), which can occur after a person witnesses or experiences a dangerous or shocking event. 11
Signs of PTSD include: 11
- Flashbacks of the event.
- Frightening thoughts.
- Avoiding reminders of the event.
- Feeling sad, worried, or guilty.
- Sleep disturbances.
- Being startled easily.
- Feeling restless or tense.
- Increased conflict or anger toward loved ones.
- Memory problems.
- Negative thoughts about self or others.
- Being startled easily.
- Feelings of guilt or blame.
- Loss of interest in hobbies.
Research has found that 60% to 80% of people with PTSD also have substance abuse issues.12 People who experience PTSD may use drugs and alcohol as a way to cope with stress or to relieve symptoms such as anxiety, depression, and irritability. However, drugs and alcohol do not help PTSD go away and may exacerbate symptoms.
Fortunately, treating PTSD can reduce the likelihood of developing addiction. Treatment may involve medications, individual and group therapy , and/or support groups.
There is a strong link between a person's mental health and addiction.13 People who suffer from an anxiety or mood disorder, such as depression or bipolar disorder , are twice as likely to also have a substance use disorder.13 Those with conduct disorder or antisocial personality disorder also have an increased risk of alcohol or drug addiction. 13
A person is said to have a co-occurring disorder or dual diagnosis when both a mental health disorder and addiction are present. In 2015, 8.1 million Americans had a co-occurring disorder.14
Both addiction and mental health disorders are impacted by several factors, including genetics, history of trauma, and the environment.13 In some cases, people may use drugs and alcohol as a way to self-medicate or cope with mental health issues.
Mood disorders, such as major depressive disorder and bipolar disorder.
Anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder.
Attention-deficit hyperactivity disorder (ADHD).
Antisocial personality disorder and conduct disorder.
Psychotic disorders, such as schizophrenia and schizoaffective disorder.
Rates of co-occurring disorders among people with drug use disorders are as follows:15
28% for anxiety disorders (i.e., 28 out of every 100 people with a drug use disorder also struggle with anxiety).
26% for mood disorders.
18% for antisocial personality disorder.
7% for schizophrenia.
The overlap between addiction and mental health disorders may be influenced by a variety of factors:13
Genetics - Genes may directly and/or indirectly impact a person's vulnerability to addiction. For example, genes may affect how a person metabolizes a drug. Also, genes may influence how a person copes with stress, which can increase or decrease the risk for addiction.
Neurological influences - Neurotransmitters in the brain, such as dopamine, are impacted by substance abuse, but they also play a role in various other mental health conditions. Brain changes resulting from mental health problems may impact or lead to substance abuse and vice versa. Also, changes in the brain due to a mental health disorder may impact how a person experiences drugs.
Treatment of mental health disorders may reduce the likelihood of future drug use.13 In some cases, treating substance use disorders may also decrease the severity of mental health disorders. Treatment for co-occurring disorders among adults and adolescents may include a combination of medications, family therapy , cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), exposure therapy, and group therapy approaches.
Addiction is a serious but preventable condition. Early intervention and preventive measures can decrease the risk of substance abuse and addiction in children and adolescents.
Taking the following steps can help prevent addiction:8,16
Prevention programs: Prevention programs can be targeted at families, schools, and communities. They may be aimed at helping children struggling with aggression, poor social skills, and academic problems.
Education: Educating children, adolescents, and parents on the dangers of addiction and the risks of specific substances can promote informed decisions and decrease the risk of drug and alcohol abuse.
Skills training: Programs can be aimed at teaching parenting skills, healthy communication among family members, and appropriate parental involvement. Children may also benefit from programs to help assist with improving study habits, peer relationships, assertiveness skills, and self-esteem. Other skills taught to young people may include emotional awareness, self-control, communication, and social problem-solving.
Outreach: Reaching out to children, adolescents, and families can create awareness of available programs, promote participation, and increase engagement. This can be especially helpful for minority groups, who may experience difficulty accessing programs.
Promoting protective factors among children and adolescents may also prevent addiction. Protective factors include:8
Impulse control: the ability to manage urges or delay gratification.
Parental monitoring: monitoring children's behaviors, supporting their physical and emotional needs, setting limits, and enforcing discipline.
Academic achievement: encouraging and promoting success in school, as well as involvement in extracurricular activities outside of school.
Antidrug use policies: advocating for drug-free schools and enforcing policies and laws.
Strong neighborhood attachment: developing meaningful connections outside of the home with members of the community.
Preventive strategies may be less effective if a person has an existing addiction. People struggling with addiction may benefit from substance abuse recovery programs to help reduce their use.
Types of Addiction Treatment
Several different types of addiction treatment programs exist to help people struggling with addiction. Treatment can be beneficial at any point in an addiction and can be tailored to a person's needs.
Detox : A type of short-term treatment that is necessary for people who are physically dependent on drugs or alcohol. People are closely monitored by medical professionals to ensure a safe and comfortable withdrawal. Detox may be necessary for people withdrawing from alcohol, benzodiazepines, and barbiturates, as the withdrawal symptoms can sometimes be fatal.
Inpatient or residential treatment : A type of treatment that involves staying at a facility and participating in a number of recovery services for a set period of time. Inpatient treatment can be helpful for people who prefer to be in a structured, drug-free environment, void of temptations or triggers.
Outpatient treatment : A type of recovery program that offers therapy sessions for recovering users a few times per week, depending on the level of care needed. Outpatient programs offer less structure because people are not required to live at the facility and are free to return home once treatment is completed that day.
12-step programs : Fellowship programs, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are free to join. The only requirement is that you must want to abstain from mind-altering substances. The meetings provide individuals with a supportive and encouraging environment. Non-12-step programs, such as SMART Recovery , are also available.
Dual diagnosis : Dual diagnosis programs specialize in helping people who struggle with both addiction and mental health issues. Treatment may involve group, individual, and family therapy, and medication management.
Find a Recovery Program
If you or someone you know is struggling with addiction, call 1-888-319-2606Who Answers? . Our recovery support representatives can provide you with more information and assist you with finding a program.
. Kranzler, H. R., & Li, T. K. (2008). What is addiction? Alcohol Health & Research World, 31(2), 93-95.
. Sussman, S., & Sussman, A. N. (2011). Considering the definition of addiction . International Journal of Environmental Research and Public Health, 8(10), 4025-4038.
. National Institute on Drug Abuse. (2014). Drugs, brains, and behavior: The science of addiction . NIH Pub No. 14-5605.
. Genetic Science Learning Center, University of Utah. (2004). What is heredity?
. Genetic Science Learning Center, University of Utah. (2004). What is a trait?
. Bevilacqua, L., & Goldman, D. (2009). Genes and addictions . Clinical Pharmacology and Therapeutics, 85(4), 359-361.
. Genetic Science Learning Center, University of Utah. (n.d.). Genes and addiction .
. National Institute on Drug Abuse. (2003). Preventing drug use among children and adolescents: A research-based guide for parents, educators, and community leaders . NIH Pub No. 04-4212.
. Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111(3), 564-572.
. Substance Abuse and Mental Health Services Administration. (2016) Adverse Childhood Experiences.
. National Institute of Mental Health. (2016). Post-traumatic stress disorder .
. Goeders, N. E. (2003). The impact of stress on addiction . European Neuropsychopharmacology, 13(6), 435-441.
. National Institute on Drug Abuse. (2010). Comorbidity: Addiction and other mental illnesses . NIH Publication Number 10-5771.
. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
. Flynn, P. M., & Brown, B. S. (2008). Co-occurring disorders in substance abuse treatment: Issues and prospects . Journal of Substance Abuse Treatment, 34(1), 36-47.
. Substance Abuse and Mental Health Services Administration. (2016). Prevention of substance abuse and mental illness .
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