Why Some Do and Others Don’t. The 9 Key Factors Common to Addiction
As a young college student, what drove me to study psychology was the desire to answer one simple question, why do some who abuse drugs and alcohol become addicted, while others don’t? As I would eventually come to discover, there are no easy or straightforward answers to this question. There are, however, many factors that play a role in why some become addicted and others do not. Here we will explore these factors.
The Perfect Storm
The best metaphor I have found to describe how addiction happens is to say that it is a "perfect storm". A perfect storm of factors that come together to create what we know as an addiction to drugs and/or alcohol. The following list highlights the most influential factors. Keep in mind that any one of these factors are not what caused someone to become addicted, but rather these are the factors that place someone at "high risk" for becoming addicted.
1. The Drugs Themselves
First, obviously it is impossible to become addicted if drugs and alcohol are avoided all together, therefore, a requirement for becoming addicted is the decision to begin using and abusing drugs. That said, these are the "trump cards" of mood-altering experiences. Users must act with tremendous respect for all substances, or they can and do pay, sometimes with their lives. Inherently, however, some drugs are more addictive than others. Nicotine and opioids are extremely addictive, such that for most who abuse these drugs, addiction is a likely outcome. That said, according to the 2022 National Survey on Drug Use and Health, 177 million people ages 12 and older (62.8% in this age group) reported to have drunk alcohol in the past year, yet the overwhelming majority do not become addicted to alcohol (about 6% of the population will). In fact, a 2018 study by the Center for Disease Control (CDC), the largest ever reported with 138,000 participants, found that 90% of those who identified themselves as “excessive” or “heavy” drinkers did not meet criteria for what we would consider alcoholism. For most people alcohol is a benign substance. It would take real effort over many years to become addicted to it, and that’s if you were really trying! For most people, that is.
The bottom line is drugs are not equal in their abuse/addiction potential. Below we’ve included a list of drugs in order of their addiction potential.
As you will soon see, however, not all bodies react to drugs of abuse the same way. There can be no question that some people are more prone to become addicted to alcohol and marijuana, drugs generally considered lower on the “addiction potential” scale.
2. The Route Of Administration
Though this may not be a familiar aspect of drug use to non-drug users, how someone ingests a drug has a very real impact on its potential to be addictive. The faster that a drug reaches the blood stream and brain, the more likely it is to be addictive. For example, intravenous drug use, be it cocaine, amphetamines, or opioids (the most commonly injected drugs), will reach the brain in seconds and therefore have a much more potent impact on the user. The next fastest way to ingest a drug is by inhaling smoke through the lungs, such as is the case with smoking cigarettes, crack cocaine, free base cocaine and/or amphetamines, and smoking marijuana. Several drugs can be used a variety of ways. For example, heroin and cocaine can be smoked, snorted, or injected, and how a user delivers the drug into the body can make a considerable difference in its effect. Swallowing a prescription pain killer is notably different from crushing it up and snorting it or diluting the pill to be injected intravenously, because it must go through the entire digestion process before reaching the brain. Ingesting a drug through the stomach to be broken down through digestion is the slowest way to feel the effects a drug and can be less appealing to more seasoned drug abusers. To understand addiction, you have to begin to think like a drug abuser. Inevitably, over time, regardless of what they might tell you, it comes down to efficiency…getting the biggest bang for your buck.
3. Genetics
As you have likely heard by now, genetics does play a part in determining who becomes addicted, and who does not. Those with an identical twin who is addicted are 40-60% more likely to have a problem. Similarly, those who have a "first degree" relative ( i.e., Mother, Father, or sibling) are also at considerably greater risk for having a problem. Especially when it comes to drugs like alcohol, which is a relatively benign substance for the average person. Researchers have discovered a gene(s) that predisposes some to becoming addicted, and for those who fall into this camp, alcohol can become as addictive (and as dangerous) as heroin.
Additionally, some research into genes and addiction suggests there are other factors as well. For example, those who go on to develop a problem with substances are believed to be more sensitive during adolescence to naturally occurring intense emotional experiences. In other words, risk taking, falling in love, or other innately rewarding behaviors, are somehow more rewarding (and thereby more enticing) to some, making these folks more susceptible to seeking out and enjoying the "high" experienced from drugs and alcohol (Sapolsky, 2017).
4. Age One Starts
Studies have shown that those who begin using substances before the age of 18 are at a greater risk for developing a problem. Though we might speculate those who begin relying on substances earlier in life are more at risk for addiction because they never learn the skills to handle difficult emotions without drugs, it is actually their underdeveloped organ systems that make using drugs earlier more dangerous.
Underdeveloped organs means the drugs are not being broken down as well, and are therefore, more toxic, and more potent to an immature body and brain. The more potent, the more addictive.
5. "The Big 3" Personality Traits: The Personality of Addiction
Though the way in which the term "addictive personality" is commonly used has no real scientific meaning, there are three personality traits that years of research (dating back to the 1950s) have determined are more common to those who become addicted later in life. I should also mention, these traits are then further exacerbated by the abuse of substances. These three traits are, 1) impulsivity (acting without thinking through the consequences, or acting on impulse), 2) defiance (someone prone to, "a disposition to challenge, resist, or fight", and 3) entitlement, believing and behaving as though someone is inherently deserving of privileges or special treatment, and feeling victimized when they are not treated accordingly.
6.Parenting Style
Though we cannot say that any one parenting style causes an addiction, it is far more common for those who go on to develop an addiction to have been raised with what is called a "permissive parenting style". Popular amongst the baby boomer generation, this is the type of parent who might advocate for a “moderation” approach to using, what they consider "harmless" drugs like alcohol and/or marijuana. The “gateway” drugs. They may consider substances a routine part of adolescence, and therefore, elect to have their child drinking or using under their roof, to be able to keep a closer eye on them. For example, they may supply the alcohol for their child and their friends but insist on “taking the car keys at the door”. They may consider wine with dinner, and an after-dinner cocktail normal, and feel they’re better off normalizing substance use, over making it taboo, bad, or wrong. The miscalculation these well-meaning parents often make, however, is to assume that because they have the ability to moderate their use, so will their child. What they fail to consider, and can’t possibly know, is how immature the adolescent brain and body truly is. Though their child may appear to them to be more grown up, the combination of having underdeveloped organ systems, raging hormones, an inherent lack of impulse control, and underdeveloped "logic" circuits in the brain (stemming from a yet to be developed frontal cortex), leaves them without the same ability as Mom and Dad to moderate their use (Sapolsky, 2017). Other cultural changes in parenting over the last 2-3 decades are also factors. For example, it is common for teens today to have less oversight, to live in a single working-parent household, or to have both parents working full time.
7 Environmental Factors
The "diathesis-stress" model of addiction is a fancy way to say that those who have a genetic predisposition and experience more stressful circumstances, are at greater risk for developing a problem. Certainly, we know that certain situations, such as childhood poverty, experiencing child abuse, or families where there is an actively addicted parent living in the home, increase the likelihood for mental illness, and place someone at a higher risk for developing a substance abuse problem.
8. Mental Illness
As one could likely predict, those who suffer from a mental illness are at high risk for developing a problem with substances (Judge et al, 2022). It is currently estimated that 25.8% of those with a psychiatric disorder (36.5% of those with a substance use disorder), and 17.8% of the 75.8 million adults with either disorder, suffer from both an underlying mental illness, and a substance use disorder.
9. Insecure Attachment
Though this may sound like fancy terminology or psychobabble, understanding how, what we call "an insecure attachment", plays a role in addiction is important. This helps us to understand the motivation and behavior of those who go on to become addicted. This helps to explain how, for example, those who are addicted can steal from those they love most, or can abandon their children, spend the rent money on drugs, etc.
An insecure attachment refers to those who have always felt a bit more anxious, particularly around other people or in social situations. What develops is a habit of physiology, very early on in life, before two-years-old, as the result of not trusting one’s needs will be met by an adult caregiver. This often doesn't make sense from our view, as parents, because the truth is sometimes very good, well-intended, parents wind up with an anxious child. This can happen for any number of reasons. For some it may be that their parent(s) were guilty of loving their child too much. Meaning, with the best of intentions, and worried about their child’s safety, they can unintentionally teach their child, the world is not a safe place.
Regardless of how, or why this develops, the idea is a baseline level of increased anxiety becomes the norm. It is this increased anxiety level, or deep sense of feeling unsafe around others, that predisposes someone to experience relief from alcohol and/or drug use (in a way that those who do not have this higher level of anxiety, don’t).
Attachment, however, also refers to the areas of the brain that are responsible for our sense of feeling connected to the people, places, and things in our lives. Most notably our family, lovers. and close friends. As you will hear me say repeatedly, "falling in love", is the closest thing you can feel to being addicted to a drug in the natural world. When someone does get into an addictive relationship with a drug, the drug is then held as the most important relationship in that person's life. Not only psychologically, but physiologically. From the view of the brain, the drug fills the space of one's primary love relationship and therefore, it comes first. It becomes the most important relationship in someone’s life.
