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When considering the underlying causes of addiction, it is important to remember there is no universal answer. As an addiction counselor, I have met various individuals with unique stories and have observed how addiction generally results from some form of pain. As explained in my article on the root causes of addiction, these forms of pain may include trauma, intrusive thoughts, or unmet needs.
Although each person has their own unique story, I’ve noticed some general trends that explain why certain people may be drawn to certain substances or behaviors to cope with underlying pain.
The underlying causes of addiction include trauma, unmet needs, or other emotionally painful experiences resulting in the desire to cope in the short-term through substances or behaviors that mask the pain, resulting in long-term harm.
Addictive substances or behaviors provide the illusion of one’s need being met while further taking one away from genuinely meeting their needs in the long-term. Throughout this article, I focus on how specific substances or behaviors are generally used to escape from the pain of specific unmet needs.
As stated before, I have encountered many exceptions to these general tendencies. In this article, I draw on Stephanie’s experience, a fellow recovery advocate who is in long-term recovery from stimulants and opioids. Her experience illustrates some general patterns I have observed, but as always, it is essential to assess each individual independently to determine their underlying unmet needs.
Underlying Causes of Addiction to Stimulants
Some common stimulants include cocaine/ crack, crystal-meth, and other amphetamines. Producing a stimulating effect on the central nervous system, they often make users feel energized, confident, and powerful.
Of all the substance categories, stimulants produce the highest levels of dopamine response in the brain. This neurological effect is responsible for the increased risk of psychological addiction since dopamine is the primary neurotransmitter associated with addiction, as explained in my article on what drives addiction.
An underlying cause of addiction to stimulants is low self-esteem. Simulants offer a short-term escape from the pain of low self-esteem. This is reinforced by the high levels of dopamine production in the brain, causing a sense of confidence and invincibility.
Stephanie shares the following experience:
“The first time I did cocaine, I felt like I was invincible. If I spoke, I said all the right things; if I danced, I hit every move perfectly. It was the first time I felt completely confident in myself. When you use coke, you have a lot of friends. Being picked on most of my life, being the popular girl was just as enticing as the drug. For once, I felt what I thought was happy, on top.”
This initial experience reinforced the brain’s learning mechanism in the dopamine pathways since a significant source of pain had been unexpectedly solved.
Like figuring out how to hunt a large animal successfully, resolving the hunger pains of our ancient ancestors, the dopamine response reinforces the importance of continuing the specific behavior that preceded the relief of the pain.
This learning mechanism has been fundamental to acquiring new skills to solve problems throughout human history. The dopamine response is mainly triggered when the reward is unexpected. Stephanie shares that the first time she used cocaine in a similar way. She described it as an “ah-ha!!! Moment”. Stephanie shared the following regarding her unmet need for self-esteem:
“All my life, I grew up believing I was ugly, stupid, weird. I felt unlovable and ostracized. When I did coke, none of that mattered. I was beautiful and smart and funny.”
Although low self-esteem is a common cause of stimulant addiction, there are many other underlying causes. Another common situation I’ve encountered includes the use of stimulants to regulate one’s focus.
This is particularly common among persons who have ADHD. Rather than feeling agitated and aggressive, stimulants can have a calming effect by strengthening parts of the pre-frontal cortex, increasing one’s ability to regulate one’s focus. Research demonstrates the relationship between untreated ADHD and cocaine use.
Many people abuse stimulants for reasons beyond those mentioned here. These are just some of the major themes I’ve encountered, shedding light on some common causes.
Underlying Causes of Opioid Addiction
Common opioids include substances such as heroin, Oxycodone, and Fentanyl. Opioids are central nervous system depressants which also have an analgesic effect. This means they are calming and have a pain-relieving effect.
Of all the substance categories, opioids produce the highest risk of physical dependence. The intense pain produced by the withdrawals contributes to the highly addictive nature of these substances. Working in a withdrawal facility, I witnessed many people going through this fierce agony first hand. At its worst, it looked like a demon was trying to escape their bones. If you want to learn more about opioid withdrawals, check out my article, What Does Opioid Withdrawal Feel Like?
The withdrawal of opioids is so powerful due to the rebound effect. This means the withdrawals are generally the exact opposite of the effect produced by the drug. Opioids produce an intensely soothing effect, often compared to a warm hug.
Underlying causes of opioid addiction include lacking a sense of being loved, feeling isolated, or dealing with a great deal of emotional pain, in addition to the high level of physical dependence facilitated by this class of substances.
Stephanie shares her experience with opioids as the following:
“When I did opiates, I was in another failing relationship. The one that was supposed to love me was the one making me feel unlovable. He was constantly putting me down and cheating on me. The first time I ever used, I felt this warm hug wash over me, and the pain of the abuse went away. I was numb, and if he started in on me again, I would just close my eyes a tune him out. I didn’t care. It was the only thing that made me feel the way I did when him and I first met, and I was lying in his arms. I found a way to have that without him.”
Just as painkillers numb physical pain, they also numb emotional pain. Recent research demonstrating this effect studied the impact of acetaminophen on social rejection. Although painkillers numb emotional pain, this effect is fleeting since tolerance to opioids rapidly builds. This causes users to require a significantly larger dose over time to maintain the same effect.
Stephanie describes this experience as the following:
“The warm hug wears off and is only there for a fleeting second. It’s all just to stay normal.”
Like all addictions, the initial effect fades, and the primary purpose of using becomes an attempt to feel somewhat normal. Due to the physically addictive nature of opioids, the pain of withdrawal is continually looming on the horizon.
Although opioids can produce intense pleasure, it is a myth to assume everyone responds the same way. Research demonstrates a large variability in individual subjective responses to opioid use. I have witnessed this in my encounters with individuals who have used opioids primarily as a way to be more productive or function better at work.
Although opioids are a central nervous system depressant, some users report having more energy and the ability to complete tasks they would otherwise find boring. This same response is also found in the ability to stay up later, get up earlier, or be more productive in the gym. Although these things are often associated with stimulant use, opioids can facilitate this type of response by numbing the painful elements of these tasks, making them easier to complete.
Like stimulants, there are a variety of potential responses someone can have to opioids. Therefore, it is essential to consider how each individual is affected by the substance and what they are using it to achieve.
Underlying Causes of Gambling Addiction
Although many people understand how substances can be addictive due to their composition and direct chemical effect on neurophysiological processes, it might be hard to understand how behaviors such as gambling and gaming can have the same effect.
The underlying causes of gambling addiction include random rewards that hijack the brain’s dopaminergic reward mechanism, combined with the illusion of hope for winning back losses, the desire to escape from emotional pain, and a sense of belonging or specialness.
Recall the previous description of dopamine and the brain’s reward mechanism. Gambling hijacks this reward system due to the unpredictable nature of random rewards. Newer slot machines are designed to heighten this dopamine response even further by incorporating several features that result in more opportunities for a surprise. False wins, free spins, and bonuses are some of these features.
False wins are spins where a “win” is triggered, but the amount you receive is less than the amount you bet. Since dopamine responds to the surprise more than the amount won, false wins provide the opportunity for more frequent surprises without having to pay out.
Free spins are another common feature that allows the machine to surprise the player, often accompanied by special graphics or sounds. Like false wins, they allow the machine to incorporate further surprises without necessarily having to pay.
This sense of constant anticipation is a common feature of gambling addiction. In the beginning, it may start as a sense of hope for a better future. As reported in a Vice article:
“People don’t play the lottery because they expect to get rich. They play the lottery because it’s fun to indulge in the fantasy that, one day, their lives could suddenly get easier.”
Like opioid addiction, the warm glow of this glimmering hope quickly dissolves into desperation and the need to escape underlying pain.
In an article in The Guardian, Craig shares this experience:
“Gambling for me wasn’t about chasing the big win, it was about chasing the money I’d already lost.”
From the outside, gambling can seem like an activity focused on greed. For someone with a gambling addiction, the issue goes much deeper. It’s often not about the money. Instead, it is primarily a way to escape a painful reality. According to a participant in a study published in the Journal of Gambling Issues:
“It’s just been a nice escape for me, so even though it causes me grief at times, it’s an escape from reality… I think that’s the basic reason… to get away from reality, just go to a fairy world. Yeah, it’s an escape; wherever your mind blanks out, you don’t think about it. That’s it, your little hideaway, on that chair.”
Just like any addiction, short term relief comes at a long term cost.
Other common underlying features of gambling addiction are the thrills, the social environment, and the sense of importance.
When someone lacks a sense of belonging, they often cope by seeking out status or specialness. Casinos are built around this principle, fostering status and specialness through elaborate marketing and reward programs.
Casinos often have multiple tier-leveled membership programs based on the amount someone wagers throughout the year. With names like Gold, Platinum, or Diamond status, members strive to achieve the next level, giving them special access to parking, entrances, rooms, trips, and events.
Casino hosts are sent real-time electronic information on where members are playing, how much someone has spent, and any other relevant information such as birthdays. Members are greeted by name at their machine or table and offered incentives. Of particular interest are players spending increasing amounts of money.
Other common casino incentives include invitation-only gift giveaways where players are mailed an invitation to visit the venue to pick up a gift, which often consists of everyday household items like pots and pans.
Casino’s have a culture of their own, continually facilitating a sense of specialness. The casino marketing machine can artificially meet this need for those who are socially isolated or suffer from low self-esteem. Many people describe the casino as the only place they feel like “somebody.”
There are many underlying reasons for being drawn into a gambling addiction, most of which are not about the money. If anything, money becomes devalued to the point of feeling fake. Casinos and online gambling venues help facilitate this further by turning dollars into chips or credits.
Over time, these numbers merely signify how much longer someone is able to continue their escapism. At the extreme end, some people even become annoyed or agitated when they win a jackpot because it takes away their ability to continue playing, as they wait for venue staff to pay them out manually. At this point, money becomes nearly irrelevant, and the need to continue playing becomes the sole reason for playing.
Like all addictions, each person with a gambling addiction has a unique experience. Although I have presented some common underlying causes, one must fully inquire into how each individual experiences gambling to get their full perspective.
Underlying Causes of Gaming Addiction
As described in my article on why video games are addictive:
The underlying causes of gaming addiction include their ability to meet our basic psychological need for a sense of autonomy, purpose/progress, and social connection. Many games also incorporate random rewards, similar to gambling, in “loot boxes.”
Video games provide an environment to experience a sense of autonomy/freedom from social constraints, reduced social anxiety, and allow for a sense of adventure. This is particularly relevant for persons who feel stuck, constrained, or bored/dissatisfied in their offline life.
Video games also provide a sense of purpose and progress through a mission orientation and the ability to level up. This is particularly relevant for persons who lack a sense of purpose in their offline world. Games offer this through various forms of leveling up in addition to encouraging a flow state where players feel completely immersed in the activity.
Video games also provide a platform for individuals to gain a sense of social connection with like-minded individuals. This offers a sense of connection that is particularly relevant for persons feeling isolated. Multiplayer online games can facilitate this through a team environment, whereas single-player role-play games provide an experience where you feel connected to a grand narrative imitating a hero’s journey.
When one’s underlying need for autonomy, purpose, and connection is unmet in one’s offline environment, games can be used to meet these needs virtually. Although gaming can be a healthy way to meet these needs when done in moderation, gaming addiction makes one psychologically dependent on games. Meeting one’s needs through games at the expense of meeting them in non-gaming environments further reinforces the appeal of gaming, making it more challenging to meet these needs offline.
Like all addictions, when gaming is used as a way to escape from pain, it can have long-term costs when the underlying issues are unaddressed.
This guide to the underlying causes of various types of addiction is not meant to be a strict template, but rather, a general way of understanding how certain substances or behaviors are commonly experienced.
At the core, persons with addiction are attempting to fill a void, escape from pain, or meet an unmet need. Although there is significant overlap between each substance/behavior, the specific details presented here are meant to help you gain deeper insight into the common subjective experiences of those struggling with addiction.
If you want to learn more about the subjective experience of addiction, check out my article, What Does Addiction Feel Like?
To learn more about our underlying psychological needs, check out my article, What Are Our Underlying Needs?
For more on the root causes of addiction, check out my interview with Stephanie from Aegis Health Group:
As an addiction counselor, my approach to helping clients is based on recognizing these underlying factors. Recovery results from effectively turning toward the underlying pain in a self-compassionate way, uncovering core values, and building habits of committed action.