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When considering the root causes of addiction, it is important to look at various underlying contributors. The media is full of oversimplified depictions of addiction, making it seem like substances themselves cause addiction. Working in the field, in addition to looking at the research, I realized this is a myth.
Upon beginning treatment, I often share the iceberg model with my clients. The addiction is the visible tip of the iceberg, whereas the underlying causes are generally invisible but comprise the vast majority of the issue. To effectively deal with the addiction, we must first consider what is causing it. So what are some of these root causes?
Underlying root causes of addiction include trauma, pain, and unmet needs such as purpose, belonging, and self-esteem, which may be amplified by family and genetic factors.
Let’s dig into the research and unpack each of these underlying causes to dispel some popular myths about addiction.
Also, if you or someone you know is struggling with mental health or addiction issues, you can check out my resource page for suggestions on how to find help.
Drugs Don’t Cause Addiction
Growing up, I recall the anti-drug campaigns spreading the myth that drugs cause addiction. The logic was simple: Drugs are so powerful and so pleasurable that once you try them, you’ll be hooked; therefore, “just say no.”
Perhaps this was effective for someone like me. With my cautious temperament, the fear of such powerful substances kept me away from them.
In general, research does not support the effectiveness of fear-based anti-drug campaigns. Also, it leads to further harm by perpetuating a superficial understanding of how addiction works.
Bruce K. Alexander is a popular advocate against the myth of drug-induced addiction. In his address to the Canadian Senate, he cites a longitudinal study on substance use rates among secondary school students, stating:
“In this group, 41% reported having used cocaine at some time in their life… and less than 0.1 % reported using it at least 20 days in the month of the interview. Thus, less than one student in 400 who reported having used cocaine could be considered a current addict.”
He goes on to share a similar finding regarding crack usage:
“…5.1% had used crack at least once in their life… and less than 0.05% had used 20 or more days in the month of the interview. Thus, the ‘most addictive drug on earth’ caused persisting addiction in no more than 1 experimental user in 100.”
These findings dispel the myth that substances necessarily cause addiction. Although substances are involved in addiction, there needs to be a better explanation of why some people become addicted, and others do not.
Bruce Alexander further dispels this myth in his famous Rat Park Study. He demonstrated that if you put rats in a bare cage alone with addictive substances, they will overdose. But if you put them in a cage with other rats and engaging novelties, they no longer overdose.
This study points to social isolation as one of the underlying causes, explaining why some people develop an addiction. The pain of isolation led rats to cope through ingesting the drug, whereas the rats not subject to this form of pain were more resilient.
This leads us to the insightful words of Gabor Maté:
“The question is not why the addiction, but why the pain.”
Early Trauma Can Cause Addiction
Traumatic adverse experiences during one’s childhood is one of the biggest underlying causes of addiction. Adverse childhood experiences may include physical abuse, emotional abuse, neglect, parental discord, and sexual abuse.
According to a report by the Substance Abuse and Mental Health Services Administration:
“When children are exposed to chronic stressful events, their neurodevelopment can be disrupted. As a result, the child’s cognitive functioning and/or ability to cope with negative or disruptive emotions may be impaired. Over time, and often during adolescence, the child may adopt unhealthy coping mechanisms…”
A 2008 study confirms that substances are a key aspect of this unhealthy coping, early on in life:
“…children with particular adverse childhood experiences may initiate drinking earlier than their peers and that they may be more likely to drink to cope with problems (rather than for pleasure or to be social).”
The anti-drug campaigns focused on inducing fear of substances neglects the fact that the most at-risk youth are not primarily using it for pleasure. Rather, they are using substances to escape from pain.
Another study on childhood abuse, neglect, and household dysfunction found that those who had more than five adverse childhood experiences were seven to ten times more likely to report substance use problems. The authors state:
“Because adverse childhood experiences seem to account for one half to two-thirds of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences.”
These findings reinforce the need to redirect public funds away from anti-drug campaigns, focusing on the root of the problem: adverse childhood experiences.
A recent 2019 study summarizing two decades of research on adverse childhood experiences argues:
“Adverse childhood experiences and rearing may generate a public health burden that could rival or exceed all other root causes.”
These early experiences affect the brain differently from experiences in adulthood, resulting in long-lasting neurological changes. Beyond the brain, these changes impact parental attachment, resulting in changes in one’s ability to gain secure attachment in one’s relationships later on in life.
Beyond using substances to cope with these early experiences, a recent 2020 study found that adverse childhood experiences also contribute to mobile phone addiction. Other common behavioral addictions among youth might include internet use, gaming, and various forms of gambling within online games.
The recent recognition of behavioral addiction in the DSM-V further emphasizes that substances are not necessary for an addiction to develop. Although substances are often involved in addiction, they are are not the primary cause.
Various Forms of Pain Cause Addiction
Adverse childhood experiences and other forms of pain may not necessarily come in the form of trauma. The field of psychology defines trauma as typically involving actual or threatened death, or other extreme events involving hopelessness or horror.
A person may never have pivotal experiences that fit the typical definition of trauma but may suffer long-term due to their perception of certain early events.
For example, a person may recall being insulted or embarrassed by a parent. This situation may not necessarily have stood out to an onlooker as “traumatic,” but one’s perception of the event can have lasting effects.
For example, a child may internalize an off-handed comment regarding their weight, and they may carry these words with them throughout their life. These internalized words distort their perception of themselves, resulting in a spiral of further distorted perceptions as they interact with others, filtering others’ responses through this self-stigmatizing identity.
This form of emotional pain can result in core psychological needs not being met. For example, if avoiding social situations becomes one’s primary coping method, one’s need for connection may be unmet. Turning to substances or behaviors is one way someone may cope with the pain of these unmet needs.
The spiral of short-term coping leads to long-term consequences, taking the person further away from actually dealing with the problematic core beliefs.
Another common underlying cause of addiction may be a lack of purpose. When feeling bored, stuck, or tired of the monotony of daily life, substances or addictive behaviors may be used to escape. This is another example of a situation that wouldn’t typically qualify as traumatic but can significantly impact someone’s mental health.
Family and Genetics Increase Risk of Addiction
When looking at the root causes of addiction, many people are quick to point out genetic factors. I thought it would be necessary to consider here since genetics does not necessarily cause addiction. Instead, genetics increases the risk someone will develop an addiction if the above factors are present.
This means your genes do not cause you to develop an addiction. Rather, they may be a risk-factor or protective-factor, offering a particular level of resilience against early traumas and other forms of pain or unmet needs.
In a study looking at pairs of twins, the researchers found
“…genetic factors played a major role in the development of alcoholism…”
Although this is the case, there is no particular “addiction gene.” More recent research argues several genetic interactions are involved. Therefore, it is essential to consider the interaction between genetics and other psychological factors such as trauma. The authors state:
“…it has become apparent that variants in stress-related genes such as CRHR1, may only confer risk in individuals exposed to trauma, particularly in early life.”
Genes may affect one’s baseline resilience, but as stated previously, early traumas, emotional pain, and unmet needs are the root causes.
Also, genes are not the only way a person inherits traits. Effective and ineffective forms of coping may be inherited through social learning within the family.
Addictive substances and behaviors are the tip of the iceberg. The root causes of addiction include adverse experiences in childhood and emotional pain resulting in unmet needs.
Substances or behaviors are used to cope with this underlying pain, offering short-term benefits and long-term costs, making it harder to actually meet one’s underlying needs.
Meeting one’s need for a sense of connection, self-esteem, and purpose requires delving into the underlying forces driving one’s addiction and developing the skills to more effectively deal with the difficult thoughts and emotions driving one’s behaviors.
If you are interested in reading more, check out my Addiction and Recovery section.
I currently work as a Substance Use Disorder Professional and have spent over 6 years working specifically with individuals suffering moderate to severe opioid use disorder through medically assisted treatment. I am always interested in hearing and seeing what is new within the field of substance use.
One of the challenges regarding some of the points you have made appears to disregard the major contributions of Neuroscience and brain imaging concerning how active substance use impacts the pleasure pathway of the brain.
While I do not discredit the nature of studies showing how traumatic experiences, chronic pain, and other factors contribute to active substance use. I have done some extensive research in how Substance Use Disorder really is a learned behavior.
Majority of my patients I sit in counsel with do have traumatic experiences. This may also include the comorbidity of underlying mental health issues. However, I have worked with individuals who have developed chronic and heavy alcoholism and drug dependence and disorders despite growing up in healthy family environments with healthy social networks of people.
What are your thoughts on how substance use disorder is a learned behavior that impacts a person’s volition? Do you view substance use disorder as a disease of choice?
Thank you for this thoughtful response, Timothy!
I completely agree addiction is a learned behaviour. Neurologically, I understand it as involving dopamine production in the ventral tegmental area resulting in stimulation of the nucleus accumbens, reinforcing adaptive short-term coping strategies while inhibiting the pre-frontal cortex, resulting in loss of control.
Since the article is focused on root causes, I narrowed the scope to trauma, other non-traumatic forms of pain, and unmet needs. I see these as causal factors whereas I see the neurological level as process-oriented factors responding to the lived experiences which are necessary precursors to the learning mechanisms.
Steve, thank you for replying. I agree. There are complex issues at play. Sometimes, it helps to narrow down to specific areas. Definitely understand where you are coming from.
I think your article is spot on. I think every circumstance is different, but we are all Gods children whom wish to return to him someday having battled the demons when all hope was gone. Alone
Thank you, Ian! Glad you enjoyed the article.
Thank you so much for this excellent article, Dr. Rose! I am a former mental health clinician turned mental health blogger, writing about addiction and its correlation to childhood trauma. At any rate, I was looking for some outbound links when I came across yours, and I genuinely appreciate your compassion and insight.