A Deeper Look into the Roots of Substance Use Disorders

Addiction is often seen through the lens of poor choices or lack of willpower, but this view oversimplifies what is, in reality, a highly complex mental health condition. Through my academic journey in addiction counseling, I’ve come to understand that substance use disorder (SUD) is not a single-cause issue, it stems from a web of biological, psychological, and social factors, all of which contribute to abnormal behaviors associated with addiction.

This blog explores the major causes behind those behaviors, helping us to see addiction not as a moral failing but as a multifactorial disorder that requires compassion, understanding, and evidence-based support.

Understanding Addiction as a Mental Disorder

SUD is classified as a chronic and relapsing brain disorder, characterized by a person’s inability to stop using substances despite negative consequences on health, relationships, and responsibilities. It’s not simply a behavior; it involves neurobiological, psychological, and social dysfunctions that impair judgment, motivation, and self-control.

As I learned through research, addiction is best understood using a biopsychosocial model, one that integrates the biological, psychological, and social influences into one framework.

 

1. Biological Factors: How Our Bodies and Brains Contribute to Addiction

1.1 Genetic Predispositions

Studies suggest that nearly 50% of addiction risk is inherited. People who have a family history of addiction may carry certain gene variants that affect how their brain responds to substances. For example:

• The CNR1 gene (G allele) is linked to more severe cannabis withdrawal and cravings.
• The DRD2 gene, associated with dopamine receptor levels, can reduce the brain’s ability to experience pleasure naturally, making drugs more attractive.

These genetic tendencies can also be affected by epigenetics, meaning that even if someone carries risky genes, their environment can “switch” these genes on or off. This helps explain why even identical twins can differ in their susceptibility to addiction.

1.2 Neurobiological Changes

Addiction alters the brain’s structure and function, particularly in regions responsible for reward, decision-making, and self-control. Repeated drug use weakens the dopamine system, which is responsible for pleasure and motivation. Brain areas like the prefrontal cortex, nucleus accumbens, and amygdala become dysfunctional.

For instance:

• Cocaine damages neurons in reward-related pathways.
• Cannabis use in genetically susceptible individuals reduces the hippocampus, affecting memory.

These brain changes cause an overwhelming compulsion to use substances, even when users want to stop.

1.3 Early Drug Use

Adolescence is a critical brain development stage. If a person begins using drugs at a young age, it can disrupt the brain’s developmental pathways, increasing lifelong vulnerability to addiction. The earlier the exposure, the higher the risk.

1.4 Sex-Based Biological Differences

Biological sex also influences addiction:

• Estrogen in women can increase dopamine levels, making stimulants like cocaine more addictive.
• Testosterone in men is often linked with riskier behaviors, potentially leading to higher rates of substance misuse.

These sex-based differences highlight the need for gender-sensitive addiction treatments.

 

2. Psychological Factors: The Mind’s Role in Substance Use Disorders

2.1 Co-occurring Mental Health Disorders

Mental health and addiction often go hand in hand. Around 41.2% of individuals with SUD also suffer from conditions like depression, anxiety, PTSD, or bipolar disorder. Sometimes, substances are used as a coping mechanism to manage emotional pain, but this strategy backfires by worsening the underlying mental health condition and increasing dependency.

For example:

• Between 30% and 60% of individuals seeking treatment for alcohol issues also meet criteria for PTSD.
• People with PTSD may use alcohol to calm their symptoms, unknowingly starting a dangerous cycle.

2.2 Early Life Experiences

Trauma during childhood, such as physical or emotional abuse, neglect, or parental substance use, is a significant risk factor. The Adverse Childhood Experiences (ACE) Study shows that childhood trauma increases the likelihood of adult substance abuse. These early experiences can cause long-lasting emotional dysregulation, which individuals may try to manage through substance use.

2.3 Personality Traits and Motivations

Certain personality traits can make individuals more vulnerable to addiction. These include:

• Low self-esteem
• Impulsivity
• Poor emotional regulation
• Fatalistic thinking (believing life is controlled by external factors)

People may also use substances to:

• Escape from emotional pain or stress
• Enhance performance or social interaction
• Satisfy curiosity, especially during adolescence

In a study among teens:

• 75% reported using substances to feel good
• 22.5% for social reasons
• 2.5% for stress relief

 

3. Social Factors: The Influence of Relationships, Media, and Environment

3.1 Peer Influence

Among adolescents, peer pressure is one of the strongest predictors of substance use. Teens often start using drugs or alcohol to fit in, even without direct coercion. Research shows that 57.5% of teen substance users began between the ages of 15–18, largely due to social influence.

3.2 Availability and Accessibility

When drugs or alcohol are easily available, especially in high-poverty or high-crime areas, the risk of addiction rises dramatically. Children and adolescents in such areas are especially vulnerable due to lack of supervision and community support.

3.3 Media and Cultural Influences

Media glorifies substance use — depicting it as trendy, exciting, or even sophisticated. This normalization desensitizes youth, making them more likely to experiment. Celebrities or influencers who glamorize drinking or drug use can have a particularly harmful impact.

3.4 Family Dynamics

Family plays a critical role. Teens with a family history of substance use are far more likely to become addicted. In fact, 55% of teen users have a family member with a substance issue, compared to 20% of non-users. Parental neglect, lack of emotional support, or exposure to household conflict increases the risk significantly.

3.5 Socioeconomic and Community Factors

Poverty, discrimination, lack of education, and weak community infrastructure create conditions in which substance use thrives. These factors limit access to health care, education, and supportive relationships, making it harder to prevent or recover from addiction.

 

4. The Interplay of All Factors: A Perfect Storm

Addiction rarely results from just one factor. More often, it’s the result of biological vulnerability, psychological distress, and social exposure working together. For instance:

• A teenager with a genetic predisposition may begin using alcohol after a traumatic event, encouraged by friends and surrounded by media that glamorizes substance use.
• Someone with PTSD living in a poor community with easy access to drugs may use substances to self-medicate and escape reality.

This biopsychosocial model shows that to truly understand or treat addiction, we must look at the whole picture, not just the symptoms.

 

5. Moving Forward: Recommendations for a Holistic Approach

Based on my findings, I propose the following recommendations for more effective addiction prevention and treatment:

Integrate Screening into Primary Healthcare

Identify risk factors early by screening for genetic vulnerabilities, mental health conditions, and early substance use during routine checkups.

Trauma-Informed Mental Health Care

Provide counseling and psychiatric services that address trauma and co-occurring disorders. Promote cognitive-behavioral therapy (CBT) to strengthen resilience and motivation.

Community-Based Interventions

Limit the availability of substances, promote peer mentorship, and develop community programs that raise awareness about addiction. Offer support to families, especially in high-risk areas.

Media Literacy and Advocacy

Educate youth about how media misrepresents substance use. Encourage healthy role models and responsible messaging in the entertainment industry.

Multidisciplinary Collaboration

Health professionals, social workers, educators, law enforcement, and policymakers must work together to create sustainable, culturally sensitive solutions to reduce addiction rates.

 

6. Compassion Over Judgment

Addiction is not a choice, it’s a condition rooted in deep biological, emotional, and environmental realities. Understanding the abnormal behavior patterns in addiction helps us to replace stigma with empathy and develop responses that are informed, inclusive, and effective.

As someone on the path to becoming an addiction counselor, I believe our society must shift its approach from blame to care, from punishment to prevention, and from silence to support.

Together, we can create communities where recovery is not only possible but celebrated.

 

7. References

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Cleveland Clinic. (n.d.). Substance use disorder (SUD): Symptoms & treatment. https://my.clevelandclinic.org/health/diseases/16652-drug-addiction-substance-use-disorder-sud

Gopiram, P., & Kishore, M. T. (2014). Psychosocial attributes of substance abuse among adolescents and young adults: A comparative study of users and non-users. Indian Journal of Psychological Medicine, 36(1), 58–61. https://doi.org/10.4103/0253-7176.127252

Jahan, A. R., & Burgess, D. M. (2023). Adverse childhood experiences and substance use: The mediating role of psychological distress. Journal of Child & Adolescent Trauma.

Jahan, A. R., & Burgess, D. M. (2023). Substance use disorder (Archived) [Updated 2023 Jul 21]. In Jahan & Burgess (Eds.), Substance use disorder. Jahan & Burgess Publishing. https://www.ncbi.nlm.nih.gov/books/NBK570642/

Leung, J., Hall, W. D., & Degenhardt, L. (2020). Adolescent cannabis use disorders. In C. A. Essau & P. H. Delfabbro (Eds.), Adolescent addiction (2nd ed., pp. 111–135). Academic Press. https://doi.org/10.1016/B978-0-12-818626-8.00004-9

Leung, J., Hall, W. D., & Degenhardt, L. (2020). Personality traits and substance use disorders: A systematic review and meta-analysis. Drug and Alcohol Dependence.

Minnesota Department of Health. (2024, December 6). Determinants of health: Substance use. https://www.health.state.mn.us/communities/opioids/prevention/socialdeterminants.html

Minnesota Department of Health. (2024). Substance use and misuse: Risk and protective factors. https://www.health.state.mn.us/communities/substance/prevention/riskfactors.html

Substance Abuse and Mental Health Services Administration (SAMHSA); Office of the Surgeon General (US). (2016). Facing addiction in America: The Surgeon General’s report on 13

alcohol, drugs, and health [Chapter 2: The neurobiology of substance use, misuse, and addiction]. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK424849/

Substance Abuse and Mental Health Services Administration [SAMHSA]. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. https://www.samhsa.gov/data/

WebMD. (n.d.). Addiction and substance abuse. https://www.webmd.com/mental-health/addiction/default.htm

WebMD. (n.d.). Genetics and addiction. https://www.webmd.com/mental-health/addiction/genetics-and-addiction