Risk factors for addiction

Risk factors for addiction are characteristics or conditions related to biological, family, psychological, cultural, or community influences that increase the likelihood of negative outcomes, including substance use disorders. These factors increase an individual’s susceptibility to addiction by creating vulnerabilities or challenges in coping with life’s stresses and pressures.

Risk factors for substance abuse contribute to addiction by altering the brain’s reward system, creating difficulty in practicing coping mechanisms in real life situations. These factors increase the likelihood by making people become more vulnerable, thus increasing their likelihood to try substances and reduce their ability to resist repeated use. They weaken an individual’s insight and judgment, causing poor decision-making, lower resilience to stress, and enhance the appeal of the drug’s short-term rewards over long-term consequences. By understanding these risk factors, prevention and early intervention becomes feasible.

Substance abuse risk factors are categorized into various types, each playing a distinct role in increasing the likelihood of it. These risk factors for addiction are listed below.

• Biological risk factors
• Psychological risk factors
• Environmental risk factors
• Social risk factors
• Drug dependence potential (abuse liability)

1. Biological risk factors for addiction

Biological risk factors for addiction are genetic and physiological conditions that increase an individual’s vulnerability to developing addiction. Understanding the biological factors of addiction reveals why overcoming it requires more than just willpower or good intentions. Biological factors that contribute to addiction are listed below.

• Age: Age is a significant biological factor that contributes to addiction. People who start using alcohol or drugs at a young age are more likely to become addicted. This is because substance use during adolescence interferes with brain development, particularly in the parts responsible for thinking clearly and making good choices. Young people are more likely to take chances, which makes them more vulnerable to addiction as evidenced in the research article “Sensitive periods of substance abuse: Early risk for the transition to dependence” by Chloe J. Jordan and Susan L. Andersen, published in the journal Developmental Cognitive Neuroscience in 2017. The article explains that during this stage, the brain is still developing, especially in areas linked to risk-taking and impulse control. Experimenting with drugs during this period increases the chances of long-term addiction because the developing brain is more sensitive to the effects of substances, making dependence more likely. According to Chapter 2“The Neurobiology of Substance Use, Misuse, and, Addiction, published in the book Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health by Substance Abuse and Mental Health Services Administration (SAMHSA); Office of the Surgeon General (US), most young adults (ages 18-30) in treatment programs started using drugs before the age of 17. Early drug use leads to more serious problems later in life, including addiction. The younger someone starts using drugs, the more likely they are to become addicted.
• Genetic disposition: Genetic disposition is another important addiction risk factor, as certain genes are associated with a higher likelihood of developing addictive behaviors. According to the research article “Genetic disposition to addictive disorders — current knowledge and future perspectives” authored by Peter Mayer and Volker Hollt, published in the journal Current Opinion in Pharmacology in 2005, addiction risk factors are often influenced by multiple interacting genes rather than a single genetic mutation. For example, genetic disposition in alcoholic addiction has shown up to 60% of the risk. Genetic variations, such as single nucleotide polymorphisms (SNPs), particularly in genes related to the brain’s reward system (e.g., opioid or dopamine receptors), further influence how individuals respond to drugs, increasing their susceptibility to addiction. Furthermore, these genetic markers do not act in isolation. It is generally assumed that more than one gene is involved in addictive disorders.
• Brain chemistry: The brain’s reward system plays a significant role in addiction. Activities essential for survival, like sex, socializing and eating, cause the release of a neurotransmitter called dopamine. This creates feelings of pleasure but motivates them to continue those behaviors. Similarly, drugs stimulate the same reward system in the brain. According to the research article “Drugs, Brains, and Behavior: The Science of Addiction Drugs and the Brain” published by the National Institute on Drug Abuse in 2011, drugs mimic or manipulate natural neurotransmitters such as dopamine, leading to abnormal signaling between neurons. This overstimulation of the reward system makes drug use more pleasurable than natural activities, leading to tolerance, dependence, and compulsive drug-seeking behavior. Another research article titled “Neurobiologic Advances from the Brain Disease Model of Addiction” authored by Nora D. Volkow et al. published in The New England Journal of Medicine in 2016, shows that prolonged drug use reduces the brain’s ability to experience pleasure due to diminished dopamine release. This desensitizes the brain’s reward system, lowers motivation for daily activities, and increases cravings.

2. Psychological risk factors for addiction

Psychological risk factors of addiction are the mental and emotional characteristics, conditions, and processes that increase an individual’s susceptibility to developing addictive behaviors. The psychological risk factors for addiction are listed below.

• Mental health disorders: Addiction and mental health disorders frequently go hand-in-hand, making it difficult to pinpoint which one causes the other. The research article “Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention” authored by Nora D. Volkow and Carlos Blanco published in the World Psychiatry: Official Journal of the World Psychiatric Association (WPA) in 2023, points out the frequent overlap between substance abuse and mental health problems. It suggests that people struggling with addiction often experience mental health issues like depression, personality disorders, anxiety, psychosis, and attention-deficit hyperactivity disorder (ADHD), and vice versa. Individuals with mental health disorders usually use substances as a form of self-medication to alleviate symptoms of their conditions as highlighted in the article “The Self-Medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications” by Edward J. Khantzian, published in the journal of Harvard Review of Psychiatry in 1997. According to Khantzian’s self-medication hypothesis, individuals engage in substance use as a compensatory strategy to alleviate psychological distress, which ultimately leads to addiction.
• Impulse control problems: Impulse control problems refer to difficulties in resisting urges, temptations, or impulses that are harmful to oneself or others. Impulsivity is characterized by actions undertaken without adequate forethought, reflection, or consideration of the consequences. This trait is a significant psychological risk factor for substance abuse, as it leads individuals to experiment with substances or engage in addictive behaviors without fully assessing the potential negative outcomes. Addiction is both impulsive and compulsive, but impulsivity drives the early stages. Drugs and alcohol alter the brain structure, causing people to uncontrollably act on strong urges, which is the root of addictive behavior. These changes in the brain’s prefrontal cortex provide significant insight into the connection between impulsive behavior and addiction.

3. Environmental risk factors for addiction

Environmental risk factors for addiction refer to external influences that increase the likelihood of developing an addiction. The environmental risk factors for addiction are listed below.

• Family history of substance use: Growing up in a family with substance use normalizes drug or alcohol use, exposing children to addictive behaviors early on and increasing their risk of following the same path. Children model these behaviors, adopting substance use as a coping mechanism for stress or emotions, raising their likelihood of developing a substance use disorder (SUD). The 1998 study “Familial Transmission of Substance Use Disorders” by Kathleen R. Merikangas et al. published in the journal Archives of General Psychiatry, found an 8-fold increase in the risk of drug disorders among first-degree relatives of individuals with drug disorders. This increased risk includes substances such as cocaine, alcohol, opioids, and cannabis, highlighting strong familial aggregation and suggesting that substance use disorders often run in families and contribute as a substance abuse risk factor. Similarly, the research article “Family, Individual, and Other Risk Factors Contributing to Risk of Substance Abuse in Young Adults: A Narrative Review”by Mustafa Alhammad et al. published in the journal Cureus in 2022, highlights that individuals with a family history of substance abuse are at a heightened risk of developing substance use disorders themselves.
• Poor parental monitoring: Poor parental monitoring is a significant risk factor for addiction, as it allows individuals more freedom to engage in risky behaviors, including experimenting with drugs and alcohol. According to a research article “The Effects of Parental Monitoring and Communication on Adolescent Substance Use and Risky Sexual Activity: A Systematic Review” by Jill Ryan et al. published in The Open Family Studies Journal in 2015, it was found that positive parenting practices, such as communication and monitoring, delay risky behaviors in adolescents who haven’t yet started them.
• Early exposure to substance use: Early exposure to substance use significantly increases the risk of developing SUD later in life. According to the 2008 study “Is It Important to Prevent Early Exposure to Drugs and Alcohol Among Adolescents?” by Candice L. Odgers et al. published in Psychological Science, early exposure to substances has significant long-term effects on adolescents. The study highlights that adolescents exposed to drugs and alcohol before age 15 are at greater risk for negative adult outcomes, such as substance abuse. The article further highlights that 50% of adolescents who began using substances before age 15 didn’t have a history of misconduct, yet they still suffered harmful effects.
• Child abuse: Child abuse has been identified as a major risk factor for addiction, as highlighted in the 2023 study titled “Adverse childhood experiences and their association with substance use disorders in adulthood: A general population study (Young-HUNT)” by Rosalie Broekhof et al. in the journal Addictive Behaviors Reports. The research shows a strong link between adverse childhood experiences (ACEs) like emotional, physical, and sexual abuse and the development of SUDs in adulthood. Adults with ACEs are 4.3 times more likely to develop SUDs, with women particularly at risk for alcohol use disorders, while men face a higher likelihood of illicit drug use disorders. Therefore, the study underscores the need for early detection of abuse and gender-specific interventions to reduce the long-term addiction risk factors.
• Accessibility: Accessibility refers to the ease of access individuals have to addictive substances, which significantly increase the likelihood of substance use and addiction. Factors related to accessibility include the availability, affordability, and social or environmental exposure to substances like alcohol, tobacco, or drugs. According to the study “Contributory Factors of Drug Abuse and the Accessibility of Drugs” by Cai Lian Tam and Yie-Chu Foo, published in the International Journal of Collaborative Research on Internal Medicine and Public Health in 2012, easy access to drugs significantly drives rising drug abuse, particularly among vulnerable groups like students. It reveals that 22% of high school students have encountered drugs on school premises, demonstrating the role of availability in initiating drug use. The internet further exacerbates this issue, providing easier access to illicit substances, while drug syndicates and student dealers contribute to the growing accessibility of drugs among youth.

4. Social risk factors for addiction

Social risk factors for addiction encompass the influence of societal and interpersonal relationships that increase the likelihood of substance abuse. Social risk factors for addiction are listed below.

• Deviant peer relationship: Deviant peers are individuals who belong to a peer group where members exhibit similar problematic behaviors, such as substance abuse. The word “deviant” originates from the Latin term deviare, meaning “to stray from the path”. The study “Deviant Peer Affiliations, Crime and Substance Use: A Fixed Effects Regression Analysis” by David M. Fergusson et al. published in the Journal of Abnormal Child Psychology in 2002, highlights the significant influence of deviant peer affiliations on substance use disorders (SUDs) in adolescence and young adulthood. The research shows that adolescents who associate with deviant peers have a higher likelihood of engaging in substance abuse, including alcohol and cannabis use. The study further found that the impact of deviant peers on substance use is stronger in early adolescence at ages 14-15, emphasizing the critical role of peer influence in the development of SUDs during formative years.
• Peer pressure: Peer pressure is a major social risk factor for addiction, particularly among adolescents and young adults. It occurs when individuals feel pressured by peers to engage in behaviors like trying alcohol, tobacco, or drugs to fit in or avoid rejection. This influence leads to choices they wouldn’t typically make, such as experimenting with or regularly using addictive substances. The study “Family Process and Peer Influences on Substance Use by Adolescents” by Alice Yuen Loke and Yim-wah Mak, published in the International Journal of Environmental Research and Public Health in 2013, found that peer influence plays a significant role in adolescent SUDs. The study found that teens with friends who smoked or drank were much more likely to smoke or drink. Peer pressure to smoke or drink significantly raised these odds, with smoking (odds ratio 10.455) and drinking (odds ratio 11.825) being highly influenced by peer pressure.
• Socioeconomic status: Socioeconomic status (SES) is a major risk factor for addiction. Individuals from lower-income backgrounds face higher exposure to substance use due to financial stress, limited education, and unemployment. They often use substances as coping mechanisms and have less access to treatment and support for recovery. The study “Socioeconomic Disparities and Self-reported Substance Abuse-related Problems” by Kesha Baptiste-Roberts and Mian Hossain published in the journal Addiction and Health in 2018, highlights a clear link between lower socioeconomic status and increased likelihood of substance abuse issues. Individuals with a family income under $20,000 were 82% more likely to report problems related to substance abuse compared to those earning over $75,000. Additionally, factors such as unemployment, lower levels of education, being unmarried, and lack of health insurance were all associated with higher rates of substance abuse issues.

5. Drug dependence potential (abuse liability)

Drug dependence potential, alternatively known as abuse liability, refers to the likelihood that a substance is abused due to its effects on the central nervous system (CNS). According to the 2017 manual “Assessment of Abuse Potential of Drugs Guidance for Industry” by the U.S. Department of Health and Human Services Food and Drug Administration, drugs that affect the CNS, particularly those that induce hallucinations, euphoria, or cognitive changes—are more susceptible to misuse. Dependence manifests as either physical addiction or psychological addiction. Physical addiction occurs when the body needs the drug to function, leading to withdrawal symptoms when stopped. Psychological addiction involves emotional or mental reliance, where individuals crave the drug to cope with stress or emotions. Substances with high dependence potential, such as opioids and cocaine, pose significant addiction risk and require treatment that addresses both physical withdrawal and psychological cravings.

How does the combination of risk factors for addiction further increase the risk?

The combination of risk factors for addiction further increases the risk as these factors interact and amplify each other. A person with a genetic predisposition to addiction growing up in an environment where drug use is common is more likely to develop an addiction than someone without these combined influences.

As stated in the article “Understanding Drug Use and Addiction Drug Facts” published by the National Institute on Drug Abuse in 2018, a person’s likelihood of developing addiction is shaped by a mix of genetic, environmental, and developmental factors. The greater the number of substance abuse risk factors, the higher the likelihood of addiction.

This cumulative effect occurs because each risk factor enhances vulnerabilities in the brain’s reward system and decision-making processes. Early exposure to drugs intensifies brain changes related to judgment and self-control, making it harder to resist urges, especially in someone with a genetic predisposition or a stressful environment. The more risk factors for substance abuse are present, the greater the likelihood of developing addiction.