Why People Develop Substance Use Disorders

20079674_mSubstance use disorders can be devastating on many levels, causing the erosion of familial ties, social relationships and physical and emotional well-being. So why can’t some people who are using substances just stop? Why do they develop substance use disorders? It’s not due to a lack of good character or will power. It’s chemistry!


Research shows that drugs and alcohol alter brain chemistry in ways that promote continued drug use. According to the National Institute on Drug Abuse (NIDA):

Drugs contain chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs cause this disruption: (1) by imitating the brain’s natural chemical messengers and (2) by overstimulating the “reward circuit” of the brain.

So intense are these chemical reactions in the brain that they can be observed in brain imaging studies of individuals with substance use disorders, particularly in areas of the brain pertaining to judgement, decision making, learning and memory, and behavior control, reports indicate.

But not everyone develops a substance use disorder…a variety of risk factors exist. The number of risk factors a person has can determine their susceptibility to a substance use disorder. NIDA describes the following risk factors:

Biology. The genes that people are born with- in combination with environmental influences- account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.

Environment. A person’s environment includes many different influences, from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting can greatly influence the occurrence of drug abuse and the escalation to addiction in a person’s life.

Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to more serious abuse, which poses a special challenge to adolescents. Because areas in their brains that govern decision making, judgment, and self-control are still developing, adolescents may be especially prone to risk-taking behaviors, including trying drugs of abuse.

Clearly, the best way to prevent substance use disorders is to stay away from drugs altogether, but as we are seeing in overwhelming numbers today, some individuals are led down the path of substance use, not through illicit drug use initially or at all, but through the legitimate means of prescription medications – opiod pain relievers, stimulants used to treat ADHD, and benzodiazepines used to treat anxiety and sleeping disorders, just to name a few. These medications can have some of the same effects on the brain and body that illicit drugs have. As individuals use opiods to relieve pain after injury or surgery, for example, they may find that they begin to build up a “tolerence,” needing more of the drug to achieve the same desired effect. Additionally, over time, stopping the drug can produce physical withdrawal symptoms such as restlessness, muscle and bone ache, insomnia, vomiting diarrhea, cold flashes or chills, adding another complicated layer to quitting.

Physicians can help in the prevention of substance use disorders by surveying patients regarding possible risk factors and explaining the side-effects of medications and the potential risks associated with taking them.

When substance use becomes a problem, NIDA reports that combining medication-assisted treatment with behavioral health therapy is the best way to ensure success of recovery for most individuals. While relapse is not uncommon, it does not signal total failure. Like with many other diseases, sometimes a new course of treatment needs to be charted.

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