Risk Factors for Addiction

Addiction can impact anyone, regardless of age, gender, or socioeconomic status, particularly because risk factors for addiction are numerous. In 2020, approximately 40.3 million people aged 12 or older (or 14.5%) reported having a SUD in the previous year. This includes 28.3 million people with alcohol use disorder, 18.4 million with an illicit drug use disorder, and 6.5 million who had an alcohol use disorder and illicit drug use disorder at the same time.¹

Several factors may contribute to a person’s risk for developing an addiction, including environmental, social, and biological factors.² The more risk factors a person has, the greater potential a person may have for developing an addiction if they use drugs or alcohol.³

Understanding the risk factors for addiction may prevent someone from developing an addiction or prevent worsening the state of a current addiction.

The Role of Genetics in Drug Addiction

Genes, or the material that makes up DNA, are one of the biological risk factors associated with addiction.⁴ Genetics is the study of how traits are passed on from parents to children.^4,5 While not all children will inherit the trait of addiction from their parents, it could impact a child’s genetic makeup, potentially increasing their risk for developing an addiction at some point in their lives.⁴

In recent years, several studies have focused on isolating a gene or genetic marker that is linked to addiction in human behavior.⁶ Even though there may be a link between genes and addiction, there are likely many other risk factors for addiction, including one’s environment and social influences.^2,5 

A complete understanding of the presence of an “addiction gene” is still limited, but research continues to help better identify the causes of addiction. Current research supports the idea that genes may play a significant role in developing an addiction, around 20% to 50%.^2,4

Environmental Risk Factors and Addiction

Environmental influences are one of many potential risk factors for addiction and may include:^3,4,7

• Easy access to substances.
• Exposure (at home, school, work etc.) to substances.
• Socioeconomic factors.
• Minimal access to treatment and/or education about substance misuse.
• Stress at home.
• Trauma.
• Domestic violence.
• Sexual abuse.
• Lack of supervision.

These environmental influences can be quite powerful. People in recovery programs often refer to their environments as part of what makes it difficult to stop misusing substances.⁸ For example, if a person stops using substances, but stays in the same stressful or unhealthy living and social environments, it may be more challenging to remain abstinent.

When a person’s exposure to certain environmental factors impacts their genetic makeup, it may increase their risk of developing an addiction. The study of this phenomenon is known as epigenetics, which looks at the impact of environmental factors on gene expression.⁴

A 2013 systematic review of research on epigenetics found that emotional and social stressors may have a strong influence on activating a person’s genetic predisposition towards addiction, suggesting that the environment may play a more significant role.²

Domestic Violence and Addiction

Defined by the U.S. Department of Health and Human Services as “a pattern of coercive behavior, including acts or threatened acts, that are used by a perpetrator to gain power,” the effects of domestic violence impact not only a person’s environment and stress level but their physical and mental health as well.⁹ Domestic violence can include:⁹

• Physical, verbal, or sexual abuse.
• Harassment.
• Threats.
• Intimidation.
• Other forms of coercion and control, which maintain the perpetrator’s power over the victim.

Perpetrators of domestic violence can be a person’s current romantic partner, former partner, someone they share a child with, a family member, or a household member.⁹

Research has shown that people who have suffered domestic violence by an intimate partner are at higher risk for substance use disorders (SUDs), depression, post-traumatic stress disorder (PTSD), and other mental health conditions.⁹ They may also be more at risk for being controlled by an abusive partner if they already have a substance use or mental health disorder.⁹

People experiencing domestic violence may find that their perpetrator is using substances to control them either by forcing them to take a substance or preventing them from seeking necessary treatment.⁹

Some people may also use substances to cope with the physical or emotional pain of domestic violence, sometimes called “numbing” by mental health professionals.⁹ Coping or numbing emotional pain with substances could be a risk factor for addiction, especially with continued substance use.

Sexual Abuse and Addiction

People who have experienced sexual abuse and trauma may be at a heightened risk of developing an addiction to drugs or alcohol. The impact of sexual trauma in early childhood can be significant and can potentially lead to the development of mental and/or physical health conditions, physical injury, substance misuse, and risky sexual behavior.^10,11

Childhood sexual abuse is defined by the Centers for Disease Control and Prevention as “involvement of a…person less than 18 years old…in sexual activity that violates the laws or social taboos of society and that he/she does not fully comprehend [and] does not consent to or is unable to consent to.”¹⁰

Childhood physical and sexual abuse may be a risk factor for addiction because it can lead children or young people to use substances to cope, or because people around them are using.⁷ Research has shown that the earlier a person starts using substances, the more likely they are to develop a substance use disorder and other problems.⁷ This may be in part because of the way substances affect the brain during childhood development.⁷

Stress and Addiction

The impact of stress on a person’s health and well-being can play a significant role in their risk factors for developing an addiction.⁸ A person with chronic stress in their work, social, or home environments may experience changes in their gene expression (epigenetics) over time.^8,12 This change may lead to unhealthy behaviors such as drug or alcohol misuse to relax, unwind, or cope with emotions.^8,12

Stress may also make a person more vulnerable to relapse.⁸ Cravings for substances may become stronger if a person is exposed to stressful situations or experiences chronic stress.⁸

Using drugs or alcohol to de-stress has been shown to have the opposite of the desired effects over the long term. A 2018 study on the link between stress and addiction reported that using drugs over-activated the brain’s stress response, increasing the threshold for pleasure and reward and making it more difficult to relieve stress in future episodes.¹³

This means that a person using substances to cope would have to use the substance in higher doses or use the substance more frequently to relieve stress. When a person needs more of the substance to achieve the same effects, it’s known as tolerance and may increase a person’s risk of developing an addiction.¹⁴

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Addiction and Mental Health Disorders

Mental health has the potential to be a significant risk factor for addiction, particularly if a person’s environment triggers predispositions toward mental health conditions.² People who have mental health disorders may be at increased risk for using drugs and developing an addiction.³

When someone is diagnosed with both a mental health and substance use disorder, they are considered to have co-occurring disorders.¹² Research has shown that as many as half of all people who are diagnosed with a substance use disorder have a co-occurring mental health disorder.¹²

There is significant evidence that exposure to trauma can be a predictor of developing substance misuse later in life. Although trauma is considered an environmental factor, it can potentially lead to the development of mental health disorders such as anxiety, depression, acute stress disorder, and post-traumatic stress disorder.

A 2020 report from the National Institute on Drug Abuse shared that roughly 1 in 5 veterans diagnosed with PTSD also have a co-occurring substance use disorder¹²

A strong link between mental illness and SUDs has emerged through years of research and study. These two elements can influence human behavior in several ways:^12,15

• Substance use disorders and mental health disorders have shared risk factors, including environmental stressors or exposure to trauma.
• People with mental health disorders might use drugs to self-medicate their symptoms or cope with difficult emotions.
• Using drugs can alter the brain chemistry of people with mental health disorders, which may cause the brain to experience more pleasure, less discomfort, and stronger cravings to use substances.
• People struggling with addiction may be more likely to develop mental health disorders due to changes in brain chemistry from using substances.

Prevention and Treatment for Addiction

While addiction is a chronic condition, it is highly treatable. Early identification and treatment of addiction has been shown to decrease risk factors for addiction. This is especially true for youth and adolescents, who may benefit greatly from additional support as they transition into a new stage of life.¹² In recent years, some middle and high schools have started offering prevention programs for students and families to help identify the warning signs of addiction.¹⁶

There is evidence suggesting that identifying risk factors can be highly effective in preventing the development of drug addiction.¹⁷ Protective factors are those aspects of a person’s life that can play an important role in preventing addiction.¹⁶ Protective factors might include strong parent/child relationships and adequate supervision, healthy coping skills, or good impulse control.¹⁶ For some people, these protective factors might be more innate, and for others, they can be taught through prevention and early intervention strategies.

If you or a loved one are currently struggling with addiction, it may be helpful to seek treatment. Treatment types and intensity vary depending on each person’s needs; however, any form of treatment should address the whole person with an individualized plan that is adjusted as needed.

• Detox. This is typically the first phase of the recovery process, which helps people safely manage the detox and withdrawal process. Depending on a person’s needs and the substances being used, medication may be used to help ease withdrawal symptoms.
• Inpatient or residential treatment. Inpatient treatment involves staying in the facility during treatment, giving patients 24-hour supervision and access to care. Services at inpatient centers may include behavioral therapy, medication, mutual support groups, aftercare planning, and more.
• Outpatient treatment. Outpatient programs allow a person to live at home while visiting a treatment facility to receive support and addiction treatment. A wide range of services are typically available at outpatient facilities including therapy, detox, medication, support groups, and drug counseling.
• Behavioral therapy. Treatment therapy can take place one-on-one and in groups and may include a range of modalities such as cognitive behavioral therapy or contingency management to help a person identify behavior patterns, triggers, underlying causes of addiction, and help create a plan to maintain sobriety.
• Mutual support groups. These groups are designed to provide encouragement and support as a person moves through recovery. 12-step groups like Alcoholics Anonymous and Narcotics Anonymous are one type of mutual support group, however, there are several types of groups that offer support.

Find the Addiction Treatment Help You Need

If you or a loved one are struggling with addiction and want help, know that you are not alone. It is never too early or too late to seek help. American Addiction Centers (AAC) offers a free, confidential helpline with caring admission navigators ready to take your call at . They can answer questions about our treatment facilities, provide resources about addiction treatment, and help you check insurance coverage at AAC facilities.