Whilst it’s relatively common for people to drink alcohol, gamble and use prescribed (or even recreational drugs) at times, not all of us will go on to develop an addiction to one of these. But why? What puts people at greater risk of developing an addiction? Why can some people use these substances and maintain control over their use, others spiral into an overwhelming pattern of addiction which can have devastating implications for their life and health.
The answer lies partly in which substance you are using, and partly on individual factors. Some substances are thought to be more addictive than others: heroin, for example, is known to be highly addictive, whereas cannabis is more controllable.
In general, though, it is thought that nobody is immune to the effects of substances: it comes down to how much you use, and how often, as well as social and personal factors that can affect your vulnerability. Here we describe how and why addictions are thought to develop.
Evidence shows that addiction is a brain disease. This means that changes occur in the brain that can lead to addiction occurring: essentially, over time, substance use stops being a choice and starts becoming a biological necessity.
Substances, be they drugs or alcohol, are usually used because they have desirable effects on how we feel and experience the world. This occurs because they alter our brain chemistry by introducing ‘feel good’ chemicals into the brain, which, on top of the ‘feel good’ chemicals that are already there, makes us feel really good.
However, the brain uses feedback loops to monitor its chemical production, and if it senses that there is more ‘feel good’ chemical hanging around than there should be, it will start to produce less and less. This accounts for why you can feel lousy if you don’t keep ‘topping up’ with more substances when their effects start to fade. The problem is that, over time, the brain stops making its own chemicals, which you need to feel and think normally.
This means that you have to rely on substances to feel normal, and if you want to feel high, you have to take ever-greater quantities. Taking more substances means taking bigger risks, to both your body, your personal safety, and your financial security, and what was once a fun habit can soon spiral out of control.
Not only do substances affect which messages get passed around in the brain, they also affect how messages get passed around.
The brain communicates by sending chemical messages through neural pathways. When these pathways are used frequently, they grow bigger and stronger, so that messages can get passed to the high use areas more easily. This is how we learn.
So, every time we use a substance and it makes us feel good, our brain learns that the substance is a good thing. This means that our brain starts to seek out cues in the environment that point to drugs or alcohol – smells, sights, sounds, or experiences which remind us that substances are fun.
This can trigger more frequent cravings, as we remember how good we felt the last time we took them. The part of our brain involved in impulse control is less exercised, so, over time, it becomes less effective, meaning that it is easier to give in to cravings each time they occur. The cycle continues: the drive to find and use substances grows, and the ability to control when and how often you want to use it diminishes.
This cycle can occur in anyone, no matter how old you are or what your circumstances might be. However, because the brain continues to develop throughout adolescence into early adulthood, individuals who use substances in their childhood or teenage years are thought to be particularly at risk of addiction.
In mature brains, the blueprints describing normal patterns of chemical production and distribution are well developed, and whilst substance use can disrupt these processes, they are thought to be recoverable. If substances are used while the brain is still developing, the blueprints may well have these substances incorporated into them. This can make it much, much harder to both resist and to overcome addictions.
So, we know that frequent use of substances can lead to biological dependencies. But why start using them in the first place? Four main psychological theories help to explain what leads up to developing a substance use habit.
Developed by Professor Albert Bandura in the 1970s, Social Learning Theory is a broad theory describing how people learn different behaviour patterns from care-givers and other role models. The idea is that individuals brought up in homes where substances were used, or who associate with groups who use substances, might learn to view substances as a good way of coping with stress, or a way to be accepted and valued by friends or colleagues.
Alcohol and/or drugs are frequently used as a form of ‘self medication’, to help cope with difficult life events or circumstances. Many use substances to relax, or ‘switch off’ from day-to-day pressures, for example. Individuals with mental or physical health difficulties might look to substances to help cope with pain or distressing symptoms.
People use substances because they are rewarding. Some seek a rush, some want to feel relaxed, and some might seek the unusual sensory experiences associated with hallucinogens. For many, they also offer social rewards, such as acceptance, respect, or admiration. The theory of behavioural economics holds that we invest more in rewarding activities and less in activities that we find unrewarding. As such, those who haven’t found reward in education or work, sport or other social activities, might turn to substances as an alternative pathway.
Many people grow up in environments that can make it hard to learn what to do for the best. Having parents who were very strict, or very lax, or both, can leave children feeling out of control and powerless. Similarly, schools can be overly permissive, and often inconsistent in their conduct expectations. Society, too, might be seen to dictate that we live in certain ways, without any real guidance for how to go about it. Without fair and/or reliable ‘rules’ to guide behaviour, it is easy to see why some might choose substances as a way of rebelling against, or escaping from, parents, schools or the establishment.
No single theory can explain every person’s motivation for using substances, and many of these theories might act in combination. There may also be other factors that explain why some are more vulnerable to addictions than others: matters of genetics, and personality, for example. If none of these explanations rings true for you, consider what it is that drives you – understanding this can be an important step towards breaking the habit.
In summary, there are many social, psychological and biological reasons to understand how and why addictions can occur. Many of these factors are entirely outside of individual control, and few, if any, start a habit with the intention of becoming dependent on it.
These are just some of the many reasons why good addiction services offer a sympathetic and non-judgemental approach to treating dependencies, viewing it very much as a brain disease and not just a lifestyle choice.
Addiction is real, debilitating, and often hazardous to both health and personal safety, so it is important to seek support - to put you back in the drivers seat.
If you think you are suffering with an addiction and would like specialist mental health support, call 0203 326 9160 to see how we can help.
Clinical Partners is the UK’s largest private mental health partnership, helping children, adults, families and organisations nationwide.