2.4 Why do people develop addictions?

A Family Guide to Concurrent Disorders - Part I: What are concurrent disorders?

Not everyone who engages in a pleasurable behaviour ends up becoming addicted. At many levels, behaviours that can become addictive are either encouraged or discouraged by larger social forces (think of advertising) or by factors that are within the person (biological or psychological). If we understand the ways that behaviours can be powerfully rewarding for people, instead of viewing addictive behaviour as inherently bad or totally negative, we can begin to have a more sympathetic understanding of the problems of substance dependence and other addictive behaviours.

As the biopsychosocial model suggests, the causes of addictive behaviours are complex, and can include the following:

• A person usually perceives the behaviour itself as being strongly rewarding in some way. The nature of the reward, however, may vary from person to person, and may change over time. Some individuals may be rewarded by the energizing, exciting or pleasurable effects of a substance or of a behaviour such as gambling.
• Some people may engage in addictive behaviours because the physiological or psychological effects relieve physical or emotional suffering.
• Addictive behaviours may divert attention from distressing or overwhelming life circumstances. For example, some substances may temporarily lessen the symptoms associated with anxiety, depression or chronic frustration. Unfortunately, many of the destructive consequences associated with addictive behaviours—for example, damage to relationships, finances, self-esteem and emotional and physical health; development of physiological tolerance and ultimately increased anxiety, depression and other symptoms—may draw the person even deeper into his or her addiction. As the consequences associated with the behaviour grow more severe, a person feels less able to address the problem. Even when it reaches the point where the person is not getting any positive rewards, the person may keep using to avoid the distress of having to quit the behaviour. For example, many people dependent on substances report using substances long after they stop experiencing any pleasant effects.

The biopsychosocial approach to understanding substance dependence

Biological factors

There is evidence that some people inherit a higher risk of dependent behaviours than others. To have a sibling or a parent with a history of dependence is to be at higher risk. We are learning more about the biological dimensions of addictions. These behaviours themselves might produce biological changes that make the person more vulnerable to relapsing (returning to the behaviour).

Psychological factors

Any powerfully rewarding experience encourages a person to repeat the experience. There are many aspects of addictive behaviours—including the rituals, the environmental factors, and the thoughts and feelings that are involved—that can help us understand addictive behaviours. Usually the rewards from these behaviours show up first, while the costs tend to follow later or gradually build up over time. When someone feels a powerful urge, and the reward is immediate, while the negative consequences are nowhere in sight, it is tempting to give in to the power of the moment.

Social factors

Addictions are strongly shaped by our relationships with other people and by interpersonal processes.

Peer factors help to determine if someone will experiment with a behaviour such as using tobacco, alcohol, marijuana or other drugs that may cause dependency.

Availability affects the risk of a behaviour becoming addictive. The increase in opportunities to gamble in the western world has led to an increase in the number of people with gambling problems in the region. Making cigarette smoking in public spaces illegal, along with higher prices through taxation, has led to significant decreases in the numbers of people who smoke.

Cultural factors also shape what people consider to be acceptable or unacceptable behaviours.

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