Risk Factors for Drug & Alcohol Addiction

What Makes Drugs and Alcohol Addictive?

Chronic use of drugs or alcohol can result in brain changes that can contribute to addiction.² Being exposed to addiction risk factors, which we will discuss later, can increase a person’s likelihood of developing addiction.³

Drugs and alcohol can increase the activity dopamine, a chemical messenger that plays a role in motivation and the reinforcement of repeating certain behaviors. The body naturally releases dopamine in response to pleasurable activities, such as eating or having sex. When a person takes drugs or drinks alcohol, they typically experience unnaturally high levels of dopamine activity; this can result in powerful urges to repeat the experience.²

Increases  in dopamine activity reinforce the connection between using the drug or drinking alcohol and the resulting pleasurable feeling, as well as other cues associated with drug or alcohol use, such as the place or people with whom the person uses drugs or drinks. Over time, this can contribute to a person prioritizing substance use over other pleasurable experiences or commitments, including relationships, work, and hobbies.²

Once a person is regularly taking drugs or drinking heavily, their body becomes accustomed to the presence of the drug or alcohol, which may result in  experiencing intense cravings or uncomfortable withdrawal symptoms when they aren’t using drugs or drinking, further fueling their continued substance use and contributing to an ongoing cycle of addiction.²

While any substance use can be dangerous, not everyone develops an addiction. The decision to start using drugs or alcohol is usually voluntary and a person can usually stop using, but, with regular use over time, a person’s ability to control their substance use can become impaired. So why can some people stop while another’s substance use results in addiction? Research has shed some light here and has identified certain risk factors that can increase the risk an individual’s substance use might develop into an addiction.¹

What Makes People More Vulnerable to Addiction?

Addiction to drugs or alcohol is a complex issue caused by contributions from many overlapping and interacting factors that include a person’s environment, genetics, life experiences, and more.³ Risk factors create vulnerability for addiction, but they aren’t the sole cause. Having more risk factors increases the chances a person will develop a substance use disorder.¹

Below, we’ll discuss some of the common addiction risk factors within the following broader categories:

• Family history of addiction
• Social determinants and environmental risk factors
• Early use
• Co-occurring mental illness and chronic illness

Family History of Addiction

Studies have shown that having parents or older family members who drink, use drugs, or commit crimes can increase a child’s risk of developing an addiction.¹

Although a family history of addiction can significantly increase a person’s risk of addiction, it does not guarantee that someone will develop an addiction. Genetics and shared family environmental factors can lead to a greater risk.¹

Researchers estimate that genes, as well as the effects environmental factors have on a person’s gene expression (i.e., epigenetics) account for around half of a person’s risk of addiction.¹

While genetics and epigenetics are important, it’s not always a straightforward inheritance. Families with addiction issues might also share an environment that increases risk. For example, a parent struggling with addiction might create a chaotic or stressful household, making a child more likely to turn to substances as a coping mechanism.¹ 

Social Determinants & Environmental Risk Factors

Environmental risk factors for substance use disorders are the external conditions that can increase a person’s vulnerability to addiction. These factors can be related to family (as discussed in the previous section), school, work, social circle and community.^1,4

Some environmental risk factors for substance use disorders (SUDs) include:^1,4

• Adverse childhood experiences (ACEs) are stressful or traumatic events that can occur in childhood and have long-term impacts on health and well-being, such as abuse, neglect, violence, or family dysfunction.
• Trauma (physical or emotional).
• Significant or chronic stress, grief and loss.
• Peer pressure to use substances.
• Easy access to drugs and alcohol.
• High stress professions like healthcare professionals, first responders, lawyers, and military personnel.

Social determinants of addiction are the social and economic conditions that shape a person’s environment. They more indirectly influence addiction risk compared to environmental risk factors, which focus on a person’s immediate surroundings. Key social determinants of addiction include:⁴

• Economic stability: Homelessness or lack of access to affordable housing, overty, unemployment or limited job opportunities can create stress and a sense of hopelessness, which can increase the likelihood of substance use as a coping mechanism.
• Education access and quality: Limited  educational opportunities can hinder a person’s future prospects and contribute to feelings of despair, making them more susceptible to using substances.
• Social and community support: Experiencing racial discrimination, discrimination or disapproval of  gender identity or sexual orientation, lack of social support or any other social isolation can contribute to feelings of loneliness and alienation, increasing the likelihood of turning to substances for comfort.

Early Use of Substances

Research has shown that early substance use can be one of the biggest predictors of later addiction. Studies have found that an early age at first intoxication with alcohol is associated with an increased risk of developing SUDs later in life, when other risk factors are taken into account.⁵ According to the Centers for Disease Control and Prevention (CDC), the majority of adults who meet the criteria for having a substance use disorder started using substances during their teen and young adult years.⁶

However, it’s not entirely clear as to whether this occurs because of the effects of substances on the developing brain or due to other early environmental and/or biological factors.¹

Co-Occurring Mental Health Issues & Chronic Illness

People who have co-occurring mental health problems can experience an increased risk of developing an addiction, and vice versa.  Mental health disorders, including depression, anxiety, posttraumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, personality disorders, and schizophrenia, among others, often occur alongside a substance use disorder.⁷ The co-occurrence of mental illnesses and addiction may happen for a variety of reasons.

Mental health disorders can contribute to substance use. Sometimes, people with mental health disorders, including anxiety, depression, or PTSD, may attempt to cope with their symptoms by using drugs or alcohol. Furthermore, brain changes that take place in people with certain mental health disorders may make it more likely that they will experience the rewarding effects of substances, which, in turn, could make it more likely that they will continue to use the substance.⁷

Conversely, substance use and substance use disorders could trigger mental health symptoms. Drug or alcohol use can impact brain functioning and cause brain changes that might make it more likely that a person will develop certain mental health disorders.⁷

However, just because a person has one condition doesn’t necessarily mean it caused the other. Substance use disorders and mental health conditions often have shared risk factors. For example, both conditions can be influenced by genetics and environmental stress or trauma.^1,7,8

Studies also suggest that chronic diseases and physical ailments like chronic pain, cancer, and arthritis can increase the likelihood of developing SUDs.⁴

Recognizing Signs of Drug & Alcohol Addiction

Doctors and qualified mental health professionals diagnose addiction as a substance use disorder, or SUD.⁷ top They use criteria from the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and take into account other factors such as physical, behavioral, and social symptoms, to guide their diagnosis.9 Only a doctor or other professional can diagnosis a substance use disorder, but knowing the criteria can help people understand when it might be time to seek treatment.

Some substances or types of substances have their own unique diagnosis, for example, opioid addiction would be diagnosed as an “opioid use disorder,” and alcohol addiction as an “alcohol use disorder.”⁹

The general criteria for substance use disorder include the following:9

1. Taking higher amounts or more frequent doses of the substance than originally intended.
2. Expressing a persistent desire to cut down or regulate substance use, and reporting unsuccessful attempts to decrease or control substance usage.
3. Spending a great deal of time obtaining, using, and recovering from the effects of the substance.
4. Cravings, or strong desires or urges to use the substance.
5. Recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home.
6. The person may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities may be given up or reduced because of substance use. The person may withdraw from family activities and hobbies in order to use the substance.
8. Recurrent substance use in situations in which it is physically hazardous, such as while driving or operating machinery.
9. The person may continue substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, meaning the person requires a markedly increased dose of the substance to achieve the desired effect or experiences a markedly reduced effect when the usual dose is used.
11. Withdrawal, which is a syndrome that occurs when blood or tissue concentrations of a substance decline in a person who had maintained prolonged heavy use of the substance. After developing withdrawal symptoms, the person is likely to consume the substance to relieve the symptoms.

Substance use disorders can range in severity, from mild to severe. Generally speaking, a person with a mild substance use disorder displays 2-3 of the above symptoms within a 12-month period, a moderate SUD involves 4-5, and a severe SUD involves having 6 or more symptoms within a year.⁹

Finding Help For Drug and Alcohol Addiction

If you or a loved one are struggling with drug or alcohol addiction, we are here to help. American Addiction Centers (AAC) is a leading provider of substance use disorder rehab services in the U.S., with treatment centers located across the nation. We offer personalized treatment plans and evidence-based treatments on different levels of care to suit all needs, including medical detox, inpatient rehab, and outpatient rehab.

Please call our free, confidential helpline at to speak to a caring admissions navigator about your rehab options, begin admissions, or to inquire about the treatment process. You can also read our rehab guide for young adults, or our drug rehab guide to learn more and find answers to many commonly asked questions.

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