We Know What Causes Addiction, It's an Inherited Brain Disease, Right?
- Dee
- 2 days ago
- 10 min read
Not so Fast!
What is THE number one thing that causes addiction?
That feels like such an important question.
The Nature Nurture Debate
There's a fierce overall argument between nature versus nurture in addiction as in all kinds of disciplines. Is addiction rooted deep in our genes or in our environment and experiences?
Causes of Addiction - Nature
The nature stance is deeply embedded in our culture here in the US. This is a foundation for both the medical viewpoint and by 12-step support groups like AA as well as the broader public and has become adopted as a sort of "common knowledge." These disparate groups agree that it is a disease. Doctors tend to believe it's a genetic medical disease but that AA can help. AA tends to believe that it's a spiritual disease and they are pretty suspicious of medicine and especially medications.
Standard available pathways for help may include detox (an excellent starting point for anyone), medical and psychiatric assessment, treatment and counseling, and the recommendation to attend AA and other support groups.
I would venture to say most people agree that there is a predisposition or vulnerability to addiction that runs in families, and that there may be a genetic piece in there. The ideas that our genes are not the sole or even primary factors in addiction, and that people can recover are less well received.
Causes of Addiction - Nurture
The nurture stance approaches from a center-point of psychological and physical health and well-being. Pioneers in the field of addiction research and treatment include Dr. Stanton Peele, Gabor Mate, Bruce Alexander, SMART Recovery, Carl Hart and (thankfully) increasing numbers of modern-day professionals and treatment experts. I'm with these folks.
I would add that people can recover with or without religion, spirituality, or medicine. You're not required to rule these out. These may make recovery and the future better, easier and brighter.
According to the Experts
In 2011, the American Society of Addiction Medicine (ASAM) defined addiction as a chronic brain disease. In 2019 they included language that allowed for some of the factors below, and that has been the overall direction in the way the professionals are trying to understand addiction.
The latest version of the The Diagnostic and Statistical Manual of Mental Disorders, the DSM 5, the psychiatrists’ and psychologists’ bible, has a complicated, mostly behavioral, checklist and classifies them as psychiatric disorders, by the object of the addiction (alcohol use disorder, gambling disorder, opioid use disorder, etc.) with only a handful of behavioral addictions included, but we'll save that for another day.
The Cleveland Clinic defines addiction as: " ... a chronic (lifelong) condition that involves compulsive seeking and taking of a substance or performing of an activity despite negative or harmful consequences." https://my.clevelandclinic.org/health/diseases/6407-addiction.
I think this is a pretty common one, and my issue is with the "chronic (lifelong) condition," part of it. My definition would be:
"Addiction is when we develop a relationship with a substance or activity that becomes compulsive, and we continue to pursue it in spite of harm to ourselves or others." ~ Dee
In that same article they state that 40-60% of addiction is caused by genetics. Well, I would question that. I am very suspicious that genetic causation has been proven reliably, and that is a very big, bold statement. The correlations we find in households and families MAY be equally or more related to learning, adaptation and belief systems within a family and immediate environment. We have a lot of trouble with correlations and causations in general. A lot of authoritative-sounding statements and beliefs don't hold up when we really distinguish between these two.
Early Factors and Associations in Addiction
Genetics
Genetics is widely accepted as the largest factor in addiction, and it is the one that gets the most attention. The entire addiction industry is centered around the idea that we are genetically programmed for addiction. There are two groups that have helped build and strengthen this understanding. Most medical professionals apply this mainly to substances, but they definitely are trying more and more to shoehorn as much as possible into that viewpoint -- behavioral addictions like gambling or sex or eating or ... all kinds of things.
Medical and Related Professionals
There are some strange bedmates under this medical tent. Doctors and research point to medical solutions -- anti-craving drugs, substitutes without the high, drugs that deaden the effect of a substance or enjoyment, mood drugs, and previously, drugs that make you violently ill if taken with alcohol.
Attacking the craving mechanisms for particular substances by substituting with those that send the same signals to the body without the craving component has been promising for opiates and others that cut off the ability to experience the euphoria of the drug and, recently, alcohol. Newer GLP-1 drugs are in this picture somewhere too, for food issues, but also as showing potential promise in other areas.
By the numbers, these approaches show strong successes, especially in opioid use. It can help remove the cravings so that physical dependence can be addressed, or a sustainable plan for ongoing pain management can be created. It helps people disconnect from the euphoria associated with use, which is huge!
A lot of research money has been spent on identifying neural pathways for addiction with brain scanning. It's all very interesting, but hasn't really generated applicable, practical directions to benefit the general public.
So, the medical profession claims addiction under its auspices, but then prescribes religious cures via support groups and detached it from psychiatry and psychology for years.
12-Step Programs
The classic wisdom of AA puts it as a moral/spiritual disease that people are afflicted with, and they agree that it is genetic. You can't be cured, but you can be transformed by surrendering your mortal sins, all the defects of character that caused your shameful weakness and badness, to a higher power and pursue forgiveness and atonement via 12 steps and peer support meetings. It's a lifetime curse, but you can learn to keep it at bay.
Adverse Childhood Experiences
There have been many studies about the role of childhood experience, particularly in terms of adverse childhood events (ACEs) that show huge correlations between early traumatic events or situations (and the number of them) and difficulties in later life coping. These can include neglect, abuse, lack of affection and on and on. Here, too, there’s a range of severity, obviously, and people can be emotionally wounded, neglected and abused in all kinds of outwardly-seeming stable situations. Here's a very recent article from Psypost, reinforcing these links: https://www.psypost.org/how-growing-up-alone-changes-the-brain-s-response-to-alcohol-2026-03-26/.
The focus has been more on social welfare and mental health issues in this area, but there is huge overlap between addiction, mental health and a host of social issues.
Beliefs
This has to do with our overall perspective on life, shaped by our experiences and the assumptions and values we then make about the world and our place in it. Even though it feels like these are etched in stone, as something we just “know,” we clearly change our beliefs as we go along through life and learn and are forced to adapt to all kinds of things. Most mainstream psychology teaches that some of our beliefs, adopted as children, don't hold up anymore. We get an awful lot of stuff wrong as we go along.
We may not even be aware of it, but take, for example, the Boomers. It’s hard to imagine that this was actually the hippy generation! They were all about peace, free love and societal change. What happened? OMG!
I hope you Gen-Z’ers and Gen Alphas can stay true to your ideals. It’s harder than you think!
Preferences
We all have our own preferences about things. How things taste. What colors attract us. If we prefer quiet. What kind of music or art we like … Same with the things that we see as especially pleasurable. And our preferences are shaped by all these other things, too.
How much of our addictive choices are about personal preference? Initially, all of it! We start by trying things, and something hits a high note on the pleasure scale. Generally, we get over an initial infatuation with something after a bit and we rebalance. Think making mudpies, doing cartwheels, first loves. Or we figure out how to rebalance our lives incorporating these elements. That's all good.
Over time, we may realize that something isn't as great as we thought, we lose interest, there are downsides. Maybe something's changed in our lives. We cultivate different tastes and preferences over a lifetime, based on all the same factors we're looking at specific to addiction, like choice, learning, the people around us and what they like, health, trends, availability, advertising and so on.
Our Tastes Change Over Time
For instance, I don't like Raviolios anymore, but I used to consider them food!
As a kid, I saw the commercials. Everyone had them in their pantries. As information became available and I became more aware of what I was eating and what was good food, they didn't taste as good to me anymore. I definitely do not find them enticing now.
If I see death and destruction in my mind when I look at a liquor bottle, I don’t react the same way as if I envision joy and freedom and youthful abandon.
A lot of that is within my control if I actively, forcefully make that new association and push back against the old one with known facts and contrary experiences.
We learn to like and dislike things, too. Liquor bottles behind a bar used to wink at me. Then they looked like poison to me. Now, they just aren't really something I notice anymore. We don't have to lament the good parts of using or other toxicity or honor fuzzy, rosy, false memories. Over time, we can remember those times, perhaps with a smile, as just a part of the past.
Unfortunately, the temptations of excess, easy availability and the underlying emotional needs we are trying to fill are so vast these days, it can be very, very hard to keep our larger goals and values in mind and try to find some balance in daily life.
I think it starts with questioning things. Preferences are not needs.
We can learn and choose and change. Gosh, there's so much power in that!
Culture
Culture and society, of course, have a huge effect on how we view various addictive activities and help shape those preferences as well as all kinds of aspects of how we see ourselves. If everyone around us believes that alcohol is good or bad, well, that’s probably what we'll think too.
Stanton Peele often mentions that Europe tends to normalize social and ritualistic drinking better than we do in the US. Drinking and drugs fall in and out of favor all the time -- Prohibition vs. the '80s and cocaine. We're having a pretty big love affair with marijuana right now in the US. And of course, our friend circles, family norms, the lifestyles we find ourselves in all play roles in how we view and use drugs, alcohol, various behaviors of almost limitless kinds.
Ways We Fortify Addiction
Habit
To some extent these things have become habits. Deeply ingrained habits. In some ways, they’re not that different than brushing our teeth in the morning. Many, many people have a cup of coffee first thing, both as ritual and for the caffeine boost. We like habits and routines, and they can soothe us and help us navigate our days. People with good habits around their time, their housework, their work, have harnessed their habits in healthy, life supporting ways.
Addiction can turn habits into an enemy, and they are hard to break. Try reversing the way you usually do something in your basic routines. Put your shirt on first instead of your pants or vice versa. Shower in the evening instead of the morning. Brush your teeth with your left hand. These all feel TERRIBLE. They are not natural. It’s hard to push through that for more than a few days. It takes a good while for even a simple, new, unfamiliar habit to really take hold, especially if there is an easier, more short-term satisfying one in easy reach.
Dependence
And here we’re sort of full-circle back to the medical model. A lot the people who use drugs and treatment professionals tend to focus on this piece as the marker and withdrawal as the biggest challenge of addiction. We consider our most serious addictions to be the ones that can have terrible withdrawal symptoms -- alcohol, opioids and anti-anxiety meds.
When I talk about addiction, I am talking primarily about the emotional and mental dependence. The physical, while it can be intense, is short-term and often not as bad as people fear. There are excellent medications and medical protocols that can help with the actual detoxification part of things.
**PLEASE NOTE: Severe withdrawal from alcohol or benzos can be life threatening. Please don't do this on your own if you've been drinking/using heavily or for a long period of time.
Coping Mechanism
Lots and lots of people use addictive substances and activities as a kind of coping mechanism. We may be consciously self-medicating or the little daily/weekly rituals we've developed to help us through our stressful, pressured lives may start to turn on us. But it's a maladaptive coping mechanism. Instead of helping us, it actually hurts us. Also, using a drug or behavior of choice as a regular, short-term coping mechanism creates problems because we never develop more strong, sustainable ways to cope with life.
Be careful about substituting one thing with another, including medications, food, even exercise and work. These can all be great helps; it's the way we use them and for how long. If they're helping us escape, run, avoid, numb out, then we want to keep a close eye on that.
People use substances in an attempt to manage anxiety or depression all the time. Unfortunately, it really is a bad idea. These issues can be uncovered for what they are and much better treated/managed.
There is often a period of a couple of weeks of anxiety/depression post-detox. If those symptoms persist for more than two weeks after that, it is definitely worth a trip to the doctor to get a little help.
And as a general note, please, please be careful about any prescribed meds that may tickle that "addiction" button -- anti-anxiety medications, pain medication, stimulants, sleep meds, cough medicines, etc.
Formulating a Solid Approach So You Can Break the Cycle
Addiction feels like it's beyond our control, and the idea that it's genetic, coded into our being from our families feels right. That's the disease model.
More modern approaches emphasize psychological models, like SMART Recovery's CBT framework and next-generation therapeutic practices, like family systems, ACT, DBT, trauma-based therapies, or Stanton Peele's Life Process Model, and lean into the overlap between addiction, mental health and situational factors.
Generally, societally, I think we want to better educate people so they can give themselves and their children stronger bases of realistic confidence, skills for coping with things like disappointment, fear, obstacles, being brave, boredom, and assessing risk, so they can make good choices that benefit them, the people around them, their communities, and quite possibly the world.
Here, today, I want to help people where they are now. Since there is no such thing in real life as a perfect childhood, parents, genes or situations, we want to figure out how to 1) recognize and mitigate imperfect histories, circumstances, unhelpful messages and practices from the past so they don't continue to haunt us, as well as 2) improve our current situations and get rid of the things that are harming us.
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I'd like to help if you have questions or could use somebody to talk to. Shoot me a note or give me a call below if you'd like to chat a bit. No obligation. No pressure. Just some encouragement and support
