How Addictions Develop

In "What Is Addiction" section, we saw that people can be said to be addicted when they lose control over the use of a substance and continue that behavior despite negative consequences. In such a case, using the substance takes precedence over all other goals and responsibilities in the person's life, often to the point of incarceration or death. We've also seen that not everybody who drinks or uses drugs ends up losing control. So how is it that some people become addicted and some don't?

Because addiction is a multifaceted problem with many aspects, the answer to this question is simply, "Well, it depends . . ." So let's see if we can get a grip on how addictions develop.

One way of thinking about addiction is to compare it to an infectious disease, like the flu. At the beginning of an outbreak of the flu, the virus is introduced into the population by one person. Since the flu is spread by airborne contact - sneezing and coughing - it begins to spread quickly. But does everyone who is exposed to the virus get the flu? No.

Does everyone who experiments with an addictive substance become an addict? No.

Let's look at our comparison with the flu from an epidemiological standpoint. A number of factors are in play, and these can be put into three groups: host, environmental, and agent.

Host Factors

Some people inherit a tendency to develop addiction. We will examine the genetics of addiction in more detail later on in this section.

Psychological factors may also increase or decrease an individual's vulnerability to becoming addicted. People with psychiatric disorders such as clinical depression or anxiety have a higher risk of developing addiction. People who come from disrupted homes or who have been abused are also more prone to develop addiction.

Some personality factors may make a person more likely to experiment or to use. Risk takers, people with poor impulse control or low stress tolerance, and people who have difficulty learning from negative consequences are at increased risk.

Environmental Factors

Environmental factors might include the cultural acceptance of social use of the substance, the availability of a substance in the community, the degree of criminality associated with use of the substance, and so on. Community prevention and education programs aim at modifying the environmental aspect of the spread of addiction.

An example of the importance of environmental factors is seen in the rise of crack cocaine addiction in the late 1980s.

Powder cocaine, which is used intranasally (being snorted) was readily available in the early 1980s, but was fairly expensive. Extracting the cocaine base from the powder form of the drug, called free-basing, allowed for intravenous and inhalation use - methods that intensified the high - but was a somewhat involved and dangerous chemical process requiring the use of highly flammable chemicals. (The actor Richard Pryor was severely burned while free-basing.) Some clever but diabolical individual discovered, however, that you could take powder cocaine, dissolve and dilute it, mix it with common household chemicals, and cook it in the microwave to produce a crystalline form of cocaine called "rock" or "crack" cocaine that could be smoked in a pipe for an immediate and intense, although brief, high. This was a marketing coup for the drug cartels, because someone could take a kilogram of cocaine and produce mountains of cocaine rocks that could be sold very cheaply. The going price for a rock in some urban locations dropped below a dollar, opening the market to younger and less affluent users. Crack rocks were also much easier to conceal and transport than bulkier drugs like marijuana. The use of crack spread like wildfire, and so, unfortunately, did the intense addiction that it causes.