When severe substance use disorder or addiction strikes, it often has devastating consequences to individuals, families, and communities across our nation. With the current attention the opioid epidemic is bringing to addiction and those who suffer, it is human nature to try to find the root cause of the crisis. This exploration to find what causes addiction often leads to blaming one source over another, adding to its stereotype and myth.
As a clinician who works with individuals and families who are making the transition from active addiction toward a pathway of wellness and recovery, I am often asked what causes addiction. Most individuals and family members who are seeking to understand why this is happening to them, and those they love, are earnest and desperate to find answers. Many of them are coping with the loss of sons, daughters, fathers, and mothers who have died from the disease of addiction. Others are in a state of manic fear as they reach out for help in their difficulty and suffering before the disease takes their own life or that of a loved one. Although there are no easy answers to these questions, being able to discuss the complexities of the disease is helpful in alleviating blame, frustration, and fear.
There are many parties, in the recovery and mental health field, who point to specific biological, psychological, and social factors contributing to someone developing and suffering from addiction. Addiction is a chronic brain disease, that is clear.1 However, like most diseases, the formation of the disease of addiction is complicated and complex. In my mind, addiction is best explained by the biopsychosocial model.
Before we discuss its application to addiction, a working knowledge of the components of the biopsychosocial model is important. Created by George Engel and John Romano to help physicians to understand the holistic nature of disease formation in the 1970’s, the biopsychosocial model compelled clinicians to consider the biological, psychological, and social “dimensions” of illnesses.2 Although the biological components of illnesses are incredibly important to understand, an over-focus on biology can promote seeing patients as objects instead of within the multiple social contexts and internal psychological factors impacting diseases. The more “subjective” elements of a person’s life, the psychological and social, are incredibly important to be considered and can be studied and measured. This study can encompass disease prevention, disease formation, and the healing and recovery from disease.2
Within the model, the “biological” considers the genetics of an individual and, due to these genetic factors, the vulnerability or susceptibility an individual has to different illnesses and disease processes. Beyond this, the biological includes our sex (i.e., male or female), brain functioning, and the general functioning of the body. An example of functioning impacting general health includes someone with a physical disability, someone who experiences chronic pain, or both.
The “psychological” part of the biopsychosocial model encompasses thoughts, emotions, and behaviors. When stress is present in the environment, the psychological dimension informs how people experience, feel, manage and deal with that stress. How we cope with the stress in our life is essential in considering the prevention of diseases, disease formation, and healing. Psychological factors that are important to consider in the model also include identity and self-esteem as well as attitudes, memories, and beliefs.
Social factors also contribute to disease prevention, formation, and healing. Social components, such as socioeconomic status, religion, family peer groups, social support, other relationships, traditions, and culture, all are included in understanding the whole person. For example, experiencing trauma within our social environment can impact both our psychological and biological well being and vice-versa.
Biopsychosocial model of addiction
To answer the question(s) about the origins of the brain disease of addiction and what causes it, we, as professionals within the field, must be able to explain the complicated factors associated with disease.
Foremost, biological factors including genetic predisposition play a role in all diseases including addiction. For whatever reasons, not of our choosing, we are born with our genetic makeup and must deal with both the strengths and weaknesses of what is passed down to us through our genetic line. What this means is that some people have a stronger genetic “pull” to manifest with and suffer from addiction than others and still others may not have any susceptibility at all.
With individuals who may have less of a genetic pull, psychological and social factor may line up a certain way creating the context where the disease of addiction manifests. The best parallel I have found to help those who suffer and those who love them is a comparison between addiction and diabetes. Some diabetics, mostly Type I Diabetics, have a strong genetic susceptibility and manifest with diabetes early in their life. Others, mostly Type II Diabetics, may have less of a genetic pull but manifest later in life based on several different psychological and social factors including stress, diet, exercise, etc. Although different, both Type I and Type II Diabetics must deal with the ramifications of having the disease of diabetes.
In addition to the biological, psychological factors influence disease formation. This is seen in the connection between the prevalence of mental health disorders and addiction. The National Institute on Drug Abuse reports:
“Many people who are addicted to drugs are also diagnosed with other mental disorders and vice versa. For example, compared with the general population, people addicted to drugs are roughly twice as likely to suffer from mood and anxiety disorders, with the reverse also true.”2
Thus, the psychological factors leading to depression and anxiety disorders impact the creation of the disease of addiction and vice versa. How one internally manages and copes with the stressors of life certainly impacts anxiety and depression symptoms. Often these symptoms pre-date the initial use and subsequent suffering from addiction. In fact, alcohol and drug use may begin as a powerful and readily available coping mechanism to deal with fear, stress, crises of identity, and low self-esteem.
Social dimensions can serve as protective factors of disease formation as well as contribute to addiction manifesting. Additionally, social factors are incredibly important in the healing and recovery for those who suffer from addiction. In my clinical experience, pain derived from social factors is the most common element between those who suffer from addiction and those who are pursuing a recovery journey. The source of the pain can come from a variety of social contexts (e.g., family, peers, community, culture, etc.).
Trauma, in all its forms, is experienced by most people who suffer from addiction. Social factors should never be used to blame families for the disease of addiction. I am, however, pointing out that social factors do play a role in the context of diseases formation. More importantly, social factors, including healthy family interaction and social support, are critical in recovery from addiction.
The bottom line
In conclusion, it is important to note that no one factor is the “cause” of addiction. There are multiple culprits and, as stated earlier, all are complex and complicated. The culprits are biological, psychological, and social in nature. The “cure” for those who suffer must be equivalent in complexity and holistic to tackle all three dimensions. Recovery and healing from addiction must consider the biological, psychological, and social. Anything less will continue to result in poor outcomes and more suffering.
Kimball, T.G. Addiction is a Chronic Disease Not a Character Flaw. https://thedoctorweighsin.com/addiction-is-a-chronic-disease-of-the-brain-not-a-character-flaw/
Borrell-Carrió, F., Suchman, A. L., & Epstein, R. M. (2004). The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Annals of Family Medicine, 2(6), 576–582. http://doi.org/10.1370/afm.245
National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/comorbidity-addiction-other-mental-disorders