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Risk Factors for Substance Abuse & Addiction

Substance abuse and addiction risk factors include environmental stress, genetics, mental health issues, interpersonal problems, and age. Recognizing these factors is key for early intervention and effective treatment in preventing and managing addiction.

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There are several factors that can influence a person to abuse alcohol and/or drugs. Stressors in the environment, genetic factors, medical or mental health issues, interpersonal problems, and age can all be potential risk factors.

Addiction is a complex disease that makes changes in the pathways of the brain. There are often multiple contributing environmental, biological, and contextual factors that are involved in the onset of a substance abuse disorder.

Assessing Risk

According to the National Survey on Drug Use and Health (NSDUH), in 2020, approximately 14.5 percent of the American adult population (ages 12 and older) had a substance use disorder (SUD) in the prior year.

Not everyone who drinks or uses drugs will become addicted or struggle with problematic drug or alcohol use, however. There are some predictive factors that can increase this risk, but this still does not mean that a person is bound to develop addiction. The presence of risk factors simply means that it is more likely that someone will abuse substances or end up addicted.

What Are the Risk Factors for Addiction?

Addiction is a disease that develops when someone uses drugs and/or alcohol excessively and for a long period of time. Not everyone who uses drugs or alcohol is addicted, but addiction occurs when the pathways in the brain are altered, causing shifts in mood, behaviors, actions, impulse control, and reward-seeking.

There is no one thing that “causes” addiction, but there are many different factors that increase a person’s vulnerability and risk for addiction when substances are abused regularly.

Typically, these fall into three main categories: biological (aspects related to physical biology, brain chemistry, and heredity), psychosocial (social and interpersonal relationship factors), and contextual (circumstances related to the environment or events).

Biological Risk Factors

  • Family history of addiction: Addiction is believed to be a heritable condition as often as 40 percent of the time. If you have a direct family member with addiction, the odds are higher that you too can develop addiction.
  • Genes and brain chemistry/function: Gene studies are constantly being conducted to determine the level of influence specific genes have in developing diseases such as addiction. It is likely that deficits in certain brain chemicals or regions responsible for impulse control, reward processing, and pleasure can be a risk factor for substance abuse and subsequent addiction.
  • Dual diagnosis (co-occurring medical or mental illness): Medical and mental health conditions can increase the risk for addiction in a variety of ways. Consuming drugs and alcohol can become a dangerous method of self-medication. Similar brain regions can be involved in both disorders, and life stressors can contribute to the risk for both. For example, someone with a mood disorder has nearly the double the risk for also struggling with addiction in their lifetime
  • Early onset of drug/alcohol abuse: The earlier a person starts using drugs or alcohol, the higher the likelihood they will also struggle with drug/alcohol abuse and/or addiction later in life. Brains are not fully formed until around age 25, and when adolescents start abusing drugs and alcohol before adulthood, the brain can be irreversibly altered before it has fully developed.
  • Type of drug abused: Different drugs have different addictive qualities, and it can take less of one drug to form drug dependence and addiction than another. For instance, heroin is considered a highly addictive drug that does not take many uses to form drug dependence and then addiction.
  • Method of drug use: The way drugs are put into the body makes a difference too. For example, injecting, smoking, or snorting drugs sends them more quickly across the blood-brain barrier and into the bloodstream. This can intensify the “high” and the risk for developing drug dependence and then addiction more quickly than if ingesting or swallowing drugs.

Psychosocial Risk Factors

  • Stress: Continual stress can contribute to substance abuse and addiction, making someone more prone to a substance use disorder. Not only does stress make chemical changes in the brain, alcohol and drugs can also provide a temporary escape from reality and relief from stress, creating a desire to repeat use.
  • Peer relationships: Especially in adolescence, peer interactions can play a big role in substance abuse. Teenagers often lack impulse control and an ability to think through consequences. Peer pressure can be a risk factor for addiction as can unhealthy peer relationships that cause stress and trauma, such as bullying.
  • Childhood trauma: Trauma increases the risk for substance abuse and addiction, often as a method to cope with troubling memories, in an attempt to be accepted and fit in, or as a form of comfort.

Contextual Risk Factors

  • Lack of parental support/supervision: A lack of support or supervision, especially during adolescence, can make it easier for teens to have access to drugs and alcohol. This can increase the odds for substance abuse at a young age and therefore the risk for addiction.
  • Social isolation: Drugs and alcohol can be a form of self-soothing or a method to try and be accepted into a group when someone, especially a young person, is feeling isolated and alone. This can raise vulnerability for problematic substance use and addiction.
  • Poor living environment: Environmental stressors can play a big role in the desire to use drugs or drink alcohol. A chaotic living situation, troubled neighborhoods, greater access to drugs and alcohol, and poor socioeconomic factors can all be potential risk factors for drug and alcohol use and addiction.
  • Major life events: Difficult transitions, such as divorce, moving, death of a loved one, or loss of a job, can all increase the risk for substance abuse as a coping mechanism, which elevates the odds for addiction.

Preventing Addiction

Addiction is caused by regular and repeated drug and/or alcohol use. To prevent addiction, you must minimize opportunities to use drugs and alcohol. It is especially important to monitor teenagers, keeping them busy and engaged with positive outlets and social opportunities.

The Centers for Disease Control and Prevention (CDC) lists the following preventative methods for addiction:

  • Family support
  • Family and parent engagement
  • Monitoring by parents
  • Connection to school
  • Parental discouragement of substance abuse

Signs Someone Is Struggling with Addiction

The first step toward getting help for addiction is recognizing that a problem exists and knowing the signs of trouble. Not all of these signs will be present in everyone. The more signs that are noticeable, the higher the level of addiction.

If you notice more than two or three of the following signs of addiction, it is time to seek help:

  • Inability to stop drinking or doing drugs despite trying multiple times
  • Using more drugs or alcohol and for longer than intended
  • Mood swings, sleep changes, and appetite fluctuations
  • Lack of interest in previously important activities
  • Drop in grades or work production
  • Inability to fulfill regular obligations
  • Changes in relationships
  • More isolation and spending time alone
  • Less attention to personal hygiene
  • Problems in relationships with peers and family members
  • Spending a lot of time thinking or talking about drugs or alcohol and avoiding activities that do not include them
  • Needing to take more drugs or alcohol to get the same feeling
  • Suffering from withdrawal symptoms when drugs or alcohol wear off

Steps to Take if Someone Is Struggling With Addiction

If you spot signs of addiction and suspect that a loved one is struggling, find a calm and safe time to have a conversation with them about it. Do this when they are not actively under the influence of drugs or alcohol or coming down from their effects.

It is important to be supportive, show them you love them, and encourage them to get professional help.

If they are not receptive to the conversation, this is normal. Try to have the conversation again later. It can take a few times to really be heard.

Stop enabling behaviors, such as making excuses for their behaviors or cleaning up after them. Set clear and concise boundaries, and be consistent in your expectations.

A professional intervention, led by a trained interventionist, can be beneficial. This is a structured meeting between loved ones with the goal of helping the person get into a treatment program for recovery.

Risk Factors vs. Protective Factors

Risk factors can contribute to the likelihood that someone will abuse drugs and/or alcohol, which in turn elevates the odds for addiction. On the other hand, protective factors help to minimize these risks, lower the odds for substance abuse, and prevent addiction.

Protective factors can be useful across five different settings or domains, which include the following:

  1. Individual: teaching self-control, self-confidence, and self-awareness
  2. Family: parental monitoring and support
  3. Peer: academic competence and positive social relationships
  4. School: connectedness and anti-drug use policies and programs
  5. Community: strong attachment to one’s neighborhood and positive outreach programs

There is not just one isolated thing that causes addiction. Instead, there are often various risk factors that play a role in addiction’s onset. By addressing each of these domains, protective factors can be put in place and interventions established to prevent problematic substance use.

Limiting substance use, especially at a young age, can help to lower the odds for addiction.

Updated November 21, 2023
  1. Highlights for the 2020 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA).
  2. Genetics and Epigenetics of Addiction DrugFacts. (August 2019). National Institute on Drug Abuse (NIDA).
  3. Comorbidity: Addiction and Other Mental Illnesses. (September 2010). National Institute on Drug Abuse (NIDA).
  4. An Examination of the Association Between Early Initiation of Substance Use and Interrelated Multilevel Risk and Protective Factors Among Adolescents. (December 2019). PLOS ONE.
  5. Heroin DrugFacts. (June 2021). National Institute on Drug Abuse (NIDA).
  6. Stress as a Risk Factor for Substance Use Disorders: A Mini-Review of Molecular Mediators. (December 2018). Frontiers in Behavioral Neuroscience.
  7. When Trauma Slips Into Addiction. (December 2018). The Imprint.
  8. High-Risk Substance Use Among Youth. (October 2020). Centers for Disease Control and Prevention (CDC).
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