As with Other Health Conditions, There
Are Clear Risk Factors for the
Development of Addiction
Risk factors for developing addiction include a
genetic predisposition, structural and functional
brain vulnerabilities, psychological factors and
environmental influences. Whereas biological,
psychological and environmental factors--such
as impairments in the brain’s reward circuitry,
compensation for trauma and mental health
problems, easy access to addictive substances,
substance use in the family or media and peer
influences--play a large role in whether an
individual starts to smoke, drink, or use other
drugs,^28 genetic factors are more influential in
determining who develops the disease of
addiction.^29 A factor that is particularly
predictive of risk, however, is the age of first
use; in 96.5 percent of cases, addiction
originates with substance use before the age of
2130 when the brain is still developing and is
more vulnerable to the effects of addictive
substances.* 31
Addiction Frequently Co-Occurs with Other Health Conditions ..................................
Addiction frequently co-occurs with, contributes
to or causes a wide range of medical conditions.
Both risky substance use and addiction cause or
contribute to more than 70 other conditions
requiring medical care, such as heart disease and
cancer,^32 as well as mental health and behavioral
disorders--including depression, anxiety, post-
traumatic stress disorder, bipolar disorder,
schizophrenia and other neuropsychiatric
disorders.^33
Addiction Can Be a Chronic Disease.............................................................................
There is tremendous variation in the severity and
course of the disease of addiction and of its
symptoms. Some individuals may experience
one episode in which their symptoms meet
clinical diagnostic criteria for addiction and be
non-symptomatic thereafter.^34 In many cases,
- These individuals also might have a predisposition
to develop addiction, irrespective of their actual use
of addictive substances.
however, addiction manifests as a chronic
disease--a persistent or long-lasting illness--
which requires ongoing professional treatment
and management.^35 However, very few people
with addiction actually receive adequate,
effective, evidence-based treatment,^36 and the
usual approach to treatment involves brief,
episodic interventions rather than a model based
on long-term chronic disease management. As a
result, high rates of relapse, while comparable to
other chronic diseases, may be due at least in
part to inadequate or ineffective interventions
and treatments.^37A Lack of Standardized Terminology Compromises Effective Interventions ...............
Terms used to describe different levels of
involvement with addictive substances--such as
experimentation, use, misuse, excessive use,
abuse, dependence and addiction--lack
precision, obscuring important differences in the
nature and severity of the illness and
complicating our ability to intervene and treat it
effectively. Even the word “treatment” lacks
precision with regard to addiction, since
historically it has been used to refer to a host of
interventions, many of which are not based in
the clinical and scientific evidence as are
treatments for other diseases.Multiple Addictive Substances and
Behaviors Frequently Are Involved in
Risky Use and Addiction
Traditionally, risky substance use and addiction
have been addressed largely on a substance-
specific basis. Growing understanding of the
nature of risky use and the disease of addiction--
including the risk factors, symptoms and the
neuropsychological effects of addictive
substances--helps to explain the significant
proportion of risky users and those who are
addicted who are involved with more than one
addictive substance. Among risky substance
users who do not meet diagnostic criteria for
addiction, 30.6 percent are risky users of more
than one substance. Among those who are
addicted, 55.7 percent are risky users of one or