Rethinking Addiction

Abstract

Addiction is a complex and challenging condition with many contributing factors. Although addictive behaviors appear to be individual choices, behavior alterations cannot be addressed successfully without considering characteristics of the physical and social environments in which individuals live, work, and play. Exposure to chronic psychosocial stressors and the physiological response of individuals to their external environment activates the brain's neuroendocrine hypothalamic-pituitary-adrenal axis, with profound conditioning effects on behavior. This brief synopsis describes the social determinants of health; examines the interconnectedness of the psychosocial environment, behavior, and subsequent health outcomes; discusses the environment's critical influence on brain plasticity, adaptation and functioning; and explores additional factors that complicate adolescent addiction. Because the environment is both a determinant of behavior and an opportunity for intervention, in the context of addictions, it is important to incorporate these factors in the analysis of risk and design of early interventions for prevention and amelioration of addiction.

Keywords: addiction; adolescents; brain plasticity; psychosocial stressors; social determinants of health.

Figure 1.

Environmental effects on human behaviors and health.

Figure 2.

The relative influence of environmental and genetic factors on health changes over time. Environmental effects are greater during early development whereas genetic effects increase with age due to increased opportunity for environmental interactions, thus the physiological effects of experiences differ according to the age at which they occur. Prenatal: Physiological stressors and parental substance abuse have significant effects on fetal brain development. Childhood: Physiological stressors and intensive caregiving interventions (discussed later) have significant effects on the developing brain, with greater effects occurring among the youngest children. Adolescence: Physiological stressors still moderately affect the developing brain, but intensive caregiving interventions have only minimal effects. Substance use during this period has extensive effects on the developing brain. Adulthood: Physiological stressors and substance use have minimal effects on brain development.