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.

The Physical and Social Environments as Determinants of Health: Implications for Substance and Behavioral Addictions

“…When the environment is unhealthy, there is also a direct effect on the physiological stress response, resulting in production of excess cortisol that has further detrimental health effects. The interactions between environmental effects and behavioral choices and health outcomes are depicted in Figure 14.1, and form the basis of the evidence provided in this chapter linking PSEs as key determinants of our health (Ewald, Strack & Orsini, 2019).…”

“…Similar regions of the brain are activated by pathological or problem behaviors and substance addictions (Fattore, 2014); when they co-occur, it is more difficult to provide effective treatment (Konkolÿ Thege et al, 2016). There is also strong evidence that these same regions of the brain undergo physiological remodeling (including new neural pathways) when exposed to chronic stressors in the PSE during childhood and adolescence, a time when the brain is still developing (Everitt & Robbins, 2016;Ewald et al, 2019). As illustrated in Figure 14.1, the direct effects of PSE on individual physiological stress responses and associated brain remodeling, are important elements for the diagnosis and treatment of addictions.…”

“…As illustrated in Figure 14.1, the direct effects of PSE on individual physiological stress responses and associated brain remodeling, are important elements for the diagnosis and treatment of addictions. These brain changes are associated with impaired impulse control and may predispose individuals to addictive behaviors or substance addiction (Everitt & Robbins, 2016;Ewald et al, 2019). There is much to be resolved before there is clear understanding of the causes of behavioral addictions.…”

Analysis of capability, motivation and opportunity to prevent substance abuse in sensation seeking students on the outskirts of a city in Eastern Iran: a qualitative study

“…The tendency to use a substance is strongly influenced by various factors such as gender, age, psychological factors affecting sensation seeking, and genetic sensitivity. In addition, interpersonal and social influences also affect adolescents' behavioral choices and health outcomes [ 5 ].…”

“…In this respect, environmental factors also act as a mediator or moderator [ 11 ]. Research has shown that environmental factors influence the onset of substance use [ 5 ]. For example, neighborhoods with poor socio-economic conditions are considered high-risk environments.…”