For more than fifteen years, I have lectured that addiction is determined by one’s genetic vulnerability and environment. Exposure to a drug is necessary, but not sufficient by itself, to cause the disease of addiction–any addiction.

Genetics is more of a factor for opioid addiction than it is for most other forms of addiction, but the fact that someone is highly genetically vulnerable does not guarantee that addiction will follow exposure. A genetic predisposition contributes about 50% of the risk for an opioid addiction.

Environment is responsible for the other 50%. In a recent CNN.com article, Dr. Sanjay Gupta talks about how changing the environment — for example, sending Vietnam veterans who battle a heroin addiction home from the battlefield — can be beneficial in treating opioid addiction.

Environment is not just a physical location but also includes emotional, social, financial, and spiritual components. It includes mental health disorders and the stress of noxious environmental factors like pain. The longer the duration and intensity of pain, the greater the risk of a person’s self-medicating with an addictive substance to escape the noxious environment.

Self-medicating is not necessarily the same thing as addiction, but it may appear to be to an observer. This type of behavior has been described as pseudoaddiction in the pain field, but the term has been criticized by the media and some physicians as contributing to the over-prescribing of opioids. Of course, this isn’t to trivialize the dangers of self medicating. Self-medicating is serious, and it sometimes can lead to overdoses, and death.

Pain, ADHD, Anxiety, PTSD are some of the most stressful experiences in our environment, and they’re the reasons why our soldiers and civilians struggle with addictions. We need to change the environment and find ways to treat the underlying factors that contribute to the stress factors if we are going to find effective treatments and prevent addictions and death.

Copyright 2016, Lynn Webster, MD

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