There’s a theory that substances of abuse are incredibly rewarding. They first tantalize, then capture the brain’s reward system. These substances are so irresistible we have to keep them away from children.

Let’s start with coffee. Upon initial exposure, it tastes terrible. What excites people is the caffeine it contains, a stimulant that is also found in a great many soft drinks. Far from keeping these “addictive substances” away from children, soft drinks are marketed to them constantly and are available nearly everywhere they go.

Why hasn’t everyone exposed to coffee and caffeinated beverages become addicted to them? Many people do not find the effects of consuming coffee or soft drinks rewarding. What does that say about the theory that these substances are inherently rewarding and potentially addictive?

Let’s take a look at sugar next. Sugar supposedly lights up the brain’s reward system. You’ll find a large container of sugar in nearly every American household but I’ve never seen it under lock and key. Even people who love ultra-processed foods do not sit down in front of the screen with a five-pound bag of sugar, happily munching away.

It is doubtful, then, that the ingredients are what causes people to become addicted to food. It’s also doubtful it’s alcohol causing alcoholism, since only 10% of the people who drink alcohol daily suffer from alcohol use disorder (AUD). If 90% of the people regularly using a substance do not become addicted, can the substance really be said to be addictive?

Let’s go a step further and look at other mind-altering substances. Cannabis, THC, CBD, and hemp products have very low rates of addiction. About 25% of the people who use cannabis daily exhibit signs of cannabis use disorder (CUD). Less than 10% of those who use cannabis products regularly exhibit signs of CUD.

Americans are prescribed opioid medications 125 million times a year, according to the CDC, yet very few of them develop opioid use disorder (OUD). The opioid use is largely tied to the pain; when the pain goes away, the opioid use tends to go away, also. A famous study of Vietnam Veterans addicted to heroin found that 90% stopped using it completely within their first year at home. Their environment was much more important to their addiction than the substance being used.

The reward theory says these substances dazzle you with their magical properties and entice you into a lifetime of consumption. The relief theory says these substances provide temporary relief from pain and stress, and their use tends to be moderate unless combined with chronic stress or chronic pain.

The relief theory starts with the stress, not the substance, and builds the addiction story from there. Adverse childhood experiences (ACEs) are a much more common source of adolescent substance abuse than the rewarding effects of cannabis, alcohol, or opioids. More than 50% of the people in treatment for substance use disorders (SUDs) in the U.S. were victims of child abuse.

Let me state this number again because it is a very important indicator of the difference between reward and relief. About 15% of Americans have experienced child abuse, yet more than 50% of the people with SUDs are victims of child abuse.

If you are looking for the reasons why people become addicted to substances, spend a little less time focusing on the substance, and a little more on how the substance is being used. Substances (or behaviors) can become addictive if they are used repeatedly to displace chronic stress or chronic pain.

If you’re using anything to relieve physical pain, you are more likely to become addicted to it, even if the pain subsides. It’s the repeated use of substances and behavior to displace stress that makes them addictive to the point where withdrawal causes unbearable stress.

If we are trying to reduce addiction in the U.S., we need to reduce stress. Beginning literally in the womb, by reducing the stress of expecting parents, and continuing into infancy with parental training on managing the stress of raising an infant.

It is not the case that children have to be protected from all sources of stress to reduce the likelihood of substance abuse. Far from it. Studies show that children are very capable of rebounding from a traumatic experience without substance abuse. However, repeated or chronic abuse is different; anything it is treated with — food, drugs, exercise — can become addictive.

That’s another example of the relief theory of addiction over the reward theory. Exercise can become addictive when it is used to displace stress. There are very few people who think that running is rewarding enough to do it every day, yet I’d place a bet that of those who do run every day, their number one reason is to relieve stress.

If it is relief that drives addiction, and not reward, it changes addiction science. The goal becomes not to figure out how these substances work, but how stress works, and how to best manage and reduce stress. The idea being, if we treat the stress early enough, we are much less likely to have to deal with addiction decades later.

Written by Steve O’Keefe. First published July 15, 2026.

Sources:

“Heavy drinkers aren’t necessarily alcoholics, but may be ‘almost alcoholics’,” Harvard Health Publishing, November 21, 2014.

“What is the prevalence and risk of cannabis use disorders among people who use cannabis? a systematic review and meta-analysis,” Addictive Behaviors, May 20, 2020.

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