Looking for the origins of addiction is like peeling an onion: one layer at a time. The uncontrolled use of mood- and mind-altering substances is the surface behavior that manifests as a hedonistic drive for pleasure.

It turns out that addiction is not the result of a hedonistic drive for pleasure but, much more often, a desire to reduce pain. Pain is the starter drug for addiction. The absence of pain is the driver for addiction. At some point, the painkiller becomes the pain that can’t be killed. That’s the outside layer of the onion.

Inside the onion, where’s the pain coming from? First and foremost, pain is physical. It comes from physical damage to the body, either accidental or intentional. It comes from a lack of food, water, or shelter for a prolonged period of time. It comes from illness, disease, and aging. Pain is a state human beings are born into, and the relief of pain is a primary motivation for human behavior.

The next layer of the onion is pain induced by thoughts. Foremost are memories of painful incidents, which are relived and reinterpreted throughout life. Psychologically painful experiences involving shame or embarrassment are also remembered and often replayed in the evolving consciousness of children. All pain, whether physical or emotional, unleashes “emotional anguish,” resulting in a symphony of biological messages to take measures to mitigate the pain.

The next layer down in the onion is the epigenetic environment in the womb. Here, the developing fetus first learns about what conditions to expect in the world. A scarcity of food signals famine or drought. An abundance of alcohol, cocaine, fentanyl, or other drugs signals trouble ahead. The genetics of the fetus will make adjustments to this environment that, to some degree, program pain responses for a lifetime.

The innermost layer in this onion of addiction has to do with genetics. It is said that genetics is 50% of addiction, which sounds about half right. It might be more accurate to say that parents with substance use disorders double the chances of their children developing substance use disorders. There are so many factors involved in that dark math besides genetics that it’s difficult to know where to start.

Genes predisposed to addiction can be switched on by substance abuse during pregnancy, resulting in lifelong cravings for reward and insensitivity to reward. These tendencies can be moderated through early learning, stressing group participation and reward delay.

Perhaps the best money spent in the fight against addiction is Parent-Child Interaction Therapy (PCIT). This therapy for new parents teaches empathy for babies, how to interpret signs of distress, and how to soothe babies. It generates significant immediate benefits for parents, caregivers and babies, and enormous long-term benefits in child development.

It can’t be stressed enough how important this early phase of intervention is, not just for helping parents cope with child-rearing, but for the entire rest of the social structure. If you want to minimize future expenditures in special education, workforce training, subsidized housing, law enforcement, and addiction treatment, start at the very beginning with PICT.

The next ring moving back up the onion is to prioritize child safety. More than half of the people seeking addiction treatment in the U.S. report having been sexually abused as a child. That is a shocking statistic. 

People are stressed throughout their lives, not just by pain, but also by the memory of pain. They temporarily displace this pain through all sorts of compulsive behaviors. Ending the sexual abuse of children would go a lot further toward reducing addictive behavior than rounding up homeless people.

Keeping children safe at school matters, too. Bullying leads to memories that are hard for children to forget. During the time the human brain is rapidly developing, it creates lifelong problems that repeatedly flood the frontal cortex with the chemicals of violence or fear. Physical abuse — at school or at home — has to stop for children to properly develop.

In the previous post on AddictionNews, I showed how personality tests such as the Trier Social Stress Test (TSST) can identify whether a person has a neurotic personality. Supposedly, this neurotic personality is more susceptible to addictive behavior. The test, however, doesn’t say how the college-age students in the study became neurotic. 

Further down the onion, you see that most drug addicts are not born that way but have been shaped, through pain, to seek out painkillers. If we focus on programs that reduce the amount of pain people experience — in particular, the amount of pain that children experience — we’ll have a good chance of beating addiction before it starts.

Written by Steve O’Keefe. First published August 25, 2025.

Sources:

“Neurotic Behavior: Causes, Symptoms, and Comprehensive Treatment,” Greater Boston Behavioral Health, December 24, 2024.

“Predicting Addiction Susceptibility Based on Big Five Personality Traits,” Psychiatry and Behavioral Sciences, June 22, 2021.

“Biological and psychological markers of stress in humans: Focus on the Trier Social Stress Test,” Neuroscience & Biobehavioral Reviews, January 2014.

Image Copyright: wallyg, used under Creative Commons license.