Addiction: Nature, Nurture or Both?
September 18, 2025
Addiction is often misunderstood. For some, it’s seen as a personal failure or weakness; for others, it’s a matter of bad choices. But as science has progressed, so has our understanding of this complex medical condition. One of the most debated questions remains - is addiction caused by genetics, environment or a combination of both?
“Addiction is not a moral failing - it’s a medical condition shaped by both genetic vulnerability and life experience. Understanding this dual influence is key to offering compassionate, effective care,” says James Sherer, M.D., interim chief medical officer, Carrier Clinic and network medical director, Addiction Services, Hackensack Meridian Health.
The Role of Nature: Genetics and Biology
Research over the past few decades has shown that genetics play a significant role in the risk of developing addiction. In fact, studies suggest that up to 50% of a person’s risk for addiction is rooted in their genetic makeup.
This doesn’t mean there’s a single “addiction gene.” Instead, many genes interact in complex ways to influence how a person responds to substances like alcohol, nicotine or drugs. Some people may be more sensitive to the pleasurable effects of substances, while others may be more prone to impulsivity or have a harder time managing stress - all of which can increase vulnerability.
Sherer notes that brain chemistry also plays a role. The pleasure-reward pathway, which uses dopamine to send signals, gets hijacked by addiction. It can take the brain up to 14 months without a substance to fully recover from some addictions. “Once the brain gets hijacked, it’s very difficult to turn someone’s life around without professional help” he says.
The Power of Nurture: Environment and Upbringing
While biology may set the stage, environment often determines the script.
Children who grow up in households where substance use is present are more likely to struggle with addiction themselves. “This is not only due to potential genetic inheritance, but also because of learned behaviors, exposure to stress, trauma, availability of the addictive substance, and lack of support systems,” Sherer says..
Other environmental risk factors include:
- Peer pressure, especially during adolescence
- Unresolved trauma or abuse
- Mental health conditions, like anxiety or depression
- Socioeconomic stress, such as poverty or unstable living conditions
“Conversely, protective factors, such as strong family support, early education, access to mental health care, and healthy coping strategies, can reduce the risk, even for those genetically predisposed,” Sherer says.
So, Is It Nature or Nurture?
According to Sherer, the honest answer is both. “Nature and nurture are deeply intertwined, and it’s nearly impossible to separate one from the other entirely.”
For example, someone may inherit a genetic vulnerability to addiction but never develop it because they were raised in a stable, supportive environment. Another person without a strong genetic predisposition may still struggle with substance use due to trauma, stress or environmental pressures.
Understanding that addiction is a medical condition that arises from a combination of biological, psychological and social factors can help reduce stigma and improve treatment approaches.
Why This Matters
Recognizing addiction as a multi-faceted medical condition - rather than a moral failing - opens the door to compassion, better treatment and early intervention. It also encourages families to be proactive.
“Knowing that there may be a genetic risk allows individuals and caregivers to take preventive steps, such as fostering open communication, building resilience and seeking professional support when needed,” Sherer says.
Seeking Help
Addiction is not simply a matter of bad luck or bad choices. It’s a medical condition shaped by both nature and nurture and every individual’s story is different.
By embracing this complexity, we can move toward more effective solutions and a more understanding society.
Sherer recommends seeking professional help if you or a loved one suspect substance use.
“There are more ways than ever to get help for addiction. Recovery is real - I’ve seen it time and time again. No matter how hard it feels, don’t give up. There’s always hope.”
Hackensack Meridian Carrier Clinic is a leader in specialized behavioral health, mental illness and addiction treatment.
Blake Recovery Center Carrier Clinic has been annually ranked No. 1 on the “Best Addiction Treatment Centers in New Jersey” list by Newsweek since 2020.
Resources and Next Steps:
- Call 866-266-1616 for help 24/7/265.
- Learn more about Carrier Clinic and Blake Recovery Center.
The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.
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