Risk Factors for Addiction

Hedonism is defined in the Encarta Dictionary as the seeking or philosophy of pleasure. In the field of addiction medicine, patients described as having “low hedonic tone” – a decreased sense of well-being, pleasure or contentment – are considered at higher risk for addiction.

I find the observation interesting as it relates typically to patients who begin abusing opioids. As an addiction specialist, I often encounter clinical examples of patients who discover that opioids enhance their mood. These individuals can often recall, in vivid detail, the very first time they were given a “vicodin” for pain. It may have worked for pain, but they were more impressed by the energy boost it provided. These are individuals who quickly began taking an opioid for the wrong reason – mood enhancement, energy, euphoria, etc. When an individual uses a medication for reasons other than why it was prescribed, they are abusing that drug.


Hedonic tone, that sense of well-being or contentment, is mediated through a part of the brain known in layman’s terms as the “reward center.” Neuropharmacology specialists refer to this as the mesolimbic dopaminergic system. Dopamine is most likely the primary neurotransmitter involved in the reward system.

“There are people walking around whom for a variety of reasons, have a dopamine deficiency, something wrong with the endogenous opioid system,” says Edwin A. Salitz, MD of the Beth Israel Center in New York City. This is not the only risk factor for addiction, but it plays a big role.

Contributing to the development of addictions are genetic, environmental, cultural, social and other factors. It has been said that “Genes load the gun and environment pulls the trigger.” This accounts for the 10 – 20% incidence of addiction seen in the normal population. For example, vulnerability to abuse and addiction often starts in the teenage years, associated with feelings of low self-esteem and general feelings of sadness or “not fitting in.”

This vulnerability is related to abnormal hedonic tone. Not only does low hedonic tone play a role in the development of addiction, but regaining it in the absence of drugs is the goal of an individual recovery process.

I’m now a physician and addiction specialist, but I began my “research” as a vulnerable teenager wanting,to fit in. I found that alcohol and other drugs provided a sense of euphoria I didn’t find elsewhere and I could become the life of the party. Eventually it quit working and the consequences of my drug use lead me into a recovery program myself. I believe that one way to describe recovery is “the maintenance of a healthy hedonic tone without abusing a drug.”

One of the purposes of this website is to provide a place where addiction specialists, researchers, and individuals who suffer from addition can connect and share information to increase their endogenous hedonic tone. I hope you will join us as we discover that we all have the potential to become celebrities in recovery.

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