Addiction is often misunderstood as the result of a single bad decision, but experts say the reality is far more complex and can begin much earlier than many parents realize.

Lokesh Shahani, an associate professor and psychiatrist at UTHealth Houston, told Newsweek that one of the biggest misconceptions about addiction is that it starts with a conscious choice.

"One of the biggest misconceptions is that addiction begins with a 'bad choice,'" he said. "It's usually the result of multiple interacting factors, genetics, brain development, mental health, family environment, peer influences, and access to substances."

A 2022 study found that nearly 10 million young people in the U.S. met the criteria for a substance use disorder in 2020, including around 1.6 million adolescents aged 12 to 17 and 8.2 million young adults aged 18 to 25. The majority were not receiving treatment. Previous research has also shown that more than 90 percent of adults with substance use disorders first began using substances during their teenage years.

While addiction may not become apparent until later, Shahani said some of the earliest warning signs can emerge much earlier than people think, sometimes between the ages of 8 and 12. The risk often becomes more noticeable during early adolescence, between ages 12 and 14.

"The teenage years are a particularly important period because the brain's reward and impulse-control systems are developing at different rates," he said.

"Adolescents are naturally more likely to seek novelty, take risks, and be influenced by peers, while the parts of the brain responsible for judgment and self-regulation are still maturing."

Shahani said young people who begin drinking alcohol, using nicotine, cannabis or other substances at a younger age are more likely to develop a substance use disorder later in life.

Warning Signs of Addiction

Shahani said many behaviors associated with substance misuse can overlap with typical adolescent development. Rather than focusing on a single behavior, parents should pay attention to persistent changes, multiple warning signs occurring together, or patterns that begin to affect daily life.

Potential early warning signs include:

• A sudden decline in school performance or loss of interest in activities they previously enjoyed.
• Noticeable changes in friendships or becoming unusually secretive about where they are and who they spend time with.
• Persistent mood changes, irritability or emotional withdrawal.
• Changes in sleep patterns or appetite.
• Frequent lying, rule-breaking or becoming unusually defensive when asked simple questions.
• An unexplained need for money or missing valuables from the home.
• Declining personal hygiene or appearance.
• Smelling of alcohol, cannabis or vaping products, or possessing unfamiliar devices or paraphernalia.

Are Mental Health Conditions Linked to Addiction?

Mental health conditions do not directly cause addiction, but Shahani said they can significantly increase a young person's vulnerability to substance misuse. Children and teenagers experiencing anxiety, depression, trauma, chronic stress or loneliness may be more likely to turn to alcohol or drugs as a way to cope with emotional distress, improve their mood or fit in socially.

He explained that this is sometimes referred to as self-medication, although substance use often worsens mental health symptoms over time.

Shahani said trauma, including abuse, neglect, violence and significant family instability, is among the strongest known risk factors for later substance misuse. Persistent loneliness, bullying and social isolation can also increase the likelihood of substance use by reducing healthy sources of support and connection.

However, risk factors are only part of the picture. Protective factors can play an equally important role.

He said: "Strong family relationships, supportive adults, healthy peer connections, involvement in school or extracurricular activities, and access to mental health care can substantially reduce the likelihood that a young person progresses from experimentation to addiction."

What Can Parents Do?

Shahani said the most effective approach is not waiting until obvious signs of addiction appear.

Parents can help protect their children by:

• Creating an environment where children feel safe discussing stress, mistakes, peer pressure and emotions without fear of immediate punishment.
• Encouraging open and honest communication.
• Setting clear expectations around substance use.
• Addressing signs of anxiety, depression, trauma or behavioral changes early.
• Seeking professional support when concerning patterns emerge.
• Strengthening family relationships and support networks.

He also stressed that experimentation does not automatically lead to addiction. Early intervention can make a meaningful difference, and addressing mental health concerns and warning signs as soon as they arise may help prevent more serious substance use problems from developing later on.

Contact Newsweek editors on this story: Charlotte Nisbet and Emma Lee-Sang