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Drugs & Health Blog

The Swiss Cheese Model of Addiction

This blog post is archived and is no longer being updated. For the latest content, please visit the main Drugs & Health Blog page.
The NIDA Blog Team

Why doesn’t everyone who is exposed to drugs become addicted?

You can’t get addicted just from using a drug once. But some people who try drugs go on to take more and more, and become addicted as a result. Others don’t.

Scientists now know drug addiction is a disease and that there are lots of things that can contribute to your risk for getting that disease—what are called risk factors. These include your genes, what kind of neighborhood you live in, what kind of school you attend, and what kinds of people you hang around with. These same factors can also protect you from getting the disease.

But even though we know this about addiction, some people still want to blame it on the person’s willpower or morals, saying addiction is a lifestyle choice that reflects a flaw in the person’s character.

Our video team at the National Institute on Drug Abuse created a video explaining why some people get addicted and some don’t, using an easy-to-understand idea: The factors that put you at risk for drug addiction, and the factors that protect you, combine to make a barrier with bigger or smaller holes in it—like Swiss cheese.

Check it out!—and let us know what you think in comments.

Comments posted to the Drugs & Health Blog are from the general public and may contain inaccurate information. They do not represent the views of NIDA or any other federal government entity.


I'm a recovering addict for over 23 years and I'm also a clinical therapist working extensively in medicated assisted treatment. I've directed a methadone program and suboxone program. While results are moderate both are very effective when used properly and with a combination of 12 step programs. I believe the addicted person has to change their ideas, attitudes which allow them to change their behaviors. This is best done through CBT and 12 step programs. I have worked in the behavior health field over 23 years.
your face lol XD
With synthetics, you actually can be addicted after just one use unfortunately. The Chemists creating the chemicals know how to get to your Reward center...
I'm confused, at what point does and addiction become a disease. And more to the point, if drug use is a disease, then there must be a cure apart from all the silly programes out there! I know addicts who have stopped using without the need for any support programmes and I also know addicts who can't seem to stop using even though they have been through every programme under the sun!

Hi Jimmy.  You raise some complicated questions.  A person's genetics, physical and mental health, environment, age, and many other factors contribute to the progression of the disease and how they overcome the addiction.  There is no one size fits all model.  Also, there are many diseases that do not have a cure, like HIV/AIDS and Diabetes.  And just like doctors and scientists working on those diseases, NIDA is researching drug use so we can better understand the disease and learn ways to prevent drug use and treat addiction. 

You say you can't predict who will become addicted. But you can predict who is most vulnerable?
The idea of the environment that you live in can increase the risk of teens starting the use of drugs is a scary thought. When we all have kids we will have to decide everything around the safety of our kids and i never thought about the idea of making sure they wont become a user of any type of drug. If some teens dont get addicted but a friend does then the friend wont stop because he/she wont want to seem less than their friend for being able to handle the drug.
I am a 17yr old home schooled student and I recently wrote a poem. My mom, a published poet/ artist , was moved to tears by it. I could not believe how just communicating something another person may feel to that person could bring about such an emotional response. I wanted to share my poem to all the teens out there and ALL recovering/ suffering addicts... there is a better way. ~IT~ They say ~IT~ keeps them protected, as they sit in a pit of pain and suffering. They say ~IT~ keeps them happily infected they scream sadness as they are crying. They say they are their own person because of ~IT~ as they are being told to say that by ~IT~. They say ~IT~ increases my wit as their test scores plummet. They say I can stop at anytime that I want. ~IT~ would rather they die than let them leave the show. They say you won't make me, you can't! ~IT~ says no, YOU can't, you're mine now. They say if you tried ~IT~, you would understand as they themselves don't understand why. They say try ~IT~, or you're not a man even though they know they are telling a lie. Yet they say ~IT~ is the thing I need. I need ~IT~ they say. As it causes them to bleed, even though they say I need ~IT~, today. ~IT~ knows ~IT~ is in control. ~IT~ now has a massive army of drones. ~IT~ takes the ultimate toll. ~IT~'s throne is a pile of smoke and broken people, that's its throne. Their families and friends ask them why? Why do you hurt yourself and your friends, WHY!? They say that they can't live their shallow lives, so they take ~IT~ so they can lie to themselves about the tragedies and horrors of their lives... so they don't cry. But they don't understand that ~IT~ causes their pain. ~IT~ causes their sadness. ~IT~ has no positive gain All ~IT~ does is bring your life into darkness. ~IT~ takes everything you hold dear from you. ~IT~ then demands for more! But they have nothing... nothing more for ~IT~ to accrue. When that happens, then ~IT~ takes you. What is ~IT~? ~IT~ is a drug. ~IT~ is a horrible substance seen unfit by humanity and we try to sweep it under the rug. Along with the people trapped with ~IT~, people that are in deep pain and suffering, The people that have already quit, ~IT~ won't quit though, not just for the addicts but their families too. I know there are a lot of families and teens at risk because of illegal drugs. My greatest hope is that this world assists these poor people by making rehabs more available, affordable, and thorough. I also hope we as a people extend our individual talents to this cause because a world free of drug abuse is a free world indeed.
coo stry bru
This is a complete misnomer. The reason why some people become severely addicted and can't stop while others do not is completely due to genetics and the fact that they have the disease BEFORE they used a drug. The person is born with the disease, which is an altered neuro stress adaptation in the midbrain causing a deficiency in dopamine. They didn't choose it; it's not because of the type of friends they have or the neighborhood they live in, they were born with it. It drives me nuts that I keep seeing references to biopsychosocial factors and that people confuse the addiction as the disease, when it's actually a SYMPTOM of the disease. Please pass this on and educate others so we can actually prevent people from starting addictions and begin managing their disease from an early age.