John Makohen argues that the first use of heroin is often not the beginning of addiction. Years of trauma, stress, loneliness, mental health symptoms, prior substance use, pain, and learned relief may already have shaped the brain's coping patterns - which means prevention must begin much earlier than the drug itself.

John Makohen emphasizes the importance of family history of substance use disorder without viewing genetics as fate. Citing research on genetic liability across substances, he explains how inherited vulnerability interacts with trauma, stress, sleep issues, pain, access, and social factors and describes practical ways to build healthier responses to daily stress triggers.