Scientific evidence has shown that while the propensity to use drugs and the transition into addiction has strong genetic and neurodevelopmental underpinnings, social factors and in particular adverse childhood experiences profoundly impact an individual’s risk for drug taking, addiction, propensity to seek treatment, and their therapeutic outcomes. Stressors can affect the expression of key brain neurotransmitter systems involved in drug reward and addiction including dopamine, which help explain why stress exerts such a negative effect on drug taking. Stress effects on brain and mental health are most prominent during childhood and adolescence and recent research has shown that social determinants of health (SDH) such as low income, neighborhood deprivation, and parental education negatively impact brain neurodevelopment and function as well as cognitive performance. The negative effects of stress in the risk of drug use also occurs in adults as evidenced by the exacerbation of drug use during the COVID-19 pandemic which had the largest impact on those suffering from a substance use disorder (SUD). Factors contributing to the increase of 50% in overdose deaths in the US during the COVID pandemic reflect socioeconomic challenges such as housing instability and incarceration, as well as reduced access to health care and recovery support services. This presentation will highlight scientific advances in our understanding of the contribution of SDH in drug use and addiction with special emphasis on its effects on childhood and adolescents.