What happens when a child has almost everything money and fame can buy, and still develops an addiction?
The question is particularly painful following the death of Presley Gerber, the 27-year-old son of supermodel Cindy Crawford.
Gerber died on Sunday at a rehabilitation facility.
He spoke publicly about his mental-health and substance-use struggles.
"[Mental health] is an issue. It is such a big part of my life. It’s a 24/7 job, and there’s so much to it.” (Presley Gerber)
"People tend to treat you like the age you started with your substance abuse for the rest of your life, and you’re just kind of stuck there.” (Pesley Gerber)
Gerber's story raises a broader question: why can addiction develop in children who appear to have every advantage?
The answer starts with biology.
Dr. Nora Volkow, director of the U.S. National Institute on Drug Abuse explains that drug addiction is a brain disease. Her research using brain imaging has demonstrated measurable changes in brain systems involved in reward, motivation and self-control among people with addiction.
Addiction begins partly with the brain's reward system. Drugs can produce unusually powerful surges of dopamine in areas including the nucleus accumbens – the brain’s “this feels good, do it again” system. With repeated exposure, the brain adapts. Ordinary rewards may become less satisfying, while drug-related cues - such as people, places, objects or situations - can acquire enormous motivational power. At the same time, repeated drug use can impair circuits involved in self-control and stress regulation.
Age matters, too. The prefrontal cortex - the part of the brain involved in judgment, planning and impulse control - continues developing into the mid-20s. That means a young person can have an increasingly powerful reward system while the neurological machinery for controlling impulses is still maturing.
Genetics adds another layer. Vulnerability to substance-use disorders is partly inherited, but there is no single "addiction gene." Genes interact with age, stress, family circumstances, peer influences and access to substances. As NIH addiction researcher Dr. Lorenzo Leggio puts it:
"Addiction is a brain disorder. It's not a moral failure." (Dr. Lorenzo Leggio, Addiction Researcher)
And celebrity families can provide an unusual environment in which those vulnerabilities play out.
There is no evidence that being the child of a celebrity causes addiction. But money can make drugs easier to obtain and remove some of the immediate financial consequences of heavy use. Fame can mean exposure to adult environments and intense scrutiny at unusually young ages. And the psychological burden of living under a famous family name can be real.
Michael Douglas knows that firsthand. His son Cameron struggled with severe drug addiction and spent years in federal prison. But perhaps the most revealing part of his experience was how little control a parent ultimately has. "What you can do as a parent, what you can't do," Douglas said, was something he and fellow actor Rob Reiner discussed extensively as they each dealt with addiction in their sons. Actor/filmmaker Reiner and his wife were eventually murdered by their son.
Parents can provide boundaries, treatment, money, love and support. They cannot simply will another person's brain into recovery.
And addiction is hardly a celebrity problem.
In the United States, 44.6 million people aged 12 and older - 15.3% of the population - had a substance-use disorder in 2025. Among young adults aged 18 to 25, the figure was even higher: 23.8%. Yet only 11% of people with a substance-use disorder received substance-use treatment that year.
Perhaps privilege doesn't make addiction more common.
It simply makes it more visible.
When addiction happens in an ordinary family, it can remain behind closed doors. When it happens to the child of Cindy Crawford, the world watches.
RIP Presley.
