Risk Factors for Substance Abuse

What makes a person abuse drugs? Some people never use drugs, even if drugs are easy for them to obtain. Others use drugs occasionally or regularly for years but never become dependent . And some people become addicted and unable to function without drugs. These differences in drug-use patterns are the result of a combination of environmental and genetic factors. Genetic factors refers to a person's genes, which are passed down from parent to child and are shared in part by other family members. Environmental factors include a person's experiences in the family, home, neighborhood, school, work, and other settings.

Genetic Factors

Substance abuse often appears in more than one member of the same family. This is partly—though not entirely—due to the fact that genetic factors play an important role in the development of alcoholism and drug addiction. Identifying purely genetic factors in drug use is an important area of scientific study. Physiology is determined directly by genetic inheritance, and scientists have begun to discover that some people may have a predisposition to some forms of sub- stance abuse. What this means is that it is much easier for these individuals to become addicted. To put it another way, it is much harder for them to resist becoming addicted.

If an individual's parent, grandparent, or sibling is an alcoholic, that individual's own risk is significantly increased. Studies also show that identical twin males (who have the same genetic makeup) are much more likely to be both alcoholic—if one of them is an alcoholic—than fraternal twins (who share only half of their genes on average). Moreover, adoption studies have found that sons of alcoholic biological parents were more likely to be alcoholics as adults than sons of nonalcoholic biological parents, when both groups were adopted early in life and raised by nonalcoholic adoptive parents. In similar studies of females, evidence of genetic influence was weaker.

As for becoming addicted to drugs other than alcohol, research has not yet been able to confirm the precise role of genetics. However, the rates of drug abuse among relatives of heroin and cocaine addicts tend to be higher than they are in the general population. Genes may also influence an individual's biological response to a drug. For example, genes may increase pleasant sensations (such as relaxation or a good mood) or decrease unpleasant ones, such as nausea or the flushing reaction to alcohol, which can include a high skin temperature and a faster pulse rate.

Genetic differences in brain chemistry may also determine an individual's response to drugs and alcohol. For example, alcohol affects the release of a brain chemical called dopamine. Some severe forms of alcoholism (and possibly addiction to other drugs as well) may occur in people who have nearly 30 percent fewer dopamine receptors in their brains than normal. People with this trait may be far less able than others to find enjoyment in everyday activities, and they have much greater difficulty coping with the stresses of life. Because alcohol and many other drugs release a flood of dopamine into the brain, addicts may turn to alcohol and other drugs to feel good.

Environmental Factors

Although genetics plays an important role in the development of addiction, this does not mean that addictions are determined only by a person's genes. Environmental influences are also important, because a lot of addictive behaviors are learned by observing others. Watching a parent or another important figure using alcohol and/or other drugs has a major impact on a developing child. It tells the child that this is an acceptable behavior.

The relationship between family members is also important. Re- search has shown, for example, that teenagers who felt close to their parents and siblings were less likely than others to engage in risky behaviors, including drug abuse. A survey of over 4,000 adolescents has also found that those who had been physically or sexually abused, or had family members with alcohol or drug use problems, were at the greatest risk of developing substance abuse problems. Easy access to drugs is another important factor. If a child grows up in an environment where drugs are common and available, he or she is more likely to try them.

Family Environment. Most people who abuse drugs start in their teenage years, while they are still living with their parents. This gives parents a unique opportunity—and responsibility—to stop the problem before it starts. Several studies have shown that family interventions can play a significant role in reducing some of the risk factors associated with drug use. These risk factors include: drug use by family members; lack of a nurturing, supportive family environment; and a lack of clear and consistently enforced rules.

Experts say that the first thing parents should do is to be very clear about what their standards are, because setting clear standards and establishing limits are crucial for preventing teen drug abuse. Parents should also monitor their children, be consistent and moderate in their discipline, and they should recognize and reward positive behavior by their children. It is also important for teenagers to have the skills to be able to resist peer influences and other social influences to use drugs. It is useful for parents to teach their children so-called refusal skills, so that they know how to say "no" and still keep their friends and have a good time.

Many people believe that allowing older adolescents to drink small amounts of alcohol in the home, with their parents present, may teach them to drink in controlled ways, and that prohibiting it entirely may result in their learning to drink excessively. However, most experts disagree with this position. Studies show that the earlier children begin to drink, the greater the risk that they will abuse alcohol and possibly other drugs as well. Experts also suggest that if parents themselves drink alcohol in the home, they should do so responsibly, only in moderation. Such responsible use by parents does not seem to increase the chances of their children becoming alcoholics. Excessive binge drinking by parents, however, is a major risk factor for the development of alcoholism, which may lead to dependence on other drugs as well.

Social Environment. More often than not, adolescents begin using drugs by imitating their friends, classmates, or other peers. Teenagers looking for peer acceptance or wanting to appear cool might decide to try taking drugs, beginning a path toward continuing use. Teenagers also want to be seen more like adults, with the freedom to do what adults do. By using tobacco or alcohol—illegal for adolescents, yet both legal and socially acceptable for adults—the adolescent seeks an adult image. Adolescents are exposed to advertising on television and in magazines for beer, wine, and cigarettes that portray drinking and smoking as desirable. They may want to emulate celebrities such as movie or pop stars who are seen smoking or drinking in the media. Once adolescents begin using drugs—for any of these reasons—they may find that they are unable to stop.

Using one drug often leads to the subsequent use of another. Typically, drug use begins with alcohol or cigarettes. These are followed by marijuana, and occasional drinking may develop into problem drinking. Next in the sequence are other illicit drugs. Cocaine use tends to follow marijuana use, with crack-cocaine use occurring after cocaine use. In other words, it is likely that someone who smokes crack has already tried tobacco, alcohol, marijuana, and cocaine. Many adolescents who use drugs in one category, however, do not necessarily progress to drug use in a "higher" category, and many stop before the drug use becomes a habit.

Sexual and Physical Abuse. Researchers are studying the use of illicit drugs by people who were physically or sexually abused as children and adolescents. Some believe that victims of abuse use drugs to help cope with the emotional problems caused by their difficult experiences. Victims of abuse often suffer from a poor self-image, even from self-hatred. They may find that drugs provide an escape from these feelings.

Race. Studies show that black adolescents are less likely to begin using most drugs than their white and Hispanic counterparts. However, with increase in age, rates of drug and alcohol use increase more quickly among blacks than among whites and Hispanics. At age 65 and over, blacks are nearly twice as likely as whites to be dependent on alcohol. Young Hispanic men have about the same level of risk of developing alcoholism as whites. There is growing evidence that racial and ethnic differences in drug use and drug dependence are not due to biological differences. Other factors are far more significant in determining drug use and abuse. These include poverty, the kind of neighborhood people live in, dropping out of school, and the availability of illegal drugs.

Personality Traits

Personality refers to a person's ways of thinking, feeling, and behaving, and it is thought to be shaped by both genetic and environmental factors. Drugs affect not only a person's physical well-being but other aspects of overall well-being as well, including emotional and psychological health. When treating drug abusers, psychologists and psychiatrists try to keep in sight the total picture of the person. Although most experts agree that there is no such psychiatric illness as an "addictive personality disorder," studies indicate that certain personality characteristics do make it easier for some people to become addicted to alcohol or other drugs. These include sensation seeking and impulsivity , as well as excessive aggression and anxiety.

Sensation Seeking. Sensation seeking is a personality trait of people who seek new and intense sensations and experiences. People with this trait are willing to take physical, legal, and financial risks for the sake of a thrill. Drugs offer one such type of thrill. Among drug users, high sensation seekers are likely to use more than one drug, to use psychedelic drugs, and to use stimulants such as cocaine. Sensation seeking is involved in many other activities related to alcohol and drug use, including gambling, smoking, sex, partying, reckless driving, and criminal activities. Taken together, these factors affect the level of risk that an individual will become addicted to alcohol or other drugs.

Impulsivity. Self-regulation is the ability to manage or keep control over one's emotions, behavior, and relationships. People with impulsive personalities find it difficult to control their own behavior and they often engage in deviant behaviors, including substance abuse. For example, a person who is often angry, tense, and aggressive is unable to control, or regulate, aggressive impulses or hostile feelings toward others. Such a person might use heroin, for instance, in order to feel relaxed and calm.

Aggression. Early problem behavior often leads to drug abuse, and an early history of aggressive social behavior is one of the most important risk factors, according to a large body of research. Young children who engage in high levels of aggressive and disruptive behavior are likely to continue this behavior in the absence of some sort of school-based or family-focused intervention. Such children often do poorly in school and tend to become friends with other young people who engage in disruptive or risky behaviors. It is in this context that young people often begin using tobacco, alcohol, and other drugs.

Anxiety. People who are prone to anxiety and are looking for a chemical way out of it are at increased risk of abusing alcohol and some other drugs. These individuals may discover that alcohol or some other drugs relieve their anxiety or distress. The drug of choice for these self-medicating people is usually some type of depressant , such as alcohol, heroin, or a prescription analgesic or tranquilizer .

Protective Factors

While the above-mentioned risk factors can increase the chances that a person will become addicted to alcohol and/or other drugs, there is also another set of factors, called protective factors, that can help prevent the development of addiction. These include:

• high self-esteem and self-discipline
• advanced social and problem-solving skills
• positive, optimistic outlook on life
• easygoing temperament and affectionate personality
• adequate family income
• structured and nurturing family
• promotion of learning by parents
• warm, close relationship with parents
• little marital conflict between parents
• low prevalence of neighborhood crime

Successful drug abuse prevention programs work by helping to develop and strengthen these protective factors, while at the same

time minimizing risk factors that can contribute to the development of substance abuse and addiction.

see also Child Abuse and Drugs; Childhood Behavior and Later Drug Use; Conduct Disorder; Ethnic, Cultural, and Religious Issues in Drug Use and Treatment; Families and Drug Use; Personality Disorder; Poverty and Drug Use.