Substance Abuse and Dependence

Introduction

Substance abuse is one of the main problems that affected modern societies. The number of existing and designable potent psychoactive drugs runs to more than a thousand, and the effects at a chemical and cellular level are incomprehensibly complex for all but the specialist neuro-psycho-pharmacologist. Fortunately, for most practical purposes, the psychoactive drugs that teenagers take for pleasure can be classified much more simply by their effects. The group selected for analysis is the teenage group. According to statistical results, this group was affected the most because of psychological and age specifics. Results state that “among youth aged 12 to 17 in 2000, 9.7 percent had used an illicit drug within the 30 days prior to interview. This rate is almost identical to the rate for youth in 1999 (9.8 percent)” (National Dug Statistics Summary, 2007). The study of 15-16-year-olds in the US identified over 40 percent reported using an illicit drug (Ammerman, 1999). This does not mean that all of these young people will continue to do so. Of the 45 percent of young people surveyed in the Crime Survey, only 15 percent reported taking an illicit drug in the previous month (Ammerman, 1999). Following Finn and Sharkanshy (2000), “the cause of substance abuse and dependence are complex, the result of a combination of biological, psychological, social, and cultural factors”. The aim of the paper is to examine and analyze the impact and role of biological, psychological, social, and cultural factors in teen abduction.

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Definition of Drugs and Substance Abuse

Drugs are chemicals that trick the brain’s natural control system (Ammerman, 1999). Through this control system, located at the base of the brain in the center of the head, teenagers experience feelings of pleasure and pain. The brain is designed to manage fundamental behaviors such as aggression, feeding, and reproduction. Communities have learned techniques for managing anger, fear, eating, and sex over thousands of years of cultural evolution, much as individuals learn during their lifetimes how to manage their own feelings (Goodlett et al., 1999). Substance abuse is defined as:

Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Repeated and prolonged or heavy use of such substances can lead to dependence, which is characterized by continued use of the substance despite physical and mental problems, difficulty in controlling use, strong desire to take the substance, neglect of other activities and interests, increased tolerance, and sometimes a withdrawal syndrome if use is ceased or reduced” (WHO, 2007).

Human behavior is managed by relatively changeable and adaptive cultures even though the brain mechanisms that underlie behavior remain fixed and powerful. Individuals manage behaviors based on their values, experiences, and knowledge.

Discussion Section: Teen Age Group

Teens are more vulnerable to substance abuse than any other age group. Following Finn and Sharkanshy (2000) and their explanation of the problem, it is possible to agree that a combination of biological, psychological, social, and cultural factors has a crucial impact on this age group. When it comes to behaviors rooted in strong feelings, the family and the community are the principal locations of the hard-won, culturally based behavior management expertise. These basic, primitive mechanisms, which are common to animals, do not consciously consider future consequences or values. These are genetically determined shut-off systems (Drink and drug use high in teens, 2004). Automatic brain mechanisms do not consider other teenagers’ feelings or needs or know the importance of delayed gratification. Addiction begins when the brain comes into contact with an addicting substance such as alcohol or other drugs. Without this interaction of the reinforcing chemical and the pleasure centers, there is no addiction. That is why prevention techniques that discourage exposure to addicting drugs, outside rigidly controlled traditional medical and religious contexts, are powerful and effective in preventing addiction to the extent that they can prevent the use of alcohol and other drugs (Karch, 2006).

There is evidence that heredity plays a role in the predisposition of a teenager towards substance dependency. Alcohol studies of families strongly indicate a genetic component. Studies of identical and non-identical twins suggest that the former are very much more likely to be concordant for a substance abuse problem. Studies of adopted children also indicate that despite being brought up in families without alcohol problems, those with alcohol-dependent birth parents were more likely to develop alcohol problems (Karch, 2006). It is estimated that 20-25 percent of those with severe alcohol dependence may have an inherited predisposition. Biological theories are central to the Western medical approach to addiction. Rapid advances in genetic exploration and neuropsychopharmacology are opening up more possibilities than ever for understanding and for treatment (Goodlett et al., 1999).

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Social factors and cultural norms have the greatest impact on teenagers and their behavior patterns. Social class, based on employment classification, has a complex relationship with substance misuse. Factors such as poverty, geography, availability, and culture again act as confounders (Lowinson et al. 1997). The unemployed have been reported as being more likely to have used or to be using illicit drugs, but the loss of employment has been shown to reduce alcohol consumption, and higher income is often associated with higher consumption of alcohol and some other drugs. The impact of peers in substance abuse has been highlighted, especially in relation to prevention and health promotion Lisnov, 1998). The term ‘peer pressure’ is often used, although this does suggest a somewhat negative, passive, victim-like picture. In reality, friendships and peer relationships are interactive. Where parental relationships are perceived as inadequate and where substance abuse has commenced, the influence of peers can be stronger. Young teenagers choose friends who are like themselves, whilst socialization into friendship groups results in individuals adopting each other’s beliefs, attitudes, and behaviors (Lowinson et al., 1997). Greater involvement in substance abuse amongst young teenagers predicted that other peer group members would also misuse substances. Young people may develop peer groups as a result of their substance abuse behavior and may misuse substances as a result of influence from the peer group. Peer influence is not limited to the young, nor is it generally negative. Positive effects of peer relationships include friendship, support, and acceptance. These were all aspects identified by Lowinson et al. (1997) in their study of needle sharing behavior amongst injecting drug users. It was recognized that this behavior was risky but also resulted in positive outcomes of solidarity and trust. Peer influence is used to more positive effects in group treatment, 12 step and other self-help organizations (Peterson et al. 2002).

The role of the family has come under scrutiny. The idea of the substance abuse coming from a ‘broken home’ and this being the ’cause’ of their problems may be too simplistic. What constitutes a broken home is in itself debatable. It is suggested that the family process in the form of effective parenting and characterized by warmth, affection, consistency, and parental supervision is more important than family structure in relation to deviant conduct (Peterson et al., 2002). Current evidence suggests that drug use is not limited to any one specific group, although some drugs may be widely unacceptable and prohibited or encouraged and abundantly available in different cultures. There is a general lack of research in this area, and findings are complicated by the impact of other social factors such as poverty, deprivation, and historical issues. There is a need to recognize the impact of different cultures on each other over time and how these now impact multicultural societies (Peterson et al., 2002).

Environmental factors might include the cultural acceptance of social use of the substance, the availability of a substance in the community, the degree of criminality associated with the use of the substance, and so on: community prevention and education programs aimed at modifying the environmental aspect of the spread of addiction. An example of the importance of environmental factors is seen in the rise of crack cocaine addiction in the late 1980s. Powder cocaine, which is used intranasally (being snorted), was readily available in the early 1980s but was fairly expensive (Vega 1997). Extracting the cocaine base from the powder form of the drug, called free-basing, allowed for intravenous and inhalation use—methods that intensified the high—but was a somewhat involved and dangerous chemical process requiring the use of highly flammable chemicals. Some clever but diabolical individual discovered, however, that you could take powder cocaine, dissolve and dilute it, mix it with common. Household chemicals, and cook it in the microwave to produce a crystalline form of cocaine called “rock” or “crack” cocaine that could be smoked in a pipe for an immediate and intense, although brief, high. This was a marketing coup for the drug cartels because someone could take a kilogram of cocaine and produce mountains of cocaine rocks that could be sold very cheaply (Ammerman, 1999). The going price for a rock in some urban locations dropped below a dollar, opening the market to younger and less affluent users. Crack rocks were also much easier to conceal and transport than bulkier drugs like marijuana. The use of crack spread like wildfire, and so, unfortunately, did the intense addiction that it causes (Padilla et al., 2000).

For a teenage group, social factors play a crucial role in substance abuse and abduction. It is important to emphasize the role of demographics (e.g., urban versus rural environment), socioeconomic variables, and other social issues. In general, a sociological perspective determines environmental stressors that may lead to drug use, cultural support for drug use, and the type of drug that is most accessible (Ammerman, 1999). Behavioral models of alcoholism have placed emphasis on the positive and negative reinforcement aspects of drug use. Positive reinforcement describes the increased likelihood of a repeated behavior if that behavior is associated with some type of reward or pleasant experience. Thus, the use of alcohol for some teenagers is particularly rewarding because they interpret the experience as positive and pleasurable (Austin et al., 2000). Centering on the youth culture that is believed to provide contextual support for juvenile delinquency, a whole research tradition has come into existence in describing and analyzing adolescents with respect to their own cultural sources and resources. Following Burrow-Sanchez (2006):

Individual risk factors are such things as experiencing problem behaviors from an early age (e.g., aggressiveness, negative moods, and withdrawal, impulsivity), having a coexisting mental health diagnosis (e.g., conduct disorder, attention deficit hyperactivity disorder [ADHD], depression), or a learning disorder, problems in the family (e.g., low bonding to parent,… problems in school.

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Substance abuse has trends and fashions. This is, in part, to do with individual substance availability. When a substance becomes easily available and cheap, it is more likely to be misused. An example of this can be seen in the waves of new heroin misuse to spread across the US over the past thirty years (Ammerman, 1999). Local availability reflects a wider picture. A good crop of coca leaves (the source of cocaine) in South America, combined with better and cheaper transportation, may result in greater quantities of the drug reaching the streets of Europe. With a greater quantity of a drug circulating, market forces will tend to keep or force the price down (Ammerman, 1999). Accessibility is not just about how easy a substance is to obtain but is also about the way society views its use or misuse. Cannabis, once demonized as a potentially lethal drug, almost guaranteed to lead to social and moral degradation, is now viewed by many as relatively innocuous, even socially acceptable (Ammerman, 1999).

Humans living in relatively homogeneous traditional cultures in all parts of the world did not encounter drugs and had no way of personally controlling alcohol or other drug intoxication, with rare exceptions. For these reasons, the brain’s hardware in both animals and humans developed without protection from drug-caused risks (Ammerman, 1999). Only human beings have developed the capacity to use intoxicating drugs repeatedly, and only in recent times have teenagers learned how to use purified highly potent brain-stimulating drugs. Early human communities were relatively small, isolated, and culturally homogeneous. The diversity of these communities was limited as the community shared values about the management of aggression, fear, sex, and feeding. Traditional cultures permitted relatively few different roles and little personal choice of behavior. Burrow-Sanchez (2006) states:

Two influential contextual risk factors are current drug laws and the availability of substances. For example, lower legal drinking ages and lower taxation of alcohol are risk factors for the potential use and abuse of alcohol in a given geographical region. When the legal age of drinking is increased, fewer alcohol-related traffic incidents are reported”.

The shared values within these cultures served to inhibit the use of alcohol and other drugs to the extent that there was any exposure to these substances. Early human communities were relatively small, isolated, and culturally homogeneous (Ammerman, 1999). The diversity of these communities was limited as the community shared values about the management of aggression, fear, sex, and feeding. Traditional cultures permitted relatively few different roles and little personal choice of behavior. The shared values within these cultures served to inhibit the use of alcohol and other drugs to the extent that there was any exposure to these substances. Youth in North America have been exposed to dozens of addicting drugs in settings that permit or even encourage drug use. Modern values emphasizing the importance of personal control of one’s life and simultaneous increases in the social tolerance for alternative lifestyles have provided a fertile ground for the contemporary drug abuse epidemic. These values have been prominent in North America, especially for youth, in the last three decades. Modern countries with great cultural diversity have large numbers of people living in complex and interdependent communities. Not only are these modern communities much more diverse with respect to values that determine the risk of addiction, but individuals in the function with far more anonymity and independence than was true in premodern cultures. The substance being used affects the risk of addiction. Cocaine and heroin are far more likely to produce addiction than is alcohol, given the same level of use, genetic vulnerability, and social tolerance. Routes of administration are also important in establishing the relative risk of addiction. Cocaine is more addictive when smoked or injected than when it is sniffed up the nose. While these factors, and many others, govern the relative risk of addiction, all teenagers are vulnerable to addiction. Diversity of risk does not mean that some teenagers are vulnerable to ad (Lisnov et al., 1998).

Although some teenagers do experience outcomes that are negative on first experimenting with a substance (i.e., many new alcohol drinkers are sick), the positive results tend to outweigh the negative. As a practitioner engaged in helping teenagers stop or control their misuse and seeing at first hand the problems that can be caused by drugs and alcohol, it can sometimes be easy to forget the positive aspects. “Teenagers do not use substances that make them feel awful unless there is some clear payback. A simple cost-benefit analysis occurs for most people with most substances” (Greenblatt 2000, p. 45). If alcohol always makes you ill, you probably won’t use it regularly or heavily. Teenagers misuse substances because they make you feel good, make you feel different, make you more sociable or relaxed, help you perceive things in more depth or in an alternative way, make you accepted by your peers, give you energy, or calm you down. Human beings are curious; we want to experience many things, of which substance use is but one of many. For the majority of teenagers, substance use has far more pluses than minuses (Burrow-Sanchez, 2006).

Conclusion

Teenagers are not equally vulnerable to addiction to alcohol and other drugs. Genetic and environmental factors, in particular, heighten vulnerability. Teenagers whose parents and other family members are addicts and teenagers who live in environments relatively accepting of alcohol and other drug use are at increased risk of addiction. Teenagers who are oriented to immediate reward rather than to delayed gratification, teenagers who are self-centered rather than concerned with the needs of others, teenagers who lack religious values, and teenagers who are impulsive and extroverted are all more at risk of addiction. The relative risk of addiction is affected by many other factors as well, including the availability of intoxicating substances, gender, age, drug substances, and route of administration of the drug. For example, addictions to alcohol and other drugs are more common among males and among people ages 15 to 18.

Both nonhuman animal studies and human studies show that genetics is not the only factor influencing addiction. The majority of the children of alcoholics or drug addicts do not themselves become alcoholics or drug addicts. Many addicted teenagers do not have parents or siblings who were addicted to alcohol or other drugs. To the extent that addiction is inherited, what is passed on from one generation to the next is the vulnerability to addiction, not the addiction itself. The development of addiction to alcohol and other drugs requires many other forces, including those that are environmental and experiential.

On the other hand, it is hard to argue that friends’ use or peers’ encouragement of substance use are genetically controlled. In this research, peer variables provided a moderately strong influence on subsequent substance use. Thus social influences clearly play a role. Of course, a theorist could argue that genetically based personal attributes may lead to a selection of certain types of friends who might be drug users. To evaluate such a hypothesis requires a study design not envisioned in our research. Clearly, key predictors in our work and the work of others might lose their explanatory power in the presence of such omitted prior variables. Drug sequence and progression studies so far have not included measures of genetic or physiological liabilities. Their incorporation may lead to new interpretations of Gateway drugs and drug progression sequences and to a more fundamental understanding of their very nature. When a person with a high genetic vulnerability (e.g., parents or siblings who are addicted to alcohol and other drugs) and impulsive character traits is exposed to a highly addictive drug taken by a high-risk route of administration (smoking or injecting) in a setting that promotes drug intoxication with an expectation of getting good feelings (the setting and the set), the gun of addiction is loaded, it is aimed at the center of the brain, and the trigger is pulled. Sometimes addiction does not require all these high-risk factors to be present, but surprisingly often, especially in the most malignant cases of addiction, they are all lined up in just this way.

References

  • Ammerman, R.T. (1999). Prevention and Societal Impact of Drug and Alcohol Abuse. Mahwah, New Jersey London.
  • Austin, E.W. Fujioka, Y., Pinkleton, B.E. (2000). The Relationship of Perceived Beer Ad and PSA Quality to High School Students’ Alcohol-Related Beliefs and Behaviors, Journal of Broadcasting & Electronic Media 45 (2), pp. 575-584.
  • Burrow-Sanchez, J.J. (2006). Understanding Adolescent Substance Abuse: Prevalence, Risk Factors, and Clinical Implications. ournal of Counseling and Development 84 (3), 283.
  • Finn, P., & Sharkanshy, E. (2000). The effects of familiar risk, personality, and expectancies on alcohol use and abuse. Journal of Abnormal Psychology, 109(1), pp.122-133.
  • Goodlett, Ch. R., Hannigan, J. H., Spear, L. P. (1999). Alcohol and Alcoholism: Effects on Brain and Development, Lawrence Erlbaum Associates.
  • Greenblatt, J.C. (2000). Patterns of Alcohol Use Among Adolescents and Associations with Emotional and Behavioral Problems. 
  • Karch, S., (2006). Drug Abuse Handbook, Second Edition. CRC; 2 edition
  • Lisnov, L. et al (1998). Adolescents’ Perceptions of Substance Abuse Prevention Strategies. Adolescence 33 (133), 301.
  • Lowinson, J.H. et al (1997). Substance Abuse: A Comprehensive Textbook. Lippincott Williams & Wilkins; 3nd edition
  • Padilla, K.K., Turrisi, K., Wiersma, K. (2000). College Student Drinking: An Examination of Theoretical Models of Drinking Tendencies in Freshmen and Upperclassmen. Journal of Studies on Alcohol 61 (3), 598-603.
  • Peterson, M. et al (2002). Working with Substance Misusers: A Guide to Theory and Practice. Routledge.
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