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There are many factors that can play an important role in the initiation and persistence of substance
abuse. These determinants can be grouped into factors associated with the environment (sociocultural), and factors unique
to the individual (genetic, neurobiological, and psychological). No single factor accounts for the use of a drug, rather,
it is a complex interaction of social, cultural, biological, and psychological factors that determine drug use.
Genetic
factors are believed to play an important role. However, the search for candidate genes that contribute to the risk of developing
and maintaining substance abuse disorders is still in its early stages. The task of identifying such genes is made more arduous
because it is likely that variation in substance-dependence susceptibility results not only from genotype differences and
environmental influences, but also from their interactions. Thus, genetic factors are background sources of variance that
can be minimized or exaggerated by environmental factors before the substance dependence can be expressed.
There are
also reward mechanisms in the brain that mediate drug use. The acute enhancement of brain-reward mechanisms appears to be
the single essential pharmacologic commonality of abusable substances.
Substance use takes place within a sociocultural
environment that mediates which substances are available, their desirability, and their acceptability. Accordingly, the drugs
to which persons are exposed and their reactions to them are strongly influenced by the person's place in society.
It
is important to realize that a certain biology or environment is not a destiny. People are more than bags of genes that produce
behavior. They are influenced by their environment and can control their behavior voluntarily. The bottom line is that everyone
with a brain can become an addict. Some people will find the experience more compelling than others, but exactly what brain
chemistry leads to this vulnerability has not yet been defined.
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