Why do some become addicted

Why do some become addicted

Samuel Vorster

Introduction

The period of adolescence is a crucial stage of human development1,3,4,6,9,10.  Biologically, there is a vast amount of neural pruning taking place, which the outcome thereof prepares the individual for adulthood.  Unfortunately, during this process, the opportunity to initiate substance use (or any addictive behavior) takes place4.  Not every adolescent who starts using substances will become dependent, but when combined with certain risk factors, in the absence of protective factors, can lead to the presentation of a substance use disorder (aka SUD) later in life.1,2,3,6,10

Risk factors and protective factors in Adolescent substance use disorders

Risk factors that put adolescents in danger of, and the factors that play a major role in the harm reduction or limiting of, a SUD can be divided into the following categories.  The role that these factors play in the South African (aka SA) context will be described when indicated.

Biological factors

Genetic factors for example, family history of SUD predispose individuals to the development of a SUD.  Magnetic resonance imaging research studies have indicated to be under redevelopment in areas of the brain that deals with impulse control, executive functioning, cognition and emotional regulation to be effected in SUD patients1,2,9,10,11.  These areas become more vulnerable to the effects of substance than fully developed counterparts2,9.  Dopamine and GABA-A receptor quantity has been seen to increase during this time3, which has been linked to the mechisms of substance specific intoxication, tolerance and withdrawal.

Coincidently these areas are highly vulnerable in the period of adolescence, as they are in the process of pruning11.  Neurological studies have found that the pre-fontal cortex, where executive functioning/ reasoning takes place, is only fully developed around the age of 2510,11.  As adolescents lack foresight in their actions, the probability is higher that they place themselves in more risky situations, are highly suggestible and pleasure seeking1,2,10.

Familial factors

The method that parents rear their child has shown to increase the risk towards SUD14.  Authoritarian parenting style (aka ineffective parenting3) has shown to breed the incapacity to deal with or to endure challenges in the individual’s life14.  In contrast when parents use an authoritative style of parenting this can empower learning and skill building to best navigate through life’s challenges14.  In the SA context, especially where case of adult and adolescent SUD exist, parent(s) are either absent, abusive, ill informed of adequate parenting skills or are themselves, actively involved in a SUD6,9,10.  In the SA context, like other 3rd world countries, have a generational pattern of parenting which with an adequate intervention can be broken.

Environmental factors

The environment which the child grows up in, what they are exposed to (substance access and tolerance of a substance culture3), the limitations or problems3 in the access to adequate educational and life skill training, puts them at risk of developing a SUD3.   Exposure to violence, trauma, parental divorce, and or early live adversities (poverty) can predispose adolescent for SUD3,4,7,9,10,12.  Environmental factors play a significantly higher role in the initial use of substances but the importance of the role of genetics is more indicated when looking at factors why the individual moves from infrequent recreational use to problem use to a SUD1.

Social factors

Adolescence is a time when the transition from the family/ parental role modeling and support becomes less of importance to the individual4.  The peer group becomes a potential risk or protective factor3.  Where the peer group contains negative elements (substance beliefs, attitudes and modeling of peer use) these could be transferred to the adolescent6,9.  It is the peer group which contributes significantly to the frequency and longevity of use1,3.  In the South African context, alike to other countries, the use of substance is linked to the becoming of an adult, the “right of passage” and is perceived as a tool to gain social status with in the peer group6.

Psychological factors

The way the child attaches, attachment styles as illustrated by Bowlby4, to the caregiver has been linked to as a risk or protective factor in SUD.  When there is an observable insecure avoidant, insecure ambivalent and or disorganized attachment style, has shown the potential for the individual to attach to a substance for the relief of stress or to gain more self confidence, which is absent in a dysfunctional family system4.   Pre-existing comorbid disorder put the adolescent at higher risk of a SUD9,12.   Studies have indicated up to 60% of patients diagnosed with another diagnosis have used substances or have experienced problems related to the use of substances9.  Most common dual disorders were conduct disorder followed by ADHD (externalizing disorders) and mood disorders (internalizing disorders)9,10,12.

In the context of SA, studies has shown a increase of single parent household4, dual working parents, or child reared family systems that affect the way the child’s attachment style4 develops and how the child deals or shows resilience in the 1st stage conned by Erikson, Trust verses Mistrust which has the outcome of sense of safety and a sense of the ability to be vulnerable in the acquisition of new skills and abilities.

Prevention intervention for at risk adolescents

Research into this cohort of individuals has shown that adolescents require multi-level interventions that reduce the incidents of SUD’s in adolescents, adequately reduce the harm or to delay the initiation of substance use3,5,8.  Strategies that have shown efficacy are geared to increase the adolescent’s social and life skills and only when indicated, the use of brief intervention or SUD treatment programs would be used3,5,8.  Strategies have been divided into universal, selected and indicated interventions3,5,6.  Universal interventions like the ‘life skill training’ program3,6,7 (educating and training adolescents to endure life challenges and to instill interpersonal skills), the ‘strengthening families’ selected (and universal) intervention program3 (to increase and to adapt parents in effective methods of role modeling and discipline) and ‘brief invention (ASSIST)’, an indicated program (in the assessment and treatment of indicated SUD adolescents), have proven to be effective in reducing incidents of SUD5.

 

Conclusion

When there is a combination of a secure attachment to a caregiver3, authoritative style of parenting, a positive peer group support structure, a nurturing home environment that can instill coping and resilient strategies to deal with life challenges, to build independence and to either delay or to effectively manage any experimentation of substances, until the individual’s mid 20s, would assist in the normal trajectory to adulthood1,3,6,9.

The concerning issue that is a driving force of future research and focus on adolescents is the consistent lowering of age of initiation of substance use13.

Word Count [1081]

Reference list

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  2. Winters KC. Advances in the science of adolescent drug involvement: implications for assessment and diagnosis – experience from the United States. Current opinion in Psychiatry 2013; 26(4): 318-324
  3. NIDA. Preventing Drug use among children and adolescents. A research Based Guide for parents, educators and community leaders. 2nd ed
  4. Höfler DZ et al. Attachment Transition, Addiction and Therapeutic Bonding – An Integrative Approach. Journal of Substance Abuse Treatment 1996; 13(6): 511-519.
  5. Revise UNODC: International Standards on Drug Use Prevention (reading material from year 1, introduction module)
  6. Griffen KW; Botvin GJ. Evidence-Based Interventions for Preventing Substance use Disorders in Adolescents. Child Adolesc Psych Clin N Am 2010; 19(3): 505-526
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  9. American Academy of Child and Adolescent Psychiatry official action. Practice Parameter for the assessment and Treatment of Children and Adolescents With Substance Use Disorders. Journal of the American Academy of Child and Adolescent Psychiatry 2005; 44(6): 609-621.
  10. NIDA. Principles of Adolescent Substance Use Disorders Treatment: A research based guide
  11. Blakemore S. Teenage kicks: cannabis and the adolescent brain. The Lancet 2013; 381:888-889
  12. Couwenberg C et al. Comorbid psychopathology in adolescents and young adults treated for substance use disorder. European Child & Adolescent Psychiatry 2006; 15: 319-328
  13. Dada S et al. South African Community Epidemiology Network on Drug Use. Research brief. Monitoring Alcohol, Tobacco and Other Drug Use Trends in South Africa (July 1996 – June 2018). Phase 44. Cape Town.  Medical Research Council.  2018
  14. Calafat, García, Juan, Becoña, and Fernández-Hermida. “Which Parenting Style Is More Protective against Adolescent Substance Use? Evidence within the European Context.” Drug and Alcohol Dependence 138.1 (2014): 185-92. Web.

 

Tags:  Risk factors; Youth; parenting; Attachment, social factors; environmental factors; Familial factors; Biological factors.