418 CHAPTER 9
Social Factors
The social factors that are commonly associated with abuse of or dependence on
stimulants and depressants also apply to narcotic analgesics, hallucinogens, and dis-
sociative anesthetics (see the starred items in Table 9.8). These include dysfunctional
family interactions and a higher proportion of substance-abusing peers, which in
turn affects the perceived norms of substance use and abuse (Kuntsche et al., 2009).
Moreover, economic hardship and unemployment are associated with substance
abuse and dependence, perhaps because of chronic stress that arises from economic
adversity as well as increased exposure to substance abuse.FEEDBACK LOOPS IN ACTION: Understanding
Substance Use Disorders
The neurological, psychological, and social factors that contribute to substance
abuse and dependence in general do not act in isolation but affect each other through
various feedback loops (see Figure 9.11). For example, in one study, researchers
examined children who did not have a substance use disorder, but whose parents
had a history of either alcohol or drug dependence (Elkins et al., 2004). Children
from the two types of families had different characteristics. Children whose parents
had a history of alcohol dependence were more likely to have negative emotions
such as sadness and anger and to be aggressive. They were also more likely to feel
alienated and to react more strongly to stressful events (psychological factors). In
contrast, children whose parents had a history of drug dependence reported lower
self-control and showed lower levels of the temperamental trait harm avoidance;
people who are low in harm avoidance are less responsive to signals of possible
punishment.
One possible explanation for these results is that these personality differ-
ences in the children arose because of neurological differences (genetic or
temperamental) between the two groups of parents. However, the researchers
found that differences in the two groups resulted from all three types of fac-
tors and from interactions among them via feedback loops. For instance, some
neurological factors tend to have a direct relationship with substance abuse and
dependence: The effects that a given substance produces in the brain can be
directly infl uenced by specifi c genes and an individual’s prior exposure to the
drug—either in the mother’s womb or after birth. These factors affect everyone,
although in different ways. As a specifi c example noted earlier in this chapter,
participants who rated an injection of Ritalin as pleasant had fewer dopamine
receptors, which suggests a neurological—and possibly genetic—vulnerability to
stimulant abuse. But neurological factors, such as genes and their infl uence on
temperament, can also have indirect effects: Someone who is high in the trait of
novelty seeking, for instance, may be more willing to try a drug than someone
low in that trait (DeJong, 2001). However, being high in novelty seeking doesn’t
necessarily lead to substance use and abuse; after all, most people who score high
in this temperament do not abuse substances. As another example, some people
have a temperament that leads them to be more responsive to reward (and to a
drug’s rewarding effects) than others are. In turn, this temperament leads them to
be more easily affected by operant conditioning when using a drug (psychologi-
cal factor): Someone who is more responsive to reward is likely to fi nd a given
blood alcohol concentration more enjoyable than might someone who is less re-
sponsive to reward.
And psychological factors and social factors also play a role in the develop-
ment of substance use disorders. For instance, as noted previously, experiencing
child abuse, neglect, or another significant social stressor increases the risk for
substance abuse (Compton et al., 2005), although it does not inevitably lead to
it. Moreover, as we saw for alcohol use, peer and family interactions and culture
(social factors) help determine perceived social norms, which in turn alter a person’sP SN