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What Factors Lead to Drug Addiction?

What causes drug addiction? Find out about the known risks and protective factors for drug addiction.
The pathways which lead a person into drug use are both varied and complex (4,5). These involve factors which put a person at greater risk to turn to drugs as a means of comfort and support. Risk factors involve multiple dimensions, including parenting style, people, places, and situations that can influence a person to engage in drug abuse. Conversely, protective factors involve anything which supports a person in disengaging from drug use behaviour.
The more risks a child is exposed to while growing up, the more likely the child will abuse drugs, (6). Some risk factors may be more powerful than others at certain stages in development. Parental substance use can impact children from birth. Research suggests that the first few years of life are critical for a child’s healthy development (12).
John’s story tells of the risks he experienced as a child:
‘I had a father and a mother … All uncles, all aunties, all friends of my mother drank or used drugs. …My father he, passed when I was only a child. it was suicide….He had mental problems, drug problems, cocaine and alcohol…Me mother was an alcoholic and in the mix cocaine but mostly an alcoholic all her life…‘I started heroin at 13 and I’ve been on that throughout my whole life. But I have been smoking cannabis from a younger age. I was just getting up seeing me ma drunk so just going smoking weed and making sure me brothers got something to eat and got them to school…. I never had a parent there to tell me no…’
However some protective factors, such as a strong parent-child bond, can have a greater impact on reducing risks during the early years. Developmental researchers suggest the most important protective factor for children is their primary caregiver, usually the mother. The primary caregiver provides the child with a role model to help them navigate potential risk factors and guide them as they develop into healthy adults (11).
An important goal of prevention is to change the balance between risk and protective factors so that protective factors outweigh the risks. Families can provide protection from later drug abuse when there is a strong bond between children and parents with clear boundaries, and consistent application of family values.
Rhodes and colleagues (2003), identified risk factors at three levels: intrapersonal, microenvironmental and macro-environmental. Intrapersonal risk factors relate to the person which could involve having parents with problematic drug use, family dysfunction and/or child abuse. The strongest microenvironmental factors, particularly during adolescent years are: peer selection and socialisation, which influences how young people seek out others and engage in group based behaviour. Macro-environmental risk factors include social and economic environment, education, the availability and flexibility of health care systems and societies response to the misuse of legal substances (7). According to Bronfenbrenner’s ecological theory, (8) , the importance of functioning can be classified within three systems for healthy personal development:
  • The microsystem which represents the individual surrounded by their family, school, friends, work colleagues and religiosity.
  • The mesosystem which augments the microsystem with the addition of the wider social environment a person lives within.
  • the ecosystem which includes broader economic, political, religious, and educational systems which influence an individual throughout the lifespan.
When these relationships or systems function positively, they can act to protect the person from potential harms. However, when there is dysfunction in these systems, such as parental mental health problems, a caregiver who abuses drugs, poor educational attainment or growing up in a socially deprived neighbourhood. A potential protective factor can become a risk factor for adolescent and young adults to become involved in substance misuse and addiction.

Protective and risk factors in overdoses

Opiate misuse represents the highest risk of overdose and death among drug users. European research on risk factors for overdose cite opiates (both illicit and prescribed) as the most significant factor in many poisoning deaths internationally (9). In the United States, 70,630 people died from a drug related overdose in 2019 and almost 50,000 of those deaths involved opioids (9). EMCDDA reported that opioids, mostly heroin, were involved in most of the 8,238 drug-induced deaths reported in Europe in 2017 (10).
Among the protective factors for overdose prevention are information, training and opiate substitute treatment. According to the EMCDDA, problem opiate users often underestimate their risk of overdose. Information, counselling, and training are therefore vital in order to recognise the risks for, and signs of, overdose. The agency therefore recommends that information, along with training in basic cardio-pulmonary resuscitation, should also be provided to family and friends of potential drug users, with access to treatment and retention in opiate substitution treatment one of the best ways to reduce opiate-related deaths (10).
In conclusion, the risk and protective factors which can lead or prevent a person from engaging in problem substance use involve a complex interplay between the person and their families; their socio-economic status and peer group influences; the wider political, religious, and educational systems which can influence an individual throughout the lifespan. For understanding risk and protective factors the systems can be analysed within three dimensions, intrapersonal; microenvironmental and macro-environmental.

References

4. Galligan K, Comiskey CM. Hidden harms and the number of children whose parents misuse substances: A stepwise methodological framework for estimating prevalence. Substance use & misuse. 2019;54(9):1429-37.
5. Van Der Kolk B. The-Body-Keeps-the-Score. 2015.
6. Maté G. Addiction: Childhood trauma, stress and the biology of addiction. Journal of Restorative Medicine. 2012;1(1):56-63.
7. Rhodes T, Lilly R, Fernández C, Giorgino E, Kemmesis UE, Ossebaard HC, et al. Risk factors associated with drug use: the importance of ‘risk environment’. Drugs: education, prevention and policy. 2003;10(4):303-29.
8. Lau J, Ng K-M. Conceptualizing the Counseling Training Environment Using Bronfenbrenner’s Ecological Theory. International Journal for the Advancement of Counselling. 2014;36(4):423-39.
9. Alho H, Dematteis M, Lembo D, Maremmani I, Roncero C, Somaini L. Opioid-related deaths in Europe: Strategies for a comprehensive approach to address a major public health concern. International Journal of Drug Policy. 2020;76:102616.
10. EMCDDA. Drug-related deaths and mortality in Europe: update from the EMCDDA expert network. Lisbon: European Monitoring Centre for Drugs and Drug Addiction; 2019.
11. Harris NB. Toxic Childhood Stress: The Legacy of Early Trauma and How to Heal. London: Pan Macmillan; 2020.
12. Bowlby J. A Secure Base. London: Routledge; 1988.
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Identifying and Responding to Drug and Alcohol Addiction in Nursing, Midwifery and Allied Healthcare Practice

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