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Risk Factors for Drug Addiction: A Review

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Indian Journal of Health and Well-being 2023, 14(3), 383-387 © 2023 Indian Association of Health, Research and Welfare
Peer-reviewed and Indexed Journal ISSN-p-2229-5356,e-2321-3698
https://iahrw.org/our-services/journals/indian-journal-of-health-wellbeing/ NAAS Rating 4.11

Risk Factors for Drug Addiction: A Review

Sunita Devi and Sandeep Singh
Department of Applied Psychology, G.J.U.S.T., Hisar, Haryana

Drug addiction has become a serious and complex problem. It affects all aspects of a person's life including social,
physical, and psychological. As a result of addiction, students' academic performance gets affected, a person's job
performance and relationships at workplace are affected, there is an atmosphere of unrest and tension at home, and
financial difficulties are faced. Many factors affect drug addiction. The main objective of the present study is to
highlight the factors affecting drug or substance use/addiction. After reviewing, all the factors are mainly divided
into four types: (1) Family, (2) Peers, (3) Psychological factors, and (4) Social and Environmental factors. Family
factors mainly include heritability, family violence and conflicts, parent's education, parental monitoring etc. Peer
pressure or influence, antisocial peer groups, and peer rejection etc. are peer related risk factors. Psychological
problems such as individual personality, PTSD, depression, anxiety, conduct disorder, and ADHD, etc. have been
found to have an association with drug addiction. Similarly, poverty, unemployment, lower level of SES, and
victimization are social factors which increase the probability of drug addiction. Hence drug addiction is a
multidimensional problem which is affected by many factors.

Keywords: drug addiction, risk factors, psychological and social factors

The whole world is making good progress in the field of health.
Health services in India are also on the path of improvement. But
drug addiction is such a problem that has taken a serious form. The
young generation is getting trapped in the clutches of drugs. In the
run-of-the-mill life, people have started resorting to drugs to solve
their problems, which is a matter of concern. For the treatment of
drug/substance abuse, there is a need to take concrete steps at the
global level as well as at the local level. Drug addiction is the most
serious problem faced these days.“Addiction is a psychological and
behavioural syndrome with a high desire to use drugs and reuse it
after stopping” (Dackis & O'Brien, 2005). Regular use of drugs
affects all aspects including the mental, physical and social life of a
person. The person's working life remains disturbed, relationship
problems increase and academic performance in students is badly
affected. According to the World Drug Report given by the United
Nations Office on Drugs and Crimes (UNDOC, 2020) 284 million
people use drugs in the world. According to this report, India is the
largest market for opiate. Some types of drugs are used religiously in
India. In some areas, the use of alcohol is acceptable for religious
occasions (Beyers et al., 2003). Similarly, cannabis (bhang) is also
widely used in religious festivals like Holi and Shiv Ratri. Social
accommodation provides personal and social factors to drug or
substance use, while cultural accommodation provides acceptance at
the legal and broad levels (Wilson et al., 2010). In North-Western
India, opiates are also used as a home remedy (Ganguly et al., 1995).
Author Note
Sunita Devi, Research Scholar, Department of Applied Psychology
G.J.U.S.T., Hisar, Haryana
Dr. Sandeep Singh, Professor, Department of Applied Psychology
G.J.U.S.T., Hisar, Haryana
E-mail: sandeephisar@gmail.com
We have no known conflict of interest to disclose
Correspondence concerning this article should be addressed to
Sunita Devi, Research Scholar, Department of Applied Psychology
G.J.U.S.T., Hisar, Haryana
E-mail: sunitakaluana@gmail.com
In India, the problem of drug addiction has taken a huge form. The
problem of drug addiction brings with it many problems like
economic loss, violence, security problems, traffic and workplace
accidents etc. The risk of HIV/AIDS increases by sharing needles
among those who consume drugs by injection (Mahmood et al.,
2019). Drug addiction is not a sudden problem, but many factors
affect it. In this review, we have divided all the factors into four
major parts. These factors are as follows:
Family
Family is considered an important factor among the factors affecting
drug addiction. The family affects a drug addict in many ways and
vice-versa (Brook et al., 2006; Measelle et al., 2006). Family-related
factors such as family income, family life, family expressed emotion,
family disruption and family violence are factors that influence drug
use (Kumar et al., 2013; Atadokht et al., 2015). Family members,
especially parents are role models for their children. It has been seen
that the problem of drug addiction in the children of families whose
members used to use drugs was two and a half times more than those
whose family members did not use drugs (Webetu et al., 2020).
According to one study, children with parents or siblings who smoke in
their families have 1.5 times the risk of smoking, and those whose
family members use alcohol have 5 times the risk of alcohol addiction
(Whitesell et al., 2013). It is believed that perceived family-burden
leads a person to drug addiction (Salyers & Mueser, 2001; Biegel et al.,
2007). A significant relationship has been observed between perceived
family-burden and drug abuse (injecting drugs & non-injecting drugs)
(Nebhinani et al., 2013). Family stigma has been perceived as a risk
factor for drug addiction (Mattoo et al., 2015). Family conflict has
been found to be an important risk factor for alcohol addiction. The
risk of substance use disorder also increases in the children of homes
where there are more conflicts (Cunradi et al., 2002). Similarly, a
positive relationship has been found in job-family conflict (in both
males and females) and increased alcohol addiction (Roos et al.,
2006). Both types of social learning can be learned from the family,
i.e., children can learn drug usage from the family or can develop a
negative attitude towards drugs.
 DEVI AND SINGH/ RISK FACTORS FOR DRUG ADDICTION: A REVIEW
Rose et al. (2003) found that the onset of alcohol use in adolescents is
strongly affected by their family, school, and neighborhood.
Relationship has also been seen in genetic factors and drug addiction
(Rose et al., 2003). Jacquelyn and Danielle (2010) found in their
study that no single gene is responsible for substance use disorder,
rather many genes together exert their influence. In the same study,
they found that drug use disorder rarely occurs suddenly, rather its
risk-related behaviors begin well in advance. A meta-analysis of twin
studies found that all types of drug addiction have a heritability rate
of 40% to 60% (Goldman et al., 2005). Heritability range of illicit
drug dependence has been observed from 30% to 60%. This variation
comes from the age, cohort differences and phenotype of addicts
(Kendler et al., 1998). In 2008, Kendler and colleagues studied
participants ranging from adolescents to middle adulthood to look at
the role of genes and environment in substance use disorder. Many
positive results came out of this study. This study lends more support
to the etiologic model and found that along with social and family
factors, genes also influence drug use patterns. Genetic effects on
drug addiction are amplified by the lack of parental monitoring (Dick
et al., 2001). This is because the reduced parental-monitoring
environment provides them with opportunities to express genetic
predispositions.
A project "Collaborative Study of the Genetics of Alcoholism"
(COGA) works on a large scale to identify alcohol-dependence
genes. COGA is a family-based study that collected phenotypic data
from alcoholic members. The strongest linkage region of alcohol
addiction was found with chromosomes 4 and 7 (Edenberg et al.,
2004; Edenberg et al., 2008). According to the developmental model
of Brook et al. (2003) level of attachment and conflict are important
factors in family factors that predict substance use disorder. Vakalahi
reviewed theories regarding family-based risk factors. Quality
relationships among family members are one of the most significant
family-based factors (Su et al., 1997; Brook et al., 2001; Vakalahi,
2001). Similarly, Johnson and Pandina (1991) found that
malevolence and lack of heartiness increase the risk of alcohol and
drug addiction. Lower quality of parental relationships is associated
with a high level of marijuana addiction (Jessor & Jessor, 1997).
Peers
The personal characteristics of peers influence the group. Behavior
and attitude have an effect on each other in the group. Friends learn
good and bad habits from each other. Companions and peers have an
effect on drug commencement and alimentation (Mason & Windle,
2001). It has been found that the number of drug users and the
frequency of use predict the onset of marijuana abuse (Bailey &
Hubbard, 1991). Similarly, Wills et al. (2001) found that alcoholism
is also affected by the number of friends who use it. The attitude of
peers is an important factor that influences drug addiction (Dackis &
O'Brien, 2005). Curran et al. (1997) found a mutual relationship
between drug addiction and peer-group in their study. According to
Oetting and Beauvais (1997), small friend groups reduce risk-related
psychosocial variables.
Antisocial peers and delinquent behavior are some of the strong
risk factors for substance use (Nation & Heflinger, 2006). A lot of
researches have been done to assess the relationship between peer
pressure and drug addiction (Coggans & McKellar, 1994). The study
by Rukundo et al. (2017) also supports that peer influence is the
strongest risk factor for drug use in school children. It has been found
in a qualitative study that in order to prove their masculinity, their
384
friends motivate South African males for alcohol consumption
(Rich et al., 2015). Another study found a significant association
between alcohol use with peer influence among youth in urban
counties compared to rural counties (Wilson & Donnermeyer,
2006).
One quality study found that peers living in the ranch were more
likely to use alcohol, smoke-free tobacco, inhalants and other illicit
drugs than peers who lived in burg (Rhew et al., 2011). Because the
peer group reinforces the favorable attitude towards the drug, which
increases the level of substance use and the substances become
easily available in the group (Mason & Windle, 2001). Among peer
factors, prosocial-instruction and moral order with the peer group
reduce the risk of drug addiction (Guo et al., 2001).Peer-related risk
factors include exclusion from a non-using group, presence of a
heroin-using peer group, and having a heroin-using partner (Wisley
et al., 1997). Thus, association with a drug using group is a power
predictor of drug use (Glantz, 1992). Hawkins and colleagues
(1992) consider peer rejection to be a strong risk factor for drug
addiction. Peer rejection during schooling creates adjustment
related problems and enhances the risk of drug abuse problems in
students (Coie, 1990).
Psychological Factors
Posttraumatic stress, specific personality, behavioral characteristics,
and psychological issues are critical factors in drug addiction
(Kirkpatrick et al., 2000; Brook et al., 2003). According to the HAS
report (1996), “conduct disorder is one of the powerful predictors
and substance abuse in the absence of conduct problems is rare”.
Researchers have mainly given more importance to nine types of
conduct disorder (CD) as predictors: "discipline related problems in
school, arrest, stealing, running from home, lying, schooleviction,
truancy and vandalism, fighting, and occurrence prior to age 15"
(Robins & McEvoy, 1990). According to Zeitlin (1999),
psychological problems can either predict risk for drug abuse or
reflect a disturbed behavior syndrome.
A study was done on 166 patients of alcohol and drug treatment.
The findings reported that approximately50% of participants met
the diagnostic criteria for conduct disorder independently of alcohol
and drug use. When drug addiction-related symptoms were
included, 95% of participants met conduct disorder criteria (Brown
et al., 1996). Similarly, adolescent CD and adult antisocial
personalities predict alcohol and substance use (Robins & Price,
1997). After reviewing drug abuse risk factors, Weinberg (2001)
found that the current conceptualization does not accurately
illustrate the interaction of clinical symptoms and risk factors.
According to a qualitative study, all forms of psychopathology have
been connected with alcohol abuse, but only attention-related
problems and CD have been linked with marijuana addiction (White
et al., 2001).
Molina and Pelhan (2003) studied ADHD and a control group and
found that attention issues were more connected alcohol addiction,
tobacco and other drugs. Also, they found that those with more
severe ADHD used more prominent substances. The same ADHD
sample was studied again and found that among these patients with
higher academic achievements used drugs more quickly and
frequently.
A research found a significant relationship between emotional
instability and trauma exposure with drug use (Schiff et al., 2012;
Petruzzi et al., 2018). In fact, people who have had trauma exposure
385 Indian Journal of Health and Well-being 2023, 14(3), 383-387
turn to drugs to regulate their emotions, PTSD symptoms,
depression, anxiety, and symptoms related to flashbacks (Khantzian,
1997; Weiss et al., 2012).
According to the cognitive point of view, the perceived benefits of
drug use directly affect it (Cable & Sacker, 2006). Similarly, outcome
expectancy influences the decision of substance use (Park, 2004;
Mitchell et al., 2006). In a study conducted on 100 alcoholics, it was
found that anxiety, neuroticism, depression, psychopathic deviation,
extroversion, and stressful life events were significantly higher in
alcoholics, whereas the level of self-esteem was low in comparison
to the control group (Chaudhary et al., 2006).
For specific conduct disorders, being expatriated from school and
stealing are most commonly associated with multiple drug use. A lot
of studies have also been done regarding the relationship between
suicidal behavior and drugabuse (Ziedonis, 1995; Wisley et al.,
1997). Ziedonis (1995) found a significant relationship between
depressive disorder and suicidal ideation and also between behavior
and drug addiction. A study conducted on school students in the
Netherlands found that 18% of boys and 38% of girls who had used
hard drugs had attempted suicide at least once in the past. UNDOC
(1998) has also included mental health issues such as depression or
anxiety, lack of impulse control and vulnerability to addiction as
causes of substance use. Scheier et al. (1999) found that
rebelliousness and sensation seeking are associated with drug
addiction.
Social and Environmental Factors
A lot of hassles go on in life. It also affects our daily routine.
According to Chassin et al. (1996), children from families with more
negative life events are at risk of joining drug-addicted peer groups
and at increased risk of drug use. According to the study done on
pregnant females, the girls with whom sexual intercourse was done
more forcefully, the probability of drug use was found to be high as
compared to the non-using group (Lanz, 1995). The risk of
alcoholism and other drug addiction is increased in those youth who
have either been victims of physical or sexual violence or have been
witnesses (Kirkpatrick, 2000). Qualitative research was conducted
on Liberian youth to identify risk factors. According to the
information received in the interview, gender, fear of failure, poverty,
availability of drugs within a community, and unintentional are
important risk factors of drugaddiction (Petruzzi et al., 2018). Civil
war, homelessness, impoverishment, otioseness, and trauma
exposure are the most important risk factors associated with
substance use in African countries (Neugebauer, 2009; Lee et al.,
2011). Brady and Randall (1999) found that males use drugs as a
coping mechanism because they are relatively unable to express their
emotions and fears. Lower level of socioeconomic status is an
important risk factor for substance use in adolescents (Dodge et al.,
2009). Hawkins and colleagues (1992) found a relationship between
school failure and substance abuse. A study was done on 500 students
in Himachal Pradesh and in the results age, type of education
institute, mother's occupation, bad company and curiosity were
found to be more predictable risk factors of drug addiction (Katoch et
al., 2003). The report found that every year 55000 children belonging
to low socio-economic status start using tobacco (Ghosh, 2013).
Parental and guardian employment was found to have a negative
correlation with substance use (Gordon et al., 2021).
Gudaji et al. (2016) found that participants who were single had a
significant association with psychoactive drugs. Similarly,
government school boys were found to have 1.3 times more drug use
than private school boys, while government school girls were found
to have 1.5 times more alcohol addiction than private school girls
(Narain et al., 2020).
Mahmood and colleagues (2019) also found a significant
relationship between bad company and attitude toward drugs with
drug addiction. Similarly, the tendency of psychoactive drugs like
inhalants, cannabis, stimulants, and opiates is increased in children
whose father smokes (Gudaji et al., 2016). Religiosity and socio-
regional factors also significantly influence substance use
(Koopmans et al., 1999). Another study found community norms
and community disorganization to be predictable risk factors for
drug addiction (Beyers et al., 2003). Children's lower attachment to
school was found to have a positive relationship with drugs (Mason
& Windle, 2001).
Conclusion
Drug addiction has become a matter of serious concern. The young
generation should be aware and pay attention to the unpleasant
consequences of this problem. Drug abuse is endangering the
present as well as the future of the youth. There is a need for
improvement in drug addiction treatment and rehabilitation services
in India as well. In the present study, an attempt has been made to
study the various factors affecting drug addiction. The factors
identified after reviewing various research studies are divided into
four main categories: (1) Family, (2) Peers, (3), Psychological
factors, and (4) Social and Environmental factors. Family conflict,
family income, socio-economic status, psychological and mental
health issues, depression, stress, attitude toward drugs, parental
relationships, and unemployment are some of the main factors that
influence drug use. To improve the treatment process of drug
addiction-related problems, it is necessary to find out the exact
causes and research studies are also being done in this area. Research
studies related to factors in the field of drug addiction are still being
done.
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Received August 8, 2023
Revision received August 24, 2023
Accepted August 26, 2023